Telehealth and Medical Education – Training the Next Generation of Virtual Care Providers

Background: The COVID-19 pandemic transformed care delivery and impacted how academic healthcare systems teach and train. Teaching hospitals launched telehealth programs in multiple specialties with high adoption rates. The AAMC developed cross-continuum competencies in TeleHealth & the ACGME revised its common program requirements' levels of supervision with guidance on telehealth supervision by faculty. As adoption increased, telehealth issues unique to teaching settings arose such as rounding, faculty & trainees’ competence, supervision skills, among others. The main goal of this abstract is to effectively embed TeleHealth across a free-standing teaching hospital and evaluate its impact.

Methods: To reach our goals, we aligned telehealth training and competence-building with institutional inter-disciplinary areas including Medical Education. This abstract focused on two areas:
1- Competence-building throughout GME training: TeleHealth-specific educational goals, training models, and aligning telehealth training and implementation with trainees’ daily activities e.g. orientation, integration in resident subspecialty experiences, virtual care, virtual rounding and shadowing, to enhance residents' experiences. TeleHealth was also adopted as one of the quality improvement (QI) focus areas in trainees' projects addressing care coordination, discharge planning, patient satisfaction, among others.
2- Faculty professional development to prepare supervisors for their roles in feedback and supervision and the provision of safe care.

Data sources for program evaluation metrics and key performance indicators and QI projects included clinical databases e.g. electronic health record; Business Intelligence Telehealth Dashboard; surveys; telehealth App reports and other tools. Data was collected monthly and reported quarterly. Process improvement, Lean methodologies were used for program evaluation (e.g., A3, process mapping flowchart, failure modes and effects analysis). Metrics included number of providers and trainees who completed TeleHealth training; unique children receiving virtual care in over 24 pediatric specialties; access to virtual care (wait time) compared to in-person; patient/parent and guardian satisfaction; among other metrics.

Results: Through phased implementation and stakeholders’ collaboration in various settings, a pediatric teaching hospital incorporated telehealth training across the GME continuum, and aligned GME trainees' competencies with the AAMC telehealth competencies. Details on few residents’ QI projects will be shared in discharge planning, care transition, and patient experience. Program evaluation results and lean tools supported identification of best practices in telehealth care, lessons learned in training, and implementation which are used to inform future planning, implementation, and continuous program evaluation. Process improvement and lean projects contributed to enhancements in telehealth training and competence-building.

Conclusion: Our results along with the lessons learned will help inform medical education and telehealth training implementation for students, and trainees to deliver high quality virtual care, improve access, control costs and optimize the patient experience. Best practices will be highlighted aimed at preparing the next generation of physicians and support healthcare innovation to meet the needs of patients and families during the pandemic and beyond.