Study Objectives
With the dawn of the COVID-19 pandemic and the need for enhanced social distancing measures, telemedicine has become an integral part of emergency medicine. Medical schools have started to integrate telemedicine training into their curricula, but there are few reports of telemedicine training in GME programs. The primary objective of this study was to examine current emergency medicine resident knowledge of telemedicine, expose residents to standardized telemedicine patients virtually, and analyze the effectiveness of telemedicine training on completing a successful encounter.
Methods
Seventeen emergency medicine residents first underwent a virtual standardized telemedicine encounter using the ZoomTM application without prior training in telemedicine. Standardized patients were queried on resident success during this untrained encounter using a survey with aspects of a successful encounter. The following session with sixteen of those 17 residents, involved a lecture by a telemedicine physician with years of experience on the fundamentals of a successful encounter, as well as pre-reading materials on the topic. After this intervention, sixteen residents underwent a repeat virtual encounter, with standardized patients responding to the same questions as the pre-training. Residents also underwent a post-survey on their experiences.
Results
Standardized patients evaluated 17 emergency residents before telemedicine training, and 16 of those 17 residents after telemedicine training with a 13-question survey focused on aspects of a successful telemedicine interview. Statistically significant differences were noted on aspects of the encounter related to telemedicine when analyzing pre- and post-training data and using a Z test for proportions: obtaining informed consent (0% vs. 61%, p = 0.00012), asking about privacy in the patient’s environment (6% vs. 87%, p <0.00001), verifying name and/or date of birth (29% vs. 94%, p =0.00014). Aspects of the encounter that did not have statistically significant results on pre- and post-test surveys included: resident introducing themselves (94% vs. 100%, p =.31732), asking focused questions about medical condition (100% vs. 100% p = 1), closing the encounter by explaining care plan (94% vs. 94%, p = 1). Fourteen residents responded to a post-training survey with 92.8% of respondents stating that they “strongly agree” that the telemedicine training was helpful to their education. Only 28.6% of respondents stated that they “strongly agree” that they understood how to do a virtual physical exam.
Conclusion
Overall, emergency medicine residents had significant improvement on aspects of an encounter with a standardized patient that were unique to telemedicine after undergoing training from an expert in the field. Residents scored well both before and after training on aspects of the encounter not pertaining specifically to telemedicine, suggesting good clinical overlap between virtual and in-person environments. Residents uniformly felt the training was helpful to their education. Participants did feel less confident with the ability to do a virtual physical exam, which could possibly be ameliorated with more practice in this environment. Many EM residencies are undergoing virtual didactics and because of this, similar training could easily be utilized across the country. This training could prove to be essential in the future because of the global health crisis of the COVID-19 pandemic.