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Medical Schools and Telehealth: Learning Webside Manner

Posted by Michael Greiwe, MD | September 20, 2018 |
Michael Greiwe, MD

Attention Clinicians: The medical workflows you practice now will be radically different in the future. While that may bring to mind advances in medicine, which will surely happen, you should also consider advances in technology, which are certain to change our practices in myriad ways we haven’t even imagined yet.

One prediction that we can guarantee in the coming years is that the deployment of telehealth technology will accelerate. How can we predict this with such certainty? Because the medical schools are now basing a good deal of their curriculum on “webside manner” – and everyone from the AAMC to the AMA is recommending our teaching facilities offer training on telehealth technology. When coupled with widespread consumer fixation on the handheld digital device, it’s clear that telehealth is growing whether we want it to or not.

The Future State of the Virtual Visit

“Current medical students are among the first generation of ‘digital natives’ who are well versed in the incorporation of technology into social interaction. These students are well positioned to apply advances in communications to patient care.”
Telemedicine Education: training Digital Natives in Telemedicine
Pathipati, Azad, Jethwani Journal of Medical Internet Research

bigstock-Medical-Students-3171096

The Journal of Medical Internet Research calls it “training the digital native.” They’re referring both to developing a medical school curriculum that incorporates telemedicine training for the first generation of residents in history that grew up with digital technology. But they’re also referencing the thought that telehealth is technology that will become as ubiquitous to the medical profession as the white coat and stethoscope.

To reach this goal, the Association of American Medical Colleges (AAMC) strongly recommends development of telehealth curriculum in today’s medical schools. According to their data, roughly 58% of medical schools in the United States currently offer telemedicine as either an elective or a required course. This is a fairly substantial increase from 2014 when 41% of our clinical classrooms provided training on telemedicine.

In 2016, the American Medical Association (AMA) endorsed telehealth in the classroom for fledgling doctors. At their annual meeting that year, they adopted policies encouraging students and residents to learn to use telemedicine as part of their course of study. They stated, “The new policy also reaffirms existing AMA policy, which supports reducing barriers to incorporating the appropriate use of telemedicine into the education of physicians.”

At that time, the majority of medical schools were not offering training in either telehealth or electronic health records during medical school or residency.

One framework suggested in the Journal of Medical Internet Research to incorporate telemedicine as a standardized curriculum in all medical schools. The article stresses the importance of this new approach:

Creating a formal training program will allow students to directly compare and contrast telemedicine with traditional medicine, recognize when to use it, and learn best practices.

The point, the author’s suggest, is that fledgling clinicians become as familiar with the virtual visit as they do the traditional care setting. But the AAMC suggests there are extensive differences in how medical schools offer telemedicine training. Some schools offer only a few hours of elective training while others provide a full course on the topic.

For example, the Department of Emergency Medicine at George Washington University now offers a fellowship program focused on telemedicine. Their goals include:

  • Teaching fellows how to develop and operationalize a telehealth program.
  • Training in the hardware, software, and administration of telehealth.
  • Skills to conduct the clinical visit remotely, or “webside manner.”

Clinicians learn how to provide the most effective clinical consultation by learning to position the camera properly and how to maintain eye contact and engage patients in a digital setting.

Weill Cornell Medicine offers a two-week telemedicine elective featuring simulated video visits. One Cornell professor suggested:

As telemedicine and virtual healthcare modalities increase, students are going to need even better core clinical skills related to communication, interviewing and history-taking. Once we put any technical platform between the provider and the patient, it becomes even more critical that those skills are nuanced and effective.

What’s interesting is that, while new doctors are coming out of residency with at least a familiarity with telehealth, older physicians are simply not keeping up with the trends. The Washington Post poses this dilemma for readers to consider:

As is often the case with technological change, our capacity to generate innovation has exceeded our capacity to understand its implications. With telemedicine, we’ve done what we generally do: Introduce a new treatment, technology, or care model, and assume doctors will figure out how to use it.

Are doctors figuring out how to use telemedicine to its full advantage? The Post article suggests this will be increasingly the case and that a new specialty area called the “medical virtualist” is an option for the future. A study in Advances in Medical Education and Practice points out that our nation’s new crop of nurses and mid-levels are also being introduced to the virtual visit. They suggest:

Preparing nurse practitioners to utilize telehealth technology requires specific and dedicated didactic and experiential telehealth education incorporated within existing curricula. It is important that educational programs focus on the understanding of telehealth and its application as well as skills development.

What’s Next for Webside Manner?

The Journal of Medical Internet Research predicts there will be more than 100 million telehealth visits annually by 2020 – just two years from now. More than half of all American hospitals already offer telemedicine to their patients. A 2017 survey of the healthcare c-suite showed that 75% of their organizations currently offer or are planning to deploy telemedicine. It’s clear that telehealth will continue to spread as the virtual visit becomes more commonplace for everything from diagnosing the common cold to providing post-surgical wound care.

OrthoLive has developed an orthopedic application that provides telehealth to the small to mid-sized provider. It’s packaged in a seamless, HIPAA-compliant subscription service that, while not adding extensive cost, keeps practices competitive with larger organizations. Contact us today for a complimentary demo and discussion about adding telehealth to your practice.

Topics: "telemedicine", medical school, technology

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