Implementing a telemedicine curriculum for internal medicine residents during a pandemic: the Cleveland Clinic experience

  1. David J Savage
  2. Omar Gutierrez
  3. Bryce Edward Montané
  4. Achintya Dinesh Singh
  5. Eric Yudelevich
  6. Jamal Mahar
  7. Andrei Brateanu
  8. Lakshmi Khatri
  9. Catherine Fleisher
  10. Stacey E Jolly

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Abstract

Telemedicine training was not a substantial element of most residency programmes prior to the COVID-19 pandemic. Social distancing measures changed this. The Cleveland Clinic Internal Medicine Residency Programme (IMRP) is one of the largest programmes in the USA, which made the task of implementing a telemedicine curriculum more complex. Here we describe our experience implementing an effective, expedited telemedicine curriculum for our ambulatory resident clinics. This study was started in April 2020 when we implemented a resident-led curriculum and training programme for providing ambulatory telemedicine care. The curriculum was finalised in less than 5 weeks. It entailed introducing a formal training programme for residents, creating a resource guide for different video communication tools and training preceptors to safely supervise care in this new paradigm. Residents were surveyed before the curriculum to assess prior experience with telemedicine, and then afterward to assess the curriculum's effectiveness. We also created a mini-CEX assessment for residents to solicit feedback on their performance during virtual appointments. Over 2000 virtual visits were performed by residents in a span of 10 weeks. Of 148 residents, 38% responded to the pre-participation survey. A majority had no prior telemedicine experience and expressed only slight comfort with the modality. Through collaboration with experienced residents and faculty, we expeditiously deployed an enhancement to our ambulatory care curriculum to teach residents how to provide virtual care and help faculty with supervision. We share our insights on this experience for other residency programmes to use.

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  1. Version published to 10.1136/postgradmedj-2020-139228
  2. ScreenIT

    SciScore for 10.1101/2020.10.12.20211136: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Our limitations were a low survey response rate and variable preceptor experience with telemedicine. The response rate for the pre-participation survey was higher than the post-participation survey, but the response rate on both instruments was low. This is likely because of the accelerated pace that this curriculum was rolled out to meet the needs of our learners and patients. The pre-participation survey was offered immediately before the telemedicine curriculum was taught, while the post-participation survey was distributed electronically at the end of the academic year. We had the most success with getting pre-participation surveys completed by providing time at the start of the didactic course for residents to fill them out with their phones. We also kept the number of survey questions short to encourage participation. It has thus far been even more challenging to get learner post-participation feedback because of their busy work schedules and the ongoing pandemic. The post-participation survey response rate was also impacted by timing. It was distributed at the end of the academic year when many residents were preparing to graduate or advance to the next training year. Anecdotally, though, residents have told their preceptors and program leaders that this curriculum made them feel more comfortable with providing telemedicine care. Lack of preceptor experience with ambulatory telemedicine was also a limitation early on, but this improved with time, practice,...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.10.12.20211136v1 on medRxiv