Article:

Lee MS, Nambudiri V. “Integrating Telemedicine into Training: Adding Value to Graduate Medical Education Through Electronic Consults.” J Grad Med Educ 11.3 (2019): 251-254. https://doi.org/10.4300/JGME-D-18-00754.1

Note: This interview originally occurred prior to the acceleration of the COVID-19 pandemic. However, in the interim the outbreak unexpectedly pushed telemedicine to the forefront of outpatient medical practice. In this current environment, learning about telemedicine and its future in medical education and practice has become even more relevant.

Summary:

Telemedicine is a rapidly expanding field that has bridged a gap in specialty care in rural areas. Through the use of electronic consultations or clinical inquiries patients receive management recommendations and referring physicians receive education by engaging in clinical dialogue with a sub-specialist. However, formal education in telemedicine has been variable with many programs offering no structured training. Drs. Lee and Nambudiri proposed a framework for trainees navigating electronic consultations. They also address some of the barriers to implementing a telemedicine curriculum for programs. For this blog post Tiana Endicott-Yazdani interviewed senior author Vinod Nambudiri.

Interview:

TE: The use of telemedicine has grown significantly over the years, presumably due to the benefits you noted in your article, such as increased access to specialty care. Do you have any thoughts on the expanded use of telemedicine or how you anticipate it to grow in the future?

VN: Telemedicine use has dramatically expanded over the past several years, particularly with the integration of technology into all facets of medical care and the proliferation of connected devices in our lives. Data has shown growth of telehealth of greater than 50% from just 2016 to 2017 in the United States and an increasingly rapid trajectory of uptake (https://www.ama-assn.org/practice-management/digital/telehealth-53-growing-faster-any-other-place-care). I expect that this trend will continue, and telemedicine will continue to expand across virtually all clinical disciplines.

TE: Are there special requirements to be able to practice telemedicine? Are there physicians that are entirely telemedicine-based or is there usually a combination of telemedicine and traditional practice?

VN: There are not currently separate requirements in terms of licensing or training to be able to practice telemedicine. However, depending on the clinical specialty being practiced, there may be specific pieces of technology or equipment that are required to be able to deliver care remotely. In other instances, all that may be required is a smartphone or standard computer. While the number of physicians who are solely telemedicine practitioners is difficult to quantify, the number is likely to grow in the future.

TE: You noted that some of the specialties that most utilize telemedicine are dermatology, hematology and endocrinology. What specialties do you foresee having the most future growth potential for telemedicine utilization?

VN: Those specialties have had a heavy use of electronic consults. There has been a growing use of patient-centric telemedicine services, particularly for primary and urgent care to help with access to care, and I think this is a burgeoning space for telemedicine. Similarly, the delivery of specialty care to areas that are remote or underserved is another growing area of telemedicine.

TE: With the ever-expanding role that telemedicine plays do you anticipate a time when the Accreditation Council of Graduate Medical Education (ACGME) will require programs to incorporate telemedicine training?

VN: We are seeing innovative programs integrating teaching and training of telemedicine into both undergraduate and graduate medical education curricula. In some ways, with the ACGME Core Competency focusing on Systems Based Practice, one could argue that it is a responsibility of training programs currently to prepare their graduates to acquire fluency with best practices of telemedicine, whether or not this is stated explicitly.

TE: You referenced some of the potential barriers in developing telemedicine curricula. What are some of the challenges for trainee education that differ from traditional training in clinical environments?

VN: One challenge for trainee education regarding the delivery of telemedicine services may be the limited body of literature on best practices for educators regarding new and emerging technologies. While generations of physicians have honed their skills literally at the patient’s bedside, the delivery of telemedicine services decouples that immediacy of direct patient contact. In an increasingly technologically-driven world, making sure fundamental principles guiding humanism in medical encounters does not get lost is an important challenge for the telemedicine physician.

 

Blog post author

Tiana Endicott-Yazdani, MD, PhD is a Pulmonary and Critical Care Fellow at Baylor University Medical Center in Dallas, TX. She completed her MD, PhD training at Texas A&M Health Science Center with research focuses on microbiology and the pathophysiology of infectious disease. She completed residency in Internal Medicine at Baylor prior to joining the fellowship. Her medical interests include lung transplantation and the pulmonary microbiome. Her other loves include her husband and 3-year-old son.

Twitter: @vofty

 

 

Article author

Vinod Nambudiri, MD MBA, FACP FAAD, is an Associate Physician at Brigham and Women's Hospital and Dana Farber Cancer Institute, and Assistant Professor of Dermatology at Harvard Medical School. His clinical interests are in dermatology, internal medicine, and cutaneous oncology. His research interests span medical education, innovation and technology in medicine, and physician leadership. He is passionate about mentorship of trainees, teaching, and understanding the business of medicine.

Twitter: @BWHDermatology