IMPACT OF INCREASED TELEMEDICINE USAGE ON RESIDENT EDUCATION

ABSTRACT

BACKGROUND: The COVID-19 pandemic has led to an unprecedented and rapid increase in telemedicine visits. It is unclear how this has affected resident training. This study explores Internal Medicine residents' perceptions of the impact of the transition to telemedicine on their learning experience. METHODS: Three focus groups were held over Zoom with post-graduate year 1 - 3 residents at the New York University Grossman School of Medicine who have their Primary Care continuity experiences at the Manhattan Veterans Affairs Medical Center. Issues explored include relationships with patients, decision-making around clinical issues, use of preceptors, and general impressions of tele-visits. Recordings of the focus groups were transcribed and thematically analyzed. RESULTS: Common themes across the focus groups were categorized into five domains 1) building patient relationships, 2) using the remote setting, 3) judging appearance and physical examination, 4) confidence with decision making, and 5) interactions with supervisors. Participants felt that they were able to maintain relationships with pre-existing patients, particularly those with chronic conditions for whom tele-visits were an appropriate and even preferable alternative to routine in-person encounters. Participants reported difficulty connecting and building rapport with new patients but suggested the remote setting was helpful for providing additional context (e.g. input from a family member), allowing them to better understand patients' concerns or circumstances. However, some participants expressed hesitancy about asking personal questions because patients were not in private settings. The inability to conduct comprehensive physical exams made it difficult to evaluate physical concerns, and participants were frequently unable to rely on skills that were emphasized in their training, such as assessing overall appearance and frailty. As a result, they had a higher level of uncertainty about diagnosis and management and a lower threshold for making referrals and ordering diagnostic testing. Residents did not ask preceptors for help during a tele-visit - in contrast to in-person clinical visits - which precluded real-time support when participants encountered uncertainty. Due to the awkwardness of asynchronous communication, participants had a higher threshold for asking their preceptors questions and making changes in management plans after televisits were concluded. CONCLUSIONS: In light of the staying power of telemedicine and the overall trend towards virtual care, our findings substantiate the need to identify and address new clinical training competencies. In particular, trainees may need guidance for negotiating clinical decision-making and management when caring for patients remotely;structured preceptor protocols can help to support trainee education and quality patient care.