Safe and rapid implementation of telemedicine fracture clinics: the impact of the COVID-19 pandemic.

BACKGROUND: The coronavirus disease outbreak in December 2019 rapidly spread around the world with profound effects on healthcare systems. In March 2020, all elective surgery and elective outpatient clinics were cancelled in our institution, a regional hospital in Northern New South Wales, Australia. With regard to orthopaedic fracture clinics, a telehealth system was implemented on an emergency basis for patient and staff safety to prevent disease transmission. The aim of our study was to investigate whether rapid implementation of telehealth for orthopaedic fracture clinics resulted in an increase in complications. METHODS: A retrospective cohort study of all patients with orthopaedic fracture clinic appointments at a regional New South Wales hospital between 17 March and 8 May 2020 was undertaken. There were 191 patients, including 390 appointments of which 23.1% were conducted via telehealth, namely by phone call. Complications requiring phone calls to the orthopaedic team, presentations to the emergency department, admission to hospital or return to theatre, were recorded. RESULTS: There was no increase in complications following emergent implementation of telehealth for orthopaedic fracture clinic follow-up in our institution. Patients in the telehealth group were significantly older than those in the clinic group. CONCLUSION: The study demonstrates that application of telehealth fracture clinics in a regional Australian setting can be achieved without increasing complication rates and can be used to formulate a rapid telehealth implementation plan if a similar scenario occurs in the future.

Adaptive Tutorials Versus Web-Based Resources in Radiology: A Mixed Methods Comparison of Efficacy and Student Engagement.

RATIONALE AND OBJECTIVES: Diagnostic imaging is under-represented in medical curricula globally. Adaptive tutorials, online intelligent tutoring systems that provide a personalized learning experience, have the potential to bridge this gap. However, there is limited evidence of their effectiveness for learning about diagnostic imaging. MATERIALS AND METHODS: We performed a randomized mixed methods crossover trial to determine the impact of adaptive tutorials on perceived engagement and understanding of the appropriate use and interpretation of common diagnostic imaging investigations. Although concurrently engaged in disparate blocks of study, 99 volunteer medical students (from years 1-4 of the 6-year program) were randomly allocated to one of two groups. In the first arm of the trial on chest X-rays, one group received access to an adaptive tutorial, whereas the other received links to an existing peer-reviewed Web resource. These two groups crossed over in the second arm of the trial, which focused on computed tomography scans of the head, chest, and abdomen. At the conclusion of each arm of the trial, both groups completed an examination-style assessment, comprising questions both related and unrelated to the topics covered by the relevant adaptive tutorial. Online questionnaires were used to evaluate student perceptions of both learning resources. RESULTS: In both arms of the trial, the group using adaptive tutorials obtained significantly higher assessment scores than controls. This was because of higher assessment scores by senior students in the adaptive tutorial group when answering questions related to topics covered in those tutorials. Furthermore, students indicated significantly better engagement with adaptive tutorials than the Web resource and rated the tutorials as a significantly more valuable tool for learning. CONCLUSIONS: Medical students overwhelmingly accept adaptive tutorials for diagnostic imaging. The tutorials significantly improve the understanding of diagnostic imaging by senior students.