A new elective in telehealth at the UND School of Medicine & Health Sciences has faculty reimagining how they teach medicine to students at a distance.<\/p>\n
\u201cI really think this is the direction medicine is going, and I think all of us are going to have to have some experience with it,\u201d mused Dr. Suzanne Human. \u201cI kind of enjoy it\u2014but I\u2019m also a bit of a weirdo.\u201d<\/p>\n
Laughing at this admission, Human, speaking via video conference from a Veterans Affairs (VA) clinic in northwest Minnesota, was describing her teaching of a UND School of Medicine & Health Sciences (SMHS) elective for fourth-year medical students \u2013 FMED 9322 \u2013 on telehealth in family medicine.<\/p>\n
\u201cThis morning I did telehealth for someone who lives in very rural Minnesota,\u201d Human continued. \u201cAnd I got to see this little grandchild run past in the background, and [the patient] chuckled and said, \u2018Yeah, I\u2019ve got two dogs, a cat, and 15 chickens downstairs because they\u2019re too cold outside, the little baby chicks.\u2019 It\u2019s a lot of fun.\u201d<\/p>\n
The spring 2022 elective was the first of its kind to be offered by the SMHS, said Dr. Bryan Delage, co-director of the SMHS Department of Family & Community Medicine clerkship for third-year students. And it certainly won\u2019t be the last. (Editor\u2019s note: the SMHS Department of Internal Medicine now houses a similar course, IMED 9503, for interested students.)<\/p>\n
\u201cTelehealth has become a critical part of patient access since the pandemic and was able to fill a gap for some patients who needed contact with their provider more consistently,\u201d Delage wrote in an email. \u201cThe risks and fear of [COVID] exposure when coming to the clinic had forced some patients to forego treatment, so part of the driving force for the elective was its timeliness in light of the increased demand for skills in telehealth nationally.\u201d<\/p>\n
No doubt about it, added Dr. Eric Johnson\u2014telehealth is here to stay.<\/p>\n
\u201cIf it wasn\u2019t apparent that the telehealth boom during the pandemic was relevant, it very likely is understood now, just due to the sheer volume of telehealth delivered by hospitals and clinics,\u201d said Johnson, who is director of interprofessional education at the SMHS.<\/p>\n
A former radio personality who has been training students on virtual body language and communication skills for years, Johnson noted that while the School\u2019s Department of Psychiatry & Behavioral Science was training psychiatry residents in telehealth some time ago, there wasn\u2019t an official course for medical students on the subject until recently.<\/p>\n
\u201c[Students] need to learn these skills now, as most practices will have a least some telehealth encounters of various types, including residencies and fellowships,\u201d Johnson continued, noting that he has helped incorporate telehealth into an interprofessional Simulation Center experience since 2017, after he, Dr. Richard Van Eck, and Dr. Jon Allen secured grant funding for a Simulation Center-based program. \u201cStudents today need to learn good camera skills and microphone presence. In addition, they need to manage the camera, patient screen, and a screen with the patient\u2019s electronic health record simultaneously. It\u2019s not easy.\u201d<\/p>\n
Housed within the School\u2019s Department of Family & Community Medicine, the elective helps train students on practicing medicine at a distance, experience with which the pandemic made almost a requirement for many health providers.<\/p>\n
Part of the reason this new healthcare delivery model is complicated, added Dr. Andrew McLean, the chair of the SMHS Department of Psychiatry & Behavioral Science, is that it raises a series of thorny questions related not only to patient safety and care, but privacy, reimbursement, and licensure.<\/p>\n
\u201cWhile medical students have had the ability to take part in this depending on their rotations or attendings, it\u2019s important that trainees understand the importance of these factors,\u201d he said, imagining a patient encounter where the patient on vacation calls up their doctor for a telehealth session from a state in which the provider is not licensed. \u201cWhat does one do when there is a crisis on the \u2018other end,\u2019 and what are the legal or licensure issues that might be different from in-person experiences?\u201d<\/p>\n
Along the way, added Van Eck, students learn how they need to approach diagnosis and treatment differently.<\/p>\n
\u201cThe debate quickly becomes: is it as good as face to face?\u201d asked Van Eck, the School\u2019s associate dean for Teaching and Learning. \u201cBut as Dr. Human points out, you can\u2019t just ask \u2018Is it as good [as in-person]?\u2019 It\u2019s just different. And if you align what you\u2019re trying to do with what the technology is good at, it can be better in some ways.\u201d<\/p>\n
For example, said Van Eck, a gait test on a patient walking back and forth in an exam room in-person can\u2019t show providers how a patient moves around their own home.<\/p>\n
Newly minted physician Dr. Ryan Norris agreed.<\/p>\n
\u201cOverall, I think the elective was great, and I highly recommend it,\u201d said Norris, who is in the first year of an anesthesiology residency at Wake Forest University. \u201cI started clinicals in the height of the pandemic, and there were several times that the doctor would do a telehealth visit. And sometimes they had me sit in, and it was really interesting to see how much we could do virtually\u2014physical exam maneuvers for shoulder pain, knee pain, hip pain, looking at rashes, and getting some idea of the problem.\u201d<\/p>\n
All the educators agreed that it is students like Norris whom they have in mind as they seek to improve the School\u2019s curriculum.<\/p>\n
And because Human and Johnson are likely ahead of many of their colleagues in not only providing telehealth to patients but serving as a telehealth preceptor to medical students, Van Eck, Johnson, and others helped develop the AMA educator-focused Telehealth Clinical Education Playbook in 2021.<\/p>\n
\u201cInitially, the cognitive burden of telehealth and the physical and emotional pressure associated with the pandemic required physicians and other health care professionals to (rightly) prioritize patient care over medical education,\u201d wrote Van Eck and his co-editor Vimal Mishra in the first chapter of a book designed to help teachers train medical students in providing telehealth services. \u201cNow, with our growing familiarity and comfort with the telehealth process comes an increased capacity to expand our focus to include education again.\u201d<\/p>\n
Part of this increased capacity involves helping providers-educators reimagine what a patient encounter looks like, how it\u2019s reimbursed, and what it means to be on-call\u2014or make a house call.<\/p>\n
In that sense, telehealth is not such a new idea.<\/p>\n
\u201cThe VA started some of this 50 years ago,\u201d continued Human. \u201cIn rural medicine, we\u2019ve done \u2018telehealth\u2019 forever. My first job 25 years ago was in Wadena, Minnesota, and we would do teleconferences with the University of Minnesota once a month. The VA has been doing this kind of thing in very rural areas with nurse practitioners and physician assistants for a long time. We\u2019re coming full circle here in some ways.\u201d<\/p>\n
A new elective in telehealth at the UND School of Medicine & Health Sciences has faculty reimagining how they teach medicine to students at a distance. \u201cI really think this is the direction medicine is going, and I think all of us are going to have to have some experience with it,\u201d mused Dr. Suzanne […]<\/p>\n","protected":false},"author":36,"featured_media":9493,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[7],"tags":[2030,1545,2031,2029,596,897,2032,1153,2033,2028,2034,298,722],"class_list":["post-9491","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-delage","tag-distance","tag-eric-johnson","tag-fmed-9322","tag-human","tag-mclean","tag-norris","tag-telehealth","tag-teleprecepting","tag-teleteaching","tag-va","tag-van-eck","tag-veterans"],"acf":[],"yoast_head":"\n