Digital Health

Digital Health Curriculum Educational Goals & Objectives

Telemedicine, a tool used infrequently in primary care before the COVID-19 pandemic, has become a routine part of healthcare and integral to the practice of ambulatory medicine. The Digital Health Curriculum will provide trainees with the skills to provide virtual care as they focus on the prevention, evaluation, and management of medical conditions in the ambulatory setting. The focus will be on extending the doctor-patient relationship to the virtual setting as well as relevant legal, billing, and privacy concerns. This curriculum is intended to be used in conjunction with the Ambulatory Curriculum and to supplement specialty-specific curricula.

Faculty will facilitate learning in the six core competencies as follows:

Patient Care and Procedural Skills

I. PGY1s should be able to effectively lead the patient through the basic elements of a telemedicine visit.

II. PGY2s should be able to triage patients appropriately to in person versus virtual visits and during virtual visits, assess the patient’s surroundings for potential health risks.

PGY2s should work to gain an understanding of the limitations of medical decision making given the limited vital signs, physical exam, and point-of-care testing available through telemedicine visits.

III. PGY3s should be able to model the effective use of telemedicine, guiding patients through a thorough history and a focused physical exam and effectively incorporating this information into a patient-centered care plan.

IV. All residents should develop technical skills sufficient to become competent in the effective use of telemedicine.

• Residents should learn to troubleshoot common technology problems affecting communication during a visit.
• Residents should learn how to securely add faculty and/or translators to a visit.
• Residents should become familiar with the legal and privacy regulations for telemedicine and recording visits.

Medical Knowledge

I. PGY1s should have a basic understanding of the appropriate uses and limitations of various modalities for providing clinical care.

II. PGY2 should know how to obtain informed consent during a telehealth encounter.

III. PGY3s should be aware of relevant legal, billing, and privacy regulations for telemedicine, including limits of e-prescribing for controlled and uncontrolled substances

Practice-Based Learning and Improvement

I. All residents should know how to access relevant telehealth guidelines from specialty organizations, for example:

• Association of American Medical Colleges
• American College of Physicians: Checklist for Incorporation of Video Visits and Telehealth Guidance and Resources

II. PGY1s will learn to efficiently incorporate EHR documentation into the telemedicine visit.

III. PGY2s should develop skills in evaluating studies on digital health in published literature, through Journal Club and independent study.

IV. All residents utilizing telemedicine should learn to collaborate with the health care team to optimize patient care, with PGY3s taking a leadership role.

V. All residents should respond with positive changes to constructive feedback from members of the healthcare team.

Interpersonal and Communication Skills

I. PGY1s must learn to optimize communication during a telemedicine visit, explaining and narrating their actions, expressing empathy, and using eye contact, voice, and nonverbal cues to communicate clearly.

II. PGY2s must also develop interpersonal skills that facilitate virtual collaboration with patients, educate patients, and where appropriate, promote behavioral change.

III. PGY3s should play a leadership role in using telemedicine to effectively deliver care to special populations (e.g. geriatric patients, mental health patients).

Professionalism

I. All residents must demonstrate strong commitment to carrying out professional responsibilities, ensuring that telemedicine visits are conducted in private, with adequate visibility and sound, wearing appropriate attire, and attuned to patients’ needs and preferences.

II. All residents should be able to use telemedicine to educate patients and their families in a compassionate manner respectful of gender, age, culture, race, religion, disabilities, national origin, socioeconomic status, and sexual orientation on choices regarding their care.

III. PGY2s should be able to conduct a mix of telemedicine and in person visits, using time efficiently to see patients and chart information.

IV. PGY3s should be able to provide constructive criticism and feedback to more junior members of the team.

Systems-Based Practice

I. PGY1s must have a basic understanding of the basic elements of a quality telemedicine visit and be aware of equity challenges, including access and digital literacy, posed by telemedicine visits.

II. PGY2s should understand state and federal regulations for coding and insurance reimbursement for telemedicine visits.

IV. PGY3s should address equity challenges, quality concerns, and medicolegal risks posed by telemedicine visits.

Teaching Methods

I. Supervised patient care in the clinic:

• Residents initially will be directly observed conducting telemedicine visits with patients, to facilitate the acquisition of excellent webside manner as well as virtual history taking and focused physical exam skills.
• As residents become more proficient, they will interact independently with patients and present cases to faculty.
  • For PGY1s, initial emphasis will be on diagnosis and basic management of telemedicine visits.
  • For more senior residents, focus will be on medical decision-making, and residents will work with supervising physicians to finalize a care plan.

Evaluation

• Mini-CEX bedside evaluation tool – residents must complete a minimum number in PGY1 and PGY2 year in the venue of their choice. Additional direct observation during telemedicine visits is strongly encouraged.
• Communications skills are covered in Continuity Clinic evaluations and 360 evaluations