Training the Next Generation in Telemedicine

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New telehealth “boot camps” are ensuring that freshly minted physicians are fluent in a brand new model of care.

Anyone reading this journal, or more specifically, anyone reading this article, is smart enough to realize that future healthcare delivery models will widely embrace telemedicine to deliver care. The question becomes, “How will providers learn to incorporate this tool into their armamentarium?” A decade or two ago, we did not have tissue adhesives or cardiac troponins. Over 100 million cases later, we know how to use these tests. Telemedicine will follow the same course. Virtually all providers will learn to care for patients where and when patients want care. Like they always have, they will learn to use newer technologies.

To facilitate this transition, Thomas Jefferson University has created a robust training program that includes staff, medical students, resident physicians, fellows, and faculty. This article will focus on the goals for the Telehealth Leadership Program. If we don’t train future leaders, we won’t position the field for success. In addition, we briefly describe some of our other training programs. After all, our vision is that robust interprofessional training and development opportunities for providers will be a recurrent theme for the continued advancement of our careers.

Telehealth Leadership Program (Physician Fellowship)
The mission of this year-long program is to train physicians with the knowledge, skills, and attitudes necessary to become independent telehealth researchers and leaders. Utilizing team-based learning, hands-on application of knowledge, and simulation training, the curriculum is informed by the principles of experiential and self-directed learning theories to foster knowledge in four core areas of study (Leadership & Management Skills; Entrepreneurship; Research & Education; and Clinical Skills). These core areas and their associated competencies continuously complement one another and work to build a foundation of telehealth and leadership success.

Before taking on new clinical and administrative responsibilities, fellows will complete an intensive “Telehealth Boot Camp,” which will integrate simulation-based instruction, team-based training, and traditional didactic teaching.

An essential component of the learning experience and responsibilities of the fellow is the work carried-out in various telehealth use cases. Prospective fellows are required to work on an existing, developing, and new use case with increasing levels of administrative responsibilities. The fellow will be trained in LEAN Thinking, Crucial Conversations, and Emotional Intelligence to provide the tools needed to successfully perform this expectation.

To develop global understanding of the complicated nature of telehealth development and application, fellows will have asynchronous, focused immersions into various concentrations of business study, including marketing, finance, legal and health informatics rotations.

It is an expectation that fellows contribute in a meaningful way to the current research supporting the evidence base of telehealth. Research training and deliverables are designed to produce independent scientists capable of performing innovative research that is competitive for funding opportunities. To develop the needed research knowledge and skills, fellows will immediately be incorporated into research projects; develop and complete a telehealth research project under the supervision of a team of preceptors throughout the program; and complete a rigorous course of didactics and seminars.

The curriculum is tailored to the fellow’s personal interests, allowing for individualized concentrations of research and knowledge application, as well as the option to complete an advanced degree or certificate.

To demonstrate their acquisition of knowledge, skills, and attitudes throughout the duration of the program, fellows will be required to complete a capstone use case applying the core competencies of the program. The capstone will complement the entrepreneurial rotations as the fellow builds financial and marketing models alongside developing the legal supporting documentation.

Resident Physicians and Medical Student Electives
We can’t expect providers of the future to be prepared for the medicine of the future if we don’t take advantage of teaching them while they are most primed for learning. We have, therefore, created elective rotations for residents and medical students. These electives are a minimum of 4 weeks in duration.

There is a base educational curriculum with an opportunity for learners to further pursue interests appropriate for their degree of training. In addition to basic readings and an interactive curriculum specifically tailored for their level of education, all learners will participate in the conception, development, and implementation of various telehealth use cases throughout the health system, regional ACO’s, and large community groups. To further broaden exposure to telehealth operations, learners will also be given the option to choose an area of concentration (i.e., administrative, clinical, research).

Residents and medical students will participate in all major telehealth related work group meetings, including the monthly enterprise-wide leadership committee with representatives from finance, marketing, information technology, legal, and academic departments; weekly team strategy meetings, weekly innovation committee meetings; and biweekly research-in-progress meetings. They will receive formal training in the provision of telehealth services, as well as participate as an instructor in telehealth training sessions.

Participants will spend 12-24 hours directly observing and/or providing telehealth care in a variety of use cases (i.e., virtual rounds, on-demand urgent care, and scheduled outpatient appointments) and perform follow-up surveys to evaluate patient and provider satisfaction with telehealth.

Telehealth Facilitator Certificate Program
Physician support staff is of paramount importance in facilitating seamless patient care. To achieve our vision of providing the option for medical care via telehealth to all patients, we designed an instructional training program for support staff in healthcare or health-related fields. The program was designed for those interested in further developing their careers by acquiring the skills needed to facilitate clinical telehealth encounters at their respective organizations.

Through a series of self-directed, self-study, online learning modules, students enrolled in the program learn how to improve patient healthcare access, efficiency, and safety, as well as improve patient outcomes, by acquiring an arsenal of telehealth skills enabling them to successfully facilitate telehealth within their respective healthcare organizations. Students are immersed in modules that promote the skills needed to support clinical telehealth encounters, including, but not limited to, using telehealth in inpatient and outpatient settings, and providing technical assistance when needed. Through a hands-on practicum module, students have the opportunity to deliberately practice skills covered in previous modules, as well as circumvent common troubleshooting encounters and/or resolve common issues faced during typical telehealth encounters.

Paramount to the successful delivery of telehealth is the application of effective interpersonal and communication skills required to assume the role of telehealth facilitator on the interprofessional healthcare team. These concepts are a recurrent theme across all modules. On completion of the program, participants receive a certificate of completion and continuing education credits. Participants also have the option to complete subsequent coursework, which will further build upon the telehealth facilitator skillset.

The authors would like to acknowledge the contributions of Alexandra Printz and Shoshana Sicks.

ABOUT THE AUTHORS

Senior Vice President for Healthcare Delivery Innovation, Thomas Jefferson University Associate Dean for Strategic Health Initiatives, Sidney Kimmel Medical College Vice Chair, Finance and Healthcare Enterprises, Department of Emergency Medicine

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