Implementation of a Workplace-Based Telemedicine Simulation Program to Assess Clinical Skills After Transitions of Care.

BACKGROUND

The transition from hospital discharge to home is a critical period prone to gaps in care. Telemedicine has potential to smooth this transition; however, few educational interventions assess the unique skills required for high-quality telemedicine care at this critical juncture.

OBJECTIVE

To develop and integrate in situ standardized patient (SP) encounters in internal medicine residents' actual clinics to assess telemedicine skills in the post-discharge period.

METHODS

We developed 2 cases portraying recently discharged patients, designed behaviorally anchored assessment checklists, created mock electronic health record entries, and scheduled telemedicine visits in residents' clinics throughout the 2023-2024 academic year. SPs assessed skills as "not done," "partly done," or "well done" across 5 skill domains: Information Gathering, Relationship Development, Education and Counseling, Telemedicine-Specific Skills, and Care Transition Skills. We analyzed differences in the percentage of "well done" items, fit an ordinal mixed-effects model to assess for performance by case and postgraduate year (PGY) level, and surveyed residents.

RESULTS

All 42 (100%) PGY-1s and PGY-2s in our program participated in 79 total encounters. Residents performed well in core communication domains but struggled with Telemedicine-Specific Skills, Care Transition Skills, and Education and Counseling skills. PGY-2 performance was stronger than PGY-1 performance in these domains. Among residents who completed both cases, performance in case 2, which took place 6 months after case 1, was stronger; this effect was driven by PGY-1 performance. Twenty-nine of 31 residents (94%) reported this intervention improved their telemedicine skills.

CONCLUSIONS

We report a high-fidelity strategy that captures telemedicine skill development in the context of patient care.