Expanding Telehealth Competencies in Primary Care: A Longitudinal Interdisciplinary Simulation to Train Internal Medicine Residents in Complex Patient Care.

Background: Despite increasing use of telehealth, there are limited published curricula training primary care providers in utilizing telehealth to deliver complex interdisciplinary care.

Objective: To describe and evaluate a telehealth curriculum with a longitudinal objective structured clinical examination (OSCE) to improve internal medicine residents' confidence and skills in coordinating complex interdisciplinary primary care via televisits, electronic consultation, and teleconferencing.

Methods: In 2019, 56 first- and third-year residents participated in a 3-part, 5-week OSCE training them to use telehealth to manage complex primary care. Learners conducted a standardized patient (SP) televisit in session 1, coordinated care via inter-visit e-messaging, and led a simulated interdisciplinary teleconference in session 2. Surveys measured confidence before session 1 (pre), post-session 1 (post-1), and post-session 2 (post-2). SP televisit checklists and investigators' assessment of e-messages evaluated residents' telehealth skills.

Results: Response rates were pre 100%, post-1 95% (53 of 56), and post-2 100%. Post-intervention, more residents were "confident/very confident" in adjusting their camera (33%, 95% CI 20-45 vs 85%, 95% CI 75-95, < .0001), e-messaging (pre 36%, 95% CI 24-49 vs post-2 80%, 95% CI 70-91, < .0001), and coordinating interdisciplinary care (pre 35%, 95% CI 22-47 vs post-2 84%, 95% CI 74-94, < .0001). More residents were "likely/very likely" to use telemedicine in the future (pre 56%, 95% CI 43-69, vs post-2 79%, 95% CI 68-89, = .001).

Conclusions: A longitudinal, interdisciplinary telehealth simulation is feasible and can improve residents' confidence in using telemedicine to provide complex patient care.