Education Research: An experiential outpatient teleneurology curriculum for residents

Abstract

ObjectiveTelemedicine is rapidly becoming a major vehicle of delivering neurologic care to patients who have limited access to subspecialists and exaggerated travel hardship. However, neurology residents receive little to no training in telemedicine in outpatient clinics.MethodsWe piloted, to our knowledge, the first formalized, experiential outpatient teleneurology curriculum. Neurology residents in their third and fourth postgraduate years (PGY3 and PGY4) at the University of California San Francisco completed an interactive lecture and 4 weeks of teleneurology clinics at the San Francisco Veterans Affairs Medical Center. Change in residents' telemedicine knowledge and perspectives on the utility, challenges, benefits, and future practice implementation of teleneurology were evaluated in 11 residents using precurriculum and postcurriculum quizzes and surveys after 2 of 4 weeks on the rotation.ResultsResidents' performance on quizzes improved from 53% to 88% (p = 0.002). Residents' impression of video visits compared to in-person visits changed, with more individuals indicating video visits to be the same if not somewhat superior with regards to obtaining a focused history, formulating a focused assessment and plan, communicating recommendations, and the overall care provided (p ≤ 0.04). All residents felt more competent using telemedicine for patient care in their eventual career.ConclusionOur formal didactic and clinic-based teleneurology curriculum for neurology residents, which shared core themes suggested by the 2017 American Academy of Neurology Telemedicine Work Group's published recommendations, showed a statistically significant improvement in knowledge and perspectives about the promise and limitations of teleneurology practice, as well as increased comfort levels in future implementation.

Survey of Telehealth Adoption by Neuro-ophthalmologists During the COVID-19 Pandemic: Benefits, Barriers, and Utility

“…Ongoing use and further adoption of telehealth modalities will require organizations to continue providing and improving telehealth infrastructure. Protocols for incorporating nonprovider staff into telehealth delivery, strategies to optimize patient selection, and scheduling to optimize both efficiency and outcomes and train trainees and providers will need to be expanded and refined (16).…”

COVID-19 and neuromuscular disorders

“…62 Neuromuscular clinics and information about incorporation of trainees are underrepresented in the limited data about outpatient telemedicine in neurology. 63,64 Resources and telemedicine references have been created by numerous professional societies including the American Academy of Neurology and the American Association for Neuromuscular and Electrodiagnostic Medicine.…”

Training in Neurology: Adoption of resident teleneurology training in the wake of COVID-19

“…The University of California San Francisco implemented a teleneurology rotation for their postgraduate year 3 and 4 residents. 5 After 2 nonconsecutive 2-week blocks of didactics and rotating in telemedicinebased neurology outpatient clinics, residents had improved telemedicine knowledge, more favorable impression regarding teleneurology, and fewer perceived challenges in conducting the neurologic examination over a camera. The Mayo Clinic at Jacksonville, Florida, instituted a telestroke education program for their residents with didactics, simulation training, and real-time clinical practice.…”

“…The AAN recognized the need to incorporate telemedicine in neurology training in 2013 and multiple subsequent publications outline recommended curricula, 1,5,6,9 provide data on implemented programs, 7,9,10 and demonstrate the real-world benefits of systematic telemedicine training. [7][8][9] Anecdotally, the residents at our 3 institutions have expressed increasing interest and curiosity regarding additional teleneurology exposure, which is magnified by the emergent changes in clinical practice implemented in response to the COVID-19 pandemic.…”