Incorporating learners (residents, medical and allied health professional students) into telehealth workflows can be challenging at first, though has unique advantages. In the traditional model of outpatient rotations, a learner would typically gather the information first, and come out of the patient’s room to discuss management with a faculty member. Telehealth provides an opportunity for faculty to directly observe learners interact with patients and gather a history, with a chance to provide immediate feedback.
Recommended principles for learners in telehealth:
- Integrate learners of all levels into patient care visits while continuing attending supervision
- Prioritize both clinical care and education during visits
- Maintain safe working conditions
- Optimize self-directed learning resources
Scenario 1 - Learner and preceptor start together
Preceptor assesses the patient and whether there will be need for higher acuity care (i.e. requiring in-person visit or needs to be sent to the emergency room), and the learner completes the visit.
This model is more flexible and can be appropriate for all levels of learners. However, this method is also more time consuming (given history is gathered together), and may need to be adapted based on clinic volume of telehealth visits.
Scenario 2 - Learner focused (Traditional model)
Learner begins the visit, similar to the traditional model of teaching in medicine. Once information is gathered (either over phone call or video visit), the learner pauses to present the history to the preceptor. Then, both learner and preceptor are present for the virtual physical exam and management.
This model is most common for medical and other allied health professional students as well as interns as the preceptor is able to provide greater guidance based on the exam as well as management plans.
Scenario 3 - Learner starts / Patient called back
Learner completes the history gathering and virtual exam portion of the visit. Then discusses with the preceptor and calls the patient/family back with a management plan.
This model is effective for an advanced learner such as a resident and a straightforward acute or well visit.
Technical and logistical considerations:
- Three way calling with preceptor is possible, though technical problems are more likely
- Consider having preceptor and learners in same room for ease of precepting
- Ensure each learner has the appropriate necessary technology
- Consider conducting part of the visit by phone and exam by video, if internet connection (and bandwidth) is a barrier to access for patients and families