Telehealth in Training
Telemedicine has become an integral part of the practice of Allergy and Immunology in recent years. The benefits of telehealth for both the provider and the patient are numerous and detailed elsewhere. It is essential that future generations of allergists receive appropriate training in this area. There is no formalized telemedicine curriculum for Allergy and Immunology specifically at this time. The objective of this toolkit is to provide resources that can be used in trainee education so that they can utilize telemedicine as a tool to enhance healthcare provided to patients in their future practice. Below, we use the Association of American Medical Colleges (AAMC) Telehealth Competencies as a framework and provide additional references that may be used to create a telemedicine curriculum for trainees.
Unique Benefits of Telemedicine in Training
Telemedicine provides the opportunity to more easily directly observe trainees during their patient interactions. The teacher can provide real time feedback on communication skills, professionalism, and patient education. “Webside” teaching can also increase patient and learner engagement. The use of telemedicine can also help to decrease burnout in trainees and teachers as it can often be done from home, decreasing commute time and allowing a more flexible learning environment.
Current AAMC Telehealth Competencies
Each domain spans three sections, “Entering Residency (Recent Medical School Graduate)”, “Entering Practice (Recent Residency Graduate)”, and “Experienced Faculty Physician (3-5 Years Post-Residency)”.
Domain 1: Patient Safety and Appropriate Use of Telehealth
Domain 2: Access and Equity in Telehealth
Domain 3: Communication via Telehealth
Domain 4: Data Collection and Assessment via Telehealth
Domain 5: Technology for Telehealth
Domain 6: Ethical Practices and Legal Requirements for Telehealth
Journal Club/Resources based on Competencies:
1. Appropriate Use
Bajowala SS, Shih J, Varshney P, Elliott T. The Future of Telehealth for Allergic Disease. J Allergy Clin Immunol Pract. 2022 Oct;10(10):2514-2523.
Ferrante G, Licari A, Marseglia GL, La Grutta S. Digital health interventions in children with asthma. Clin Exp Allergy. 2021 Feb;51(2):212-220.
Persaud YK. Using Telemedicine to Care for the Asthma Patient. Curr Allergy Asthma Rep. 2022 Apr;22(4):43-52. doi: 10.1007/s11882-022-01030-5
Justvig SP, Haynes L, Karpowicz K, Unsworth F, Petrosino S, Peltz A, Jones BL, Hickingbotham M, Cox J, Wu AC, Holder-Niles FF. The Role of Social Determinants of Health in the Use of Telemedicine for Asthma in Children. J Allergy Clin Immunol Pract. 2022 Oct;10(10):2543-2549
2. Access and Equity
Telehealth Equity Coalition: https://www.telehealthequitycoalition.org/#Facts
American Telemedicine Association: https://www.americantelemed.org/resources/a-framework-for-eliminating-health-disparities-using-telehealth/
AMA Equity In Telehealth: taking key steps forward -https://www.ama-assn.org/delivering-care/health-equity/9-key-steps-advance-equity-emerging-telehealth-landscape (and then an AMA press briefing/pdf - https://www.ama-assn.org/system/files/issue-brief-equity-in-telehealth.pdf
AMA Telehealth Immersion Series - Webinar (Implementing Innovative Solutions with an Equity Lens. Aug 10, 2021) on Telehealth Equity: (https://www.youtube.com/watch?v=to3-rYt4F5E)
Duan GY, Ruiz De Luzuriaga AM, Schroedl LM, Rosenblatt AE. Disparities in telemedicine use during the COVID-19 pandemic among pediatric dermatology patients. Pediatr Dermatol. 2022 Jul;39(4):520-527.
Gilson SF, Umscheid CA, Laiteerapong N, Ossey G, Nunes KJ, Shah SD. Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis. JMIR Med Inform. 2020 Dec 4;8(12):e24544.
Walker, Daniel M., et al. “Exploring the digital divide: age and race disparities in use of an inpatient portal.” Telemedicine and e-Health 26.5 (2020): 603–613.
Ye S, Kronish I, Fleck E, Fleischut P, Homma S, Masini D, Moise N. Telemedicine Expansion During the COVID-19 Pandemic and the Potential for Technology-Driven Disparities. J Gen Intern Med. 2021 Jan;36(1):256-258.
3. Communication
Tele-Presence 5 - https://med.stanford.edu/presence/initiatives/stanford-presence-5/tele-presence-5.html
Elliott T, Matsui EC, Cahill A, Smith L, Leibner L. Conducting a Professional Telemedicine Visit Using High-Quality Webside Manner. Curr Allergy Asthma Rep. 2022 Feb;22(2):7-12.
Elliot T., 4AI4YOU How to conduct a professional telemedicine visit using good webside manner [video]. YouTube. 2020. https://www.youtube.com/watch?v=8bMFL56Zflc
4. Data Collection and Assessment
Elliot T., 4AI4YOU How to conduct a physical exam via telemedicine [video]. YouTube. 2020. https://www.youtube.com/watch?v=4hRObfNyDvc&feature=youtu.be
5. Technology
Technology is variable depending on the platform used. The supervising attending must be comfortable with the workflow of the specific telehealth platform in their clinic before incorporating trainees. The trainee should complete training on the technology before starting to work in a virtual clinic.
6. Ethical Practice and Legal Requirements
Legal requirements vary depending on the state in which you are practicing. Please see your state-specific guidelines, and you can also reference the US Government Telehealth Policy website.
Telehealth Policy, Telehealth.HHS.gov: https://telehealth.hhs.gov/providers/telehealth-policy
AAMC Domains further detailed information can be found at: https://www.aamc.org/data-reports/report/telehealth-competencies
These links are for research only. They are not endorsed by the American Academy of Allergy, Asthma & Immunology (AAAAI).
12/7/2023