Alexander Hart1, Douglas Romney2, Ritu Sarin3, Oren Mechanic4, Attila J Hertelendy5, Deanna Larson6, Kelly Rhone7, Kristi Sidel8, Amalia Voskanyan9, Gregory R Ciottone10. 1. A. Hart is director of research, Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and emergency physician, Hartford Hospital, Hartford, Connecticut; ORCID: https://orcid.org/0000-0002-0910-2316. 2. D. Romney is director of education, Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and instructor of emergency medicine, Harvard Medical School, Boston, Massachusetts. 3. R. Sarin is affiliated faculty, Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 4. O. Mechanic is director of telehealth, Harvard Medical Faculty Physicians, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 5. A.J. Hertelendy is assistant professor, Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida, and director of innovation and technology, Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-6174-0289. 6. D. Larson is senior vice president, Avera Health, and chief executive officer, Avera eCare, Sioux Falls, South Dakota. 7. K. Rhone is medical director of outreach and innovation, Avera eCare, Sioux Falls, South Dakota, and assistant professor, University of South Dakota Sanford School of Medicine, Vermillion, South Dakota. 8. K. Sidel is director of telemedicine education, American Board of Telehealth, Sioux Falls, South Dakota. 9. A. Voskanyan is co-director, Disaster Medicine Fellowship, Department of Emergency Medicine, Harvard Medical Faculty Physicians, Boston, Massachusetts. 10. G.R. Ciottone is director, Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and associate professor of emergency medicine, Harvard Medical School, Boston, Massachusetts.
Abstract
PURPOSE: Telemedical applications have only recently begun to coalesce into the field of telemedicine due to varying definitions of telemedicine and issues around reimbursement. This process has been accelerated by the COVID-19 pandemic and the ensuing expansion of telemedicine delivery. This article demonstrates the development of a set of proposed competencies for a telemedicine curriculum in graduate medical education. METHOD: A modified Delphi process was used to create a panel of competencies. This included a systematic review of the telemedicine literature through November 2019 to create an initial set of competencies, which were analyzed and edited by a focus group of experts in January 2020. Initial competencies were distributed in a series of 3 rounds of surveys to a group of 23 experts for comments and rating from April to August 2020. Competencies that obtained a score of 4.0 or greater on a 5-point Likert scale in at least 2 rounds were recommended. RESULTS: Fifty-five competencies were developed based on the systematic review. A further 32 were added by the expert group for a total of 87. After 3 rounds of surveys, 34 competencies reached the recommendation threshold. These were 10 systems-based practice competencies, 7 professionalism, 6 patient care, 4 practice-based learning and improvement, 4 interpersonal and communication skills, and 3 medical knowledge competencies. CONCLUSIONS: Half (17/34) of the competencies approved by the focus group and surveyed expert panel pertained to either systems-based practice or professionalism. Both categories exhibit more variation between telemedicine and in-person practice than other categories. The authors offer a set of proposed educational competencies that can be used in the development of curricula for a wide range of providers and are based on the best evidence and expert opinion available.
PURPOSE: Telemedical applications have only recently begun to coalesce into the field of telemedicine due to varying definitions of telemedicine and issues around reimbursement. This process has been accelerated by the COVID-19 pandemic and the ensuing expansion of telemedicine delivery. This article demonstrates the development of a set of proposed competencies for a telemedicine curriculum in graduate medical education. METHOD: A modified Delphi process was used to create a panel of competencies. This included a systematic review of the telemedicine literature through November 2019 to create an initial set of competencies, which were analyzed and edited by a focus group of experts in January 2020. Initial competencies were distributed in a series of 3 rounds of surveys to a group of 23 experts for comments and rating from April to August 2020. Competencies that obtained a score of 4.0 or greater on a 5-point Likert scale in at least 2 rounds were recommended. RESULTS: Fifty-five competencies were developed based on the systematic review. A further 32 were added by the expert group for a total of 87. After 3 rounds of surveys, 34 competencies reached the recommendation threshold. These were 10 systems-based practice competencies, 7 professionalism, 6 patient care, 4 practice-based learning and improvement, 4 interpersonal and communication skills, and 3 medical knowledge competencies. CONCLUSIONS: Half (17/34) of the competencies approved by the focus group and surveyed expert panel pertained to either systems-based practice or professionalism. Both categories exhibit more variation between telemedicine and in-person practice than other categories. The authors offer a set of proposed educational competencies that can be used in the development of curricula for a wide range of providers and are based on the best evidence and expert opinion available.