Despite exploding in popularity during the pandemic, telehealth has been around in healthcare for years. But the sudden shift to virtual care in 2020 forced the pace of innovation in health tech to accelerate—and some providers have struggled to keep up.
In a March study by health tech startup Wheel, 63% of the nearly 400 providers surveyed said they think virtual primary care will surpass in-person services in the next five years. But 46% percent of respondents say they didn’t feel prepared by their employer to make the switch during the pandemic.
While on the surface telehealth visits may seem just like normal visits conducted over video chat, effective patient care requires a different skillset when delivered virtually.
“You can be a good doctor in real life, but if you change your environment, you can really struggle,” said Colton Hood, associate director of George Washington University's Telemedicine and Digital Health Fellowship program. “It takes some getting used to. You have to be creative to get the same answers.”
To assess their patients from a distance, clinicians have to tackle problems that they didn't learn about in school, like using multiple cameras or different camera angles during an exam, managing patients with varying degrees of digital literacy, and integrating telemedicine effectively into a patient's existing care plan.
Programs across the country are emerging to teach those skills.
"All future physicians will use telehealth in some way,” said Neal Sikka, M.D., director of George Washington University’s Telemedicine and Digital Health Fellowship program. “It’s incumbent on schools to make sure their students are trained for modern practice.”
Leading the charge
Individual courses in telehealth are increasingly common in medical and healthcare-focused degree programs. Some schools, however, have decided to go above and beyond a semester's worth of work.
In March, Chatham University in Pittsburgh announced its four-course telehealth certificate program, available to providers on its own or as part of the school's Master of Science in Healthcare Informatics degree. Debra Wolf, director of the master's program, said the department had been thinking about creating a telehealth certificate for years, but the pandemic solidified their plans.
"The major complaint (from providers) was that they were being pushed into this type of service with no understanding of how to do it properly," Wolf told Fierce Healthcare.
Chatham's telehealth certificate not only teaches skills for virtual care like how to make patients feel comfortable during video visits but also prompts them to design telehealth services they'd seek to implement in their own practices.
The University of Arizona College of Nursing offers a telehealth certificate program, too, but takes a slightly different approach. The program is designed around healthcare delivery in rural communities and requires 90 telehealth clinical hours on top of coursework.
"We talk about telehealth at a very high level. However, that's not what practitioners or medical providers need," said Kim Shea, M.D., clinical associate professor and coordinator of the college's telehealth program. "They want a skill, they want to learn the best ways to deliver virtual care effectively and efficiently because there are obviously some limitations."
Arizona's telehealth certificate is similarly available both to students already in the university's nursing program as well as professionals outside of it.
George Washington University's telemedicine-focused fellowship, on the other hand, is designed to be added to a clinician's previous education. The two-year post-residency program was created for physicians, nurse practitioners and physician assistants who want to be leaders in virtual care.
Not all providers need the depth of expertise that GW’s fellowship hopes to impart, Sikka said. But for clinicians who want to develop telehealth programs or one day assume the position of chief telemedicine officer, for example, the fellowship gives them an edge.
Bumps in the road
In Wheel's March survey, three in four clinicians said virtual care delivery should be a core competency taught in medical schools.
Sikka thinks all future providers will begin to see telehealth integrated into existing curricula at some point in their training. In fact, he said he’s hearing from colleagues that more and more residencies will soon implement telehealth-related milestones for their clinicians.
“I really see this becoming seamlessly integrated over the next few years. Within each specialty, if you choose a residency, you’ll come in with some basic knowledge about telehealth and then you’ll choose to apply it to your domain, and those who want to be leaders in the space will find fellowships,” he said.
Not everyone is so optimistic. Medical school curricula are famously stuffed with requirements, so much so that telehealth won't easily weasel its way in, said Charles Doarn, director of the Telemedicine and e-Health Program at the University of Cincinnati.
Some courses dedicated to topics like student loan debt, though they provide useful information, don't directly relate to patient care at all. But "a lot of organizations just aren't willing to change how they do things," Doarn said.
It's also possible that telehealth will be only forced into curricula as a result of litigation, the University of Arizona's Shea said. Telemedicine skeptics have long worried about the potential for misdiagnoses with virtual care, and she thinks telehealth may work its way into medical and graduate schools over time as lawsuits pile up.
"Unfortunately, litigation drives a lot of what is absolutely necessary for people to learn," she said. "The more mistakes that are made, the more likely that it will have its own place."
Regardless, telemedicine promises to stick around, and related teaching will become unavoidable as providers and patients normalize its practice, Sikka said.
“We have to start thinking about this more as technology-enabled care," he said. "That starts day one in medical school."