Using Telemedicine Technology to Assess Physician Outpatient Teaching

摘要

Background and Objectives: Video conferencing technology (telemedicine) can be applied to many settings within the medical community; we assessed the feasibility of its use in conducting observations of faculty at remote family medicine teaching sites.Methods: We deployed seven telemedicine units to five family medicine residency sites and two observation stations within our division. Practice managers and physician faculty members received on-site training on the basic functionality of the technology, as well as “best practices” and minor troubleshooting techniques. Quick reference guides and other support documents were developed and provided for each site. During the remote faculty observation, two observers simultaneously viewed the resident being precepted, assessing the faculty member using a standardized tool. After the experience, all participants were asked to complete a survey on the usability of the technology.Results: Nineteen observations were successfully conducted from November 2011 to December 2012. From a qualitative perspective, faculty accepted this as a viable means of faculty development. Minor technical hurdles were captured in the survey and improved upon as staff and faculty became more comfortable with the technology and as our technical capabilities allowed. Overall, the technology was rapidly accepted into the practices.Conclusions: Video teleconferencing represents a valuable tool that contributes to the development of faculty by making observation available to numerous sites, including remote areas that may have been previously challenging to reach due to logistics. Recent improvements in technology should make the process easier and allow more aspects of the encounters to be readily observed.(Fam Med 2015;47(10):807-10.)Video teleconferencing technology (telemedicine) has been used in trauma care,1 in assessing neonatal resuscitation skills,2 for telementoring during surgical and other procedures,3,4 and with standardized patients in the continuing education setting.5,6 Research has focused on the use of telemedicine technology to assessinter-professional skills;7,8 however, we found no substantive exploration of the role of video teleconferencing technology for faculty development.Observation of learners during medical school clerkship and residency has been reviewed in the medical education literature.9-13 Studies have demonstrated that “the value of being clinically observed increases learner comfort and ability in the areas of physical examination and history taking.”14 However, without third-party observation and assessment of the interaction between faculty and students, faculty members do not receive the same quality of assessment regarding their teaching skills.Training faculty in teaching skills, critical to the professional development of clinician-educators, has been shown to be effective.15-16 A 2004 survey revealed that only 39% of teaching hospitals had ongoing faculty development programs specific to teaching skills with <50% of the faculty participating.17 Three barriers exist to faculty development: lack of institutional support, teachers’ attitudes and misconceptions, and minimal research on what constitutes effective teaching improvement.18 While most faculty development occurs either through self-assessment or direct observation, faculty skills are poorly represented through self-assessment.16 In 2002, our institution conducted research to evaluate faculty teaching skills through direct observation with written feedback to improve learner-centered teaching and incorporate microskills use to teach patient-centered care.19 Results showed that faculty who were observed and received written feedback ranked higher in teaching skills than their non-observed faculty counterparts.20 Additional work has shown that developing outcome-based evaluation improves teaching effectiveness.21 Given the potential of telemedicine technology, the authors sought to test the practicality of utili