Medical schools need to catch up with telemedicine advances

Telemedicine is going to keep expanding, and the medical educational establishment needs to ensure that new doctors have the skills and understanding to use the technology effectively and ensure proper quality of care.

So argue a group of educators from the University of California, San Francisco School of Medicine in an editorial recently published in the Journal of the American Medical Association.  Describing the “core challenge of medical education” as an exercise in preparing physicians for future learning, the writers list an array of potential advantages to telemedicine, but they caution that “practicing telemedicine is fundamentally different from conducting a face-to-face encounter.  In addition to physical separation and its implications for examination, telemedicine automatically brings into the relationship a third partner – the organization providing the technology and setting the parameters of the e-visit.”

While recognizing that telemedicine meets the standards of traditional encounters in that, among other things, a clinician performs an evaluation, provides evidence-based recommendations and arranges follow-up visits, they also point to the new opportunities telemedicine can provide.  “For instance,” they say, “medicine could be more patient-centered if care for a child with cystic fibrosis included regular telemedicine visits to optimize home management the disease.”

But they caution that by creating new opportunities for home care and for communication with patients, telemedicine might also significantly increase physician workloads.  “More ominously,” they note, “telemedicine strategies that fail to meet the professional standards for a clinical encounter jeopardize patient care.”

As for the specific challenges telemedicine poses from a clinical perspective, the writers emphasize the importance of helping new doctors develop examination techniques that essentially mirror traditional, hands-on practices.  “Physicians have long equated the physical examination with laying on of hands,” they write, “but much evaluation can be done virtually –for example, by watching patients walks as a functional strength examination.”

In addition to clinical challenges and opportunities, however, the writers say doctors and their teachers must also anticipate the “professionalism challenges that may result from entrepreneurial promotion of delivery platforms. Health technology often changes faster than medical regulation, and physicians should ensure that novel delivery platforms meet professional standards for quality, safety and confidentiality.”

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