Background:

During the rapid onset of the pandemic, clinicians transitioned from traditional outpatient practice to virtual modalities for providing routine care to patient panels. Like training programs nationwide, telemedicine training and assessment had not been systematically incorporated into our residency. In response, a scheduled Internal Medicine (IM) Objective Structured Clinical Examination (OSCE) was adapted to a remote modality to become virtual care-focused learning experience for trainees and to provide valuable feedback to educators.

Methods:

Standardized Patients (SPs) rated residents on their communication (including information gathering, relationship development and patient education), patient activation and satisfaction, and telemedicine skills. Analyses included a comparison of domain scores for residents who participated in both the 2020 remote and 2019 in-person OSCEs, and a review of written resident comments about the virtual OSCE.

Results:

During 2020’s video visit OSCE (VOSCE), residents (n = 23) excelled at nonverbal communication but struggled with virtual physical exams and information gathering. In debrief, residents expressed substantial interest in more opportunity to practice virtual visit skills going forward. In comparing scores of the virtual care (2020) OSCE with the in-person (2019) version, the small subset of residents who participated in both assessments (n = 9) performed similarly on communication skills, patient satisfaction and activation. Patient education scores were significantly lower during the virtual care OSCE (P = .008).

Conclusion:

Our reformulated OSCE accomplished 3 goals including; (1) physically distancing residents from SPs per COVID regulations, (2) providing residents with the opportunity to practice critical virtual visit skills, and (3) alerting our educators to curricular improvement areas. Our methods are useful for other institutions and have applications to the larger medical education community.

中文翻译：

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COVID 时代的远程医疗培训：改进常规欧安组织，让住院医师为虚拟护理做好准备

背景：

在大流行迅速发作期间，临床医生从传统的门诊实践转变为虚拟方式，为患者小组提供常规护理。与全国的培训计划一样，远程医疗培训和评估并未系统地纳入我们的住院医师。作为回应，预定的内科 (IM) 客观结构化临床考试 (OSCE) 被改编为远程模式，成为受训人员以虚拟护理为重点的学习体验，并向教育工作者提供有价值的反馈。

方法：

标准化患者 (SP) 对住院医师的沟通（包括信息收集、关系发展和患者教育）、患者激活和满意度以及远程医疗技能进行评分。分析包括比较参加 2020 年远程和 2019 年面对面 OSCE 的居民的领域分数，以及对虚拟 OSCE 的书面居民评论的审查。

结果：

在 2020 年的视频访问 OSCE (VOSCE) 期间，居民 (n = 23) 在非语言交流方面表现出色，但在虚拟体检和信息收集方面遇到了困难。在听取汇报时，居民们对未来有更多机会练习虚拟访问技能表示了浓厚的兴趣。在比较虚拟护理 (2020) OSCE 与面对面 (2019) 版本的分数时，参与这两项评估的一小部分居民 (n = 9) 在沟通技巧、患者满意度和激活方面表现相似。在虚拟护理 OSCE 期间，患者教育分数显着降低 ( P  = .008)。

结论：

我们重新制定的欧安组织实现了 3 个目标，包括：(1) 根据 COVID 法规，使居民与 SP 保持物理距离，(2) 为居民提供练习关键虚拟访问技能的机会，以及 (3) 提醒我们的教育工作者注意课程改进领域。我们的方法对其他机构有用，并适用于更大的医学教育界。