Despite the increased use of telehealth, there is a paucity of literature describing training for video-based telehealth, herein “telehealth.” Telehealth instruction frequently focuses on the use of the technology and not provider-patient interactions (1). While the Association of American Medical Colleges Telehealth Competencies exist for trainees and practicing physicians (2, 3), most telehealth training programs described in the literature are designed for medical students (4–7) or residents (8, 9) and not practicing physicians.

Standardized Patient (SP) actors have been used for decades in health professions education to teach and assess learners’ physical examination and communication skills for trainees (4, 5)including a few studies that specifically assesses telehealth-based communication skills (7, 9). To date, there are few descriptions of the use of SPs for training and assessment of practicing physicians’ telehealth skills (10), and only one described its use to orient physicians to a virtual urgent care (11).

Using Kolb’s Four Stages of Learning conceptual framework (12, 13), a two-case, one-hour pilot telehealth training was created for attending-level Emergency Physicians (EPs). During each session, EPs experienced urgent-care cases with trained SPs who subsequently provided feedback on physicians’ communication skills. The cases were written by the authors and included an Ankle Pain and a COVID-19 Infection case (Supplementary Figure 1). The Ankle Pain case was intended to be a straightforward, non-emergent case that did not need imaging, yet would require the providers to depend on the patient to perform diagnostic hands-on examination maneuvers. The COVID case was intended to encourage the clinician to rely on the patient’s observable examination and data (e.g., patient-derived vital signs). These clinical vignettes were created to provide the following learning experiences: (1) feedback on communication skills via telehealth, (2) practice adjusting in-person evaluations to video, and (3) evaluation of diagnostic and referral plans.

This pilot assessed the feasibility of this educational experience, explored participants’ attitudes toward telehealth in general, and the participants’ perceptions of the simulated telehealth experience for practicing focused telehealth skills. Primary outcomes were the participants’ perceived changes in understanding the benefits and limitations of telehealth in their clinical practice. Secondary outcomes included participants’ perceived changes in confidence related to specific aspects of the encounters: determining need for immediate in-person evaluation and the use of patient-generated data.

Limited descriptions exist in the literature of the use of simulated telehealth training for practicing physicians, despite a growing need for trained expertise in this segment of healthcare. Given this dearth, this study is novel in both demonstrating training and formative feedback on telehealth skills for practicing physicians within the context of two cases of varied urgency.

Sartori et al. described an SP actor visit embedded in the virtual urgent care physicians’ scheduled shift (11). The physicians were rated using a checklist created from their prior telehealth Objective Structured Clinical Examination for residents (8). While the telehealth skills assessed in the Sartori study were like the ones assessed in this study, the current study differed in that it was a voluntary standalone training program using two cases of different complexity and urgency. Other reported resident- and medical student-level telehealth training using SPs were similar to the Sartori study with the SP sessions being used for assessment after an educational intervention (7, 9), which is different than the current study.

The participants’ baseline scores were already relatively high, which may correlate with all reported having prior experience in telehealth. Prior telehealth experiences were not quantified; however, all EPs in the department have been required to cover telehealth programs. It is possible that the effect sizes may be greater for those practicing physicians who have not previously provided telehealth care.

The effect sizes for all questions were medium to high, demonstrating that this training experience provided an opportunity to improve participants’ telehealth skills as well as their perceptions about telehealth as a care modality. It is known that participating in a simulation case increases a participants’ knowledge (14). Further study is warranted on what aspects of this simulation were most helpful to the participants.

The effect size of the COVID case was large regarding the change in participants’ confidence in clinical decision-making. This is concordant with the intentions for the case—by adding aspects of the patient history of present illness and vital signs in the COVID case to restrain the physician from automatically telling the patient to call 911, yet also creating tension about the safety of the patient remaining at home. The Ankle Pain case was created to be straightforward, and it was not surprising to the authors that the physicians did not find a change in perceived certainty in clinical decision making for this low-acuity case. These findings suggest that providing practice in telehealth cases of potentially unstable patients may better improve physicians’ diagnostic evaluation and decision-making skills during telehealth encounters, while maximizing safe outcomes for telehealth patients.

There were limitations to this pilot study, including the small sample size from a single institution where the use of telehealth is actively being explored. This was a retrospective pre-/post-survey to capture participants’ perceptions prior to the experience which may have contributed recall bias. This study was voluntary, and it unclear how the results may be different if the experience were required. The use of Likert scales may have exaggerated the effect size calculated by the Cohen d statistic, e.g., it is not clear that the difference between a 1–2 response is the same as the difference between a 4–5 response.

In summary, practicing EPs indicated that a simulated telehealth training increased their ability to provide telehealth care and that they viewed telehealth more favorably after a pilot training experience. Future work can explore what aspects of this form of training provide the most value to physicians to optimize patient care via telehealth modalities.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by Mass General Brigham IRB. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

EH and SF: study concept and design and acquisition of the data. EH, CN, and SF: analysis and interpretation of the data. EH: drafting of the manuscript. CN and SF: critical revision of the manuscript for important intellectual content. CN: statistical expertise. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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