Preceptor Telemedicine Guide
Preceptor Telemedicine GuideThank you for your vital work in caring for patients AND in teaching the next generation! Thishandout will help you to host medical students using Telemedicine.We shared this video with students to teach about the bigger picture of Telemedicine, and thisvideo for tips on “webside manner.”BEFORE THE SESSION:1) Feel free to review the orientation guide written for students.2) Connect with your student and exchange cell phone numbers. Set a time to briefly reviewthe plan for the session (at least 15 minutes BEFORE the student needs to call the firstpatient: could be the day before, or just before the session begins). Sample topics tocover: introductions, which patients they should see, consent process, how long studentsshould spend with each patient, when you will debrief.3) Orient the student to your electronic health record and to your video/phone platform fortelemedicine visits.DURING THE SESSION:4) “Virtual Rooming”: The student should call your patient 20-30 minutes before theappointment time and get the patient set up with the visit platform (tech savvy studentscan help with IT troubleshooting!). The student will also reconcile medications, verifypharmacy and allergies, and ask anything you assign – e.g., tobacco status if that’shelpful to you. Think about how the student can help prepare the visit for you!5) Questionnaires: The student can give screening questionnaires (PHQ-9, M-CHAT).6) Doctoring: The student will take a history, note physical exam elements that are possibleon video visits (http://bit.ly/caravantelePE), and develop an assessment and plan.7) Options for the actual visit:a. While you see the 10:00am patient, your student prepares and “sees” the 10:30patient; you join at 10:30 to hear the student presentation and close out the visit.b. The student shadows you on several patients moving at your pace and assists youin real time by looking up evidence, finding resources for patients at your request,and learning via Active Observation8) Options for student presentations:a. If you have allowed your student autonomy, join the student on the video / phonecall at the appointment time (the student will have been with the patient for 20-30minutes by then). Hear the student present directly in front of the patient/parent.Then add any comments about the student’s assessment and plan, ask anyadditional questions of student or patient, and close out the visit b. OR have the student hang up. Call the student who will briefly ( 5 minutes)present the case. Then call the patient back (with or without the student) andfinish the visit.9) Texting with the student during the session works well!10) Shadowing: Students can shadow you for other patients they are not independently“seeing”; consider having the student keep video off to decrease the number of pairs ofeyes on the patient. Encourage the student to do “Active Observation” for these visits. Erlich 2020, Tufts Unveristy School of Medicine, partly adapted with permission from Dartmouth Medical School
Preceptor Telemedicine Guide11) Real Time Resource: While you’re speaking with the patient, ask students to look uprelevant evidence, find a patient handout, get contact information for therapy, or look uplabs or other information in the medical record.AFTER THE SESSION:12) Call the student after the session to debrief, answer any questions, and give feedback.13) Read the student’s notes, edit, co-sign, and give feedback.TELEPHONE TIPS:1) When dialing patient numbers, teach your students to precede a patient phone numberwith *67 to block their personal cell phone number from showing on Caller ID, OR havestudents download the Doximity Dialer and input your office phone number to displayyour office number instead of student’s number when calling patients.2) How to set up 3-way calls with patient and student for a telephone visit:a. iPhone: look at your phone once you have the patient on the lineOn the screen with options such as ‘Speaker’, ‘Mute’, etc. tap ‘Add call’Dial the student's numberOnce the student picks up, tap ‘Merge Calls’ (patient is on hold until you merge)b. Android: look at your phone once you have the patient on the lineTap the 'Menu' iconOn the screen with options such as ‘Speaker’, ‘Mute’, etc. tap ‘Add call’Dial the student's numberOnce the student picks up, tap the 'Menu' iconTap 'Merge' (patient is on hold until you merge the calls)Pointers:1) Less is more! Students only need to see 2-3 patients per session! Please do not feel youneed to deliver comprehensive teaching on every subject that arises. Students are simplycraving clinical contact (even if virtual!) and moreover will gain a lot from watching youinteract with patients via video or phone.2) Students can write notes! The same CMS guidelines about students writing notes and ususing them apply for virtual visits. As always, we must verify their history, physical,assessment and plan, but we may use their documentation if we agree with it.3) Active Observation: We are encouraging the students to use “Active Observation”rather than passively shadowing. (See student guide for details.)4) Keeping Busy: Let your students do independent reading, write a written reflection, lookup evidence, or call patients in follow up; if you have bandwidth to teach them what to doto help you, you can even have them do paperwork, review charts, or perform outreach. Erlich 2020, Tufts Unveristy School of Medicine, partly adapted with permission from Dartmouth Medical School
Student Telemedicine OrientationThis handout will help you succeed at Telemedicine visits.Please watch this video to learn about the bigger picture of Telemedicine, and this video for tipson “webside manner.”BEFORE THE SESSION:1) Touch base with your preceptor.a. Exchange cell phone numbers.b. Get oriented to the electronic health record and the video or phone platform.c. Together, work out which patients you will see and exactly what your role will be.d. Be specific when you ask questions of your preceptor: how many minutes shouldI spend with the patient? Should I wait for you to join us or should I text youwhen I’m ready? Should I hang up with the patient before you join? Should Iclean up the chart? Should I write the daily note? Is there a telemedicine templateor macro to use? Is there a consent process I should facilitate? When will wedebrief – will you call me after the session ends?2) Check the schedule. Telemedicine schedules are unpredictable: sometimes full ahead oftime; sometimes light; and sometimes filling up at the last minute as patients may needlittle to no notice to show up virtually! Fill any downtime wisely, but vigilantly watch theschedule in case patient appointments get added on in real time.DURING THE SESSION:1) Call the patients you are “seeing” 20-30 minutes prior to their appointment time.Your conversation will usually take about 20 minutes.a. Introduce yourself as the “student doctor working with Dr. XYZ,” tell the patientyou have some questions to prepare for the visit with Dr. XYZ, and let the patientknow your preceptor will be joining shortly. End with “sound OK?” or similar.b. Perform and document any consent process your preceptor discussed with you.c. Verify patient name and date of birth.d. Verify demographics (address and phone number).e. Do a medication reconciliation.f. Confirm allergies.g. Confirm which pharmacy the patient uses.h. Go right into the visit: “so what prompted this appointment today?” or somethingalong those Chief Concern lines.2) Start the doctoring part of the visit.a. Take a History of Present Illness (HPI) with pertinent Review of Systems (ROS).b. Look at Problem List for relevant diagnoses (e.g. asthma in a patient withrespiratory symptoms).c. Administer appropriate questionnaires, e.g., M-CHAT, AUDIT-C, or PHQ-9.Document scores. Erlich 2020, Tufts University School of Medicine, partly adapted with permission from Dartmouth
Student Telemedicine Orientationd. Feel free to check in more generally with the patient or parent, e.g., have you beenable to get outside recently? What has been a source of joy for you in the last fewdays? In this more isolated time, many people are craving simply connecting withsomeone outside of their immediate circle.e. Tips for Physical Exam on video visits: http://bit.ly/caravantelePEf. Assessment and Plan: Similar to what you would present in person.3) Present the case. Two options:a. Your preceptor will join you on the video / phone call and you will presentdirectly in front of the patient (use the grammatical second person “Susie, YOUhave had belly pain for a week” rather than talking about the patient or parent inthe third person as in “SHE has abdominal pain”). Then the preceptor will addany comments about your assessment and plan, ask any additional questions ofyou or the patient, and help close out the visit b. or your preceptor will ask you to hang up, present the case without thepatient/parent listening, and then you’ll call the patient/parent back together.Some preceptors will phone or video-call the patient without you first and ask theparent if you can re-join. You may not necessarily contribute to this part of thevisit depending on flow.c. Active Observation: While your preceptor is talking to the patient, use ActiveObservation. What do you notice about the preceptor’s communication style? Useof silence? Use of teach back? What is the patient’s body language (if video)?What can you glean about the doctor-patient relationship? What alterations to anin-person visit has the preceptor made? How does the preceptor end the visit?How is follow-up handled? Jot notes if this will help you remember details.4) Your preceptor will see the next patient while you prepare the following patient.E.g., at 10:00 you call the 10:30 patient while your preceptor sees the 10:00 patient alone.Remember, the schedule can be unpredictable or flow differently. Be flexible.AFTER THE SESSION:1) Debrief. After the session, debrief for 10-15 minutes with your preceptor.a. Ask for feedback on your performance.b. Discuss medical issues that you didn’t have time to clarify earlier, e.g., choice ofmedications prescribed, or the differential diagnosis.c. If time, offer your reflections from your Active Observation.2) Write your notes. Ask for feedback! Erlich 2020, Tufts University School of Medicine, partly adapted with permission from Dartmouth
Lynchburg Family Medicine Residency TELEHEALTH RESOURCES(adapted from VCU TELEMED CURRICULUM - Vishal Misha, MD)(Ctrl click will open links directly)Intro Telehealth 101 Lecture (51 mins)https://stanford.zoom.us/rec/play/vMJ8cu 7rD03GdyQtASDV J6W426KvqshCNI eMode true Telehealth Etiquettes (Review short first 10 videos)https://www.youtube.com/playlist?list PLM0VF0yZsE6f6737BT0QdUp7iC9BMINyCPhysicalExam Physical Exam in Telemedicine (Review 6 Videos)https://www.youtube.com/playlist?list PLM0VF0yZsE6eRiWVQ-RwnkIqruaFzDAON Problem-Based Approach to Physical Exam (video of provider-directed self-exam for HEENT, Low backpain, and Shoulder)http://bit.ly/virtualphysexam Telehealth Physical Exam Guide (from Caravan Health – physical exam by systems)http://bit.ly/caravantelePETipsTelehealth Quick Reference Card (from Stanford – overview of telehealth best practices and tips)TrainingCourseshttp://bit.ly/OCHtelemed101 Foundations of Telehealth Course (from The University of Virginia – overview of telehealth; CME credits andprovides certificate of completion; duration is 90 mins; 100 urse EtYvqTG9NpE%3d Telehealth Team Role and Responsibilities (Video Visits – from California Telehealth Resource Center; freebut requires registration; does not provide 021 A. Thomas ann.thomas@centrahealth.com
LFMR – STATStudent Telehealth Assessment ToolStudent Observer DateCOMMENTSRapport and Relationship Introduces Self Good eye contact Calls patient by name Appropriate facial, hand, and body gestures Listens well using continuer phrases (“um hmmm”) Demonstrates compassion Interview does not feel rushed Respects patient’s culture and backgroundVerbal Communication Begins with open-ended questions Appropriate pace Appropriate tone Minimizes interruptions Repeats important verbal content Avoids use of medical jargon Interview is easy to followHistory-Taking/Clinical Reasoning Develops agenda Elicits adequate information about the chiefcomplaint Asks follow-up and review of system questions toclarify items on differential diagnosis Recognizes/asks about a red flag symptom Explains findings in the history and physical thatjustify the diagnosis Considers the most likely causes Considers psychosocial aspects Invites questionsEmotional Handling (BATHE Technique) Explores effects of patient’s situation on them as aperson Recognizes and names emotions Expresses understanding of patient’s situationPreceptor:Recommendations:Adapted from PCOF from the University of Washington Department of Family Medicine
4) Your preceptor will see the next patient while you prepare the following patient. E.g., at 10:00 you call the 10:30 patient while your preceptor sees the 10:00 patient alone. Remembe
The impact of telemedicine on the medical development of remote regions 24 Prof. Louis Lareng , Director of the European Institute of Telemedicine in Toulouse, and Dr Monique Savoldelli , CHU Toulouse Telemedicine actors Telemedicine Ð Bringing health closer to citizens 27 Marina Geli , Catalan Minister for Health
8. Write a SOAP note and have your preceptor review it 1 time for LPP year 2. 9. Develop and Discuss Problem Lists, Assessment & Plans for 1 patient at each session. Review with your preceptor. 10. Complete a self evaluation and discuss with your preceptor (online link for E*Value will be sent in November, due January 2016)
discussion of the telemedicine case study and finally, a prescription for home care including acupressure points and rehabilitative exercises. Telemedicine Considerations Patient Consent Forms Contact your State Acupuncture Board for more information on guidelines and regulations regarding telemedicine consultations. The surge in demand for
6 Telemedicine Evaluation providers’ cost structures, current and projected future telemedicine service utilization, and the interaction between the two. CHI concluded that the potential savings of telemedicine adoption are reliant on several factors. First, more savings opportunities are available to
Google Drive Instructions 11 Information for the Preceptor 12 Example of the email sent to Preceptor(s) 14 Clinical Experience Expectations 15 Student behavior 15 . preceptor’s CV/resume, and affiliation agreement) for each clinical site AND preceptor they plan to use each semester.
Pediatric Neurological Examination via Telemedicine v2 Annette Grefe, David Hsieh, Charuta Joshi, Sucheta Joshi, Jaclyn Martindale, Mark Mintz, Sameh Morkous, Mickey Segal, and Asim Shahad This guide offers an outline and tips for the examination of infants, toddlers, and young children via telemedicine, which is limited to observations.
Check the box that you wish to display in the drop down during time log and patient entries: If the desired location or preceptor does not appear, select “Add New Location” or “Add New Preceptor” (once the location or preceptor has been added, repeat steps 3 and 5). Save the select
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