Education Research: An experiential outpatient teleneurology curriculum for residents

Background: Telemedicine is rapidly becoming a major vehicle of delivering neurologic care to patients who have limited access to subspecialists and exaggerated travel hardship. However, neurology residents receive little-to-no training in telemedicine in outpatient clinics.
Methods: We piloted, to our knowledge, the first formalized, experiential outpatient teleneurology curriculum. Neurology residents in their third and fourth postgraduate years (PGY3 and PGY4) at the University of California San Francisco (UCSF) completed an interactive lecture and 4 weeks of teleneurology clinics at the San Francisco Veterans Affairs Medical Center (SFVAMC). Change in residents’ telemedicine knowledge and perspectives on the utility, challenges, benefits, and future practice implementation of teleneurology were evaluated in 11 residents using precurriculum and postcurriculum quizzes and surveys after 2 of 4 weeks on the rotation.
Results: Residents’ performance on quizzes improved from 53% to 88% (p = 0.002). Residents’ impression of video visits compared to in-person visits changed, with more individuals indicating video visits to be the “same” if not “somewhat superior” with regards to obtaining a focused history, formulating a focused assessment and plan, communicating recommendations, and the overall care provided (p ≤ 0.04). All residents felt more competent using telemedicine for patient care in their eventual career.
Conclusion: Our formal didactic and clinic-based teleneurology curriculum for neurology residents, which shared core themes suggested by the 2017 American Academy of Neurology (AAN) Telemedicine Work Group’s published recommendations, showed a statistically significant improvement in knowledge and perspectives about the promise and limitations of teleneurology practice, as well as increased comfort levels in future implementation.