An Educational Needs Assessment of Telehealth in Primary Care Among US Internal Medicine Residents

As a result of the coronavirus disease 2019 pandemic, many Internal Medicine (IM) residency programs converted to telehealth for primary care. Our objectives in this study were to better understand resident past and present telehealth education, their perceived barriers to telehealth practice, and their perceived solutions to improving telehealth use and education.

We performed a cross-sectional needs assessment survey between November 2020 and February 2021 among residents at 10 IM residency programs across the United States. Our primary measures were telehealth use in resident continuity clinics before and during the coronavirus disease 2019 pandemic, telehealth training, and confidence and barriers in using telehealth.

Of 857 residents contacted, 314 (36.6%) responded. Residents reported low rates of education in telehealth prepandemic with significant improvements after the start of the pandemic across all visit domains (range of 10.7%-19.6% prepandemic compared with 25.6%-55.7% postpandemic, all P < 0.001). Resident confidence levels were significantly lower (P < 0.001) for video visits and telephone visits compared with in-person visiting across domains of communication, history taking, using an interpreter, making a diagnosis, counseling patients, providing psychosocial support, performing medical management, and coordinating after-visit care. Reported barriers included patient resources, clinic resources, lack of preceptor feedback, and lack of observation. Reported resources for improvement included tutorials on physical examination techniques, clinical space for telehealth, and patient resources for telehealth.

To effectively address the educational needs for telehealth practice by IM residents, educators must consider not only curricular needs but also clinical, preceptor, and patient barriers to the high-quality use of telehealth for primary care.