Becoming A Virtualist

Between Doctors on Demand, Teladoc and other online platforms, patients are willing to get their care online, but are clinicians trained to shift from bedside manner to “webside manner?” Telemedicine has quickly risen to be a novel clinical access point for patients.

Innovation (yes, I said it) is impacting the way we provide medical care; however, we need to reflect on where our current supply of clinicians is coming from and whether they are being trained to provide care in this context. Despite being three years into my internal medicine residency, I have not seen a patient via telemedicine. This is not from lack of enthusiasm or willingness to see patients via telemedicine. Much like 70% of residents, I am intrigued by the potential for interacting with my patients online as it provides opportunity for flexible care.

The extent of training has implications from medical school to board certification. As part of the journey of becoming a physician, doctors take a series of three (really four) exams called Steps. Step II: Clinical Skills involves graded, simulated patient interactions. Currently, these interactions occur in face to face simulated clinic visits with patients. The inclusion of telemedicine as part of clinical care will challenge this current training method. Much like the introduction of the electronic medical records has forced medical schools and residency programs to question their ability to test for these skill sets, telemedicine will push re-structuring of medical training.

Of course, clinical efficacy is the first and foremost goal of medical training, but the setting of providing care is undergoing significant change. As we train hospitalists, cardiologists, nephrologists, we will also need to train virtualists.