Experiential Learning for Developing Telehealth and Shared Decision-Making Skills during Rheumatology Fellowship

Objective: Telehealth and shared decision-making (SDM) enhance the care of people with rheumatic diseases. Responding to calls for training on telehealth and SDM, we developed an educational intervention for rheumatology fellows-in-training (FITs). Methods: FITs conducted two patient care telehealth encounters (pre- and post-intervention). Following the first encounter, FITs completed an online module highlighting the nuances of SDM during telehealth and a simulated patient encounter to practice telehealth skills, especially SDM. After each observation, FITs received feedback on their “webside” manner, SDM, and visit coordination skills via feedback forms (FF). Wilcoxon-signed rank tests compared quantitative FF measures, whereas qualitative methods analyzed written comments. FITs completed a survey and self-reported their confidence in SDM during telehealth visits. Results: A total of 9 and 11 FITs completed pre- and post-intervention encounters, respectively; 47 FITs completed the simulation. Total points earned on the FF and points specific to the visit coordination subsection of the FF significantly increased from pre- to post-intervention (P = 0.011 and P = 0.049, respectively). “Webside” manner scores improved without reaching statistical significance (P = 0.067). SDM scores remained unchanged, whereas confidence conducting SDM during telehealth improved significantly (P < 0.001). Qualitative analysis highlighted the apt use of technology as a skill FITs could further develop for enhancing SDM during telehealth. Conclusion: Education dedicated to telehealth skills with an emphasis on SDM improves FITs’ confidence in practicing SDM during telehealth and advances general telehealth skills implemented during patient care. Our materials and approach to instruction prepare FITs for delivering telehealth care and enriching patient-centeredness as new entrants into the rheumatology workforce.