Training Providers for Teleneurology: Five Essential Skills
Written by Rob Malka, MD
As the demand for neurologic care continues to outpace the availability of in-person specialists, teleneurology has emerged as a robust, efficient, and effective solution. Not only does it improve access to neurologists in underserved areas, but it also enhances the delivery of care in otherwise well-staffed communities, improving quality metrics such as timeliness of care and patient satisfaction. As such, many neurologists are opting for telehealth as their practice modality of choice, enjoying the enhanced career satisfaction of being able to effectively reach patients around the country while also benefitting from improved lifestyle factors such as flexible work location. At the same time, teleneurology also poses its own unique challenges to providers and requires an enhanced set of clinical skills that many learn only after they dive into the virtual health landscape. As this practice modality continues to grow, many physicians (and in turn, their patients) will benefit from attention to these essential skills during training.
Essential Skill #1: Communication
Any high-quality clinical practice requires excellent communication skills – verbal, non-verbal, and written. In teleneurology, this skill set is brought under the spotlight. A teleneurologist should be able to deliver a clear, concise, and understandable explanation of the diagnostic considerations and recommended treatment plan so that patient trust and confidence are maintained, especially if a patient has not previously experienced a telehealth encounter. It is also crucial that the physician maintains good eye contact and stays aware of their own facial expressions, body language, and tone of voice. Empathy can and must be conveyed via a telehealth visit. Just as an in-person patient would feel dismissed if the neurologist stared at their phone while talking to them and promptly scooted out the door after a monologue, the telehealth patient will feel dismissed if the teleneurologist slouches in their chair, types the whole time, doesn’t make eye contact (through the camera), and abruptly logs off without ensuring the conversation is complete.
On the other hand, patient feedback from positive telehealth visits demonstrates how greatly they value a caring and communicative physician regardless of the virtual context. When done right, they feel like the physician is in the room with them (because, really, they are). In addition, good documentation and clear, polite communication with nurses and other providers are essential to ensure mutual understanding of and alignment with the treatment plan between the teleneurologist and the clinical staff on the ground.
Best Practices
Training programs should emphasize and evaluate physicians’ written, verbal, and non-verbal communication skills during supervised patient encounters. Physicians should actively seek feedback about documentation and patient interactions from mentors and peers. Formal courses in communication, such as those used in the corporate world and other industries, deserve specific consideration for doctors.
Essential Skill #2: Technology and Electronic Medical Record Usage (EMR)
Delivering teleneurology care often requires a variety of video conferencing and electronic health platforms. In all cases, basic computer skills are required. While access to technical support is necessary, navigating an EMR effectively and even performing some basic troubleshooting at the workstation can save time, reduce stress, and free up time and energy for focusing on patient care.
Every training program should, at this point, incorporate an electronic health record system for all aspects of care. Being intimately familiar with at least one EMR can make learning other systems far less daunting, as most share core functionalities—differing mainly in how they display, collect, and organize information. This is also true for video platforms, which share similar features but vary in how these are accessed and utilized.
Additionally, setting up a desk station for optimal workflow and comfort requires some familiarity with the necessary tools—monitors, camera, mouse and keyboard, and headset or conference speaker. There are plenty of online reviews, and consulting with seasoned teleneurologists can provide excellent tips on the best gear and setup options. Finally, while one doesn’t have to be a network security expert by any means, using an encrypted secure password keeper, being familiar with multi-factor authentication, and feeling comfortable navigating a VPN will be crucial.
Best Practices
Training programs should ensure basic computing skills and high-level usage of the EMR by physicians. Physicians should seek opportunities to use various EMRs and employ technology in their practice during training. A brief rotation with IT professionals would be an innovative consideration.
Essential Skill #3: Awareness and Flexibility
During a teleneurology visit, just as in-person, the physician needs to be aware of the surrounding environment. HIPAA still applies, and just as confidential information shouldn’t be discussed in an elevator or in the earshot of third parties, the same is true when speaking from a telemedicine cart. Being aware of what room the cart is in, who else is in the room, whether the door is closed, how loud the cart volume is, etc., requires extra attention during a virtual visit. A lot of this can be quickly assessed by asking the nurse or other assistant in the room about these details when necessary or having a peek around by moving the camera on the cart. Awareness also applies to understanding the facility being served, its workflow, and its capabilities.
For example, recommending an MR cisternography at a small remote facility might require the patient to be transferred, and the risks/benefits of transfer must be considered against the actual need for such testing. Thus, staying flexible as to the needs of the patient and the facility is best when working in various circumstances. Having a “listen-first, speak-second” approach will, in general, help avoid mishaps. Regardless, patient safety and privacy should remain paramount.
Best Practices
Training programs should provide opportunities for physicians to practice in various environments. Privacy training required by all entities should include telehealth and remote access issues. Physicians should seek to hone their clinical skills in basic care environments and diversely-equipped tertiary centers. Rotations in rural centers and outreach clinics should be valuable experiences that can provide additional perspective.
Essential Skill #4: Self-Care
Regardless of the setting, the practice of medicine stresses the physician mentally and physically, resulting in high rates of burnout. In teleneurology, the provider can be seated (or, at times, standing) at their workstation for extended periods while sometimes faced with high-intensity stressful situations. Radiologists and surgeons face similar challenges.
To counterbalance these pressures, physicians need to maintain a healthy lifestyle that includes regular exercise, a reasonable diet, adequate sleep, and opportunities for recreation to recharge the cognitive, emotional, and physical batteries. Making time for family and friends is critical for good emotional health. The same is true for exploring a creative outlet such as art, music, writing/journaling, dance, etc. In addition, mindfulness techniques can help physicians remain focused and calm when the going gets rough. Together, these habits can improve resilience, reduce stress and burnout, and increase the likelihood of deriving satisfaction from practice.
Best Practices
Training programs, while necessarily rigorous, should emphasize the importance of physical and emotional health for physicians and provide education about the importance of lifestyle factors to reduce burnout. Physicians should employ these skills and prioritize time off to connect with friends and family and explore creative endeavors. Access to mindfulness coaching, exercise equipment, and opportunities for creative work should be considered.
Essential Skill #5: Telehealth Experience
Indeed, there is no substitute for actually doing it! Having some exposure to teleneurology in training can help physicians who transition to full-time virtual practice. The opportunity to practice teleneurology with guidance from an attending or mentor ensures that the physician has a firmer understanding of the preceding skill sets and other aspects of teleneurology practice. The best teleneurology practices provide mentorship opportunities during the onboarding process. Still, hands-on clinical experience in virtual medicine can help clinicians get a first-person feel for this modality of care and ensure they are confident whether it is the right career option for them.
Best Practices
Training programs should provide opportunities to practice teleneurology under supervision during their clinical rotations. Physicians should embrace this aspect of training as it has become exceptionally pertinent to modern medicine.
While the above skills are integral to any clinical practice, the unique environment of teleneurology brings them particular importance. As the teleneurologist has become an integral member of the healthcare team, the appropriate training and education will help ensure competency and confidence for providers in providing exceptional service through this ever-advancing profession.
