Impact of Increased Telemedicine Usage During Covid-19 on Residency Training and Implications for Graduate Medical Education

Background: The COVID-19 pandemic has led to an unprecedented and rapid increase in virtual care visits. Previous literature on telehealth centered clinician and patient perceptions, with limited attention to telehealth’s influence on residents’ clinical education. This works aims to explore the perspectives of Internal Medicine (IM) residents on clinical training amidst the transition to telehealth and identify competencies specific to virtual care. Methods: In March 2021, post-graduate year (PGY 1 – PGY3) IM residents at the Manhattan Veterans Affairs Medical Center in March 2021 were invited to participate in focus groups as part of standard program evaluation. Issues explored include patient relationships, clinical decision-making, and preceptor use. Focus group recordings were transcribed and thematically analyzed. Results: 26 residents participated in three focus groups. Themes were categorized into five domains: 1) building patient relationships, 2) using remote technology, 3) conducting physical exams, 4) decision-making, and 5) interacting with supervisors. Participants felt able to maintain relationships with pre-existing patients, though some expressed concerns about privacy and difficulty connecting with new patients. Many found evaluating physical concerns difficult and thus were more hesitant to make diagnoses. Preceptors were not present during tele-visits which precluded real-time support when participants encountered uncertainty. Participants had a higher threshold for asking their preceptors questions and making changes in management plans after tele-visits were concluded. Conclusions: Our findings support the need to establish new clinical training standards. Trainees need guidance for navigating remote decision-making and care management; structured preceptor protocols can improve trainee education and quality patient care.