JMIR Publications

ABSTRACT

Background:

Since the COVID-19 pandemic onset, telemedicine has increased exponentially across numerous outpatient departments and specialties. Qualitative studies examining clinician telemedicine perspectives during the pandemic identify challenges with physical examination, workflow concerns, burnout and reduced personal connection with patients. However these studies only included a relatively small number of physicians or were limited to a single specialty, and few assessed perspectives on integrating trainees into workflows, an important area to address to support the clinical learning environment. As telemedicine use continues, it is necessary to understand a range of clinician perspectives.

Objective:

To survey pediatric and adult medicine clinicians at the University of Chicago Medical Center (UCMC) to understand their: (1) telemedicine benefits and barriers (2) workflow impacts and (3) training and support needs.

Methods:

In July 2020, we conducted an observational cross-sectional study of UCMC faculty and advanced practice providers in the Departments of Medicine (DOM) and Pediatrics (DOP).

Results:

Overall response rate was 39% [200/517, DOM 42% (135/325), DOP 34% (65/192)]; most respondents were physicians [DOM 74% (100/135), DOP 79% (51/65)]. One-third took longer to prepare for (33%, 65/200) and conduct (32%, 64/200) video visits compared to in-person. Male clinicians reported conducting a higher percentage of telemedicine visits by video than their female counterparts (P=0.02), with no differences in number of half-days per week providing direct outpatient care or supervising trainees. Further, clinicians who conducted a higher percentage of their telemedicine by video were less likely to feel overwhelmed (P=0.02), with no difference in reported burnout. Female clinicians were “more overwhelmed” with video visits compared to males (32% vs. 19%, P=0.05). Clinicians >50 yo were “less overwhelmed” than those <50 yo (35% vs. 20%, P=0.02). Those who received more video visit training modalities (e.g., a document and webinar on technical issues) were less likely to feel overwhelmed by the conversion to video visits (P=0.007) or burnt out (P=0.009). Also, those reporting a higher ability to technically navigate a video visit were also less likely to feel overwhelmed by video visits (P=0.02) or burnt out (P=0.001). The top telemedicine barriers were patient-related: lack of technology access, skill, and reluctance. Training needs focused on integrating learners into workflows. Open-ended responses highlighted need for increased support staff. Overall, more than half “enjoyed conducting video visits” (60%, 119/200) and wanted to continue using video visits in future (75%, 150/200).

Conclusions:

Despite positive telemedicine experiences, more support to facilitate video visits for patients and clinicians is needed, as is additional instruction on trainee education and integration into virtual workflows. Further work is needed to better understand why gender and age differences exist. In conclusion, interventions to address clinician and patient barriers and enhanced clinician training are needed to support telemedicine’s durability. Clinical Trial: None.