PDF(Pubmed)
Abstract：
BACKGROUND: As telemedicine plays an increasing role in health care delivery, providers are expected to receive adequate training to effectively communicate with patients during telemedicine encounters. Teach-back is an approach that verifies patients\' understanding of the health care information provided by health care professionals. Including patients in the design and development of teach-back training content for providers can result in more relevant training content. However, only a limited number of studies embrace patient engagement in this capacity, and none for remote care settings.
OBJECTIVE: We aimed to design and evaluate the feasibility of patient-centered, telehealth-focused teach-back training for family medicine residents to promote the use of teach-back during remote visits.
METHODS: We codeveloped the POTENTIAL (Platform to Enhance Teach-Back Methods in Virtual Care Visits) curriculum for medical residents to promote teach-back during remote visits. A patient participated in the development of the workshop\'s videos and in a patient-provider panel about teach-back. We conducted a pilot, 2-arm cluster, nonrandomized controlled trial. Family medicine residents at the intervention site (n=12) received didactic and simulation-based training in addition to weekly cues-to-action. Assessment included pre- and postsurveys, observations of residents, and interviews with patients and providers. To assess differences between pre- and postintervention scores among the intervention group, chi-square and 1-tailed t tests were used. A total of 4 difference-in-difference models were constructed to evaluate prepost differences between intervention and control groups for each of the following outcomes: familiarity with teach-back, importance of teach-back, confidence in teach-back ability, and ease of use of teach-back.
RESULTS: Medical residents highly rated their experience of the teach-back training sessions (mean 8.6/10). Most residents (9/12, 75%) used plain language during training simulations, and over half asked the role-playing patient to use their own words to explain what they were told during the encounter. Postintervention, there was an increase in residents\' confidence in their ability to use teach-back (mean 7.33 vs 7.83; P=.04), but there was no statistically significant difference in familiarity with, perception of importance, or ease of use of teach-back. None of the difference-in-difference models were statistically significant. The main barrier to practicing teach-back was time constraints.
CONCLUSIONS: This study highlights ways to effectively integrate best-practice training in telehealth teach-back skills into a medical residency program. At the same time, this pilot study points to important opportunities for improvement for similar interventions in future larger-scale implementation efforts, as well as ways to mitigate providers\' concerns or barriers to incorporating teach-back in their practice. Teach-back can impact remote practice by increasing providers\' ability to actively engage and empower patients by using the features (whiteboards, chat rooms, and mini-views) of their remote platform.
OBJECTIVE: We aimed to design and evaluate the feasibility of patient-centered, telehealth-focused teach-back training for family medicine residents to promote the use of teach-back during remote visits.
METHODS: We codeveloped the POTENTIAL (Platform to Enhance Teach-Back Methods in Virtual Care Visits) curriculum for medical residents to promote teach-back during remote visits. A patient participated in the development of the workshop\'s videos and in a patient-provider panel about teach-back. We conducted a pilot, 2-arm cluster, nonrandomized controlled trial. Family medicine residents at the intervention site (n=12) received didactic and simulation-based training in addition to weekly cues-to-action. Assessment included pre- and postsurveys, observations of residents, and interviews with patients and providers. To assess differences between pre- and postintervention scores among the intervention group, chi-square and 1-tailed t tests were used. A total of 4 difference-in-difference models were constructed to evaluate prepost differences between intervention and control groups for each of the following outcomes: familiarity with teach-back, importance of teach-back, confidence in teach-back ability, and ease of use of teach-back.
RESULTS: Medical residents highly rated their experience of the teach-back training sessions (mean 8.6/10). Most residents (9/12, 75%) used plain language during training simulations, and over half asked the role-playing patient to use their own words to explain what they were told during the encounter. Postintervention, there was an increase in residents\' confidence in their ability to use teach-back (mean 7.33 vs 7.83; P=.04), but there was no statistically significant difference in familiarity with, perception of importance, or ease of use of teach-back. None of the difference-in-difference models were statistically significant. The main barrier to practicing teach-back was time constraints.
CONCLUSIONS: This study highlights ways to effectively integrate best-practice training in telehealth teach-back skills into a medical residency program. At the same time, this pilot study points to important opportunities for improvement for similar interventions in future larger-scale implementation efforts, as well as ways to mitigate providers\' concerns or barriers to incorporating teach-back in their practice. Teach-back can impact remote practice by increasing providers\' ability to actively engage and empower patients by using the features (whiteboards, chat rooms, and mini-views) of their remote platform.
摘要：
背景：随着远程医疗在医疗保健提供中发挥越来越大的作用，医疗服务提供者预计将接受足够的培训，以便在远程医疗期间与患者进行有效沟通。回教是一种验证患者对医疗保健专业人员提供的医疗保健信息的理解的方法。将患者纳入提供者的背授培训内容的设计和开发中，可以产生更相关的培训内容。然而,只有有限数量的研究支持患者以这种身份参与，和没有远程护理设置。
目的：我们旨在设计和评估以患者为中心的可行性，为家庭医学居民提供以远程健康为重点的背授培训，以促进在远程访问中使用背授。
方法：我们为医疗住院医师共同开发了POTENIAL（增强虚拟护理就诊中的背教方法的平台）课程，以促进远程就诊时的背教。一名患者参与了研讨会视频的开发，并参与了关于回教的患者提供者小组。我们做了一个飞行员,双臂集群，非随机对照试验。干预现场的家庭医学居民（n=12）除了每周的行动线索外，还接受了基于教学和模拟的培训。评估包括调查前和调查后，居民的观察,以及与患者和提供者的访谈。为了评估干预组干预前和干预后得分之间的差异，使用卡方检验和单尾t检验。总共构建了4个差异模型，以评估干预组和对照组在以下每个结果中的事后差异：熟悉背授，背教的重要性，对背教能力的信心，和易于使用的背授。
结果：医疗居民高度评价他们的回授培训课程的经验（平均8.6/10）。大多数居民（9/12，75％）在训练模拟中使用简单的语言，超过一半的人要求角色扮演患者用他们自己的话来解释他们在相遇期间被告知的内容。干预后，居民对他们使用背教能力的信心增加(平均7.33vs7.83；P=.04)，但是在熟悉程度上没有统计学上的显著差异，对重要性的感知，或易于使用的背授。所有差异模型均无统计学意义。练习背授的主要障碍是时间限制。
结论：这项研究强调了将远程健康背授技能中的最佳实践培训有效整合到医疗住院医师计划中的方法。同时,这项试点研究指出了在未来大规模实施工作中改进类似干预措施的重要机会，以及减轻提供者在实践中纳入背授的担忧或障碍的方法。回教可以通过提高提供者通过使用功能(白板，聊天室,和迷你视图)的远程平台。
目的：我们旨在设计和评估以患者为中心的可行性，为家庭医学居民提供以远程健康为重点的背授培训，以促进在远程访问中使用背授。
方法：我们为医疗住院医师共同开发了POTENIAL（增强虚拟护理就诊中的背教方法的平台）课程，以促进远程就诊时的背教。一名患者参与了研讨会视频的开发，并参与了关于回教的患者提供者小组。我们做了一个飞行员,双臂集群，非随机对照试验。干预现场的家庭医学居民（n=12）除了每周的行动线索外，还接受了基于教学和模拟的培训。评估包括调查前和调查后，居民的观察,以及与患者和提供者的访谈。为了评估干预组干预前和干预后得分之间的差异，使用卡方检验和单尾t检验。总共构建了4个差异模型，以评估干预组和对照组在以下每个结果中的事后差异：熟悉背授，背教的重要性，对背教能力的信心，和易于使用的背授。
结果：医疗居民高度评价他们的回授培训课程的经验（平均8.6/10）。大多数居民（9/12，75％）在训练模拟中使用简单的语言，超过一半的人要求角色扮演患者用他们自己的话来解释他们在相遇期间被告知的内容。干预后，居民对他们使用背教能力的信心增加(平均7.33vs7.83；P=.04)，但是在熟悉程度上没有统计学上的显著差异，对重要性的感知，或易于使用的背授。所有差异模型均无统计学意义。练习背授的主要障碍是时间限制。
结论：这项研究强调了将远程健康背授技能中的最佳实践培训有效整合到医疗住院医师计划中的方法。同时,这项试点研究指出了在未来大规模实施工作中改进类似干预措施的重要机会，以及减轻提供者在实践中纳入背授的担忧或障碍的方法。回教可以通过提高提供者通过使用功能(白板，聊天室,和迷你视图)的远程平台。
