Fellow’s Corner: Telemedicine from the Fellow’s Perspective

Contributed by Elana Mitchel, MD, MSCE

Our lives have been greatly impacted by the novel COVID-19 pandemic, most notably, how we interact with others. We have found ourselves avoiding large gatherings and minimizing in-person interactions, relying on Facetime and Zoom for get-togethers. This has translated to patient care, moving visits to telemedicine to minimize risk to patients, their families, and healthcare providers.

Our GI Fellows’ clinic is high-volume, and fellows are encouraged to take ownership over their patients. In the traditional clinic model, the fellow meets with the patient and their family, the fellow then leaves the room to precept with the attending, and then the fellow and attending rejoin the family to make recommendations. During clinic sessions, fellows lead conversations and develop rapport with their patients, have lively discussions with the attending while devising a plan, and learn from the attending’s physical exam and bedside manner skills.

The transition of non-urgent clinic visits to telemedicine in the spring of 2020 posed significant challenges to this model. From the fellow’s perspective, adjusting to a new workflow, developing rapport with patients and performing physical exam over a screen, asserting autonomy in patient care, and promoting teaching from attendings was daunting.

In the initial phase of telemedicine, the attending and fellow would complete the visit together. A new model developed in which the attending and fellow would “huddle” before clinic to review patients for the day. The fellow and attending would join the visit together while the fellow would take the lead and provide a plan, with support from the attending. During visits where more discussion was needed, the visit could be paused and the fellow and attending could convene “off-line.” After clinic, many attendings would provide feedback to fellows by email or phone, reflecting on what went well and note areas for improvement.

This new model offered surprising yet striking advantages from the fellow’s perspective. Fellows felt it was more efficient, enjoyed direct observation and feedback from attendings, and learned a great deal by creating patient plans on the spot. However, the challenges were also apparent with less independence, difficulty connecting with patients and their families over a screen, missed teaching opportunities from attendings, and frustrating technology issues with frequent interruptions.

As we have transitioned back to more in-person visits, we have adjusted our telemedicine model to resemble our old fellows’ clinic model. We are happiest when seeing our patients and having face-to-face interactions. However, even as we return to in-person and telemedicine visits with a more familiar model, we must acknowledge that telemedicine has pushed us to develop and nurture our patience, creativity, communication, and collaborative skills. It has made us more comfortable with our clinical intuition. We have seen the benefits of direct observation and feedback from our attendings, and strive to continue to foster this. It will take effort to continue to emphasize fellow education through these unique and difficult times, but if we look to our positive experiences and focus on improving patient care, we can be successful.