Novel Tele-psychiatry Curriculum for Integrated Care Psychiatry Fellows

This week we will be discussing an article that was published in January in the Journal of Academic Psychiatry. The article, titled “The Development, Implementation, and Evaluation of a Novel Telepsychiatry Curriculum for Integrated Care Psychiatry Fellows” was written by authors McCann, Erickson, and Plam-Cruz. Within the article, the authors discuss the process of developing and implementing a telepsychiatry training experience for psychiatry fellows in an integrated care setting.

What did they do?

The University of Washington developed a collaborative care model of integrative health care called the Integrated Care Training Program (ICTP) psychiatry fellowship, a one-year, non-accredited fellowship curriculum. The curriculum was developed as an avenue for psychiatry residents to gain collaborative care experience. This article was written to thoroughly explain the process of developing this program, as well as results that stemmed from its use.

Why did they do it?

Collaborative care is an effective, cost-efficient approach for delivering mental health services. As a quick reminder, the term “collaborative care” refers to the delivery of both medical and behavioral health services within (often) a primary care setting. Additionally, as technology continues to drive the ways in which healthcare can be delivered, telepsychiatry is becoming a much more realistic and often appropriate approach toward accomplishing the goals of a collaborative care model. However, while a survey of psychiatry residents and fellows demonstrated that more than two-thirds of these individuals expressed interest in telepsychiatry, only 26% of programs offer a formal telepsychiatry training curriculum for psychiatry residents. The authors note that while preliminary data for existing telepsychiatry training curriculums show promising results, more research is needed to establish a training approach that is specific to integrated care.

How did they do it?

Content for the ICTP was developed by four faculty using an evidence-based approach to guide the process of creating the training experience. In all, the researchers developed a four-part, 12 hour didactic series that was part of the broader ICTP fellowship didactic series. The first didactic reviewed the history of telehealth and covers the basics of the implementation of telepsychiatry. The second didactic covers the application of federal and state law relevant to telepsychiatry and discusses billing procedures. The third didactic reviews the evidence-base for various tele-technologies, and the settings in which these technologies can be provided. The third part of the series also focuses on the additional development of core telepsychiatry skills. The fourth part of the training series was developed to be customized for each cohort such that fellows reviewed and discussed their telepsychiatry training experiences and were able to ask additional questions. The fellowship that was developed also included clinical experiences, including delivering clinical consultations over the phone. With regard to the analysis and evaluation of the curriculum, three consult-liaison (CL) psychiatry fellows also participated in the ICTP telepsychiatry didactics, but not the ICTP telepsychiatry rotations, and two of the three CL fellows separately obtained telepsychiatry clinical experience during their fellowship. 

To evaluate the curriculum, the researchers included an anonymous survey which yielded both qualitative and quantitative feedback from psychiatry fellows. Notably, none of the fellows had prior experience with telepsychiatry. 

What did they find?

Results from the anonymous surveys suggested that perceived competence to practice telepsychiatry increased over the course of the fellowship, and the didactic series and clinical experience were separately identified by fellows as factors that increased competence. General satisfaction with telepsychiatry and perceived competence following completion of the fellowship was reported to be higher for the four fellows who received the telepsychiatry training experience than for the fellow who did not. It was also reported that the training didactics’ focus on practical and logistical aspects of telepsychiatry was particularly helpful. 

What does it all mean (our take)?

All-in-all, this is really a great study. Of course it includes a small sample size, which we must keep in mind when thinking through the external validity of the results, but that should not overshadow the emphasis of this brief report. As telepsychiatry is increasingly becoming a highly realistic approach toward providing integrated care, the recognition that competently providing telepsychiatry services requires additional training is crucial. We suspect that as tele-based services become more common (which we have begun to see and will continue to see, particularly given the current global pandemic), training programs such as the program described in the reviewed report will become critically important. We thank these authors for their exciting work and look forward to watching the world of tele-psychiatry continue to grow.