Standardizing Quality of Virtual Urgent Care: Using Standardized Patients in a Unique Experiential Onboarding Program

Abstract

Introduction: Virtual urgent care (VUC) provides real-time evaluation, triage, and treatment of low-acuity medical problems; however, VUC physicians have varying levels of telemedicine training. We created a workplace-based experiential onboarding program that deployed standardized patients (SPs) into a VUC clinic to evaluate and deliver feedback to independently practicing physicians, providing quality assurance and identifying areas for improvement. Methods: We simulated evaluation of an adult with upper respiratory symptoms. To replicate a real-life encounter, we developed a mock electronic medical entry with demographic and medical information and scheduled SPs into the clinic's actual patient queue. SPs provided seamless, realistic training within the real-world virtual clinic environment. Using an adapted assessment tool anchored to not done, partly done, or well done, SPs evaluated communication, disease-specific, and telemedicine skills by observing behaviors. We surveyed participants to evaluate the program. Results: Twenty-one physicians participated. All performed well in core communication and disease management domains. Ninety-three percent of behaviors (SD = 11%) were rated well done within the information gathering domain, 90% (SD = 8%) within relationship development, and 95% (SD = 5%) within disease management. Physicians struggled with telemedicine-specific skills-55% (SD = 38%) well done-and education and counseling-32% (SD = 34%) well done-highlighting specific behaviors most ripe for improvement. All queried participants indicated that this simulation improved communication and telemedicine skills. Discussion: This workplace-based experiential onboarding program uncovered knowledge gaps within telemedicine skills and patient education domains. Identification of these gaps can help drive new virtual care curricula.