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Telepsychiatry in Graduate Medical Education: A Narrative Review

  • In Depth Article: Systematic Review
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Abstract

Objective

Telepsychiatry is an innovation that addresses disparities in access to care. Despite rigorous clinical research demonstrating its equivalence and effectiveness relative to face-to-face care, many providers are unfamiliar with this technology. Training residents in telepsychiatry is critical to building mental health care capacity in rural and underserviced communities. However, many questions remain regarding the competencies that future psychiatrists require with respect to telepsychiatry, and technology generally, and regarding pedagogical approaches that will promote their attainment. This literature review aims to elucidate evidence-based approaches to developing residents’ competence to practice telepsychiatry.

Methods

The authors conducted a literature search of telepsychiatry training for psychiatry residents. The authors searched MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane, and ERIC using subject headings and keywords; and hand searched reference lists, forward citations of relevant articles, and tables of contents of relevant journals. Articles were included if they were in English, discussed teaching psychiatry residents to provide direct or indirect clinical care via real-time videoconferencing technology, and were published by January 2014.

Results

In total, 215 unique references yielded 20 relevant publications. The literature on graduate training in telepsychiatry is sparse, heterogeneous, and primarily descriptive. Even brief learning experiences may increase the likelihood that residents will incorporate telepsychiatry into their future practice. Training should address competencies that are (1) technical, (2) collaborative/interprofessional, and (3) administrative. Training typically consists of supervised provision of clinical care to build modality-specific clinical skills and may also include didactic teaching to provide health systems and transcultural and medicolegal perspectives.

Conclusions

A more evidence-based approach to telepsychiatry training is needed, including an assessment of residents’ learning needs, use of multiple learning modalities, and evaluations of educational curricula. Pedagogically sound curriculum development and evaluation of postgraduate education in telepsychiatry could promote social accountability, cultural competence, interprofessional care, and, ultimately, improve clinical outcomes.

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Acknowledgments

For assistance with organizing the search strategy, we are grateful to Ms Ana Jeremic, Manager of Library Services, St. Joseph’s Health Centre, Toronto, Canada. For feedback on earlier versions of this manuscript, we thank Dr. John Teshima, Director of Faculty Development and Assistant Professor, Department of Psychiatry, University of Toronto; Mr Mike Minear, Associate Professor, Johns Hopkins Bloomberg School of Public Health and Chief Information Officer, UC Davis Health System; and Dr. Peter Yellowlees, Professor of Psychiatry and Director of the Health Informatics Graduate Program, University of California Davis.

Disclosures

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

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  1. University of Toronto, Toronto, ON, Canada

    Nadiya Sunderji, Allison Crawford & Marijana Jovanovic

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Correspondence to Nadiya Sunderji.

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Sunderji, N., Crawford, A. & Jovanovic, M. Telepsychiatry in Graduate Medical Education: A Narrative Review. Acad Psychiatry 39, 55–62 (2015). https://doi.org/10.1007/s40596-014-0176-x

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