How can we use distance education to teach medicine in conflict-affected countries?

Rates of global conflict have increased by over 40% from 2020 to 2023, increasing the demands on healthcare systems and impacting healthcare training, education and workforce. There is a need for innovative educational support from the international community. Distance education is a sustainable avenue that is not as contingent on travel, political, or financial restrictions. We sought to undertake a preliminary scoping exercise of the issues involved in delivering distance medical teaching to conflict zones, by reviewing examples in the literature and interviewing key stakeholders in this field. We found that there was need and scope to deliver specific, case-based, non-practical teaching, and to re-connect medical personnel with the international community and research. We propose recommendations to achieve this: directing purpose according to learner needs, evaluations and care outcomes; maintaining patient confidentiality and anonymity; supplementing, rather than undermining, existing educational infrastructures; co-ordinating with relevant stakeholders and expatriates, whilst maintaining neutrality; and consider the use of pre-existing, low-cost online scripts and social media platforms, as well as non-live, low-bandwidth modes of technology.

Medical students' knowledge and attitude towards tele-education and associated factors at University of Gondar, Ethiopia, 2022: mixed method.

BACKGROUND: Tele-education is the use of ICTs to conduct remote learning. It has been utilized to deliver ongoing training for many years. The world's modern culture is increasingly reliant on the use of information technology to enhance standards of education. However, in order to deploy successful e-learning systems in a developing nation, understanding of user characteristics is required in the creation and usage of e-learning systems. Thus, this study will enable us to understand the user's level of knowledge and attitude towards tele-education. METHODS: An institution-based quantitative cross-sectional study supported by qualitative design was used 397 medical students at University of Gondar from May to June 2022. A pre-tested self-administered structured questionnaires and in-depth interview were used to collect quantitative and qualitative data respectively. Thematic-content analysis was conducted using open-code software for analyzing qualitative data. Quantitative data was entered to Epi-data version 4.6 and exported to SPSS version 25 software for further statistical analysis. Binary logistic regression was conducted. The adjusted odds ratio(AOR) was used to measure the association between the dependent and independent variables. RESULTS: A total of 397 medical students were participated in this study with a response rate of 93.63%. In this study nearly six out of ten 230(57.9%) of study participants had good knowledge towards tele-education. More than half. 211(53.1%) of medical students participated on the study also had a favorable attitude towards tele-education. Factors associated with knowledge about tele-education is training related to ICT (AOR = 2.27 95% CI; (1.13,4.55)), knowledge of medical education digitization (AOR = 3.80 95% CI; (2.12,6.84)), high computer literacy (AOR = 2.82 95% CI; (1.68,4.72)) and favorable attitude towards tele-education (AOR = 3.52 95% CI; (2.12,5.84)). Factors associated with attitude towards tele-education is age group > 21 (AOR = 3.89, 95% CI; (1.33,11.39)) and good knowledge towards tele-education (AOR = 3.42,95%CI;(2.06,5.66)). CONCLUSION: The study revealed that the knowledge of the medical students was good and nearly five out of ten of them had a favorable attitude towards tele-education. The study shows that training related to ICT, knowledge of medical education digitization, high computer literacy and favorable attitude towards tele-education were associated significantly with knowledge of tele-education. In this study age group > 21 and good knowledge towards tele-education of study participants were associated significantly with attitude towards tele-education.

Pediatric Project ECHO® for Pain: implementation and mixed methods evaluation of a virtual medical education program to support interprofessional pain management in children and youth.

BACKGROUND: Pediatric pain is a complex health challenge requiring a multi-modal management approach. It is critical that healthcare providers (HCPs) have access to ongoing, flexible education and mentorship specific to pediatric pain. However, there are significant gaps in available pain education and a need for more opportunities to support interprofessional training. Project Extension for Community Healthcare Outcomes (Project ECHO®) is a model for delivering online HCP education and cultivating a virtual community of practice. Within the pediatric pain setting, ECHO® has potential to improve local access to specialized pain knowledge, particularly among the physicians, nurses, and allied health providers who primarily manage these cases in community and hospital settings across rural and urban environments. The purpose of this study was three-fold. First, to evaluate the feasibility (participation levels, acceptability) of implementing Project ECHO® in the context of pediatric pain. Second, to measure preliminary program impacts on HCP knowledge, self-efficacy, and clinical practice. Third, to characterize HCP program engagement levels before and after onset of the COVID-19 pandemic. METHODS: A needs assessment was conducted to identify interprofessional education gaps and inform the program curriculum. The no-cost Pediatric ECHO® for Pain program offered TeleECHO sessions (didactic and case-based learning) as well as foundational education. Surveys were distributed at baseline and 6 months to assess outcomes using 7-point Likert scales. Participant engagement was assessed for periods prior to and during the COVID-19 pandemic. Descriptive and inferential statistical analyses were conducted. RESULTS: Eighty-five TeleECHO sessions were hosted, with a mean attendance of 34.1 ± 23.4 HCPs. Acceptability scores at 6 months (n = 33) ranged from 5.0 ± 1.4 to 6.5 ± 0.5. Participants reported statistically significant (p < 0.05) improvements in knowledge (7 out of 7 topics) and self-efficacy (8 out of 9 skills). Most participants reported positive practice impacts, including improved satisfaction with managing children with pain. Exploratory analyses showed a trend of greater engagement from ECHO® learners after onset of the COVID-19 pandemic. CONCLUSIONS: Project ECHO® is a feasible and impactful model for virtual education of interprofessional HCPs in managing pediatric pain.

Evaluating the Effect of a Telepsychiatry Educational Program on the Awareness, Knowledge, Attitude, and Skills of Telepsychiatry Among Spanish Psychiatrists during COVID-19 Pandemic.

Introduction: The COVID-19 pandemic has renewed the interest in telepsychiatry as a way to help psychiatrists care for their patients, but mental health providers' unfamiliarity and concerns may impede implementation of such services. This study aimed to determine the effect of an online educational intervention on awareness, knowledge, attitude, and skills (AKAS) of telepsychiatry among psychiatrists. Methods: The study used a pre-post-test design to compare AKAS of telepsychiatry among psychiatrists participating in an online course of practical telepsychiatry. The telemedicine AKAS questionnaire adapted to telepsychiatry was applied before and after the educational intervention, during the months of October to December 2020. Results: Responses from 213 participants were analyzed before the educational intervention and from 152 after it. The knowledge showed by Spanish psychiatrists before the educational intervention was good in 61% of participants, fair in 37%, and inadequate in 2%. With respect to attitudes toward telepsychiatry, 62% self-reported a high attitude, 33% moderate, and 5% low. With regard self-reported skills, 57% of the participating psychiatrists were highly skilled or experts, 22% moderately skilled, and 9% unskilled in handling telepsychiatry equipment. Despite the high baseline values, the educational intervention significantly improved psychiatrists' awareness, knowledge and attitudes toward telepsychiatry although not their skills. Conclusions: Online course of practical telepsychiatry was effective although future editions need to improve its focus on skills. This educational intervention represents an effort to promote the implementation of telepsychiatry as a health care alternative.

Preparing Future Medicine Physicians to Care for Cancer Survivors: Project ECHO® in a Novel Internal Medicine and Family Medicine Residency Curriculum.

Cancer survivorship education is limited in residency training. The goal of this pilot curriculum was to teach medicine residents a structured approach to cancer survivorship care. During the 2020-2021 academic year, we held eight 45-min sessions in an ambulatory noon conference series for a community family medicine (FM) and internal medicine (IM) residency program. The curriculum used Project ECHO®, an interactive model of tele-education through Zoom video conferencing, to connect trainees with specialists. Each session had a cancer-specific focus (e.g., breast cancer survivorship) and incorporated a range of core survivorship topics (e.g., surveillance, treatment effects). The session format included a resident case presentation and didactic lecture by an expert discussant. Residents completed pre- and post-curricular surveys to assess for changes in attitude, confidence, practice patterns, and/or knowledge in cancer survivorship care. Of 67 residents, 23/24 FM and 41/43 IM residents participated in the curriculum. Residents attended a mean of 3 sessions. By the end of the curriculum, resident confidence in survivorship topics (surveillance, treatment effects, genetic risk assessment) increased for breast, colorectal, and prostate cancers (p < 0.05), and there was a trend toward residents stating they ask patients more often about cancer treatment effects (p = 0.07). Over 90% of residents found various curricular components useful, and over 80% reported that the curriculum would improve their practice of cancer-related testing and treatment-related monitoring. On a 15-question post-curricular knowledge check, the mean correct score was 9.4 (63%). An eight-session curriculum improved resident confidence and perceived ability to provide cancer survivorship care.

A randomized trial of comparing video telecare education vs. in-person education on dietary regimen compliance in patients with type 2 diabetes mellitus: a support for clinical telehealth Providers.

BACKGROUND: Compliance to dietary recommendations by patients is the most difficult part of diabetes management. The nature of any educational method is to increase patients' awareness. But the question is, what is the effect of each method and for this purpose a comparative method should be considered. Therefore, this study was conducted to compare the effects of in-person education versus video tele-education on dietary regimen compliance in patients with T2DM. METHODS: In this trial, 378 patients with type 2 diabetes mellitus (T2DM) were random allocated into video tele-education, in-person education and control groups. The patients' weight and biochemical parameters were measured before educational programs and three-month later. RESULTS: The mean changes of patients' weight, glycemic parameters, and Lipid profiles decreased more in the two educational groups than the control group in a three-month period. There were no significant differences in the all study variables between the in-person and video education groups in post interventions except Total Cholesterol (TC). The pre- and post-intervention changes in the weight, TC, hemoglobin A1c, Triglyceride, and Very Low-density Lipoprotein Cholesterol were significant in both in-person group and video group. None of the educational programs had a significant impact on the Fasting blood sugar, Low-Density Lipoprotein Cholesterol, and High-Density Lipoprotein Cholesterol. DISCUSSION: Video tele-education was just as effective as in-person educational method on dietary regimen compliance among patients with T2DM in a three-month period. Therefore, it is recommended to use video tele-education in combination with or as an alternative to the in-person education method. This study provides support for diabetes educator. TRIAL REGISTRATION: This investigation was registered in the Iranian Registry of Clinical Trials Center ( IRCT20150302021307N4 ).

The effect of a tele-educational intervention on modifying dysfunctional sexual beliefs of pregnant women: a randomized controlled trial.

BACKGROUND & AIM: Some cultural scenarios in pregnancy and childbirth reinforce dysfunctional sexual beliefs that reverse changes in the couple's sexual life. The present study aimed to investigate the effect of education by sending text messages on modifying dysfunctional sexual beliefs in pregnant women. METHODS & MATERIALS: This study is a randomized clinical trial, and 82 eligible pregnant women referred to educational-medical centers to receive prenatal care were randomly assigned to intervention or control group. The intervention group received 24 text messages during eight weeks (three text messages per week), and the control group received only routine care. Data was collected through a demographic questionnaire, reproductive profile, Spinner's Dyadic Adjustment Scale (DAS), and dysfunctional sexual beliefs questionnaire. Both groups completed the questionnaires before and one week after the intervention. Independent t-test, paired t-test, and analysis of covariance was used to analyze the data. RESULTS: The findings revealed no statistically significant difference in the baseline Dyadic Adjustment mean scores of control (132.4 ± 11.01) and intervention (130.10 ± 10.66) groups. Paired t-test analysis showed that the mean score of dysfunctional sexual beliefs was significantly decreased from (29 ± 7.61) at baseline compared to one week after intervention (10.54 ± 6.97) (p < 0.001). Analysis of covariance test to compare the scores of dysfunctional sexual beliefs in the intervention group (10.54 ± 6.97) and control group (26.80 ± 7.80) showed a statistically significant difference (p < 0.01) with an effect size of 0.67. CONCLUSION: This study showed that sending text messages to mobile phones of pregnant women has corrected their dysfunctional sexual beliefs. Therefore, this approach can be used in pregnancy care to promote women's sexual health. TRIAL REGISTRATION: Clinical trial registry: IRCT20161230031662N9 .

The State of Point-of-Care Teleultrasound Use for Educational Purposes: A Scoping Review.

Bedside ultrasound has been shown to change and direct patient management in the emergent setting. Demand, use, and diagnostic potential of point-of-care ultrasound (POCUS) has continually increased throughout the years. The ongoing COVID-19 pandemic and physical distancing have necessitated further POCUS innovation. With the advent of affordable portable ultrasound devices, teleultrasound teaching has become a more viable method of POCUS education, especially in resource-limited settings. Here, we provide a scoping review of the current state of teleultrasound, specifically its use for educational purposes.

The perceived need for evidence-based COVID-19 management and Tele-education in the North-East region of India: a cross-sectional survey.

Due to the sudden rise in the cases of COVID-19 in the North-Eastern region of India, this study was conducted to survey the felt needs of the medical professionals with regards to education on the evidence-based management of COVID-19. A total of 25 North-East leaders were recruited and a baseline survey was conducted through the digital medium. Out of 25 North-East leaders, 52% were undergoing training in evidence-based medicine in the capacity-building program for evidence-based child health. Participants (48%) strongly agreed and 40% agreed on the possibility of enhanced care by capacity building in the areas of COVID-19 management through discussing cases. Out of 25 North East leaders, 48% agreed to join both as a speaker as well as a participant. Various priority topics on COVID-19 management e.g. childhood, adult, ocular manifestation, ICU management, telemedicine, vaccines, lab protocols, psychological distress, and treatment strategy have emerged. We have presented the findings of the survey which will help guide the mentoring program focusing on evidence-based management of COVID-19 in remote areas through Tele-education.

Plato unmasks hidden limits of tele-education.

Plato's powerful metaphor of the Cave, from Republic, further advances a critical assessment of the hidden limits of distance learning. In the Cave, individuals are restrained to see only straight ahead to the images projected from behind them onto the wall in front of them. As in the Cave, in tele-education the dynamism of learning is replaced by passive learning. Not only do learners become largely passive with respect to their teacher, but also to each other. These effects are masked from teacher and learner alike by the technical prowess of distance learning and teaching, a version of Plato's Cave. Tele-education has at least three undeniably salient features: safety, convenience, and cost savings. Two and a half millennia after Plato gave us the concept of mimesis and the metaphor of the Cave, we can use these philosophical tools to unmask hidden limits of tele-education.

Describing implementation outcomes for a virtual community of practice: The ECHO Ontario Mental Health experience.

BACKGROUND: Project ECHO is a virtual education model aimed at building capacity among healthcare providers to support optimal management for a range of health conditions. The expansion of the ECHO model, further amplified by the pandemic, has demonstrated an increased need to evaluate implementation success to ensure that interventions are implemented as planned. This study describes how Proctor et al.'s implementation outcomes (acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability) were adapted and used to assess the implementation of ECHO Ontario Mental Health (ECHO-ONMH), a mental health-focused capacity-building programme. METHODS: Using Proctor et al.'s implementation outcomes, the authors developed an implementation outcomes framework for ECHO-ONMH more generally. Using this, outcome measures and success thresholds were identified for each outcome for the ECHO-ONMH context, and then applied to evaluate the implementation of ECHO-ONMH using data from the first 4 years of the programme. RESULTS: An ECHO-ONMH implementation outcomes framework was developed using Proctor's implementation outcomes. ECHO-ONMH adapted implementation outcomes suggest that ECHO-ONMH was implemented successfully in all domains except for penetration, which only had participation from 13/14 regions. Acceptability, appropriateness and adoption success thresholds were surpassed for all 4 years, showing strong signs of sustainability. The programme was deemed feasible all 4 years and was found to be more cost-effective. ECHO-ONMH also showed high rates of fidelity to the ECHO model, and high rates of penetration. CONCLUSIONS: This is the first study to use Proctor et al.'s implementation outcomes to describe implementation success for a virtual capacity-building model. The proposed ECHO implementation outcomes framework provides a base for similar interventions to evaluate implementation success, which is an important precursor to understanding learning, service or health outcomes related to the model. Additionally, these findings can act as a benchmark for other international ECHOs and educational programmes.

Combining patient-specific, digital 3D models with tele-education for adolescents with CHD.

INTRODUCTION: Adolescents with CHD require transition to specialised adult-centred care. Previous studies have shown that adolescents' knowledge of their medical condition is correlated with transition readiness. Three-dimensional printed models of CHD have been used to educate medical trainees and patients, although no studies have focused on adolescents with CHD. This study investigates the feasibility of combining patient-specific, digital 3D heart models with tele-education interventions to improve the medical knowledge of adolescents with CHD. METHODS: Adolescent patients with CHD, aged between 13 and 18 years old, were enrolled and scheduled for a tele-education session. Patient-specific digital 3D heart models were created using images from clinically indicated cardiac magnetic resonance studies. The tele-education session was performed using commercially available, web-conferencing software (Zoom, Zoom Video Communications Inc.) and a customised software (Cardiac Review 3D, Indicated Inc.) incorporating an interactive display of the digital 3D heart model. Medical knowledge was assessed using pre- and post-session questionnaires that were scored by independent reviewers. RESULTS: Twenty-two adolescents completed the study. The average age of patients was 16 years old (standard deviation 1.5 years) and 56% of patients identified as female. Patients had a variety of cardiac defects, including tetralogy of Fallot, transposition of great arteries, and coarctation of aorta. Post-intervention, adolescents' medical knowledge of their cardiac defects and cardiac surgeries improved compared to pre-intervention (p < 0.01). CONCLUSIONS: Combining patient-specific, digital 3D heart models with tele-education sessions can improve adolescents' medical knowledge and may assist with transition to adult-centred care.

Comparison of Tele-Education and Conventional Cardiopulmonary Resuscitation Training During COVID-19 Pandemic.

BACKGROUND: Cardiopulmonary resuscitation (CPR) performed by lay rescuers can increase a person's chance of survival. The COVID-19 pandemic enforced prevention policies that encouraged social distancing, which disrupted conventional modes of health care education. Tele-education may benefit CPR training during the pandemic. OBJECTIVE: Our aim was to compare CPR knowledge and skills using tele-education vs. conventional classroom teaching methods. METHODS: A noninferiority trial was conducted as a Basic Life Support workshop. Participants were randomly assigned to a tele-education or conventional group. Primary outcomes assessed were CPR knowledge and skills and secondary outcomes assessed were individual skills, ventilation, and chest compression characteristics. RESULTS: Pretraining knowledge scores (mean ± standard deviation [SD] 3.50 ± 2.18 vs. 4.35 ± 1.70; p = 0.151) and post-training knowledge scores (7.91 ± 2.14 vs. 8.52 ± 0.90; p = 0.502) of the tele-education and conventional groups, respectively, had no statistically significant difference. Both groups' training resulted in a significant and comparable gain in knowledge scores (p < 0.001). The tele-education and conventional groups skill scores (mean ± SD 78.30 ± 6.77 vs. 79.65 ± 9.93; p = 0.579) had no statistical difference. Skillset scores did not differ statistically except for the compression rate and ventilation ratio; the conventional group performed better (p = 0.042 vs. p = 0.017). The tele-education and conventional groups' number of participants passed the skill test (95.5% and 91.3%, respectively; p = 1.000). CONCLUSIONS: Tele-education offers a pragmatic and reasonably effective alternative to conventional CPR training during the COVID-19 pandemic.

Effects of tele-education given based on the health belief model on mode of delivery tendencies in pregnant women.

BACKGROUND: Cesarean sections, which have a high risk of maternal and neonatal complications and increase health expenditures, have become a global problem. Hence, it is extremely important to encourage women to have normal deliveries. OBJECTIVE: This study was conducted to determine the effects of tele-education given to nulliparous pregnant women based on the health belief model (HBM) on their normal delivery beliefs and tendencies. METHODS: This randomized-controlled study was conducted with 149 nulliparous pregnant women. Participants in the experimental group received a tele-education programme in 8 sessions prepared in line with the health belief model regarding normal delivery for 15 days. The data was collected by using the "Pregnancy Information Form" and "Belief Scale for Normal Delivery (BSND)". RESULTS: After the tele-education programme, the post-test BSND mean score was 89.90±14.10 in the experimental group and 78.80±12.65 in the control group, where the difference between them was significant (p < 0.01). Additionally, the post-test mean scores of participants in the experimental group in all BSND's subdimensions were significantly higher than those of the women in the control group (p < 0.05). CONCLUSION: The tele-education given in line with the HBM increased the belief and tendency levels of the nulliparous pregnant women towards normal delivery.

Development and Evaluation of a Tele-Education Program for Neonatal ICU Nurses in Armenia.

PURPOSE: Neonatal mortality currently accounts for more than 60% of all infant mortality in Armenia. The majority of health professionals in Neonatal Intensive Care Units (NICU) however, have had no specialized training in neonatology. Local and global agencies have emphasized the need for improvement in the education and skills of NICU health professionals. The objective of this study was to design, implement, and evaluate an innovative tele-education program for NICU nurses in Armenia. DESIGN AND METHODS: Seven online tele-education courses were designed on various neonatal nursing topics using Final Cut Pro and translated professionally to Armenian. The videos were uploaded to YouTube. All NICU nurses employed in two hospitals (n = 35) in Yerevan, Armenia, completed a diagnostic pretest, course viewing, a posttest, and a satisfaction survey for each topic. A difference in knowledge was defined as the number of correct test answers obtained before and after the course. Participant satisfaction was measured using a Likert scale. RESULTS: The combined average for completed pre-tests for all courses was 45% and 71% for post-tests, which was statistically significant for each course (p < 0.05). A majority of the nurses either agreed or strongly agreed with all of the satisfaction parameters of the course. CONCLUSIONS: These results support a tele-education model for effectively providing continuing education to NICU nurses in Armenia. A similar platform could be used to establish nationwide certification programs for neonatal nurses. PRACTICE IMPLICATIONS: Tele-education technology can be used effectively by nursing educators working in global health as part of international learning collaboratives.

The Role of Tele-Education in Advancing Mental Health Quality of Care: A Content Analysis of Project ECHO Recommendations.

Introduction: Project Extension for Community Healthcare Outcomes (Project ECHO®) is a global-guided practice initiative aimed at building primary care capacity and improving health care quality for underserved populations. This tele-education model brings together primary care providers and subject-matter specialists in online communities of practice to share knowledge, discuss complexities in patient care, and collaborate to reduce health disparities. Methods: Using co-generated clinical care recommendations from ECHO Ontario Mental Health, a mental health focused ECHO program, we explored alignment of recommendations across the Institute of Medicine's (IOM) six domains of health care quality to characterize its impact. A total of 417 recommendations, made for 32 patient cases, were analyzed using a modified directed content analysis method. Each recommendation was coded with one or multiple codes, representing each of the six IOM domains. Key examples of recommendations within each domain are described. Results: An average of 13 recommendations were generated per patient case. The effective domain occurred at least once in each complete set of patient care recommendations. The next highest occurring domain was safe (71.9%), followed by patient-centered (68.8%), efficient (40.6%), equitable (18.8%), and timely (12.5%). Recommendation distribution across the entire data set was effective (97.8%), safe (15.6%), patient-centered (12.0%), efficient (3.6%), equitable (1.9%), and timely (1.4%). Discussion: As the first study to characterize ECHO's impact using health care quality domains, the study highlights ECHO's significant focus on effective, safe, and patient-centered care. These findings can inform ways for ECHO to target quality improvement and measure impact in additional health care quality domains, such as efficient, equitable, and timely.

Telemedicine During the COVID-19 Pandemic: Experiences From Western China.

Disasters and pandemics pose unique challenges to health care delivery. As health care resources continue to be stretched due to the increasing burden of the coronavirus disease (COVID-19) pandemic, telemedicine, including tele-education, may be an effective way to rationally allocate medical resources. During the COVID-19 pandemic, a multimodal telemedicine network in Sichuan Province in Western China was activated immediately after the first outbreak in January 2020. The network synergizes a newly established 5G service, a smartphone app, and an existing telemedicine system. Telemedicine was demonstrated to be feasible, acceptable, and effective in Western China, and allowed for significant improvements in health care outcomes. The success of telemedicine here may be a useful reference for other parts of the world.

An innovative model using telementoring to provide geriatrics education for nurses and social workers at skilled nursing facilities✰.

Older adults with complex needs reside in skilled nursing facilities (SNFs) and are cared for by nurses and social workers with limited geriatrics education. We describe the pilot phase of an educational model using the Extension for Community Healthcare Outcomes (ECHO) platform to teach geriatrics principles to SNF staff. Twenty-five unique participants from 7 total facilities enrolled, with twenty-two participants completing both the pre/post surveys. Statistically significant improvement was seen in participants' self-efficacy to treat patients with dementia, educate patients about hospice and palliative medicine options, and assess and manage infections in older adults. The two largest barriers participants identified in making changes after the series were the time pressures of caring for complex geriatric patients and staff available to assist with social support needs of older adults. ECHO-Chicago's Geriatrics SNF pilot series is innovative and shows promise to provide geriatrics education for the SNF workforce.

The Promise of Telemedicine for Movement Disorders: an Interdisciplinary Approach.

PURPOSE OF REVIEW: Advances in technology have expanded telemedicine opportunities covering medical practice, research, and education. This is of particular importance in movement disorders (MDs), where the combination of disease progression, mobility limitations, and the sparse distribution of MD specialists increase the difficulty to access. In this review, we discuss the prospects, challenges, and strategies for telemedicine in MDs. RECENT FINDINGS: Telemedicine for MDs has been mainly evaluated in Parkinson's disease (PD) and compared to in-office care is cost-effective with similar clinical care, despite the barriers to engagement. However, particular groups including pediatric patients, rare MDs, and the use of telemedicine in underserved areas need further research. Interdisciplinary telemedicine and tele-education for MDs are feasible, provide similar care, and reduce travel costs and travel time compared to in-person visits. These benefits have been mainly demonstrated for PD but serve as a model for further validation in other movement disorders.

Building Provincial Mental Health Capacity in Primary Care: An Evaluation of a Project ECHO Mental Health Program.

OBJECTIVE: Project Extension for Community Healthcare Outcomes (Project ECHO©) addresses urban-rural disparities in access to specialist care by building primary care provider (PCP) capacity through tele-education. Evidence supporting the use of this model for mental health care is limited. Therefore, this study evaluated a mental health and addictions-focused ECHO program. Primary outcome measures were PCP knowledge and perceived self-efficacy. Secondary objectives included: satisfaction, engagement, and sense of professional isolation. PCP knowledge and self-efficacy were hypothesized to improve with participation. METHODS: Using Moore's evaluation framework, we evaluated the ECHO program on participant engagement, satisfaction, learning, and competence. A pre-post design and weekly questionnaires measured primary and secondary outcomes, respectively. RESULTS: Knowledge test performance and self-efficacy ratings improved post-ECHO (knowledge change was significant, p < 0.001, d = 1.13; self-efficacy approached significance; p = 0.056, d = 0.57). Attrition rate was low (7.7%) and satisfaction ratings were high across all domains, with spokes reporting reduced feelings of isolation. DISCUSSION: This is the first study to report objective mental health outcomes related to Project ECHO. The results indicate high-participant retention is achievable, and provide preliminary evidence for increased knowledge and self-efficacy. These findings suggest this intervention may improve mental health management in primary care.