How Do You Train for Telepsychiatry?

Jay Shore, M.D., M.P.H.

Telepsychiatry — in the form of live interactive videoconferencing — has become a core tool of daily clinical practice. Many health care institutions and individual psychiatrists are using telepsychiatry in a wide range of clinical models and settings; however, implementation is occurring in uneven patterns across the country.

Despite the increased use of telepsychiatry, formal training in telepsychiatry continues to be limited. Only a few psychiatric residencies offer didactic or experiential educational content in this area. 1

Where — and how — are psychiatrists learning the foundational knowledge (eg. administrative, regulatory) and skills (eg. clinical process modification, emergency management) that are essential to providing quality telepsychiatric care and services? Data is lacking to answer this question.

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Currently, there appears to be a continuum of ways that psychiatrists seek to educate themselves before delivering telepsychiatric care. On one side, there are formal training and mentorship programs instituted by large health care systems, such as the Department of Veterans Affairs and Department of Defense, that train and orient their staff to telepsychiatry. On the other end of this spectrum, providers simply begin videoconferencing with patients when the clinical need arises and have not received any formal training or participated in any educational activities.

In the middle exists a “self-taught” majority who cobble their education in telepsychiatry together from readings of the scientific literature, use of online resources and training, attendance at “Telepsychiatry 101” conference presentations, and colleague consultation. APA’s online telepsychiatry toolkit is one example of an online resource intended to provide a general overview and introduction to key areas in telepsychiatry. These resources are helpful and necessary, but may not fully satisfy an adequate level of baseline training in telepsychiatry.

Managing risk with telepsychiatry

My experience from developing and providing training across the previously mentioned modalities is that there is a set amount of baseline training required, both informational as well as experiential to develop the core skills to begin providing telepsychiatric care. Beyond this, achieving a high level of competency in clinical telepsychiatry requires a variable amount of time in provision of actual care, ideally across a range of populations and settings. But as a field, we do not definitively know what core skills should be required for telepsychiatry training.

There’s a growing discussion among telepsychiatry experts, informed by the scientific literature, proffering recommended telepsychiatry training requirements. Currently, the Accreditation Council for Graduate Medical Education (ACGME) does not require telepsychiatry training in residencies, although eventually, I believe this will eventually become a requirement. Even when ACGME mandates training in residency for psychiatrists already in practice, training will remain an issue. This includes not only initial training needs, but staying up-to-date on the always evolving regulatory environment and new models of delivery. These new delivery models include integrated care telepsychiatry, store and forward telepsychiatry, and team-based telepsychiatric facility care.

The field will continue to wrestle with these questions around training, while seeing ongoing refinement of the educational material and methods. For now, health care institutions and individual psychiatrists will decide where and how education in telepsychiatry occurs.

References

  1. Saeed, S. A., Johnson, T. L., Bagga, M., & Glass, O. (2016). Training residents in the use of telepsychiatry: Review of the literature and a proposed elective. Psychiatric Quarterly, 1-13.

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