Pittmann and team using grant from MGH’s Slavin Academy to evaluate telehealth training

It’s one thing to have effective patient etiquette but does that easily translate to effective telehealth etiquette? And if not, how are the patient interactions different and what do practitioners need to know? 

Assistant Professor in Communication Sciences and Disorders Rachel Pittmann and her team are finding out, thanks to a grant from The Peter L. Slavin, MD Academy for Applied Learning in Health Care at Massachusetts General Hospital. 

Over the past few years, Pittmann, an assistant dean for Interprofessional Practice, has been researching telehealth etiquette, which is often called webside manner, and through that developed a validated tool to help practitioners know the skills to use while conversing with a patient through a computer screen. Now she is using speech-language pathology students and supportive counseling nursing students to evaluate a telehealth etiquette curriculum in health professions trainees. 

“This project is to train students in the area of telehealth etiquette based on the literature review and the validated tool that I developed with a team,” said Pittmann. 

“The knowledge is significant,” said Pittmann. “I personally have had negative experiences in being the patient via telehealth and I've also had really positive ones. This work was inspired by a not-so-great visit with a telehealth practitioner who I don't think was trained in telehealth etiquette and would benefit from learning some skills and using a checklist to guide her.”

Pittmann is working with Assistant Professor of Nursing Rachel Cox Simms, Communication Sciences and Disorders Instructor Suzanne Pennington, Assistant Professor Nursing Kathy Sabo, and Communication Sciences and Disorders Assistant Professor Esther Herring. During the semester-long curriculum, they will determine the impact of the curriculum on students’ knowledge and use of telehealth etiquette skills, and report findings to Massachusetts General Hospital.

“MGH supports educational advancements in pedagogy, and so this project will help advance telehealth training for future healthcare professionals,” noted Pittmann. “We will focus on these future practitioners’ abilities to use telehealth and ensure they are up to speed on the professionalism and communications skills that will be required.”

For clinical students at the Sanders Impact Practice Center, the grant means some of their work will be in telehealth and some will be in person; the goal - comparing training to no training. 

Students like Alyssa Garza, who is in her second year in the Communications, Sciences, and Disorders (CSD) program, says the training sessions with simulated patients is already paying dividends. 

“A notable example is how you navigate any interruptions, because things like internet connections are always finicky,” observed Garza. “Setting a precedent of what should happen if this happens makes the overall session go smoother. It’s all part of being very deliberate to do the best you can in a telehealth setting to mimic the same care you would give that person if he or she was in the same room.” 

“Many of us came into telehealth without training because we were forced into it during COVID; that’s not true of everybody, but a lot of us,” reminded Pittmann. “And like anything, just because you’re doing it doesn’t mean you're doing it well. Education, training, self-reflection, and feedback is the way to improve one's performance. 

“The goal is patients feeling like they have a connection with their healthcare provider. The research shows patients who have that connection will follow their treatment plan better and have better health outcomes. This is about outcomes by way of connecting with your patients.”

The four domains being looked at are: technology, environment, confidentiality, and communication. One communication skill would be for the practitioner to engage in eye contact by directing their gaze at the camera rather than somewhere else on the screen, so that the patient can see the eye contact despite not being physically in the same spot. Another attribute is dressing professionally. 

“Even though you're not physically in the same place, you should be showing up as a healthcare practitioner,” said Pittmann. “Even though you're not being seen below the neck, dressing professionally for a visit sends a strong message.”

Second-year CSD student Nick Wilder learned the importance of what the patient might be seeing in the camera shot when the simulated patient questioned him about his clipboard. 

“I always bring my clipboard with me to all my sessions, and I don't think twice about it, but because of where the webcam was positioned, the patient could only see the upper part of it and couldn't even fully discern what I was holding,” recounted Wilder. “And that was a bit of a distraction to her because she said, ‘I didn't know if you were working on something else. I didn't know if I had your full attention.’ If I were in the room with her, of course she sees it's a clipboard, and would know what's going on. I never thought of anything like that prior to doing a training like this.”

For student Caitlin Murphy, the big takeaway has been maintaining confidentiality in the virtual world. 

“When you're in-person, you know that you're the only one in the room, but for virtual that might not be the case,” reasoned the second-year CSD student. “This training taught me that you have to ask some more specific questions, such as, ‘Are you alone right now? Is there anyone else here?’”

For Pittmann, the grant represents further involvement and contributions with the Massachusetts General Hospital. 

“It feels nice to be part of the parent institute and being aligned in its educational mission,” concluded Pittmann. “The Slavin Academy’s mission is advancing the education of healthcare practitioners or professionals, and so just seeing the alignment between our Institute whose focus is on education and the Slavin Academy’s educational entity feels good.” 

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