Objective:

This systematic review identifies best practices for using telehealth as a training modality in outpatient neurology.

Background:

After the shutdowns of the COVID-19 pandemic, telemedicine is still widely used and offers opportunities for expanding clinical capacity for trainees, which may improve familiarity with neurological disorders. However, there is no standardized practice for optimizing trainee learning in outpatient tele-neurology or training them in the effective use of telehealth.

Design/Methods:

PubMed, Scopus, Web of Science, and the CINAHL databases were searched with key phrases: (neurologic examination OR (neurology AND examination)) AND ((telehealth OR telemedicine) AND (students OR trainees OR residents)). This yielded 43 results, 5 duplicates were removed, 25 articles were removed in article title screening, 3 articles were removed in abstract review, and 1 article was added by review of cited works, leaving 11 total articles used.

Results:

Trainees preferred traditional live visits the most, followed by video visits and telephonic visits the least. Hybrid models may be feasible, non-inferior to traditional models, and even preferred by faculty and trainees. Studies revealed common barriers of technical issues, difficulty scaling to larger volumes of trainees, and an inability to perform parts of the neurological exam, though history-taking was unhindered. Positives for trainees in virtual outpatient care included high overall satisfaction, seeing a patient’s home life, and improved contact with neurology faculty. Authors highlight the importance of educators effectively directing and communicating with patients and trainees in remote encounters. The literature includes recommendations for virtual communication, trainee utilization, and remote physical exams, although techniques remain unvalidated.

Conclusions:

Virtual neurologic medical education may be adequate and potentially necessary for future clinicians. Future research needs to reproduce trainees’ ability to adequately learn and apply the neurologic physical exam virtually and validate the neurologic physical exam techniques adapted for virtual visits.