A New Curriculum Could Advance Teleneurology

As more communities face a worsening shortage of neurologists, hospitals are turning to remote providers to fill gaps in care. But by and large, medical schools and healthcare systems have yet to pin down a formal training course for teleneurology.

That is, until now.

An American Academy of Neurology workgroup has announced the outline of a new curriculum to train students, resident physicians, fellows, faculty, and other providers in teleneurology, a field that uses high-tech tools to remotely connect brain specialists with patients. The development team, which included 12 specialists, aimed to build educational standards around the use of 2-way video conferencing, wireless sensors, and text- and image-based communications.

“This has shown tremendous promise and has already played a major role in acute stroke care,” says Raghav Govindarajan, MD, the study’s lead author and assistant professor of clinical neurology at the University of Missouri School of Medicine. “Despite this, teleneurology training in residency programs is currently nonexistent, or it is sporadic and inconsistent at best.”

The curriculum study was recently published in Neurology, the journal of the American Academy of Neurology, under the title, “Developing an Outline for Teleneurology Curriculum.”

Govindarajan and the workgroup targeted 5 areas that providers must learn prior to practicing teleneurology, according to a release from the University of Missouri. These pressure points, and the thinking behind them, are as follows.

• Introduction to technology, implementation, and limitations. Providers need to understand how to use the tools of the trade. The tech enables them to review patient medical records, move cameras, and more. Plus, teleneurologists must be ready to solve issues that pop up during cure.
• Licensing, legal issues, and ethics. This would prepare up-and-coming teleneurologists so that they may ward off legal problems.
• “Webside” manners. A video screen and camera might increase the difficult of building a provider-patient relationship. Teleneurologists must learn how to connect with patients, despite the physical distance.
• Informed consent, patient privacy, and disclosure. This centers on HIPAA and the Health Information Technology for Economic and Clinical Health Act, and how neurologists must inform patients of security surrounding their personal data
• Neurology-specific clinical skills. In the end, teleneurologists are obligated to provide the same level of care as an in-person provider.

This study represents a step toward greater efficacy and accountability in teleneurology, according to the authors. As of now, many practitioners may operate without the “necessary skills and expertise to best care for patients, which places all parties at risk, Govindarajan says.

“Unfortunately, teleneurology is akin to the Wild West,” he says. “Our outline for a teleneurology curriculum is meant to be an evolving document that will continue to be adapted to best practices in the field.”

The guidelines may fuel training programs in medical schools and private practices, according to the authors. What’s more, the basic tenets of the paper can apply to other areas in telemedicine. The American Telemedicine Association has already endorsed the curriculum.

Although teleneurology has strides to make, programs have cropped up at medical schools and high-impact hospitals across the country. The University of Texas, Vanderbilt University, and Tufts Medical Center, for instance, have all waded into the field.

But the need for more teleneurology is clear. Over the years, a number of analyses have found and bemoaned a growing dearth of neurologists in the US.

A study this summer highlighted 20 states that were or would become “dementia neurology deserts,” meaning their populations of dementia patients vastly outpaced the stable of neurologists, by 2025. Wyoming, North Dakota, South Carolina, South Dakota, and Oklahoma had the most significant projected gaps, according to the report.

Images courtesy of the University of Missouri School of Medicine.