Advanced Search

Academic Psychiatry, VOL. 23, No. 3

Letter | September 01, 1999

An Introductory Curriculum on Telepsychiatry for Psychiatric Residents

Jessica R. Oesterheld, M.D.; Henry P. Travers, M.D.; Lial Kofoed, M.D., M.S.; Daniel M. Hacking, M.A.

Academic Psychiatry 1999;23:165-167.

View Article Information

LettersTelepsychiatryCurriculum

Article

References

text A A A

To THE Editor: There has been interest in the potential efficiencies of remote psychiatric consultation through two-way interactive audiovisual linkages since the first use of a microwave link to provide consultations between Omaha's Nebraska Psychiatric Institute and a state psychiatric hospital 112 miles away in 1961 (1). Recent advances in technology have made telepsychiatry a reality. This technology is particularly valuable in making specialty consultation available in remote rural areas without the inefficiencies, costs, and inconveniences of travel to both consultant and patients (2, 4). The psychiatric disorders of childhood are amenable to telemedicine evaluation (5), and children may be particularly comfortable with interactive audiovisual transmissions (6). To prepare psychiatric residents to function effectively as practicing psychiatrists in this new medium, an introductory three-module curriculum has been developed at the University of South Dakota School of Medicine and McKennan Hospital in Sioux Falls, South Dakota.

LEARNING OBJECTIVES

The learning objectives are as follows: 1) Residents will be able to identify the technical components of a bidirectional voice/video/data telemedicine system, including hardware, software, and infrastructure. 2) Residents will be able to describe clinical applications of telepsychiatry that have been published in the literature. 3) Residents will be able to compare distance and on-site consultation methods: cost, scope of services, clinician skills, and appropriate physical settings. 4) Given a mock patient, residents will be able to identify potential difficulties and suggest adaptations for effective long-distance interviewing via interactive television.

MODULE ONE: PRINCIPLES, TECHNOLOGY, AND UTILIZATION: OUTLINE

I. The Infrastructure Voice/Data/Video Communication

A. POTS (plain old telephone service): 1) the organization of a telephone exchange, 2) limitations, 3) bandwidth. B. Other Services: 1) switch 56, 2) ISDN, 3) frame relay, 4) T1, T3, fiber optics, etc. C. Intra-institutional Networks: 1) Ethernet, 2) ATM. D. The Internet. E. Communication Standards: 1) HL-7, 2) H320, 3) DICOM.

II. Telemedicine Technology

A. Basic Hardware: 1) Codec, 2) Monitors, 3) Cameras, 4) Microphones, 5) Controls, 6) Peripherals (e.g., videotape). B. Far-end room design. C. Near-end room design.

III. Utilization of Telepsychiatry

A. Review of National Experience (e.g., psychiatrist to physician consultation, long-distance peer supervision or mentoring, teleconferencing). B. Review of local experience.

Required Reading

MODULE TWO: PRACTICAL DEMONSTRATION

Residents will have a hands-on experience operating the "Picture-Tel" equipment at McKennan Hospital.

MODULE THREE: PROBLEM-BASED LEARNING CASES IN TELEPSYCHIATRY

Residents will be presented with up to three vignettes and asked to identify potential communication difficulties in a telepsychiatry setting and to develop strategies to overcome these problems. In all cases, issues such as the best hardware, including bandwidth, near and distant site setup (including who will be present), record keeping, and confidentiality can be discussed.

Vignette 1

Vignette 1 is an evaluation of a 41-year-old man with possible obsessive compulsive disorder in a family doctor's office. Special Issues: is there adequate bandwidth to diagnose tics; clarification of the nature of the consultative relationship with the family doctor, and who will prescribe medication and maintain records?

Vignette 2

Vignette 2 is an evaluation of an 8-year-old Native-American boy with possible attention-deficit hyperactivity disorder in an Indian Health Service Clinic. Special Issues: at what developmental ages does a child cognitively understand that the physician can see him as well as he being able to see the physician; importance of cultural sensitivity around telemedicine issues; modification of interviewing style for children; protecting the equipment from "curious fingers," using document camera or fax to have instant review of information from other domains, including parent and school forms.

Vignette 3

Vignette 3 is a medication follow-up of a 28-year-old woman with chronic schizophrenia on risperidone in a rural medical clinic. Special Issues: how to establish a working alliance with a psychotic patient on interactive television, how to tactfully explore issues of hallucinations and delusions in a medium that may be the "originator" of the hallucinations or delusions, how to handle the fact that there may be insufficient resolution to "see" neuroleptic-induced movement disorders or negative symptoms.

OVERVIEW OF TELEPSYCHIATRY

Although telepsychiatry is 40 years old, it remains in a formative phase of development. There are many unknowns about telepsychiatry that can provide future research opportunities. What are the qualitative differences in interviewing in person and in "virtual" interviewing? Are patients and providers satisfied with these interventions? What kinds of patients do well with interactive interviewing? What kind of intervention is effective via this media? Many complex legal, regulatory, and financial issues about telepsychiatry also remain (e.g., are these interventions cost-effective, who will pay for them, what state or federal regulations will be required for instrumentation or credentialing of telepsychiatrists and others?).

Required Reading

It is hoped that this introductory course will provide the basic know-how about telepsychiatry, to inform a new generation of cyperspace clinicians.

The development of this curriculum was supported, in part, by a grant from the Telecommunication and Information Infrastructure Assistance Program (Grant No. 46—60—9704) to the authors.

References

Wittson CL, Affleck DC, Johnson V: Two-way television group therapy. Mental Hospital 1961; 12:22—23

Bergman R: Letting telemedicine do the walking. Hospitals and Health Networks. October 20, 1993, pp. 46—48

Sanders JH, Tedesco RJ: Bringing medical care to isolated communities. J Med Assoc Ga 1993; 82:237—241[PubMed]

Perednia DA, Allen A: Telemedicine technology and clinical applications. JAMA 1995; 273:483—488 [PubMed][CrossRef]

Jerome L: Assessment by telemedicine (letter). Hospital and Community Psychiatry 1993, 44:81

Dranov P: Telemedicine. Science Digest 1981; 89:112—113[PubMed]

Wittson CL, Affleck DC, Johnson V: Two-way television group therapy. Mental Hospital 1961; 12:22—23

Bergman R: Letting telemedicine do the walking. Hospitals and Health Networks. October 20, 1993, pp. 46—48

Sanders JH, Tedesco RJ: Bringing medical care to isolated communities. J Med Assoc Ga 1993; 82:237—241[PubMed]

Perednia DA, Allen A: Telemedicine technology and clinical applications. JAMA 1995; 273:483—488 [PubMed][CrossRef]

Jerome L: Assessment by telemedicine (letter). Hospital and Community Psychiatry 1993, 44:81

Dranov P: Telemedicine. Science Digest 1981; 89:112—113[PubMed]

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.

Submit a Comments

Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of JBJS editorial staff.

* = Required Field

Comment Author(s)*(if multiple authors, separate names by comma)

Example: John Doe

Affiliation & Institution*

Comment Title*

Comment*

Cancel

Print
PDF
E-mail

Recipient(s) will receive an email with a link (good for 72 hours) to 'An Introductory Curriculum on Telepsychiatry for Psychiatric Residents' and do not need to have Academic Psychiatry account to access the content.
Your Name:*
Example: John Doe

Email Address:* CC Me:
Enter your valid email address. Example: jdoe@example.com

Recipient's Email Address:*
Separate multiple email address with semi-colons (up to 5).

Subject:* 's Academic Psychiatry: 'An Introductory Curriculum on Telepsychiatry for Psychiatric Residents'
Subject for your email.

Message:
(Optional, message will truncate at 1000 characters)

Processing your request... Please Wait...

Copyright © in the material you requested is held by The American Psychiatric Association (unless otherwise noted). This email ability is provided as a courtesy, and by using it you agree that you are requesting the material solely for personal, non-commercial use, and that it is subject to The American Psychiatric Association's Terms of Use. The information provided in order to email this topic will not be used to send unsolicited email, nor will it be furnished to third parties. Please refer to The American Psychiatric Association's Privacy Policy for further information.

Copyright © American Psychiatric Association. All rights reserved.
Share
Get Citation

Jessica R. Oesterheld, Henry P. Travers, Lial Kofoed, Daniel M. Hacking; An Introductory Curriculum on Telepsychiatry for Psychiatric Residents. Academic Psychiatry. 1999 Sep;23(3):165-167.

Download citation file:

RIS (Zotero)

EndNote

BibTex

Medlars

ProCite

RefWorks

Reference Manager

Copyright © American Psychiatric Association. All rights reserved.
Reprints