Journal Article Annotations
2020, 3rd Quarter
Annotations by Shehzad K. Niazi, MD, FRCPC, FACLP
July, 2020
PUBLICATION #1 — Administrative Issues
The finding:
Mobile Health technologies or “unwired e-med” is increasingly common in healthcare and likely to become critical in assessing and caring for the whole person. Patients are monitored 24/7, yet the results are reviewed intermittently and asynchronously. The importance of familiarity with this technology has been advocated by the WHO and IOM. IOM explicitly includes competency in use of information technology as a core competency for health professionals. However, competencies have not been well defined for Mobile Health. This paper describes a process by which the following question is answered: “What skills are needed for clinicians and trainees to provide quality care via mHealth, have they been published, and how can they be made measurable and reproducible to teach and assess them?” Authors provide recommendations regarding the teaching, assessment, and evaluation methods for mobile technologies (mobile Health, smartphone, and apps) clinical competencies and describe a framework to adapt Accreditation Council of Graduate Medical Education (ACGME) core competencies to Mobile Technologies Clinical Competencies.
Strength and weaknesses:
Comprehensive approach to identify what is known, and what can be learnt from related fields (Competencies for Telepsychiatry e.g.) via literature review. This was augmented with expert opinion to provide a very useful list of areas in which core competencies can be assessed. Additionally, a framework for how ACGME’s existing competencies can be adapted to develop the core competencies in Mobile Health is a strength of the study.
A structured qualitative research methodology after the literature search likely would have afforded additional insights. Considerable work is still needed in this area, and it also remains to be seen as to how generational differences (broadly speaking) may play into this. i.e. Generations X, Z, and Millennials’ familiarity with mHealth vs others and whether there is need for “train the trainers” before competencies can be adequately assessed.
Relevance:
Mobile health is increasingly becoming a core component of health and wellness monitoring. To a varying degree several specialties and subspecialties are increasingly using these technologies for remote monitoring, asynchronous and real-time assessment, health coaching and even as intervention tools. In clinical psychiatry data obtained from mHealth will increasingly inform diagnostic formulation, interventions needed, and response to treatment. Becoming familiar with such technologies and teaching trainees how to use them are important for the future of the field.
Type of study(EBM guide):
Systematic review or meta-analysis
The finding:
Teams consisting of advanced psychiatry trainees who received additional training relevant to palliative care were supervised by CL Psychiatrists, collaborated with palliative care team to form a unique Psychiatry-Palliative Care Liaison Team. This team addressed the dramatic increase in the palliative care needs of patients during early phase and the peak of COVID-19 pandemic.
Strength and weaknesses:
This novel model leveraged existing capabilities to develop a new service by increasing collaboration and providing additional training to advance psychiatry trainees who were redeployed to a newly formed Psychiatry-Palliative Care Liaison team. Such models may be more feasible during emergencies such as COVID-19 pandemic but face variety of barriers during non-emergent situations.
Relevance:
This precedent provides a framework for rapid responses to other national health emergencies and the role CL psychiatrists can play in such situations.
Type of study(EBM guide):
Case series or report