New compassionate virtual care orientation module

With the expanded use of telemedicine, accelerated by the COVID-19 pandemic, guides and resources have been developed to support physicians in providing safe and effective virtual care in their practice and training. When it comes to compassionate care, the in-person approach does not simply translate into virtual care, which poses a challenge, especially since little guidance or resources exist at the moment.

We are pleased to announce the upcoming launch of a new module focused on compassionate virtual care in the Communication and Cultural Competence orientation program. Created with funding received from AMS Healthcare and with input from Practice-Ready Assessment (PRA) programs, the Compassionate virtual care module explores how virtual care can both support and challenge the concept of compassionate care, which is rooted in the fundamental notion that the patient and physician are whole human beings in their interactions.

Designed for internationally and Canadian-trained physicians, this newest addition to the free self-education program delves into the provision of compassionate care through the expanded use of digital health technologies and virtual contexts in Canadian health care. Supported with illustrated scenarios of what a physician might encounter, the module examines how technology affects human interaction in virtual care, specifically communication, patient-physician relationships and compassionate care. Background information, exercises and various resources, such as the Canadian Patient Safety Institute (CPSI) podcast, are also featured throughout the sections of the module. The 22-minute episode of this podcast, included in the “Defining virtual care” section of the module, provides a brief overview of the history of virtual care in Canada and reflects on key issues in providing high-quality virtual care.

“One of the positives to come out of the COVID-19 pandemic has been the rapid implementation of virtual care across Canada and around the world. For practising physicians and those in training, this is a novel approach to connecting with patients. It requires to learn new skills and new ways of applying previously acquired knowledge, as virtual care will become an essential component of patient-care skills.” 

— Dr. Teresa Cavett
    Associate Professor, Department of Family Medicine, Max Rady Faculty of Medicine,
    University of Manitoba
    Consultant for the development of the module

Behind the scenes of the module development

The creation of the module began with an exhaustive audit of academic literature and resources in relation to virtual care and telemedicine, then questionnaires were developed to guide the focus groups that were held in February and March 2021. To capture the full scope of the challenges and benefits of virtual care, both from patients’ and physicians’ viewpoints, various audiences were represented in the focus groups. The sessions gathered patients and caregivers who had recently received care virtually from family physicians, internationally and Canadian-trained physicians who recently graduated from PRA programs in Canada or Canadian Family Medicine residency programs, as well as assessors for PRA programs and residency programs in Canada. All groups were asked to provide feedback on their experience and expectations relating to virtual care, their perception of compassion in virtual care and how virtual care has changed their overall experience of health care.

Dr. Stefan Du Toit, who has been a rural family physician for 20 years and has been closely involved, over the last 10 years, in the development of the very successful Real-Time Virtual Support program in use in rural British Columbia, took part in one of the focus groups. He considers that including patient perspective as part of the module development was essential “to ensure that the providers are actually giving the care needed. Measuring outcomes are extremely important and can only be done effectively if we consider the patient viewpoint on quality and availability of care when needed (emergent and routine).” In his opinion, ensuring quality of care was a crucial aspect of the module’s development: “virtual care can only be successful if patient needs are being fulfilled in a sensible and responsible way.”

The data collected from the focus groups were analyzed, leading to a gap analysis between those data and the literature review. Then, the second phase of the work started, with learning objectives being defined and content being developed between September 2021 and March 2022. After the module was assembled and designed, it was reviewed by subject matter experts, in preparation for its launch on the physiciansapply.ca and inscriptionmed.ca websites in July 2022.

The MCC would like to thank the College of Family Physicians of Canada for contributing to this module.

Addressing challenges and gaps

Although virtual care has been a part of the health care system in Canada for decades, it introduces some challenges in relation to equity, access and service. Those issues are due, for instance, to differences in access to technology and levels of digital literacy in patient populations, and to a lack of common standards across Canada for virtual care.

While key areas of competency have emerged through assessment tools for learners and physicians, the review of literature on virtual care and the analysis of the feedback collected through the focus groups have identified gaps in experience of providing or receiving virtual care. In view of those gaps, the module focuses on the following key aspects of delivering care in a virtual context: build and improve confidence, provide compassionate care, facilitate relationships and negotiate boundaries. “The challenge for all of us is how to practice medicine virtually while providing the best medical care possible,” analyses Dr. Cavett. “The core of medical practice rests upon our communication with our patients. Compassionate care is patient-centred care, promoting effective communication that leads to the building of trust, rapport and empathy. This module will help participants to develop skills applicable throughout their career.”

Establishing boundaries with patients is some of the aspects of providing virtual care that Dr. Claire Touchie, Professor, Department of Medicine, University of Ottawa, reflected on as she participated in the conceptualization and development of the module: “I gave some thought on how to appropriately set boundaries with patients and how to respond to those while keeping their trust.”

In the module, Dr. Touchie also values the fact that many resources are available easily at the touch of a button. Among them is an episode from the CPSI’s PATIENT podcast series. “I think the podcast is an excellent resource,” explains Dr. Du Toit. “Although it takes time to listen to it, I think it was very realistic and helpful and actually enjoyable to listen to. I feel that the use of virtual care in rural emergency medicine is under-utilized and hands-on examples and use cases are very helpful in development and training.” The patient-encounter scenarios featured in the module also enable learners to reflect on each situation presented, to select strategies and to identify ways in which virtual care and digital technology can enhance their practice.

Compassionate care is primarily understood through in-person approaches. Reflecting on how technology affects human interaction in virtual care and being aware of the tools available to physicians and patients are key components for providing compassionate and patient-centred care in a virtual context.

“Virtual care can only be successful if patient needs are being fulfilled in a sensible and responsible way.”

— Dr. Stefan Du Toit
    Rural family physician

To access the module, click here.