Lifelong Learning for Clinical Practice: How to Leverage Technology for Telebehavioral Health Care and Digital Continuing Medical Education
Purpose of Review
Psychiatric practice continues to evolve and play an important role in patients’ lives, the field of medicine, and health care delivery. Clinicians must learn a variety of clinical care systems and lifelong learning (LLL) is crucial to apply knowledge, develop skills, and adjust attitudes. Technology is rapidly becoming a key player—in delivery, lifelong learning, and education/training.
The evidence base for telepsychiatry/telemental health via videoconferencing has been growing for three decades, but a greater array of technologies have emerged in the last decade (e.g., social media/networking, text, apps). Clinicians are combining telepsychiatry and these technologies frequently and they need to reflect on, learn more about, and develop skills for these technologies. The digital age has solidified the role of technology in continuing medical education and day-to-day practice.
Other fields of medicine are also adapting to the digital age, as are graduate and undergraduate medical education and many allied mental health organizations. In the future, there will be more online training, simulation, and/or interactive electronic examinations, perhaps on a monthly cycle rather than a quasi-annual or 10-year cycle of recertification.
KeywordsDigital Technology Learning Telepsychiatry Lifelong Education
The authors express gratitude to the American Psychiatric Association and Telepsychiatry Committee, American Telemedicine Association and Telemental Health Interest Group, and Journal of Technology in Behavioral Science, Springer – Nature Publishing.
Compliance with Ethical Standards
Conflict of Interest
Donald M. Hilty, Carolyn Turvey, and Tiffany Hwang declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.• Institute of Medicine. http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed 1 January, 2018. This reference outlines the gap in health care services and field of medicine outcome targets for the next two decades.
- 2.• Shi L, Singh DA. Delivering health care in America: a systems approach, Sixth Edition. Burlington: Jones and Bartlett Learning; 2015. p. 195–245. This reference places changes in medical practice in the context of a broader health care economy. Google Scholar
- 3.• Brydges R, Stroud L, Wong BM, et al. Core competencies or a competent core? A scoping review and realist synthesis of invasive bedside procedural skills training in internal medicine. Acad Med. 2017. https://doi.org/10.1097/ACM.0000000000001726. This reference provides context for lifelong learning in psychiatry in a broader context of medicine, specifically internal medicine.
- 4.• Mohr NM, Moreno-Walton L, Mills AM, et al. Generational influences in academic emergency medicine: teaching and learning, mentoring, and technology (part I). Acad Emerg Med. 2011;18(2):190–9. https://doi.org/10.1111/j.1553-2712.2010.00985.x. This reference provides context for lifelong learning in psychiatry in a broader context of medicine, specifically emergency medicine.CrossRefPubMedPubMedCentralGoogle Scholar
- 5.• Callan J, Maheu M, Bucky S. Crisis in the behavioral health classroom: enhancing knowledge, skills, and attitudes in telehealth training. In: Maheu M, Drude K, Wright S, editors. Field guide to evidence-based, technology careers in behavioral health: professional opportunities for the 21st century. New York: Springer; 2016. This reference helps contextualize learning toward skills rather than knowledge.Google Scholar
- 8.• American Board of Psychiatry & Neurology, Psychiatry Core Competencies. https://www.abpn.com/wp-content/uploads/2015/02/2011_core_P_MREE.pdf. Accessed 1 January, 2018. The reference outlines the skills, knowledge, and practices expected by the Board and the APA for clinical care.
- 9.• Greiner AC, Knebel E, editors. Health professions education: a bridge to quality. Washington, DC: National Academies Press; 2003. This reference interprets the IOM’s broad perspectives and links them to learning.Google Scholar
- 10.• Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard medical practice study. N Engl J Med. 1991;324:360–76. This reference illustrates the linkage between lifelong learning and reducing medical errors.Google Scholar
- 12.• Hilty DM, Turvey C, Hwang T. Quality care by telepsychiatry and telemental health: patient-centered value, lifelong learning of skills, and applying guidelines and the evidence-base to practice. In: Handbook of telepsychiatry. Yellowlees PM, Shore J, editors. Washington, DC: American Psychiatric Publishing Incorporated, In Press. This reference integrates technology learning into clinical practice as a lengthy precursor to this article. Google Scholar
- 13.• Accreditation Council on Graduate Medical Education. Common Program Requirements. At: https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs2013.pdf. Accessed 1 January, 2018. This reference describes the GME competencies, which mesh with clinical practice competencies by the Board.
- 14.• Hilty DM, Crawford A, Teshima J, et al. A framework for telepsychiatric training and e-health: competency-based education, evaluation and implications. Int Rev Psychiatry. 2015;27(6):569–92. This reference is the first set of telecompetencies in the world, overall, and in psychiatric practice.CrossRefPubMedGoogle Scholar
- 15.• Hilty DM, Chan S, Torous J, et al. New frontiers in healthcare and technology: Internet- and web-based mental options emerge to complement in-person and telepsychiatric care options. J Health Med Informatics. 2015;6(4):1–14. This reference describes, for the first time, an e-MH spectrum of self-help and clinical care.Google Scholar
- 16.• Hilty DM, Maheu M, Hertlein K, et al. The need for e-behavioral health competencies: an approach based on competency frameworks and common themes across fields. J Technol Behav Sci. In Press. This reference calls for competencies across the e-MH or TBH continuum, as well as across mental health, family therapy, and allied fields.Google Scholar
- 18.• Veterans Affairs Survey of Healthcare Experiences of Patients Recently Discharged Inpatient, 2016. https://www.reginfo.gov/public/do/DownloadDocument?objectID=64954701. Accessed 1 January, 2018. This reference provides context for the VA’s innovation with technology in service delivery.
- 22.• Laranjo L, Arguel A, Neves AL, et al. The influence of social networking sites on health behavior change: a systematic review and meta-analysis. J Am Med Inform Assoc. 2015;22(1):243–56. This reference describes the application of social media to self-help and health care.CrossRefPubMedGoogle Scholar
- 23.• Christensen H, Griffiths K, Evans K. E-mental health in Australia: implications of the Internet and related technologies for policy. Canberra: Commonwealth Department of Health and Ageing; 2002. This reference provides the most commonly used definition of social media and networking.Google Scholar
- 24.• Dreyfus SE, Dreyfus HL. A five-stage model of the mental activities involved in directed skill acquisition. Berkeley: University of California, Operations Research Center; 1980. www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA084551. Accessed 1 January, 2018. This reference is the foundation for learning steps across all fields of life, far beyond, but including medicine.CrossRefGoogle Scholar
- 25.• Royal College of Physicians and Surgeons, CanMEDS Framework, 2005. http://www.royalcollege.ca/portal/page/portal/rc/canmeds/framework. Accessed 1 January, 2018. This reference provides a Canadian advanced set of competencies for clinicians in practice, complementary to the ACGME U.S. ones.
- 26.• Myers K, Turvey C. Telemental health: clinical, technical and administrative foundation for evidence-based practice. London: Elsevier Insights; 2013. This reference is a foundation for TP practice in the U.S.Google Scholar
- 27.• Roberts LW, Hilty DM. Approaching certification and maintenance of certification. In Handbook of career development in academic psychiatry and behavioral sciences, Second Edition. Roberts LW, Hilty DM, editors. Washington, DC: American Psychiatric Publishing Incorporated, In Press. This reference describes the mission, guiding principles, and learning steps by the Board for lifelong learning.Google Scholar
- 28.• Hilty DM. Advancing science, clinical care and education: shall we update Engel’s biopsychosocial model to a bio-psycho-socio-cultural model? Psychol Cogn Sci. 2016;1(1). https://doi.org/10.17140/PCSOJ-1-e001. Accessed 1 October 2017. This reference updates Engel’s model to be more inclusive of culture and as a model for lifelong learning.
- 29.• Kirkpatrick J, Kirkpatrick W. The Kirkpatrick four levels: a fresh look after 50 years, 1959–2009. http://www.managesmarter.com/managesmarter/images/pdfs/trg_20090417_kirkpatrickw hitepaper.pdf. Accessed 1 January, 2018. This reference is the foundation for evaluation of learning across all fields of life, far beyond, but including medicine.
- 30.• Institute of Medicine, 2011: Clinical Practice Guidelines We Can Trust. https://www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx. Accessed 1 January 2018. This reference describes the most respected, best evidence-based guideline approach in the world, including medicine.
- 31.• Cochrane Community Database of Systematic Reviews. http://community.cochrane.org/editorial-and-publishing-policy-resource/cochrane-database-systematic-reviews-cdsr. Accessed 1 January, 2018. This reference is the standard for publishing database studies in medicine.
- 32.• Agency for Healthcare Research and Quality Clinical Guidelines and Recommendations. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/. Accessed 1 January, 2018. This reference is the U.S. leader in literature searches related to guidelines in the U.S.
- 33.• Reus VI, Fochtmann LJ Eiler E, et al. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia, http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2015.173501. Accessed 1 January, 2018. This guideline shows the new standard of quality for guidelines and the collaborative partnership between the IOM and APA. Clinicians can make better decisions using it.
- 34.• Reus VI, Fochtmann LJ, Hilty DM, et al. The American Psychiatric Association evidence-based clinical practice guidelines for the management of substance use disorders, http://psyciq.apa.org/evidence-based-clinical-practice-guidelines-management-substance-use-disorders/. Accessed 1 January, 2018. This guideline shows the new IOM and APA standard of quality for a guideline for clinicians to make better decisions.
- 35.• American Telemedicine Association. ATA practice guidelines for video-based online mental health services. Telemed J E-Health. 2013;19(9):722–30. https://doi.org/10.1089/tmj.2013.9989. This reference is the most recent telemental health guideline; it and the ATA are recognized worldwide.CrossRefGoogle Scholar
- 36.• Marr M, Hemmert K, Nguyen AH, et al. Team play in surgical education: a simulation-based study. J Surg Educ. 2012;69(1):63–9. https://doi.org/10.1016/j.jsurg.2011.07.002. This reference highlights new developments in surgical lifelong learning and training, as a prototype for psychiatry.CrossRefPubMedGoogle Scholar