About Ryan Palmer, Ed.D., M.F.A.
Ryan Palmer, Ed.D., M.F.A. is a Principal at Kennedy and Company, a Washington DC based higher education consulting firm.Hehas over 15 years of experience in medical education in both faculty and administrative roles, most recently as an Associate Dean of Medical Education. Dr. Palmer is a national expert on telehealth simulation and in 2009 developed the TeleOSCE, a live, online telehealth simulation for clinical learners.
His TeleOSCE cases have been disseminated in both scholarly journals and conferences and the simulations have been implemented by multiple medical, clinical and residency training programs. Several of the TeleOSCE cases are featured by the Association of American Medical Colleges (AAMC) as educational resources to help address the COVID pandemic. Dr. Palmer received his Doctorate of Education in Higher Education Leadership from Portland State University.
In addition to telehealth education, his interests include distance learning, competency-based education, and implementing virtual communities of practice in clinical education.
About Kennedy & Company Education Strategies
Kennedy & Company was founded to provide colleges and universities with a differentiated advisory offering targeted at addressing their most pressing strategic questions. Our client list includes large public research institutions, state flagship universities and systems, small private colleges, graduate and professional schools, historically black colleges and universities, and community colleges.
We are headquartered in Virginia, and proud to be a Virginia-based small business. We have smaller, virtual offices where our team members live. As we grow, we plan to establish offices in some of the country’s best college towns – close to those we serve and the energy, diversity, and innovation that colleges and universities create.
Our professionals have decades of experience in higher education and consulting and have helped more than 40 institutions craft new enrollment strategies, develop strategic plans, refine models for financial sustainability, and launch new academic (on-ground and online) offerings. The expertise we bring is detailed in our biographies, but we also want to share the key characteristics that we seek in our team members, as it is not simply what they know, but why and how they do what they do, that matters. Visit us at https://kennedyandcompany.com.
Medical Travel & Digital Health News (MTDH): We love the fact that you’ve been training medical students on meeting with patients virtually. Can you start by telling the readers about your work with telehealth?
Dr. Ryan Palmer (RP): I consider myself an early advocate for telehealth. I was in the Telehealth Alliance of Oregon for several years as a board member. I’ve been in medical education for about 15 years. I’m not a clinician. I’ve always been an educator.
My work in telehealth education began during my time at Oregon Health and Science University (OHSU) around when I earned my Doctorate of Education in Higher Education Leadership. Prior to that, I was working at OHSU as course administrator for a clinical education course. After getting my doctorate I went on as faculty in the Department of Family Medicine. During this time, I helped start a program called The Oregon Rural Scholars Program.
This program placed medical students who were interested in rural practice in rural areas for extended periods of time. These students were placed all over the state, and we had developed a way to bring them together for live educational sessions in a synchronous online space (we used Adobe Connect at the time).
Nowadays this doesn’t seem like a big deal, but back then it was somewhat cutting edge, especially when you consider many of these students were using WiFi hotspots we issued them because internet connectivity was very limited in many of the rural towns they were placed in. I thought that we should give these students an opportunity to do clinical simulated encounters using the synchronous technology we were using.
I asked myself, “Why would a clinician be delivering care over a computer?” Telehealth was the obvious answer and the TeleOSCE was born.
Our first TeleOSCE was a diabetic foot sore case where the students would have a simulated patient encounter with a standardized patient in a rural setting using their computer. That is really where we started. This was in 2013 and we wanted to teach students not only how to care for patients clinically in the simulation, but also how to do so in a patient-centered way while using technology.
We needed to help teach students how to be ready to care for a patient even when things didn’t go right using the telehealth technology, so we built in a technology “stumbling block” into the case that would throw the student off. For the foot sore case the students had to download a picture during the encounter that they were not prepared for, and doing so would pop them into a different screen, then they had to figure out how to navigate back to the patient screen while still trying to stay connected to the patient.
Some students handed this with ease, some struggled and got frustrated. In the debrief we would give them feedback that even if there are technology issues (and there will be!), you need to stay with the patient. The patient must feel cared for despite the technology issues.
MTDH: Then you started to work with other students? How did this develop?
RP: From there we implemented this for all of the medical students who were remote and on campus as part of the required Family Medicine clinical rotation at OHSU. Students went through several simulated clinical encounters as a formative exercise and we made one of the stations a telehealth station.
We had approximately 160 students a year go through this case and then added in other TeleOSCE cases that we developed (all of these cases are available here and here). Students still go through the TeleOSCE cases at OHSU, so that’s a lot of learners over the years who have had this educational experience!
MTDH: Would there be application adaptations for traveling to another area for care?
RP: In terms of traveling and telehealth, we focused all the cases on teaching the students about the realities of caring for rural and underserved patients while using the technology. Transportation is often a huge issue for these patient populations. In the foot sore case, the patient actually refuses to drive to the physician’s office if the student asks the patient to go because the clinic is a 2-hour drive from where the patient is located. The student must negotiate with the patient to find another way to make sure the patient’s foot sore is cared for.
MTDH: Typically, how do you train students in telemedicine?
RP: We deliberately didn’t train them prior to the TeleOSCE except for giving them broad concepts around telehealth. We basically said, “Just jump in and do it.”
This is a philosophy of learning around formative assessment and receiving immediate feedback. Some students did great, some of them did not and all received feedback from an observing faculty member and the standardized patient. This was a great opportunity for the students to learn what they could improve on while they were still in a safe learning environment.
Our model was assessment for learning. It was about the experience of jumping into a relatively straightforward patient encounter but having to improvise a bit because of the telehealth format and technology interference. The student learns by doing. We built the cases with flexibility in mind, and over the years we were able to even scale them up for residency learners by making nuances of the case more complex for the different level of learner.
Other professions also successfully adapted the cases, and I just recently co-authored a new TeleOSCE case with some dentistry colleagues. The core format of the cases makes them very easy to adapt to different geographic locations, learner levels, professions, etc.
With the COVID-19 pandemic, everyone had to suddenly solve that same distance learning problem we faced in 2013 and telehealth has also exploded as a practice model, so interest in the TeleOSCE cases has skyrocketed. In fact, the Association of American Medical Colleges reached out to us saying they wanted to publish our four cases (linked above).
MTDH: Tell me about your new consulting role.
RP: Kennedy and Company is a higher education-focused consulting firm and brought me onboard to develop their clinical education service offerings, such as implementing telehealth curriculum and assessments. They do amazing work and I am really happy to be a part of this incredible team. I also continue my scholarly work in clinical education around telehealth, clinical simulation and other areas of interest.
I’m very proud that the TeleOSCE work we began in 2013 continues to help teach core telehealth competencies like making sure the patient can see you and you can see the patient, making sure the learner is looking at her webcam to make the patient feel like you are looking the patient in the eye, etc.
I hope this work inspires other educators to explore innovative ways to train learners on how to deliver patient-centered care using telehealth. It is a practice model that is here to stay and we must educate our future clinicians to deliver this type of care competently and compassionately.