We don't often ask whether a clinician is ready to deliver care by video. We tend to assume that someone who's good “in the room” will be good on the screen, and patients are the ones who find out whether that's true or not.
Most providers learned to build trust, ask hard questions, and “read” a patient in person. Fewer have had a chance to practice those skills through a screen before a real patient was there, so patients can end up getting stuck in the wrong side of the learning curve.
Small things carry more weight by video. A missed cue, a moment of connection that doesn't quite land, or a question about privacy that never gets asked could shape whether a patient feels safe enough to open up or even come back. Watching clinicians practice live video visits in the human simulation programs I run has changed how I think about readiness.
Telehealth is its own way of delivering care
It's tempting to think of telehealth as an in-person visit moved onto a screen, but in my experience, it's its own modality. Distance care has a long history that predates any recent surge in video visits, and it deserves to be treated as a practice in its own right.
Through a screen, behaviors that might come naturally in a room often need more intention and attention. A few examples I have seen come up in simulation:
- Building rapport when eye contact means looking at a camera, not at the person's face
- Showing you're listening when a nod is easy to miss and a glance down at your notes can read as looking away (or checking your phone)
- Being a guest in the patient's space, where they control the camera, the door, and who else might be in the room
- Guiding a remote assessment, such as coaching a patient to position their camera and describe what they're seeing/feeling
- Handling the technology without letting it pull attention away from the patient
None of these skills are hard to describe. They're harder to do well, in the moment, with a real person on the other end.
Knowing it isn't the same as showing it
Frameworks like the AAMC's telehealth competencies from the Association of American Medical Colleges give clinicians and educators a shared picture of what good virtual care includes, even as many programs are still working out what to teach and when.
What's easy to skip is the step between knowing and doing. In the clinical and educational programs I work with, clinicians conduct live video visits with simulated patients (SPs), people trained to portray a patient consistently, score the encounter, and give feedback.
I'm often struck by how a clinician who can describe good telehealth perfectly still gets surprised the first time they try it.
That's where the feedback matters. An SP can offer a verbal debrief on how the conversation actually felt from the receiving end: when they felt heard, when they felt rushed, when a question landed awkwardly through the screen. It's the patient's perspective, delivered before a real patient has to live it. Since it happens over video, clinicians practice in the same conditions they'll work in, then try again.
Readiness you can see
Most telehealth training is measured by completion, knowledge scores, confidence, or intent to change. Those tell us something, but not whether a clinician can do it with a patient on the other end.
When performance is observed and scored against specific behaviors, readiness becomes something a clinician can demonstrate, not just report. With the Rural Health Transformation Program naming rural workforce development as a goal, I suspect the question of how we know someone is ready will come up more often. For patients, it means the learning curve happens somewhere other than their visit.
The good news
If telehealth is a distinct way of delivering care, competency in it deserves to be practiced, not only taught. The tools to make that possible already exist, and they work in the very modality we're preparing clinicians for. How does your team decide if a clinician is ready for video visits? What would you want to see before they are? If this sparked a thought, I'd love to hear it, and your regional Telehealth Resource Center is a great place to keep that conversation going.