Virtual care, introduced previously as a replacement for in-person visits, is now being integrated into clinical care delivery models to complement in-person visits. The COVID-19 pandemic sped up this process. The rapid uptake of virtual care at the start of the pandemic prevented educators from taking deliberate steps to design the foundational elements of the related learning environment, including workflow, competencies, and assessment methods.
Educators must now pursue an informed and purposeful approach to design a curriculum and implement virtual care in the learning environment. Engaging learners in virtual care offers opportunities for novel ways to teach and assess their performance and to effectively integrate technology such that it is accessible and equitable. It also offers opportunities for learners to demonstrate professionalism in a virtual environment, to obtain a patient’s history incorporating interpersonal and communication skills, to interact with multiple parties during a patient encounter (patient, caregiver, translator, telepresenter, faculty member), to enhance physical examination techniques via videoconferencing, and ideally to optimize demonstrations of empathy through “webside manner.”
Feedback and assessment, important features of training in any setting, must be timely, specific, and actionable in the new virtual care environment. Recognizing the importance of integrating virtual care into education, leaders from across the United States convened on September 10, 2020, for a symposium titled, “Crossing the Virtual Chasm: Rethinking Curriculum, Competency, and Culture in the Virtual Care Era.” In this article, the authors share recommendations that came out of this symposium for the implementation of educational tools in the evolving virtual care environment. They present core competencies, assessment tools, precepting workflows, and technology to optimize the delivery of high-quality virtual care that is safe, timely, effective, efficient, equitable, and patient-centered.
Bolster MB, Chandra S, Demaerschalk BM, Esper CD, Genkins JZ, Hayden EM, Tan-McGrory A, Schwamm LH; Virtual Care and Medical Educator Group. Crossing the Virtual Chasm: Practical Considerations for Rethinking Curriculum, Competency, and Culture in the Virtual Care Era. Acad Med. 2022 Jun 1;97(6):839-846. doi: 10.1097/ACM.0000000000004660
García Dieguez M. Comment on the Crossing the Virtual Chasm: Practical Considerations for Rethinking Curriculum, Competency, and Culture in the Virtual Care Era. [Internet]. Pan American Health Organization. Bibliographic Repository. Cited on 07/10/2025. Available at: https://campus.paho.org/en/repo/crossing-virtual-chasm-practical-considerations-rethinking-curriculum-competency-and-culture
García Dieguez M.
CEEProS Universidad Nacional del Sur
This article is useful for those who design, implement, or evaluate medical training programs in the post-pandemic era. It presents a comprehensive approach to integrating virtual care (telemedicine, digital health, remote consultations) into the curriculum, without losing sight of clinical competencies, equitable access, and empathy in digital environments. It stems from a U.S. national symposium and offers both conceptual foundations and practical tools.
The article identifies a structural shift in healthcare delivery due to the definitive incorporation of virtual care, driven by the COVID-19 pandemic. It proposes a redefinition of the clinical competencies required in the digital environment, organized into six domains ranging from patient safety to health equity. It introduces an adapted pedagogical framework (“The Four Quadrants of Telemedicine Education”) to guide curriculum design from logistics to innovation.
It describes specific strategies for competency-based assessment in virtual care (direct observation, virtual Mini-CEX, video-based immediate feedback, etc.). It also emphasizes the need to train faculty in virtual teaching environments and to establish centralized curriculum repositories. Notably, it proposes involving patients in the design and evaluation of virtual care models as a strategy for promoting equity and quality.
Although it is a conceptual and consensus-based article, its strength lies in offering a structured framework and actionable recommendations to align medical education with future clinical practice.
- Specific competencies should be designed for virtual care, such as empathetic communication via video, safe use of platforms, remote decision-making, and respect for digital privacy.
- Adapted assessment tools should be used, including virtual Mini-CEX, rubrics for recorded consultations, and checklists.
- Apply the “Four Quadrants” model: what to teach (digital competencies), how (online simulations), where (real or simulated consultations), how to assess (direct or asynchronous feedback).
- Train faculty in digital education environments.
- Include the patient’s voice in curriculum planning and assessment.