Telehealth Communication
Telehealth communication is the set of skills a clinician uses to run a clinical encounter by video or telephone, covering the work that a shared physical room otherwise does for free: establishing presence, finding out who else is within earshot, holding a silence without visual confirmation that the other person is still thinking, and checking understanding when body language is cropped to a head and shoulders. The AAMC published six telehealth competency domains across the learning continuum in 2021, which treats the format as something a clinician has to be trained and assessed in rather than as ordinary bedside skill delivered through a camera.
Bajra and colleagues put 133 third and fourth year medical students at Stanford through a telehealth curriculum and a set of telemedicine OSCEs between July 2020 and August 2021, and the results, published in Frontiers in Medicine in 2023, show where the skill actually breaks. Students scored 94 to 99 percent on the four webside manner items, so warmth and rapport carried over to video without much trouble. Confirming confidentiality happened in 21 percent of encounters, and reviewing the limitations of a video visit in 35 percent. The parts of the encounter that exist only because it is remote are the parts that got dropped.
That pattern makes sense once you list what the format takes away. A clinician standing in a room can see who else is present, read a relative's face at the edge of the bed, and let a pause sit without wondering whether the connection has frozen. On video each of those has to be done out loud. Asking who else is in the room is not a courtesy, it is the only way to know whether the patient can answer honestly.
High-stakes conversations raise the difficulty again. Delivering a serious diagnosis to a patient sitting alone in a parked car, or running a family meeting with relatives joining from three locations and one of them on a phone, changes the sequencing of the conversation rather than only its tone. The Stanford study is useful because it assessed the communication half rather than the technology, and its numbers suggest the communication half is where the training gap sits.
The skill is also not confined to trainees. Attendings who spent a career learning to read a room got the same abrupt shift to video, and the habits that make an experienced clinician good in person, the pause at the door and the read of a family's mood, are exactly the ones the format interferes with.
What this looks like in a program
- Ask who else is in the room every time, and expect the answer to change what the patient is willing to say.
- State out loud what a video visit cannot do, since a patient who has not heard the limitation will assume the examination was complete.
- Rehearse the silence. A pause that reads as thoughtful in person reads as a frozen screen on video, so clinicians fill it and talk over the answer they were waiting for.
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Last updated August 2026