Preparing the Emergency Physician Virtual Workforce: Implementation of a PGY-3 Telehealth Rotation

As virtual emergency department (VED) visits and tele-observation models expand, emergency medicine (EM) practice environments are rapidly evolving. Despite this growth, formal EM residency training has not consistently incorporated structured telehealth experiences, creating a gap between emerging care models and resident preparedness for independent practice. Deliberate curricular innovations are needed to integrate residents into authentic virtual emergency care workflows.

To address this gap, we designed and implemented a mandatory post-graduate year-3 (PGY-3) VED and Tele–observation (Tele-obs) rotation at an academic medical center. The rotation integrates supervised Tele-obs rounds, direct-to-consumer VED encounters for low-acuity conditions, bedside observation rounds with virtual supervision, and participation in telehealth operational and performance review meetings. The objective is to prepare senior residents for supervisory roles in telehealth-enabled emergency care.

We implemented a required 2-week PGY-3 rotation by embedding residents into existing virtual emergency care workflows. Following structured orientation to telehealth platforms, residents functioned as primary communicators during virtual patient encounters under real-time attending supervision, participated in disposition decision-making, and engaged in virtual operational activities. Census and utilization data were abstracted from existing databases, and an early mixed-methods evaluation was conducted using standard post-rotation evaluations and free-text comments.

During the first five months of implementation, the Tele-obs unit managed 4,409 encounters, with a mean length of stay of 17.7 hours and an admission rate of 19%, comparable to the preceding five month period. Resident participation in the VED averaged approximately one patient per hour. Early resident evaluations (n = 3) reflected high perceived educational value and appropriate faculty supervision, while identifying opportunities to improve resident role clarity within Tele-obs workflows.

We implemented a required PGY-3 telehealth rotation to address the growing gap between rapidly expanding virtual emergency care models and limited formal telehealth training within EM residency curricula. Rather than relying on simulated or parallel educational experiences, this rotation embeds senior residents directly into real-world tele-observation and direct-to-consumer VED workflows supported by existing virtual care infrastructure. Within this structure, residents serve as primary communicators during virtual patient encounters under real-time attending supervision, participate in clinical decision-making and disposition planning, and engage in systems-based learning through exposure to telehealth operational metrics and performance review processes. The rotation incorporates multiple telehealth care models, including provider-to-provider Tele-obs supervision and direct-to-consumer virtual emergency visits, reflecting the diversity of contemporary telehealth practice. Early implementation demonstrated that resident participation was feasible within high-volume Tele-observation and virtual ED workflows, with over 4,400 tele-observation encounters managed system-wide during the implementation period. Length of stay and admission rates remained comparable to baseline operational metrics, suggesting that the integration of resident learners did not disrupt routine clinical operations. Learner feedback highlighted high perceived educational value, appropriate faculty supervision, and meaningful opportunities to develop clinical, communication, and systems-based competencies specific to virtual emergency care. Residents also identified practical challenges, including variable role clarity within highly efficient Tele-obs workflows, multi-site rounding logistics, and limitations of EHR and telehealth platform functionality. These insights are now informing iterative refinement of rotation structure, expectations, and supervision models. This innovation offers a scalable framework for integrating telehealth training into EM residency education by leveraging existing operational infrastructure and aligning resident responsibilities with authentic practice needs. As virtual emergency care continues to expand across diverse health systems, similar structured telehealth rotations may play a critical role in preparing the EM workforce for telehealth-enabled practice.