Virtual Care, Real Gaps: Why Telemedicine Training Has Not Kept Pace With Modern Medical Practice

In March 2020, the American healthcare system executed what may be the most rapid operational transformation in its history. Within weeks, physician offices that had conducted virtually no video visits were delivering the majority of their outpatient care through a screen. Regulatory waivers expanded telehealth access. Patients adapted with surprising speed. And medical residents, already navigating an overwhelming clinical environment, were handed new platforms, new workflows, and new patient interaction challenges with almost no formal preparation.

Four years later, telehealth has not retreated. According to the American Medical Association, approximately 85 percent of physicians now use some form of telemedicine in their practice. Yet a 2023 survey of US medical school curricula found that fewer than 30 percent of programs include any formal telemedicine training. The gap between how medicine is practiced and how it is taught has rarely been more visible—or more consequential.

What Telemedicine Actually Requires

One of the most persistent misconceptions about virtual care is that it is simply in-person medicine conducted through a different medium. In practice, telemedicine demands a distinct and learnable set of competencies that do not transfer automatically from traditional clinical training.

Effective telehealth begins with environmental and technical literacy. Physicians must understand how to optimize camera placement, lighting, and audio quality to conduct meaningful visual assessments. They must be able to guide patients in performing rudimentary self-examinations—checking lymph nodes, describing skin findings, or positioning a camera to allow adequate visualization of an anatomical site. These are teachable skills, but they require deliberate instruction and practice.

Beyond the technical, virtual care demands sophisticated communication adaptation. The nonverbal cues that experienced clinicians rely upon in face-to-face encounters—posture, gait, the subtle signs of pain or distress visible in a patient's full body—are substantially compressed in a video frame. Physicians conducting telehealth visits must develop compensatory techniques: more explicit verbal check-ins, structured questioning protocols, and heightened attention to the patient's immediate environment as a source of diagnostic information.

There is also the critical domain of triage judgment—the capacity to determine, quickly and accurately, when a virtual encounter is insufficient and in-person evaluation is medically necessary. This judgment, poorly developed, carries significant patient safety implications. Studies published in the Journal of Telemedicine and Telecare have documented cases in which inadequate telehealth training contributed to missed diagnoses and delayed escalations of care.

Documenting the Curricular Deficit

The absence of formal telemedicine education in US medical schools is not the result of indifference—it reflects the speed with which clinical practice outpaced educational infrastructure. Medical curricula are notoriously slow to change. Accreditation frameworks, course sequencing constraints, and faculty expertise all create institutional inertia that innovation struggles to overcome.

The Liaison Committee on Medical Education, which accredits US MD-granting institutions, does not currently mandate telemedicine training as a standalone competency domain. The Accreditation Council for Graduate Medical Education has begun to acknowledge virtual care in its program requirements, but implementation across specialties remains inconsistent. Without top-down accreditation pressure, curriculum reform depends on the initiative of individual institutions and program directors.

The result is a patchwork landscape. Some residency programs—particularly in primary care, psychiatry, and dermatology, where telehealth adoption has been most extensive—have developed thoughtful virtual care rotations. Many others have not.

Programs Leading the Way

A handful of institutions have moved decisively to address this gap, and their approaches offer a practical template for broader adoption.

The University of Virginia School of Medicine launched a dedicated Telehealth Curriculum in 2021, integrating standardized patient encounters conducted via video platform into its core clinical skills sequence. Students receive faculty feedback not only on their clinical reasoning but on their telehealth-specific communication behaviors—how they establish rapport through a screen, how they manage technical disruptions, and how they document virtual encounters in compliance with evolving billing requirements.

At Thomas Jefferson University's Sidney Kimmel Medical College, a telemedicine elective developed in partnership with Jefferson Health's virtual care division places students directly into functioning telehealth workflows, where they observe and participate in real virtual visits under attending supervision. The program has since expanded to include a dedicated telehealth simulation laboratory.

For residents and practicing physicians seeking to self-educate in the absence of formal institutional programs, the American Academy of Family Physicians and the American Telemedicine Association both offer structured continuing education curricula in virtual care competencies. These programs, while not equivalent to embedded clinical training, provide a rigorous foundation in the regulatory, technical, and clinical dimensions of telehealth practice.

A Call to Curricular Action

The argument for formalizing telemedicine education is not simply one of professional convenience. It is a patient safety argument. Physicians who lack training in the specific demands of virtual care are more likely to conduct inadequate assessments, miss critical findings, and fail to appropriately escalate care. As telehealth continues to serve as a primary point of contact for millions of Americans—particularly in rural and underserved communities where in-person access is limited—the quality of virtual care is a public health issue.

Medical educators bear a responsibility to close this gap with urgency. That means advocating for accreditation standards that recognize telemedicine competency as non-negotiable, developing simulation-based training that replicates the virtual care environment, and partnering with health systems to create supervised telehealth clinical experiences for students and residents.

At Zarmed University Health, we believe that the measure of a medical education is its fidelity to the realities of contemporary practice. A curriculum that prepares physicians for the clinical encounters of 2010 but not 2025 is not a rigorous curriculum—it is an incomplete one. Telemedicine is not the future of healthcare. It is the present. Medical education must meet it there.