Of the 13,017 HPTs who responded to the survey, 10,865 HPTs (83.4%) from 133 VA facilities had complete data and were included in the analytical sample (Table 1). The sample consisted of 43% physician HPTs (both allopathic and osteopathic) (n = 4,681), 40% associated health HPTs (n = 4,342), and 17% nursing HPTs (n = 1,842). Among the nursing HPTs, registered nurses (n = 1,246) were the largest group, followed by nurse practitioners (n = 371), licensed practical nurses/licensed vocational nurses, nurse assistants (LPN/LVN/NA) (n = 125) and others (n = 100). The 10 top 10 HPT associated health groups were pharmacy (n = 850), psychology (n = 687), optometry (n = 433), physical therapy (n = 364), physician assistants (n = 353), social work (n = 279), occupational therapy (n = 205), medical imaging (n = 127), dietetics (n = 120), and other (n = 924).
Participation in Telehealth and Virtual Supervision by HPT Profession
Participation in telehealth and virtual supervision varied significantly by HPT profession. (Table 2). Specifically, the highest participation rates were reported by associated health HPTs (47.2% for telehealth, 33.8% for virtual supervision), followed by physician HPTs (31.1% for telehealth, 21.5% for virtual supervision), and nursing HPTs (22.9% for telehealth, 21.5% for virtual supervision). These differences between professions were statistically significant (p < .001).
Table 2
HPT Professions’ Participation in Telehealth and Virtual Supervision (Trainee Satisfaction Survey, AY 2022–2023)
| Profession | n | Telehealth Participationa n (%) | Virtual Supervision Participationa n (%) |
| Medical | 4,681 | 1,454 (31.1%) | 1,005 (21.5%) |
| Physician Resident (MD or DO) | | | |
| Nursing | 1,842 | 421 (22.9%) | 263 (14.3%) |
| Registered Nurse | 1,246 | 130 (10.4%) | 68 (5.5%) |
| Nurse Practitioner | 371 | 266 (71.7%) | 175 (47.2%) |
| LPN/LVN/NA | 125 | 21 (16.8%) | 18 (14.4%) |
| Other | 100 | 3 (3.1%) | 1 (1.0%) |
| Associated Health | 4,342 | 2051 (47.2%) | 1466(33.8%) |
| Pharmacy | 850 | 485 (57.1%) | 364 (42.8%) |
| Psychology | 687 | 645 (93.9%) | 590 (85.9%) |
| Optometry | 433 | 25 (5.8%) | 12 (2.8%) |
| Physical Therapy | 364 | 132 (36.3%) | 31 (8.5%) |
| Physician Assistant | 353 | 75 (21.2%) | 34 (9.6%) |
| Social Work | 279 | 176 (63.1% | 130 (46.6%) |
| Occupational Therapy | 205 | 92 (44.9%) | 37 (18.0%) |
| Medical Imaging | 127 | 3 (2.4%) | 2 (1.6%) |
| Dietetics | 120 | 102 (85.0%) | 74 (61.7%) |
| Other | 924 | 313 (34.2%) | 190 (20.8%) |
| Total | 10,865 | 3926 (36.1%) | 2734 (25.2% |
| a Statistically significant differences in telehealth or virtual supervision participation by HPT profession (p < .001) |
Table 2 provides further detail on participation variations among specific professions. Among nursing HPTs, nurse practitioners had the highest participation rates (71.7% for telehealth, 47.2% for virtual supervision), followed by LPN/LVN/NA (16.8% for telehealth, 14.4% for virtual supervision), and registered nurse HPTs (10.4% for telehealth, 5.5% for virtual supervision). In the associated health professions, psychology HPTs had the highest participation rates in both telehealth (93.9% for telehealth and 85.9% for virtual supervision 85.9%), followed by social work (63.1% for telehealth, 46.6% for virtual supervision), and pharmacy (57.1% for telehealth, 42.8% for virtual supervision).
Trainee Perspectives on Telehealth and Virtual Supervision
Table 3 summarizes qualitative findings on telehealth and virtual supervision perceptions across HPT professions. Most HPTs expressed positive views on their experiences with telehealth and virtual supervision in VA facilities. High levels of positivity were expressed in the open-ended comments among nursing HPTs (98.1% for telehealth, 100% for virtual supervision), associated health HPTs (97.1% for telehealth, 97.7% for virtual supervision), and physician HPTs (90.4% for telehealth, 95.8% for virtual supervision). Some associated health and physician HPTs noted, but did not elaborate, that virtual supervision was “as effective as” in-person supervision.
Table 3
HPT Perspectives About Telehealth and Virtual Supervision
| Themes | Physician | Associated Health (AH) | Nursing |
| Telehealth Perceptions |
| Number of Comments about Telehealth | • n = 136 | • n = 210 | • n = 53 |
| Overall Perception | • 90.4% positive | • 97.1% positive | • 98.1% positive |
| Rotations/Settings where Telehealth Occurred | • Intensive care unit • Dermatology • Primary care • Neurology • Geriatrics • Radiology • Rural health • Sleep • Psychiatry • Wound check • Stroke | • Traumatic brain injury/Spinal cord injury • Medication reconciliation • Pharmacy • Tobacco cessation • Cognitive behavioral therapy • Anticoagulation clinic • Neuropsychology evaluations | • Pharmacy • Outpatient |
| Virtual Supervision Perceptions |
| Number of Comments about Virtual Supervision | • n = 338 | • n = 793 | • n = 200 |
| Overall Perception | • 95.8% positive | • 97.7% positive | • 100% positive |
| Frequency | • Weekly supervision sessions | • Rarely • 1–2 sessions/week • 25%-30% of overall supervision • Almost all supervision was virtual supervision | • Weekly |
| Virtual Supervision Model | • Resident on call - discuss cases with attending at home • Attending physically present in different room and listening while HPT conducting telehealth visit • Attending virtually present on calls and tele-visits • Calling patient for tele-visit, calling attending to staff visit, then call patient back to discuss the plan • Attending is in another state, resident takes care of telephone visits with min supervision/staffing • HPT meets with supervisor via phone or video chat as needed | • Supervisor physically present in different room and listening while HPT conducts telehealth visit • Supervisor virtually present on calls and tele-visits • HPT meets with supervisor via phone or video | • Preceptor on video visit Teams meeting, one-on-one Teams meeting |
| Factors Influencing Virtual Supervision Experience | • Attending/supervisor traits – responsive, available • Setting | • Technology issues-bad signals, poor Wi-Fi, poor audio, malfunctioning cameras/poor video, patients don’t have good technology access • Attending/supervisor traits – responsive, available, organized | • Attending/supervisor traits - Inexperienced supervisor |
Representative Comments:
“An attending supervised me either on a separate computer or in the same room as me while I conducted telehealth visits. Overall, it was a similar level of supervision and quality of education in comparison to in-person visits. -Physician HPT
“I met with my preceptor weekly via telehealth. I felt it was just as effective, if not more so, than in person. We did not have technical issues and were able to look at the same patient chart at the same time, which was very helpful.” -Nurse Practitioner HPT
“[Virtual supervision was] convenient with minimal concerns that impacted my training experience, although my preference remains face-to-face supervision. -Psychologist HPT
The quality of the virtual supervision encounters were influenced by technology and supervisory relationships. Technological challenges were frequently associated with negative views of virtual supervision including interruptions in internet connectivity, telephone or video connections, and software issues. Additionally, the supervisor-supervisee relationship played an integral role in shaping the virtual supervision experience evidenced by comments about faculty supervisors’ traits including accessibility, supportiveness, resourcefulness, effective communication skills, and attentiveness.
Representative Comments:
“I felt that this was a good experience. Everything worked very smoothly (besides the occasional technology hiccup of course). I felt that the training I received was equal to or even better than previous in-person precepting experiences.” –Pharmacist HPT
Far as technology, I was satisfied. I was able to easily access my supervisors this way and meet with supervisors at different clinics, teleworking, and with busy schedules. The supervisors have different supervision styles and I think that effected my experience. Some supervisors I didn't feel they provided adequate supervision or support.
– Psychologist HPT
“[Virtual supervision was] great, easy to review data and discuss with attending over Microsoft Teams.” – Physician HPT
“It was wonderful to have my supervisors so accessible. Virtual supervision allowed me to effectively engage in a major rotation during half of a day and engage in my minor rotation the other half of the day. Based on the way patient care fell (i.e., group schedules, appointment times), it would have been difficult to attend all of these as they are across the medical center campus. Virtual supervision truly streamlined my internship. – Psychologist HPT
“Value of virtual supervision varied by supervisor and often matched their in-person supervision style; if they were conscientious in person, that remained in remote format, if not, that was also true for both formats.” – Psychologist HPT
Depending on the type of training experience, the frequency and depth of virtual supervision varied among HPTs, ranging from occasional sessions in special circumstances to weekly sessions where almost all supervision was conducted virtually. For physician HPTs, virtual supervision most occurred within specialties utilizing telehealth clinics, such as dermatology, psychiatry, and stroke care. Pharmacy and nursing HPTs experienced virtual supervision during specific clinic rotations such as anticoagulation and ambulatory care, whereas psychology and social work HPTs received virtual supervision during cognitive behavioral therapy training experiences.