Telehealth Competency Evaluation Tools: A Scoping Review

Abstract

Introduction:

Telehealth is an integral part of healthcare. Exposure to telehealth education is essential for both students and health care professionals to support its effective adoption and appropriate utilization. This scoping review aims to explore whether and which telehealth competencies are being assessed and the methods used to evaluate them among health care professionals and students.

Methods:

An electronic literature search was performed using six electronic databases between January 2024 and February 2025. We included studies where telehealth competencies or their components were evaluated by some type of tool (validated or researcher created). Strict inclusion and exclusion criteria were used, and each article was evaluated by at least two reviewers.

Results:

Out of 1,217 articles screened by title and abstract, 75 met inclusion criteria, with 36 of those selected for inclusion in this review. Participants were evaluated mostly by researcher-created tools that lacked psychometric properties or adapted nontelehealth evaluation tools. Few validated/reliable tools directly measured telehealth competencies.

Discussion:

The results of this review illustrate there exists a lack of available validated/reliable evaluation tools to appraise telehealth competencies. Few studies included an evaluation of all telehealth competencies but rather focused only on communication and technology proficiency; none evaluated the appropriate use of telehealth or digital disparities.

Conclusions:

More research is needed to develop validated telehealth evaluation tools that can be used across disciplines and encompass all telehealth competencies. Additionally, true research methods are needed to adequately assess the impact of telehealth education on the performance and confidence of learners.

Keywords

telehealth telemedicine competency-based education telehealth competency

Introduction

Telehealth, once a distant concept, is now an integral part of healthcare. The COVID-19 pandemic, related reimbursement expansion, and telehealth regulation flexibilities thrust virtual care to the forefront of health care.¹ While definitions of telehealth vary, the term is generally used to refer to a broad array of services provided via technology beyond direct clinical care. Telemedicine, the provision of clinical care across distance, is a subset of telehealth.² The terms telehealth and telemedicine are often used interchangeably. In this article, telehealth is used to refer to patient care across distance.

Prior to the pandemic, most healthcare providers had not received formal telehealth education.³ However, providers who report receiving education have been shown to have higher telehealth self-efficacy, perceived knowledge, satisfaction, and utilization of telehealth.⁴ Due to the rapid growth in telehealth utilization, health care providers are being increasingly educated to provide care virtually. Yet, significant variations exist regarding content, methods of integration into curricula, and specific competencies evaluated.³ Education modalities used include didactics, simulations using standardized patients, practice immersions, and telehealth project development, among others.^5–8

Healthcare education for providers has been consistently moving toward competency-based education. To date, no universal set of telehealth competencies has been established as a requirement for the provision of telehealth care nationally. However, competencies and related standards have been recommended by various academic and professional organizations for specific health care provider groups and generally contain similar content. The National Organization of Nurse Practitioner Faculties (NONPF) in its 2022 Nurse Practitioner Role Competencies⁹ and the American Association of Colleges of Nursing in its Nursing Essentials¹⁰ emphasize the importance of technology integration into nurse practitioner (NP) education and its application to delivering high-quality health care. To foster telehealth knowledge, skills, and attitudes, telehealth competencies for advanced practice registered nurse (APRN) education and practice have been established using the Four Ps of Telehealth framework, which includes competencies specific to planning, preparing, providing, and performance evaluation.¹¹ However, no competencies have been reported for the nursing profession outside of APRNs.

Telehealth competencies for medical education, similar to the Four Ps of Telehealth framework, also encourage telehealth education but divide it into four tiers of physician development (recent medical school graduate or entry to residency; recent residency graduate or entry into practice; 3–5 year postresidency graduate; and experienced physicians).¹² The medical education competencies focus on patient safety and appropriate telehealth use, access, and equity in telehealth, communication via telehealth, data collection and assessment via telehealth, technology, and ethical practices and legal requirements for telehealth.¹² Despite varying standards, common themes include technology-related skills, professionalism, communication skills, virtual physical examination skills, acknowledgment of the limitations of telehealth visits, and risks related to increasing disparities in care.¹³

Telehealth pharmacy practice guidelines have been published by the American Society of Health System Pharmacists. They focus on practice applications, medication selection and monitoring, counseling, state and federal regulations, reimbursement, and infrastructure but do not incorporate telehealth etiquette or professionalism.¹⁴ Similar practice guidelines are available for teledentistry, published by the American Dental Association.¹⁵ Educational telehealth competencies for physical therapists (PT) also exist and are divided into seven broad categories (ethics, clinical skills, affect and communication, administrative, regulatory, technical, and research and development) with each further subdivided into individual competencies.¹⁶ Although telehealth competencies are available to guide its use to maximize patient outcomes and the literature is abounding with various studies highlighting their incorporation into health professions curricula, to date, there exists a paucity of validated evaluation tools to assess telehealth competencies. This scoping review aims to identify existing tools and methods of evaluating telehealth competencies among health care professionals and students. The literature search was guided by the research questions: In telehealth education of all health professionals (students and current professionals), how is telehealth education evaluated? What telehealth competencies are being evaluated? and What assessment or evaluation tools are currently being used for telehealth competencies during an educational activity?

Methods

DATA SOURCES AND SEARCH STRATEGIES

This scoping review followed the methodology of Templier and Paré,¹⁷ which is composed of six steps: (1) formulation of the research question and objectives, (2) literature search, (3) screening for inclusions, (4) quality assessment, (5) data extraction, and (6) analysis of data. The literature search was guided by the research questions: In telehealth education of all health professionals (students and current professionals), how is telehealth education evaluated? What telehealth competencies are being evaluated? and What assessment or evaluation tools are currently being used for telehealth competencies during an educational activity? It was conducted in January 2024 and then redone in February 2025. The literature search was assisted by an academic librarian from a southeastern academic medical center regarding appropriate search terms, strategies, and choice of databases. ScopusÓ, PubMed, ProQuest’s Health care Administration, and 35 databases on the EBSCOHost Platform, including CINAHL Complete, ERIC, Health Source: Nursing/Academic Edition, and Academic Premier, were accessed electronically to retrieve appropriate references. The standard search strategy used to narrow the results due to the number of databases accessed was (TITLE-ABS (“health professionals” OR “health care professionals” OR “health personnel” OR “health care personnel” OR nurses OR physicians OR “physician assistant” OR “physician associate” OR “advanced practice providers” OR “nurse practitioners” OR “physician assistant” OR “nurse practitioner” OR “advanced practice nurse” OR “registered nurse” OR nurse OR “staff nurse” OR “graduate nurse” OR “qualified nurse” OR interprofessional OR intraprofessional OR doctor) AND TITLE-ABS (“telehealth etiquette” OR tele-etiquette OR teleevaluation OR telehealth OR telemedicine OR telemonitoring OR telepractice OR telenursing OR telecare) AND TITLE-ABS ((assessment OR measure OR tool OR instrument OR survey OR evaluat* OR competency OR competencies OR test OR outcome OR performance)) AND TITLE-ABS ((“diagnostic reasoning” OR “clinical decision making” OR “clinical decision-making skills” OR “clinical judgement” OR “critical thinking” OR “critical thinking skills” OR “critical reasoning” OR simulation OR “standardized patients” OR “simulated patient”))). Upon retrieval, the search results were uploaded to Covidence Systematic Review Software portal for screening, assessment, and data extraction. Covidence is an online platform used to streamline the review process.¹⁸

INCLUSION AND EXCLUSION CRITERIA

For an article to be included in the data extraction and assessment, it had to meet the following criteria at both title and abstract screening and full-text screening: included any health professional; synchronous telehealth, asynchronous telehealth, mHealth, or remote patient monitoring; and had to include an assessment of telehealth competencies/best practices. The literature search had no limitations in date of publication. Conference proceedings/abstracts/informational documents, review papers, no specific evaluation tool included, patient-focused studies, or documents not written in English were all excluded from the review.

The quality of the articles was assessed using the Johns Hopkins Research and Nonresearch Evidence Appraisal Tools based on the study/project design, which evaluates both research and nonresearch-based articles.¹⁹ The Level of Evidence is determined based on the study/project design and ranges from the highest level of research with a Roman numeral score of I (e.g., true research with randomization) to the lowest with a score of V (e.g., quality improvement, program evaluation, and literature reviews).¹⁹ Additionally, the quality of the publication and the information contained within it are evaluated using an alphabetical scoring system of A (high quality), B (good quality), or C (low quality).¹⁹ The alphabetical scoring system varies between research versus nonresearch studies and then the type of study being evaluated. For example, for a nonresearch quality improvement study, a score of an A would include clear aims and objectives, consistent results reported across settings, formal quality improvement methods, definitive definitions, consistent recommendations, and scientific evidence references,¹⁹ whereas, for quantitative research, an A would include consistent, generalizable results, sufficient sample size, adequate control, definitive conclusions, and consistent recommendations.¹⁹ Low quality (C) of either nonresearch or research studies would not include any of these requirements. The quality appraisal of each article was completed by one reviewer, and the results were confirmed by the lead author. If any discrepancies were noted, they were discussed between the lead and senior author.

SCREENING AND DATA EXTRACTION

Screening of each article occurred in two steps: (1) evaluation of titles and abstracts by two team members and (2) full-text review. The expert panel of reviewers consisted of eight telehealth experts. These experts consisted primarily of nurse practitioner educators who all had extensive experience providing care virtually as well as integrating telehealth education into graduate nursing curricula.

Inclusion and exclusion criteria were discussed with each reviewer prior to the screening process and reassessed throughout the process by the senior author. Seven reviewers were involved in the initial screening and data extraction processes. Each article required two reviewers, and if a conflict arose, it was resolved by the senior author.

Results

LITERATURE SEARCH RESULTS

Based on the original search and the 1-year follow-up, 1,217 documents were retrieved with 197 duplicates. Members conducted the title and abstract screening of 1,020 documents, where they marked 944 as irrelevant, leaving 76 for full-text review. After assessing each article for eligibility, 40 documents were excluded for eight reasons, leaving 36 for the final inclusion for this systematic review. See Fig. 1 for the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram and Table 1 for a summary of the synthesis of the findings.

Fig. 1.

PRISMA flow diagram.

Table 1.

Summation of Articles Included in Review

REFERENCE	STUDY AIM	PARTICIPANT TYPE AND NUMBER	MODE OF EVALUATION	SETTING OF EVALUATION	TYPE OF TOOL (RESEARCHER CREATED, ESTABLISHED)	WAS TOOL VALIDATED?	TOOL NAME IF PROVIDED	TYPE OF EVALUATION	WHO COMPLETED THE TOOL?	OUTCOMES MEASURED
Arif et al. (2025)²⁰	Development and validation of a tool to assess telehealth educational environment	Step 1: Telehealth experts (10) Step 2 and 3: Telehealth physicians (5, 320)	Interviews and electronic tool	“telehealth setting”	Researcher created	Yes	Telehealth Educational Environment Measurement tool	Tool development project	Participant	Learner engagement and support, instructor guidance and communication, quality/accessibility of telehealth educational resources, and technology for education
Baliko et al. (2023)²¹	Describe a two-part telehealth simulation to build FNP student competencies in interviewing clients with depressive symptoms	FNP students (135)	Electronic survey and focus group feedback	Academic/simulation center	Researcher created	No	n/a	Posttest only (postdidactic and then postsimulation)	Participant	Change in knowledge, comfort with telehealth, competencies (etiquette, patient engagement, therapeutic communication, professionalism), intent to use telehealth, reflective self-evaluation of their performance
Berrier & Heller (2022)²²	Design evidence-based and best practice educational module that reflected the practice of telehealth medicine in today’s healthcare environment	NP/APRN students (15)	Pre/posttest and skills observation during simulation	Academic/simulation center	Established	Yes. Cronbach’s α coefficient of 0.94 (satisfaction) and 0.87 (self-confidence)	National League for Nursing (NLN) Student Satisfaction and Self-Confidence in Learning Instrument	Posttest only	Participant	Satisfaction and self-confidence
Budisalich et al. (2024)⁸	Describe a high-fidelity simulation for an acute care visit using telemedicine	NP/APRN students (212)	Skills observation during simulation	Simulation center	Researcher created	No	n/a	Posttest only	Faculty	Focus is on proof of concept. Evaluated telehealth etiquette, communication skills, and physical exam skills
Burt & Kilroy (2021)²³	Describe a multimodal, telemedicine-focused curricular innovation and student evaluation of the strategy	Adult gero NP students (6)	Posttest survey	Academic/simulation center	Established	Yes. Cronbach’s α coefficient of 0.94 (satisfaction) and 0.87 (self-confidence)	NLN Student Satisfaction and Self-Confidence in Learning Instrument	Posttest only	Participant	Satisfaction and self-confidence
Butler Carrol & Phillips (2018)²⁴	Evaluate telemedicine training program	MD ,DO, mental health providers, APRN/NP, PA, social work, CHW, CMA, RT, admin staff, nurses (176)	Pre/postcourse knowledge test followed by an OSCE with SP	Telemedicine education center	Researcher created	No	n/a	Pre/posttest and skills observation	Participant	Telehealth etiquette; technology skills; other: multidisciplinary team roles, terminology, technology
Cassidy et al. (2020)²⁵	Evaluate an online lecture and virtual telehealth simulation	FNP students (57)	Electronic quantitative survey with three open-ended questions post the lecture and simulation	TEAMS simulation	Researcher created	No	n/a	Posttest only	Participant	Change in knowledge, comfort, and satisfaction with telehealth
Cook et al. (2022)²⁶	Create and test a pilot to improve telehealth education and competency for students and foster a team-based approach	MD, DO, APRN/NP, PA (12 didactic/6 for OSCE)	Electronic survey and postsimulation debriefing sessions	Academic (e.g., classroom)	Established	Yes. Validity was assessed through confirmatory factor analysis with a p < 0.0001, and reliability was determined to be good using Cronbach’s α (0.84)	Nebraska Interprofessional Education Attitude Scale	Pre/posttest evaluation	Participant	Confidence in telehealth skills, learner attitudes toward interprofessional care delivered via telehealth. No specific telehealth competencies evaluated
Creese et al. (2024)²⁷	Assess impact of virtual medication adherence training program on student’s perceived confidence and perceived competency in delivering medication adherence services via telehealth	Pharmacy students (22)	Survey by participants and rubric completed regarding student performance by SP	Academic (e.g., classroom)	Researcher created	No	n/a	Pre/posttest	Participant and SP	Change in comfort with telehealth, satisfaction, perceived confidence, competence related to medication adherence, communication (motivational interviewing via telehealth)
Crittendon et al. (2024)²⁸	Identify principles of successful virtual volunteer engagement within simulation education and outline perceived barriers for telehealth simulation volunteer opportunities	Faculty; AmeriCorps Seniors RSVP volunteers (>56 years) x 3+ program coordinator x 2 (FNP and DNP nurse educator)	Interviews	Simulation center	n/a	No	n/a	Posttest only	Faculty interviewed participants	Perceptions of using older adults during telehealth simulations
DeFoor et al. (2024)²⁹	Describe the process of creating, implementing, and evaluating a simulation-based telehealth learning experience that incorporated content for an SP experiencing intimate partner violence during pregnancy.	Senior level nursing students	Postexperience student debriefing with faculty and faculty evaluation of student learning outcomes and the experience	Simulation lab conference room	n/a	n/a	n/a	Postevaluation of experience by faculty	Faculty	No specific telehealth competencies. Learning outcomes included identifying risk factors for intimate partner violence, incorporating effective telehealth communication that includes diversity and inclusion for OB clients and formulating an appropriate plan of care.
Gibson et al. (2020)³⁰	Describe reinforcing NP telehealth didactic curriculum and competencies through application in a clinical environment	NP students (22), and preceptors (MDs and NPs n = 19)	Skills observation during live telehealth clinical encounters	Telehealth clinical hub	Researcher created	No	“Student Telehealth Evaluation” and “Preceptor Telehealth Evaluation”	Postevaluation only	Preceptors evaluated students and students evaluated preceptors	Telehealth etiquette; webside manner; technology skills; telehealth exam skills; telehealth policy (laws/regulations); other: The criteria for evaluation addressed competencies in on-screen presence, communication, use of telehealth equipment, reimbursement, licensing, confidentiality, confidence, and competence
Gong et al. (2022)³¹	Examine the association between consultation length and the quality of E-consults services to get new insights for potential policies and practices that could improve online health service quality in China	Providers (MDs) of tele-dermatology E-consults (87)	SPs evaluated consultation length and quality of tele-dermatology E-consults in China	Clinic/worksite	Researcher created	No	n/a	Postevaluation only	Standardized patients evaluated providers	Consultation length; Time awaiting first response, time waiting for each response, time for consultation, total time of provider responses, and average words of provider responses
Greengold et al. (2025)³²	Evaluate impact of pilot online learning platform and standardized coaching program on the quality of medical student telemedicine clinical skills	Fourth year medical students who completed all core clinical rotations (n = 12)	Participant; PI/research staff observation using electronic tool	Simulation center	Researcher created	No	n/a	Pre/postevaluation of skills observation during simulation	Students: self-reported telehealth skills, attitudes, and self-efficacy Non-PI reviewers evaluated telehealth competencies	Telehealth etiquette; technology skills; telehealth exam skills; other: communication, history, physical exam, rapport, ^TM particularities
Haimi et al. (2020)³³	Explore patient safety within a pediatric tele-triage service, based on the diagnosis and appropriateness of the physician decision and decision reasonableness of the physician providing the service. Also examined physician methods to maintain patient safety	Review of 339 telephone consults; Qual: 15 physician interviews	Two independent physicians completed a retrospective chart review and physician interviews	Clinic/worksite	Established; dichotomous evaluation of diagnosis appropriateness and decision reasonableness	No	n/a	Retrospective	Two independent physicians	Safety of telehealth, diagnosis appropriateness and decision reasonableness
Heyck Lee et al. (2022)³⁴	Evaluate patient and physician perspectives on the key advantages and disadvantages of telephone consultations in a nephrology out-patient clinic setting	235 patients with CKD who participated in at least one telephone consultation with a nephrologist during COVID-19 and 11 nephrologists	Study coordinator administered survey electronically to nephrologists. Patients received survey by post mail or email	Clinic/worksite	Researcher created	No	n/a	Postvisit evaluation	Participants, nephrologists	Satisfaction/ease of use. Participants provided self-reported measures in five domains of satisfaction: user experience, technical quality, perceived effectiveness on well-being, perceived usefulness, and effect on interaction. Nephrologists provided self-reported measures within six categories: general experience, time management, medication changes, quality of care, job satisfaction, and challenges/strength
Hintz, et al. (2022)³⁵	Implement a rural trauma telementoring pilot program to increase physician confidence and trauma team dynamics in rural settings	Primary care MD, DO; X-ray technician/sonographer, trauma surgeons, RNs, lab technicians, radiology technicians (13)	Pre/posttest evaluation, skills observation during simulation and focus groups	Clinic/worksite	Established	Cronbach’s α acceptable internal consistency of 0.70. The ICC was 0.54 (95% CI, 0.34‚0.70) and the CR was 1.53 (95% CI, 1.29‚ 1.94)	Modified Non-Technical Skills for Trauma Assessment tool (T-NOTECHS)13	Pre and posttest; other: focus group data	Participant	Change in comfort with telehealth; satisfaction, technology skills, confidence
Johnson & Strauch (2024)³⁶	Leverage web-camera eye-tracking technology coupled with qualitative interviews to better understand rural NP perceptions, beliefs, experiences, and visual cues of connection and presence during mental health-related telehealth encounters	APRN/NP providers who deliver telemental health (10 for quantitative, 3 qualitative)	Use of eye tracking software/platform while watching a 73 s video of a SP and optional semistructured interviews	Academic/simulation center	Researcher created	No	n/a	Posttest only	Participant	Eye tracking (quant): (fixations, number of visits, time until areas of interest [AOI] noticed, number of times viewed, and time viewed) Interview (qual): experiences and perceptions related to connection and presence during mental health‚ related telehealth encounters
Jones et al. (2023)³⁷	Examine the effects of a new telehealth educational intervention using a multimodal approach including assignments combined with a simulated patient experience via telehealth in improving perception and confidence regarding telehealth in APRN students	APRN/NP students (68) enrolled in advanced health assessment course	Electronic survey self-administered in the course learning management system	Academic (e.g., classroom); simulation center	Researcher created	No	n/a	Pre and posttest	Participant self-administered in learning management platform	Change in knowledge; change in comfort with telehealth; satisfaction; ease of use; change in intent to use telehealth. Telehealth etiquette; webside manner; other: telepresence
LaManna et al. (2023)³⁸	Summarize student reflections after a telehealth simulation-based educational experience with an older adult standardized patient using robot videoconferencing technology	APRN/NP students (32) enrolled in a gerontologic advanced practice nursing course	Student completed a written electronic guided reflection within 24 h of the SBE in online learning system	Telehealth Center	Established	No	iSOAP Framework for Telehealth Simulation integrates telehealth-specific competencies into design of tele-health SBEs while applying best practices in simulation design	Posttest only	Participant	Change in comfort with telehealth; telehealth competencies; change in intent to use telehealth; telehealth etiquette; technology skills
Lawrence et al. (2020)³⁹	Evaluate the impact of an adapted telemedicine Objective Structured Clinical Examination (OSCE) on telemedicine-specific training competencies in residents	Primary care residents (32)	Observations by learners, faculty, and SPs during skills observation	Simulation center	No tool indicated	n/a	No specific tool. Three areas of telemedicine competency need were identified in the OSCE case: technical proficiency; virtual information gathering, including history, collateral information collection, and physical exam; and interpersonal communication skills, both verbal and nonverbal	1 out of 11 OSCE scheduled case during residency training	Observer (learner, faculty, SP)	Change in comfort with telehealth; satisfaction; telehealth competencies: webside manner; technology skills; telehealth exam skills
Lesselroth et al. (2024)⁴⁰	Describe the simulation experience to teach telemedicine competencies related to medication reconciliation and share data measuring effectiveness of the simulation	Students: Medicine (e.g., MD, DO)—primary care; PA (48)	SP completed paper evaluation form during simulation and students also completed a satisfaction questionnaire after the experience	Virtual encounter with SP site not specified	Researcher created based on Medication reconciliation and telemedicine competencies. Satisfaction by students was evaluated using a tool adapted from Levett-Jones et al referenced in the paper.	Original satisfaction tool was validated but adapted tool used here not evaluated	Satisfaction with Simulation Experience Scale 65	SP evaluated participant during simulation and satisfaction was posttest only	Participant and SP	Change in knowledge; change in comfort with telehealth; satisfaction; telehealth competencies; ease of use; change in intent to use telehealth Telehealth etiquette; webside manner; technology skills; other: competencies inferred
Liew et al. (2023)⁴¹	Describe the implementation and preliminary evaluation of a competency-based virtual consultation training module for undergraduate medical students	Medical school graduates who had not started residency (52)	Faculty and SP electronically evaluated participants	Academic (e.g., classroom); simulation center; other: online learning/simulation	Researcher created	Yes. The DOVCS checklist had an internal consistency of 0.92 with interrater reliability determined by an intraclass coefficient of 0.68, and 95% confidence intervals between 0.201 and 0.901, p < 0.001, based on a mean-rating (k = 2), absolute-agreement, two-way mixed-effects	DOVCS; assessment and Kirkpatrick level 1 and level 2 core evaluation feedback	Pre/post evaluation; skills observation during simulation	Participant; PI/research staff observation; standardized patient; other: faculty	Change in knowledge; change in comfort with telehealth; satisfaction; telehealth competencies: telehealth etiquette; webside manner; technology skills; telehealth exam skills
Love & Carrington (2021)⁴²	Educate DNP NP students to conduct patient interviews and provide interprofessional collaboration using telehealth	Psych mental health, adult acute care, family and pediatric NP students and the simulated patients involved (83)	Electronic pre/postevaluation	Academic (e.g., classroom); simulation center	Researcher created	No	N/a	Pre and posttest	Participant; standardized patient	Change in knowledge; change in comfort with telehealth; satisfaction; telehealth competencies: ease of use; change in intent to use telehealth; telehealth etiquette; webside manner; technology skills; other: competencies inferred
Moore et al. (2024)⁴³	Explore the effects of an innovative telehealth simulation-based learning experience on student telehealth knowledge, confidence, and attitudes	Total of 81 students, 66 BSN and 15 NP	Electronic, online portal Evaluation of learner responses to telehealth clinical scenarios	Academic (e.g., classroom); simulation center	Established tool Evaluation of learner responses to telehealth clinical scenarios	Yes. Face validity noted and authors state Cronbach’s α s demonstrated a relatively strong internal consistency for each TeleOSCE survey category.” Cronbach’s αs ranged from 0.694 to 0.928	Telemedicine Objective Structured Clinical Exam (TeleOSCE) instrument	Pre and postevaluation	Participant	Change in knowledge; change in comfort with telehealth; other: knowledge, confidence and attitudes related to telehealth Tool evaluates the students perception of their understanding, confidence and attitudes. It does not directly assess the student’s competency in a telehealth skill
Mulcare et al. (2020)⁴⁴	Develop, implement, and assess a training module designed to teach medical providers techniques to deliver professional, effective, and compassionate care during a telemedicine encounter	Medicine (e.g., MD, DO)—primary care (98)	Self-assessment made by learners	Academic (e.g., classroom); simulation center	Researcher created	No	n/a	Pre and posttest	Participant	Change in knowledge; change in comfort with telehealth; satisfaction; telehealth competencies; ease of use; change in intent to use telehealth Telehealth etiquette; webside manner; technology skills; telehealth exam skills
Posey et al. (2024)⁴⁵	Describe implementation of virtual flipped classroom and assess student knowledge, perceived learning, competency during simulation, association between number of simulations and level of telehealth competency, perceptions of virtual flipped classroom	APRN/NP students (64)	Electronic tool completed by participant pre/postsimulation and SP skills observation during simulation	Academic (e.g., classroom)	Established	Yes. Cronbach’s α 0.94	Telehealth Master Interview Rating Scale (Tele-MIRS) was used by SPs to evaluate students	Posttest only	Participant; standardized patient	Change in knowledge; change in comfort with telehealth; telehealth competencies: Telehealth etiquette; webside manner
Sheikh, K. (2022)⁴⁶	Framing the rapid-cycle deliberate practice (RCDP) model for advanced practice physical assessment in-person simulation laboratory sessions for telehealth learning	FNP students enrolled in a physical assessment course (16)	Skills observation by faculty during simulation	Academic (e.g., classroom); simulation center	Researcher created	No	The iSOAP simulation checklist	Observation during simulation	Faculty observation	Telehealth competencies; Other: therapeutic communication; technology skills; telehealth exam skills
Smith et al. (2024)⁴⁷	Measure students’ confidence and competence in using a telehealth platform to practice didactic knowledge and interviewing techniques via telehealth	Family APRN/NP students enrolled in a behavior health for the APN course (24), SPs (12)	Electronic pre and posttest evaluation completed before and after simulation, along with skills observation during simulation	Simulation center	Established	Yes. Prebriefing (Œ± = 0.833), learning (Œ± = 0.852), confidence (Œ± = 0.913), and debriefing (Œ± = 0.908)	Simulation Effectiveness Tool-Modified (SET-M)	Pre/post evaluation and skills observation during simulation	Participant; standardized patient	Communication and confidence (not telehealth focused) Telehealth etiquette; webside manner; telehealth exam skills; other: although does not specifically mention telehealth, was used with telehealth simulation
Taylor & Little (2024)⁴⁸	To evaluate the psychometric properties of a measure designed to capture domains of telehealth competencies among two large cohorts of interdisciplinary healthcare trainees representing 18 programs and 3 universities	Medicine (e.g., MD, DO)—primary care; APRN/NP; PA; OT/PT/ST; X-ray technician/sonographer; other: audiology, cardiovascular perfusion, clinical nutrition, generalist entry master-nursing, health sciences-bachelors, health systems management, medical laboratory sciences, pharmacy, respiratory care, speech-language pathology, other recruited from a two semester interprofessional education course N = 701 in exploratory study, n = 721 in confirmatory study	Electronic survey including TCQ-P was emailed to students for completion	Academic (e.g., classroom)	Researcher created measure of self-reported confidence in using telehealth-related skills to serve patients	Yes. CFI: 0.984, TLI: 0.978, SRMR: 0.035, RMSEA: 0.051 (0.044‚Äì0.058), p = 0.415	Telehealth Competency Questionnaire-Provider (TCQ-P)	One time survey prior to an interprofessional class	Participant	This tool evaluates self-reported perceptions of confidence in telehealth competencies; telehealth etiquette; website manner; technology skills; telehealth exam skills Validation of tool developed to measure three essential domains of telehealth competency for providers
Wakefield et al. (2004)⁴⁹	Compare nurse–patient interactions over two different videoconferencing systems designed for home telecare	26 nurses and 18 volunteers (simulating patients)	Survey completed by nurse and SP after simulated nurse–patient visits using two different videoconferencing devices to assess comfort, use and function of two different devices	Clinic/Work site	Researcher created	No	n/a	Posttest only	Participant; standardized patient	Change in comfort with telehealth; telehealth competencies; other: mix of comfort and usability
Wands et al. (2022)⁵⁰	Build nursing student’s capacity for providing patient-centered care to patients with SUD by having them learn and practice motivational interviewing skills with a vulnerable patient	Prelicensure nursing students (85)	Students completed CBI-24 and OMS-HC prior to simulation. After the simulation, students and SPs completed SCIR and CBI-6	Zoom	Established tools no specific to telehealth	Yes. OMS-HC 0.75–0.84 Cronbach’s α, SCIR Cronbach’s α > 0.90, CBI Cronbach’s α > 0.95, r = 0.88 for patients and 0.82 for nurses	Open Minds Scale (OMS-HC) Caring Behaviors Inventory (CBI) Simulated Clinical Interview Rating Scale (SCIR)	Pre and posttest	Participants	Change in assurance behaviors or motivational interviewing skills
Wittler et al. (2025)⁵¹	Evaluate family nurse practitioner students‚ perceptions of knowledge, confidence, and attitudes regarding telehealth before and after engaging in telehealth virtual simulations in six courses	APRN/NP BSN-DNP FNP students: advanced health assessment (n = 13), Women’s health (n = 13), NP role synthesis (n = 8)	Pre and postsimulation online survey	Academic (e.g., classroom); simulation center	Established	No	n/a	Pre and posttest	Participant	Perceptions of telehealth knowledge, confidence and attitudes
Wong et al. (2020)⁵²	Describe and evaluate a telehealth curriculum with a longitudinal OSCE to improve internal medicine residents‚ confidence and skills in coordinating complex interdisciplinary primary care via televisits, electronic consultation, and teleconferencing	Medicine (e.g., MD, DO)—primary care residents (56)	Two sessions: Session 1 = SP televisit, Session 2 = care coordination via intervisit e-messaging and simulated interdisciplinary teleconference Electronic survey measured confidence before session 1, postsession 1 and postsession 2. SP televisit checklists and investigators assessment of e-messages used to assess telehealth skills	Academic (e.g., classroom); simulation center	Researcher created: Questions adapted from several existing surveys with various intents	No	no	Pre and posttest	Participant pre/postsurveys; standardized patient observations; faculty evaluation of e-consultations	Change in comfort with telehealth; satisfaction; telehealth competencies: telehealth etiquette; website manner; technology skills; Communication with interdisciplinary team and other health professionals
Yang et al. (2024)⁵³	This study aimed to investigate the evidence-based gap and explore the factors for the evidence versus practice deficits as well as contributors to low-quality indirect-to-consumer telemedicine	Physicians conducting asynchronous telemedicine in dermatology and pediatric departments in China (321)	SP skills observation and scoring	Clinic/Work site	Researcher created	No	n/a	Skills evaluation during simulation and postevaluation of factors	PI/research staff observation; standardized patient	Adherence to guidelines for diagnosis and treatment
Yarnell et al. (2024)⁵⁴	Describe a pilot workshop covering vital signs and the head and neck exam. Objectives (1) describe a feasible and easily reproducible method for instruction, (2) share our evaluation approach for the VPE, and (3) report trainee performance for benchmarking	Students: medicine (e.g., MD, DO)—primary care; PA (50) Other: internal medicine residents (20) Total n = 70	Skills observation during simulation by faculty; postevaluation survey completed by participants	Simulation center	Established tool used postsimulation to evaluate satisfaction with the experience	Yes	Satisfaction with Simulation and Experience Scale 65	Skills observation during simulation by faculty; postevaluation survey	Participant	Satisfaction with experience Telehealth competencies: telehealth etiquette; webside manner; technology skills; telehealth exam skills

95% CI, 95% confidence interval; APRN, advanced practice registered nurse; CFI, comparative fit index; CKD, chronic kidney disease; DOVCS, direct observed virtual consultation skills; iSOAP, introduction, subjective, objective, assessment, and planning; ICC, intraclass correlation coefficient; OSCE, Objective Structured Clinical Examination; RMSEA, Root Mean Square Error of Approximation; RSVP, please respond; SP, standardized patient; SRMR, Standardized Root Mean Square Residual; TLI, Tucker-Lewis index.

Commonly, evaluations assessed satisfaction or self-confidence related to telehealth, or satisfaction with the education experience, rather than telehealth competencies. The telehealth competencies measured varied widely. The majority assessed communication, technology, and data collection and assessment. Few addressed patient safety or ethical practices ( Table 2 ).

Table 2.

Telehealth Competencies Measured

AUTHOR (YEAR)	PATIENT SAFETY	COMMUNICATION	DATA COLLECTION & ASSESSMENT	TECHNOLOGY	ETHICAL PRACTICES
Baliko et al. (2023)²¹		X
Budisalich et al. (2024)⁸		X	X
Butler Carrol & Phillips (2018)²⁴		X		X
Creese et al. (2024)²⁷		X
Gibson et al. 2020)³⁰	X	X	X	X	X
Greengold et al. (2025)³²		X	X	X
Haimi et al. (2020)³³	X		X		X
Hintz, et al. (2022)³⁵				X
Johnson & Strauch (2024)³⁶		X
Jones et al. (2023)³⁷		X		X
LaManna et al. (2023)³⁸		X		X
Lawrence et al. (2020)³⁹		X	X	X
Lesselroth et al. (2024)⁴⁰	X	X	X	X	X
Liew et al. (2023)⁴¹		X	X	X
Love & Carrington (2021)⁴²		X		X
Mulcare et al. (2020)⁴⁴		X	X	X
Posey et al. (2024)⁴⁵		X
Sheikh, K. (2022)⁴⁶		X	X	X
Smith et al. (2024)⁴⁷		X	X
Taylor & Little (2024)⁴⁸		X	X	X
Wakefield et al. (2004)⁴⁹		X		X
Wands et al. (2022)⁵⁰		X
Wittler et al. (2025)⁵¹		X		X
Wong et al. (2020)⁵²		X		X
Yang et al. (2024)⁵³			X
Yarnall et al. (2024)⁵⁴		X	X	X

QUALITY ASSESSMENT

The quality appraisal of each article is highlighted in Table 3 . The majority of articles (n = 26) were identified as a Level of Evidence III, indicating that they were of a nonexperimental design (multimethods, mixed methods, quantitative, and qualitative).^{20,21,23,26–31,33–36,38,41–44,47–54} One article was identified as Level of Evidence IV.³⁷ Six articles were Level of Evidence V and included quality/process improvement (n = 5)^{8,22,25,39,40,46} and program evaluation (n = 1).²⁴ Two quantitative studies were assessed at a Level of Evidence of II.^32,45 Regarding the quality of publication, most articles received a good quality (B) rating (n = 10).^{22,24,31,32,46,47,49,51,52,54} There were seven articles that received a high quality (A)^{34,37,39,40,44,45,48} and eight that received a low quality (C)^{8,25,27–30,41,50} rating. Articles that were identified as multi- or mixed-methods research had the qualitative and quantitative sections assessed separately and rated individually, and then overall. Most had each component deemed as high/good quality (n = 9)^{20,21,23,33,35,36,42,43,53} and one received a low-quality score (C) for all components.²⁶

Table 3.

Quality Appraisal

AUTHOR (YEAR)	TYPE OF RESEARCH/STUDY	EVIDENCE LEVEL	QUALITY APPRAISAL
Arif et al. (2025)²⁰	Mixed methods	III	B
	Quantitative	III	B
	Qualitative	III	A/B
Baliko et al. (2023)²¹	Multimethods	III	A/B
	Quantitative	III	A
	Qualitative	III	A/B
Berrier & Heller (2022)²²	Process improvement	V	B
Budisalich et al. (2024)⁸	QI/Process improvement	V	C
Burt & Kilroy (2021)²³	Multimethods	III	B
	Quantitative	III	B
	Qualitative	III	A/B
Butler Carrol & Phillips (2018)²⁴	Program evaluation	V	B
Cassidy et al. (2020)²⁵	Quality improvement	V	C
Cook et al. (2022)²⁶	Multimethods	III	C
	Quantitative	III	C
	Qualitative	III	C
Creese et al. (2024)²⁷	Quantitative	III	C
Crittendon et al. (2024)²⁸	Qualitative	III	C
DeFoor et al. (2024)²⁹	Qualitative	III	C
Gibson et al. (2020)³⁰	Quantitative	III	C
Gong et al. (2022)³¹	Quantitative	III	B
Greengold et al. (2025)³²	Quantitative	II	B
Haimi et al. (2020)³³	Multimethods	III	A
	Quantitative	III	A
	Qualitative	III	A
Heyck Lee et al. (2022)³⁴	Quantitative	III	A
Hintz et al. (2022)³⁵	Multimethods	III	A
	Quantitative	III	A
	Qualitative	III	A/B
Jones et al. (2023)³⁷	Quality improvement	IV	A
Johnson & Strauch (2024)³⁶	Mixed methods	III	B
	Quantitative		B
	Qualitative		A/B
LaManna et al. (2023)³⁸	Qualitative	III	A/B
Lawrence et al. (2020)³⁹	Process improvement	V	A
Lesselroth et al. (2024)⁴⁰	Quality improvement	V	A
Liew et al. (2023)⁴¹	Quantitative	III	C
Love & Carrington (2021)⁴²	Multimethods	III	A
	Quantitative	III	A
	Qualitative	III
Moore et al. (2024)⁴³	Mixed method	III	A
	Quantitative	III	A
	Qualitative	II	B
Mulcare et al. (2020)⁴⁴	Quantitative	III	A
Posey et al. (2023)⁴⁵	Quantitative	II	A
Sheikh, K. (2022)⁴⁶	Quality improvement	V	B
Smith et al. (2024)⁴⁷	Quantitative	III	B
Taylor & Little (2024)⁴⁸	Quantitative	III	A
Wakefield et al. (2004)⁴⁹	Quantitative	III	B
Wands et al. (2022)⁵⁰	Quantitative	III	C
Wittler et al. (2025)⁵¹	Quantitative	III	B
Wong et al. (2020)⁵²	Quantitative	III	B
Yang et al. (2024)⁵³	Mixed methods	III	A
	Quantitative	III	A/B
	Qualitative	III	A/B
Yarnall et al. (2024)⁵⁴	Quantitative	III	B

STUDY DESIGN

Among the relevant articles fully extracted, no articles were identified as being a true research design (i.e., randomized controlled trial) but rather quasiexperimental or nonresearch. Four articles were identified to be mixed methods,^20,36,43,53 and six were multimethods.^{21,23,26,33,35,42} Two articles were deemed process improvement,^22,39 while four studies employed a quality improvement design.^25,37,40,46 In addition, one article addressed a combination of quality improvement and process improvement designs.⁸ Three articles employed a qualitative study design,^28,29,38 while 15 articles utilized a quantitative approach.^{27,30,31,34,41,44,47–52,54}

PARTICIPANTS

Healthcare students

Thirteen articles focused on telehealth education of APRN students.^{8,21–23,25,29,37,38,42,45–47,51} The number of participants for each article ranged from 8 to 135. One article included the use of standardized patients (n = 12) within an APRN (n = 24) telehealth simulation.⁴⁷ Seven articles focused on primary care medical students, ranging from 12 to 98 students.^{32,39–41,44,52,54} One article focused on the telehealth education of prelicensure nursing students (n = 85).⁵⁰ Pharmacy students (n = 22) were discussed in one article.²⁷ Another article included an intradisciplinary group of students, both prelicensure (n = 66) and APRN students (n = 15).⁴³ A couple of articles included education focused on an interprofessional (IP) team of students.^26,48 One IP article included both medical students and APRN students, with 6–12 participants based on the type of activity.²⁶ The other IP article included students from multiple disciplines (adult gerontology nurse practitioner, audiology, cardiovascular perfusion, clinical nutrition, family nurse practitioner (FNP), generalist entry master nursing, health sciences bachelors, health systems management, imaging sciences, medical laboratory sciences, medicine, occupational therapy (OT), pharmacy, physician assistant (PA) studies, respiratory care, speech-language pathology, vascular ultrasound, and “other”) within both an exploratory study (n = 701) and confirmatory study (n = 721).⁴⁸

Established healthcare professionals

A variety of established health care providers within various health care settings also received telehealth education. Providers included physicians in teledermatology (n = 87),³¹ pediatric primary care physicians (n = 15),³³ APRNs (n = 10),³⁶ an IP trauma team (four physicians, one emergency department nurse, two operating room/trauma team nurses, and laboratory and radiology technicians; n = 13),³⁵ and an IP team composed of physicians, nurse practitioners, registered nurses, licensed vocational nurses, certified medical assistants (CMA), community health workers (CHW), licensed marriage and family therapists, social workers, respiratory therapists (RT), and administrative staff (n = 176).²⁴ One study included physicians who were actively working in a telehealth setting (variable number of participants, ranging from 5 to 320).²⁰ Another study focused on telehealth education of clinical preceptors [APRNs and physicians (n = 19)] with APRN students (n = 22).³⁰ Two articles evaluated the interaction between patients and physicians.^34,35 There was one study that included 26 registered nurses and 18 volunteer simulated patients.⁴⁹

EVALUATION TOOLS

Description of evaluation tools

While most tools were researcher created (n = 23),^{8,20,21,24,25,27,29–32,34,36,37,40–42,44,46,48,49,52–54} several studies utilized previously developed tools (n = 13).^{22,23,26,28,33,35,38,39,43,45,47,50,51} Tools that were previously published could be categorized as directly or indirectly measuring telehealth skills and competence. Scales that directly measured telehealth skills and competencies included the iSOAP Checklist,^38,46 Telehealth Competency Questionnaire—Provider (TCQ-P),⁴⁸ Student Telehealth Evaluation,³⁰ Preceptor Telehealth Evaluation,³⁰ Faculty Evaluation of Residents’ E-Consultation/E-Messaging Skills,⁵² Telehealth Master Interview Rating Scale (Tele-MIRS),⁴⁵ the Telehealth Educational Environment Measurement (THEEM) tool,²⁰ the Direct Observed Virtual Consultation Skills (DOVCS) Checklist,⁴¹ and Resident Confidence in Using Telemedicine for Interdisciplinary Care.⁵² Additionally, Wittler et al.⁵¹ utilized a previously published but unnamed telehealth survey, which evaluated telehealth knowledge, confidence, and attitudes.

Scales that indirectly measured telehealth skills and competence include Modified Non-Technical Skills for Trauma Assessment Tool (T-NOTECHS),³⁵ the National League for Nursing (NLN) Student Satisfaction and Self-Confidence in Learning Instruments,^22,23 the Open Minds Scale for HealthCare Providers (OMS-HC),⁵⁰ Caring Behaviors Inventory (CBI-24),⁵⁰ Simulated Client Interview Rating Scale (SCIRS),⁵⁰ the Simulation Effectiveness Tool-Modified (SET-M),⁴⁷ and the Nebraska Interprofessional Education Attitude Scale (NIPEAS).²⁶

Validity and reliability data were described for several of the previously published tools. The NLN Student Satisfaction and Self-Confidence in Learning Instruments are reported to have good internal consistency [Cronbach’s α = 0.94 (satisfaction) and 0.87 (self-confidence)].^22,24 The SCIRS has a Cronbach’s α >0.90.⁵⁰ The NIPEAS was assessed for validity by confirmatory factor analysis (p < 0.0001) and has good reliability (Cronbach’s α = 0.84).²⁶ The CBI-24 has been reported to have good test–retest reliability (r = 0.88 for patients and r = 0.82 for nurses) and high internal consistency (α = 0.95).⁵⁰ The OMS-HC has been found to have acceptable reliability (Cronbach’s α = 0.78).⁵⁰ The T-NOTECHS has a Cronbach’s α with acceptable internal consistency of 0.70. The ICC was 0.54 (95% confidence interval [CI], 0.34, α = 0.70).⁵⁵ The Tele-MIRS had very high reliability (Cronbach’s α = 0.94).⁴⁵ Smith et al.⁴⁷ conducted an evaluation of the SET-M and found it to have excellent internal consistency (Cronbach’s α = 0.94). The TeleOSCE instrument was evaluated for face validity and reported to have relatively strong Cronbach’s α, but the actual value was not reported.⁴³ Three of the researcher-created tools, TCQ-P, DOVCS Checklist, and THEEM, reported validity data. The TCQ-P was developed and refined through exploratory factor analysis and confirmatory factor analysis. It was found to have good model fit (CFI: 0.984, TLI: 0.978, SRMR: 0.035, RMSEA: 0.051 (0.044–0.058), p = 0.415.⁴⁸ The DOVCS Checklist had an internal consistency of 0.92 with interrater reliability determined by an intraclass coefficient of 0.68, and 95% CIs between 0.201 and 0.901, p < 0.001, based on a mean-rating (k = 2), absolute-agreement, two-way mixed effects.⁴¹ Arif et al.¹⁷ described the development and validation of the THEEM evaluation tool. They found the tool had strong content validity (S-CVI = 0.84) and excellent internal consistency (Cronbach’s α = 0.9).²⁰

Tool administration

Of the 36 tools identified, 11 were administered electronically^{21,25,26,34,37,38,41,42,48,50,52} and 2 of those studies^30,47 utilized both electronic and paper forms for administration. One study was administered via paper only.⁴⁰ Eight of the tools were administered and scored through faculty or researcher observation.^{32,39,43,45–47,51,53} Three studies involved administration via interviews.^20,28,36 Thirteen studies did not describe how the tool was administered.^{8,22–24,27,29–31,33,35,44,49,54}

Tools were administered by faculty (n = 23) in the majority of studies.^{8,22,23,25–30,32,36,41–48,50–53} Research staff (n = 5) or telehealth center staff (n = 2) were also identified as survey administrators.^{20,24,33–35,38,53} One study utilized self-administration through the online learning management system³⁷, and four studies did not describe who administered the tool.^21,31,39,49

Tools were mostly completed by participants^{20–28,32,34–38,40–45,47–52,54}; however, studies also included evaluations by simulation observers, faculty, and standardized patients.^{8,27,30–34,36,40–42,45,47,49,50,52,53}

Outcomes measured

Articles reviewed utilized a mix of evaluative outcomes, employing primarily quantitative approaches with some qualitative elements. Outcomes often reflected a consideration of curricular changes or instruction rather than patient perspectives or learner skills. In terms of design approaches, six studies were performed using standardized patients,^{31,44,47,51,53,54} and eight developed scenarios.^{21,26,43,44,47,51,52,54} The outcomes for these articles primarily targeted provider ability to use technology or their comfort with telehealth.

Eight articles assessed improvement in the level of knowledge^{26,37,41,43,44,51,52} with varying definitions of knowledge. As an example, Jones et al.³⁷ examined provider beliefs regarding the provision of telehealth, while Baliko et al.²¹ examined the inclusion of telehealth as part of curricular development. Evaluation of knowledge included assessment of curricular elements, along with an understanding of the limitations of telehealth.^{21,22,26,38,39,42,44,47,51} Studies tended to evaluate knowledge immediately after participating in a telehealth scenario or simulation rather than over time.^{26,37,41,43,44,51} The primary approach was through the incorporation of postparticipation surveys without evaluation of preparticipation knowledge.^{23,38,39,47,50} Liew et al.⁴¹ included a pre- and post-participation survey concomitant with observer evaluation of participants’ performance. What was provided in this publication was more an evaluation of the effectiveness of the curriculum rather than a change in student performance or knowledge.⁴¹

Twenty-six studies incorporated measurement of telehealth competencies to varying degrees.^{8,21,24,27,30,32,33,35–42,44–54} Competencies included telehealth etiquette,^{8,24,27,30,32,36–42,45,46,49,50} ethical practices,^30,33,40 ability to use the technology,^{3–21,23,24,26–44,46,48,49} and performance of assessment and diagnostic skills.^{8,30,32,33,39–41,44,46–48} Several articles reported using telehealth competencies as an evaluative outcome but did not clearly identify which competencies were being evaluated^{32,34,36,50,53} or neglected to provide data regarding change in performance related to evaluated competencies.²⁴ Four articles included the use of various peripheral equipment,^24,26,44,52 while the majority of the studies did not incorporate the use of peripherals in telehealth scenarios or simulations.

Seven articles reviewed considered provider satisfaction^{26,34,35,39,41,43,49} and/or comfort with telehealth.^{26,34,35,39,41,43,49} Provider satisfaction with the technology or with the potential for telehealth to adequately address care changes was a common evaluative outcome.^{22,23,35,37,39,41,42,44,49} Gong et al.³¹ considered the wording used by providers in conjunction with time spent on the session in an effort to evaluate other aspects of care delivery.

Competencies evaluated

Of the 36 studies reviewed, 26 employed instruments that measured at least one telehealth competency,^{8,21,24,30,32,33,35–42,44–54} while 10 did not.^{20,22,23,25,26,28,29,31,34,43} Telehealth etiquette, including professionalism, patient engagement, and confidentiality, was evaluated in 20 studies.^{8,21,24,30,32,36–42,44,45,47–49,51,52} Seventeen studies assessed technology skills and technical proficiency.^{24,30,32,35,37–42,44,46,48,49,51,52,54}

Fourteen studies assessed clinical skills such as history taking, physical examination, diagnosis, and prescribing.^{8,30,32,33,39–41,44,46–48,51,53,54} Communication competencies, including motivational interviewing, rapport building, and therapeutic communication, were evaluated in eight studies.^{8,21,27,30,32,40,50,52} Three studies incorporated ethics, patient safety, access/equity, and telehealth policy (including legal, reimbursement, and licensure issues) into their assessment frameworks.^30,33,40 Two studies addressed team-based or IP collaboration in the telehealth setting.^24,52

Discussion

Telehealth education is prevalent in the literature for all types of healthcare professionals, both established and students. To assist in the guidance of the educational components, telehealth competencies and practice guidelines exist across health professions and share similar recommendations in the attainment and implementation of telehealth skills. These skills are essential for the appropriate use of telehealth, increased provider and patient satisfaction, and usage.⁵⁶ The goal of conducting this scoping review was to understand what and how telehealth competencies were being evaluated. The results of this scoping review bring to attention that there exists no consistency regarding how telehealth competencies are being evaluated and that a variety of tools, some telehealth-specific and some adapted to telehealth, are being used. Most articles in this review employed researcher-created evaluation tools^{8,20,21,24,25,27,29–32,34,36,37,40–42,44,46,48,49,52–54} or those that were previously developed.^{22,23,26,28,33,35,38,39,43,45,47,50,51} The evaluation tools that were researcher created more often than not were created for the specific study interventions and lacked psychometric testing. Because of this, these tools lacked validity, reliability, and transferability, which are needed to ensure that the tool is assessing the actual desired outcome.⁵⁷ The results of these studies may therefore lack credibility.

Two direct telehealth evaluation tools included in this review have undergone psychometric testing, THEEM and TCQ-P.^20,48 THEEM was developed to evaluate the telehealth learning environment (the interaction between educators and learners and the quality of educational resources, and the technology) rather than telehealth competencies.²⁰ These domains align with the learning environment conceptual framework proposed by Gruppen et al. that identified two dimensions (psychosocial and material) composed of five overlapping and interactive core elements (personal, social, organization, and physical and virtual spaces).⁵⁸ The use of THEEM can help facilitate the integration of telehealth competencies into simulated telehealth visits by providing guidelines on how to structure the environment to ensure the learner has their educational needs met. In contrast, the TCQ-P evaluates a participant’s (established health care professional or student) self-reported perception of telehealth confidence within four domains: telehealth mastery, virtual rapport, practice fundamentals, and evaluation and assessment and was evaluated by multiple health care professions (e.g., medicine, APRNs, pharmacy, occupational therapy, physician assistant, health sciences majors, respiratory, speech-language pathology, etc.).⁵⁹ The domains of the TCQ-P align well with the AAMC and Four Ps of telehealth competencies on telehealth. Combining the THEEM with TCQ-P tools may potentially help researchers create an environment that would help facilitate learning of telehealth competencies focused on telehealth etiquette, virtual assessments, and diagnostic capability.

When evaluating which telehealth competencies were assessed using the direct telehealth evaluation tools ( Table 2 ), none evaluated all telehealth competencies but rather most focused on telehealth etiquette or communication skills and technology acumen or comfort. Telehealth etiquette is essential to how telehealth care is delivered to enhance communication, patient and provider satisfaction, and the quality of virtual care provided.⁴ A combination of self-evaluation surveys or reflections, evaluation by educators or standardized patients, global rating scales, and simulations can assess these soft skills.⁶⁰ Twenty-six researcher-created and indirect telehealth assessment tools evaluated a variety of telehealth competencies ( Table 2 ), mostly focused on communication and technology, with a few including patient safety, data collection and assessment, and ethical practices. No studies evaluated the appropriate use of telehealth and access or equity issues. Telehealth is meant to increase access to health care; however, the COVID-19 pandemic magnified disparities, both in access and understanding. When developing telehealth education and simulations, it is important to include exposure to disparities, both access (i.e., digital deserts)⁶¹ and digital literacy.⁶²

To the best of the authors’ knowledge, this article represents the first comprehensive review of the current landscape of telehealth competency evaluations and the assessment tools used to measure these competencies among health care professionals. The review of the articles was completed by at least two independent reviewers, including a rigorous literature search completed by an academic librarian, evaluating various health care professionals and students, and there were no limitations on dates of publication, all of which lend strength to this review. Few limitations exist, including that reviewed articles were those only published in English, and some articles may have been missed related to the search strategies used. Additionally, some study characteristics may have been missed, even though the authors met regularly to discuss findings and to come to a consensus when there were some questions on certain findings.

Based on the articles reviewed in this article, more research is needed to develop validated telehealth evaluative tools that can be used across disciplines and encompass all telehealth competencies. Additionally, true research methods are needed to adequately assess the impact of telehealth education on the performance and confidence of learners.

Authors’ Contributions

K.C.-H. and K.G.: Led the review's conceptualization, developed the protocol, and coordinated the project. A.L.: Executed the search strategy, managed database searches, and organized the retrieved records. All authors conducted title/abstract screening and full text review, contributed to data charting, and assisted with methodological decisions. All authors supported data extraction, contributed to synthesis and writing, and provided critical revisions to the manuscript. All authors contributed to interpreting the findings, drafting and revising the manuscript, and approved the final version for publication.

Footnotes

Acknowledgment

The authors would like to acknowledge the NONPF and the NONPF Telehealth Committee.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

References

1. Shaver

. The state of telehealth before and after the COVID-19 pandemic. Prim Care 2022;49(4):517–530.

2.The Office of the National Coordinator for Health Information Technology. What is telehealth? How is telehealth different from telemedicine? 2019. Available from: https://www.healthit.gov/faq/what-telehealth-how-telehealth-different-telemedicine [Last accessed: September 25, 2025].

3. Chike-Harris

, Durham

, Logan

, et al. Integration of telehealth education into the health care provider curriculum: A review. Telemed J E Health 2021;27(2):137–149.

4. Garber

, Gustin

. Telehealth education: Impact on provider experience and adoption. Nurse Educ 2022;47(2):75–80.

5. Rutledge

, Kott

, Schweickert

, et al. Telehealth and ehealth in nurse practitioner training: Current perspectives. Adv Med Educ Pract 2017;8:399–409.

6. Chike-Harris

, LaManna

, Eckhoff

, et al. The missing link: The iSOAP model for incorporating telehealth within simulations. Clin Simul Nurs 2021;59:39–51.

7. Jones

, Buchanan

, Maglione

, et al. Integrating telehealth: Curricular mapping to new standards in nurse practitioner post-baccalaureate doctor of nursing practice programs. J Nurse Pract 2023;19(5):1104576.

8. Budisalich

, Gilbert

, Storer

, et al. Telehealth technology integration: A simulation with family nurse practitioner students. J Nurse Pract 2024;20(7):105059.

9.National Association of Nurse Practitioner Faculties. Nurse practitioner role core competencies. 2022. Available from: https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/np_competencies_%26_ntf_standards/nonpf_np_role_core_competenc.pdf [Last accessed: July 7, 2025].

10.

10.American Association of Colleges of Nursing. The Essentials. 2021. Available from: https://www.aacnnursing.org/essentials [Last accessed: June 18, 2025].

11.

11. Rutledge

, O’Rourke

, Mason

, et al. Telehealth competencies for nursing education and practice: The four p’s of telehealth. Nurse Educ 2021;46(5):300–305.

12.

12. Noronha

, Lo

, Nikiforova

, Society of General Internal Medicine (SGIM) Education Committee. et al.; Society of General Internal Medicine (SGIM) Education Committee. Telehealth competencies in medical education: New frontiers in faculty development and learner assessments. J Gen Intern Med 2022;37(12):3168–3173.

13.

13. Wamsley

, Cornejo

, Kryzhanovskaya

, et al. Best practices for integrating medical students into telehealth visits. JMIR Med Educ 2021;7(2):e27877.

14.

14. Begnoche

, David Butler

, Carson

, et al. ASHP statement on telehealth pharmacy practice. Am J Health Syst Pharm 2022;79(19):1728–1735.

15.

15.American Dental Association. ADA policy on teledentistry. 2020. Available from: https://www.ada.org/about/governance/current-policies/ada-policy-on-teledentistry [Last accessed: October 10, 2025].

16.

16. Davenport

, Lee

, Raja

, et al. Educational competencies for telehealth physical therapy: Results of a modified Delphi process. Work 2024;79(3):1531–1549.

17.

17. Templier

, Paré

. A framework for guiding and evaluating literature reviews. Commun Assoc Inf Syst 2015;37:6.

18.

18.Covidence. Better systematic review management. 2025. Available from: https://www.covidence.org/ [Last accessed: October 9, 2025].

19.

19. Dang

, Dearholt

, Bissett

, et al. Johns Hopkins evidence-based practice for nurses and health care professionals model and guidelines. 4th ed. Sigma Theta Tau International: Indianapolis; 2022.

20.

20. Arif

, Sajjad

, Khan

, et al. Development and validation of a tool to measure telehealth educational environment (THEEM). BMC Med Educ 2025;25(1):136.

21.

21. Baliko

, Raynor

, Cox

, et al. Developing family nurse practitioner student competencies: A two-part mental health-focused telehealth education activity. J Prof Nurs 2023;49:33–39.

22.

22. Berrier

, Hellier

. Addressing telehealth education in a family nurse practitioner program through simulation-based learning. J Am Assoc Nurse Pract 2022;34(11):1204–1211.

23.

23. Burt

, Kilroy

. Nurse practitioner student perceptions of a multimodal telemedicine clinical course. Nurse Educ 2021;46(5):E122–E126.

24.

24. Butler Carroll

, Phillips

. Texas Tech University Health Sciences Center Frontiers in Telemedicine Simulation Lab and Certificate Course: Facility and curriculum development. In: Proceedings of The 12th International Multi-Conference on Society, Cybernetics and Informatics, Orlando, Florida, USA. July 8-11, 2018, pp.1–6.

25.

25. Cassiday

, Nickasch

, Mott

. Exploring telehealth in the graduate curriculum. Nurs Forum 2021;56(1):228–232.

26.

26. Cook

, Becklenberg

, Kendall

, et al. An interprofessional telehealth educational and simulation program for primary care student providers: A research pilot study. NEC 2022;40(5):230.

27.

27. Creese

, Hale

, Benny

, et al. Assessing confidence and competence of student pharmacists in a virtual medication adherence training program. Am J Pharm Educ 2024;88(5):100699.

28.

28. Crittenden

, Toppin

, Longley

. Experiences of older adult volunteers and nursing simulation coordinators in a graduate-level primary care telehealth simulation: Benefits, facilitators, and volunteer management considerations. J Technol Hum Serv 2024;42(3):173–193.

29.

29. DeFoor

, Irons

, Glover

, et al. Seeing beyond the screen: Integrating trauma- and violence-informed care during a telehealth simulation. Clin Simul Nurs 2024;86:101473.

30.

30. Gibson

, Arends

, Voss

, et al. Reinforcing telehealth competence through nurse practitioner student clinical experiences. J Nurs Educ 2020;59(7):413–417.

31.

31. Gong

, Hou

, Guo

, et al. Investigating the relationship between consultation length and quality of tele-dermatology E-consults in China: A cross-sectional standardized patient study. BMC Health Serv Res 2022;22(1):1187.

32.

32. Greengold

, Spahic

, Serwint

, et al. Novel educational strategies to improve the telemedicine clinical skills of medical students. Prim Health Care Res Dev 2025;26:e10.

33.

33. Haimi

, Brammli-Greenberg

, Baron-Epel

, et al. Assessing patient safety in a pediatric telemedicine setting: A multi-methods study. BMC Med Inform Decis Mak 2020;20(1):63.

34.

34. Heyck Lee

, Ramondino

, Gallo

, et al. A quantitative and qualitative study on patient and physician perceptions of nephrology telephone consultation during COVID-19. Can J Kidney Health Dis 2022;9:20543581211066720.

35.

35. Hintz

, Haines

, Dawe

. Rural trauma telementoring: A pilot project. cjs 2022;65(5):E567–E572.

36.

36. Johnson

, Strauch

. A mixed-methods pilot examination of Montana, North Dakota nurse practitioner telepresence behaviors through web-camera eye-tracking and qualitative descriptive interviews. J Am Assoc Nurse Pract 2024;36(5):270–278.

37.

37. Jones

, Ammerman

, Joiner

, et al. Evaluating an intervention of telehealth education and simulation for advanced practice registered nurse students: A single group comparison study. Nurs Open 2023;10(6):4137–4143.

38.

38. LaManna

, Eckhoff

, Duncan

. Applying nurse practitioner student reflections in design of telehealth curricula. Am J Nurse Pract 2023;19(1):104416.

39.

39. Lawrence

, Hanley

, Adams

, et al. Building telemedicine capacity for trainees during the novel Coronavirus outbreak: A case study and lessons learned. J Gen Intern Med 2020;35(9):2675–2679.

40.

40. Lesselroth

, Monkman

, Liew

, et al. Simulating telemedicine, medication reconciliation, and social determinants: A novel instructional approach to health systems competencies. Stud Health Technol Inform 2024;310:1201–1205.

41.

41. Liew

, Tan

, Breen

, et al. Microlearning and online simulation-based virtual consultation training module for the undergraduate medical curriculum – A preliminary evaluation. BMC Med Educ 2023;23(1):796.

42.

42. Love

, Carrington

. Introducing telehealth skills into the doctor of nursing practice curriculum. J Am Assoc Nurse Pract 2020;33(11):1030–1034.

43.

43. Moore

, Jairath

, Montejo

, et al. Telehealth simulation: Effect on nurse learner knowledge, confidence, and attitudes. Nurs Educ Perspect 2024;45(2):106–108.

44.

44. Mulcare

, Naik

, Greenwald

, et al. Advanced communication and examination skills in telemedicine: A structured simulation-based course for medical students. MedEdPORTAL 2020;16(1):11047.

45.

45. Posey

, Wallington

, Sikka

, et al. Evaluating a virtual flipped classroom approach to nurse practitioner telehealth competency development. J Nurs Educ 2024;63(8):546–551.

46.

46. Sheikh

. Rapid-cycle deliberate practice telehealth as an integrative learning strategy in nurse practitioner education. J Am Assoc Nurse Pract 2022;34(11):1187–1192.

47.

47. Smith

, Sand

, Gore

. Incorporating a psychiatric telehealth simulation in a family nurse practitioner curriculum. Issues Ment Health Nurs 2024;45(4):436–439.

48.

48. Taylor

, Little

. Development and validation of telehealth competency questionnaire-provider. Telemed J E Health 2024;30(6):e1713–e1718.

49.

49. Wakefield

, Holman

, Ray

, et al. Nurse and patient communication via low- and high-bandwidth home telecare systems. J Telemed Telecare 2004;10(3):156–159.

50.

50. Wands

, Pfeiffer

, Pelkmans

. Demonstration of caring and motivational interviewing in online simulation: A cross-sectional observational study. Nurse Educ Pract 2022;63:103370.

51.

51. Wittler

, Perez

, Griffin

. Telehealth virtual simulation across the family nurse practitioner curriculum. Nurs Educ Perspect 2025;46(1):52–54.

52.

52. Wong

, Ng

, Spinnato

, et al. Expanding telehealth competencies in primary care: A longitudinal interdisciplinary simulation to train internal medicine residents in complex patient care. J Grad Med Educ 2020;12(6):745–752.

53.

53. Yang

, Gong

, Song

, et al. Evidence-do gap in quality of direct-to-consumer telemedicine: Cross-sectional standardized patient study in China. Telemed J E Health 2024;30(4):e1126–e1137.

54.

54. Yarnall

, Monkman

, Akel

, et al. Teaching and evaluating the virtual physical exam in telemedicine. Stud Health Technol Inform 2024;316:1519–1523.

55.

55. Oscar

, Blom-Ham

, Huijsmans

, et al. Reliability of the assessment of non-technical skills by using video-recorded trauma resuscitations. Eur J Trauma Emerg Surg 2022;48(2):441–447.

56.

56. Nguyen

, Waller

, Pandya

, et al. A review of patient and provider satisfaction with telemedicine. Curr Allergy Asthma Rep 2020;20(11):72.

57.

57. De Souza

, Alexandre

NMC

, De Brito Guirardello

. Psychometric properties in instruments evaluation of reliability and validity. Epidemiol Serv Saude 2017;26(3):649.

58.

58. Gruppen

, Irby

, Durning

, et al. Conceptualizing learning environments in the health professions. Acad Med 2019;94(7):969–974.

59.

59. Wright

, O’Shea

M-C

, Sekula

, et al. Assessment of communication skills using telehealth: Considerations for educators. Front Med (Lausanne) 2022;9:841309.

60.

60. Anawade

, Sharma

, Gahane

. A comprehensive review on exploring the impact of telemedicine on health care accessibility. Cureus 2024;16(3):e55996.

61.

61. Saeed

, Masters

. Disparities in health care and the digital divide. Curr Psychiatry Rep 2021;23(9):61.

62.

62. Palmer

, Rdesinski

, Galper

, et al. Assessing the impact of a telemedicine simulation on clinical learners. J Fam Med Comm Health 2017;4(5):1120.