A Competency-Based Framework for Telepsychiatry Training in U.S. Psychiatry Residency

Telepsychiatry has become a sustained component of mental health care delivery in the United States, driven by workforce shortages, access disparities, and rapid digital transformation. Despite widespread clinical adoption, telemedicine training remains inconsistently integrated into psychiatry residency education, resulting in variable preparedness, supervision, and assessment of trainees. To present a competency-based framework for integrating telepsychiatry training into U.S. psychiatry residency programs that aligns with Accreditation Council for Graduate Medical Education (ACGME) competencies and supports longitudinal educational and systems-based outcomes. Using principles of competency-based medical education and synthesizing established telepsychiatry competency models, we define seven core telepsychiatry domains: virtual clinical skills, technological proficiency, video-based communication, legal and ethical practice, cultural competence and digital equity, professionalism, and systems-based practice. These domains are operationalized through a longitudinal curriculum mapped across postgraduate training years, incorporating didactics, simulation, supervised clinical encounters, and milestone-based assessment. The proposed framework translates telepsychiatry competencies into an actionable, residency-wide curriculum embedded within core clinical rotations rather than isolated electives. Curriculum mapping demonstrates alignment with ACGME milestones and supports progressive entrustment, standardized supervision, and programmatic assessment. At the systems level, the model promotes integration of telepsychiatry into clinical workflows, interprofessional collaboration, and institutional quality and access initiatives. Embedding telepsychiatry training within a competency-based, systems-aware educational framework may improve trainee readiness for contemporary psychiatric practice while supporting institutional goals related to access, equity, and workforce sustainability. This model offers a scalable approach for graduate medical education programs seeking to align telepsychiatry education with accreditation standards and evolving healthcare delivery systems.