Perceptions of Digital Health Education Among European Medical Students: Mixed Methods Survey

Influence of information anxiety on core competency of registered nurses: mediating effect of digital health literacy

BACKGROUND

In the information age of health care, nurses often face information overload, leading to negative emotions, e.g., anxiety that may impede the adoption of evidence-based practice and clinical decision-making process. Nurses with higher digital health literacy can effectively process and manage information. Despite this, no research has explored the relationship between information anxiety, digital health literacy, and core competency among nurses. Therefore, this study aims to investigate the mediating effects of digital health literacy on information anxiety and core competency among nurses.

METHODS

From July to October 2023, the data for this cross-sectional study were collected. The study surveyed a total of 608 nurses from three tertiary hospitals in Fujian Province, and the survey instruments included a sociodemographic information questionnaire, Chinese revision version of the Digital Health Literacy Instrument (CR-DHLI), Information Anxiety Scale (IAS), and Competency Inventory for Registered Nurses (CIRN). Descriptive statistics and Pearson correlation analysis were conducted using SPSS 29.0, and the mediating effect of digital health literacy was examined using Mplus.

RESULTS

The mean score of nurses' information anxiety, digital health literacy, and core competency was 3.03 ± 0.91, 2.46 ± 0.56, 2.72 ± 0.88, respectively. And the mediation model of information anxiety on core competency for nurses showed a good model fit index (χ²/df = 2.207, CFI = 0.985, TLI = 0.982, RMSEA = 0.045, SRMR = 0.035). Digital health literacy was positively correlated with nurses' core competency but negatively correlated with information anxiety. The results of path analysis revealed that information anxiety had negative and significant direct effects on NCC (β = -0.119, P = 0.004) and DHL (β = -0.297, P < 0.001). DHL had a positive effect on NCC (β = 0.306, P < 0.001). Digital health literacy played a partial mediating role, accounting for 43.54% of the relationship between information anxiety and nurses' core competency.

CONCLUSIONS

Information anxiety among nurses was at relatively high levels, which had a negative impact on the core competency of nurses. This issue requires attention from nursing managers. The mediating role of digital health literacy in the relationship between information anxiety and core competency among nurses has been established. Nursing managers should strengthen the evaluation of nurses' DHL and devise effective support strategies to enhance DHL, thus improving the core competence of nurses in information age.

Transforming medical education: the impact of innovations in technology and medical devices

INTRODUCTION

The rapid advancement of technology and the integration of innovative medical devices are significantly transforming medical education. This review examines the impact of these changes and the importance of adapting educational strategies to leverage these advancements.

AREAS COVERED

This narrative review employs a qualitative approach. From an initial pool of 294 articles, researchers conducted independent screenings and identified 134 studies relevant to innovations in technology and their impact on medical education. Following a comprehensive review and consensus, studies deemed to be of low relevance were excluded, resulting in a final selection of 74 articles. An expert panel discussion was held, and the study concludes with a final section that presents the findings and offers brief, clear recommendations.

EXPERT OPINION

This study indicates that the utilization of Innovative medical technologies has the potential to enhance learning outcomes. The use of simulations allows students to engage in hands-on practice without risking patient harm. Mobile devices afford students uninterrupted access to educational resources, thereby enabling efficient learning. Artificial intelligence (AI) has the potential to personalize education, enhance diagnostic skills, and foster critical thinking. Further research in this field has the potential to yield significant insights.

Embracing the Future of Health Care: Investigating Medical Students' Willingness to Become Online Doctors

Purpose: With the rapid advancement of technology, online health care services are becoming increasingly prominent. This study aims to investigate medical students' perceptions, attitudes, and readiness to adopt online health care services. Methods: Based on a literature review, this study constructed a conceptual model describing the relationships among medical students' perception, personality traits, and usage intention, grounded in the Technology Acceptance Model and Technology Readiness Index (TRI). The data for this study were collected from January to February 2023 through a questionnaire survey at Wenzhou Medical University, China. The proposed hypotheses were tested using structural equation modeling through AMOS software. Results: Out of the 340 respondents, 281 (82.6%) validly responded. Among these, 58.4% of medical students agreed and strongly agreed with the intention to become an online doctor. Within the TRI's motivational factors, optimism positively and significantly affected perceived usefulness (PU) and perceived ease of use (PEOU). Innovativeness also significantly enhanced PEOU. Among the inhibitory factors, insecurity was found to have a negative and statistically significant influence on PU. The rest of the dimensions did not have a significant effect on either PU or PEOU. Importantly, both PU and PEOU demonstrated a direct and substantial effect on usage intention. Conclusions: This study emphasizes the significance of comprehending medical students' readiness to adopt the role of online doctors in shaping the future of health care. By equipping medical students with the necessary skills and competencies, health care institutions can effectively leverage the full potential of online health care services while ensuring the provision of high-quality, accessible, and patient-centered care in the digital era.

The Digital Determinants of Health: A Guide for Competency Development in Digital Care Delivery for Health Professions Trainees

Unlabelled

Health care delivery is undergoing an accelerated period of digital transformation, spurred in part by the COVID-19 pandemic and the use of "virtual-first" care delivery models such as telemedicine. Medical education has responded to this shift with calls for improved digital health training, but there is as yet no universal understanding of the needed competencies, domains, and best practices for teaching these skills. In this paper, we argue that a "digital determinants of health" (DDoH) framework for understanding the intersections of health outcomes, technology, and training is critical to the development of comprehensive digital health competencies in medical education. Much like current social determinants of health models, the DDoH framework can be integrated into undergraduate, graduate, and professional education to guide training interventions as well as competency development and evaluation. We provide possible approaches to integrating this framework into training programs and explore priorities for future research in digitally-competent medical education.

Teaching Digital Medicine to Undergraduate Medical Students with an Interprofessional and Interdisciplinary Approach: A Proof of Concept Study

BACKGROUND

An integration of digital medicine into medical education can help future doctors to shape the digital transformation of medicine.

OBJECTIVE

A newly developed course for teaching digital medicine (Bielefeld model) is described and evaluated for the first time.

METHODS

The course was held with undergraduate medical students at Medical School OWL at Bielefeld University, Germany, in 2023, and evaluated via pre-post surveys. The subjective and objective achievement of superordinate learning objectives and the objective achievement of subordinate learning objectives of the course, course design and course importance were evaluated utilizing five-point Likert scales (1="strongly disagree", 5="strongly agree"), a multiple choice format for reasons of absence, and open comments. The superordinate objectives comprise the understanding of factors driving the implementation of digital medical products and processes (1), the application of this knowledge to a project (2), and the empowerment to design such solutions (3) in the future. The subordinate objectives comprise competencies related to the first superordinate objective.

RESULTS

10 undergraduate medical students (male: 4, female: 6, mean age 21.7 years, SD: 2.1 years) evaluated the course. The superordinate objectives were achieved well to very well: the medians for the objective achievement were 4 scale units (su) (IQR 4-5 su), 4 su (IQR 3-5 su) and 4 su (IQR 4-4 su) for the first, second and third objective and the medians for the subjective achievement of the first, second and third objective were 4 su (IQR 3-4 su), 4.5 su (IQR 3-5 su) and 4 su (IQR 3-5 su). Participants mastered the subordinate objectives, averagely, better after the course than before (pre-survey median:2.5 su (IQR 2-3 su), post-survey median: 4 su (IQR 3-4 su)). The course concept was rated as highly suitable for achieving the superordinate objectives (medians: 5 su (IQR 4-5 su) for the first, second, and third objective). On average, the students highly liked the course (median: 5 su (IQR 4-5 su)) and gained a benefit from (median: 4.5 su (IQR 4-5 su)). All students fully agreed that the teaching staff was a strength of the course. The category "Positive feedback on the course or positive personal experience with the course" received most comments.

CONCLUSIONS

The course framework exhibits promise in attaining learning objectives within the realm of digital medicine, notwithstanding the constraint of limited interpretability arising from a small sample size and further limitations. It aligns with insights derived from teaching and learning research and the domain of digital medicine, albeit with identifiable areas for enhancement. A literature review indicates a dearth of publications pertaining to analogous courses in Germany. Future investigations should entail a more exhaustive evaluation of the course. In summary, this course constitutes a valuable contribution to incorporating digital medicine into medical education.

CLINICALTRIAL

Competencies required to make use of Information Science and Technology among Japanese medical students: a cross-sectional study

BACKGROUND

Competency in the use of information science and technology (IST) is essential for medical students. This study identified learning objectives and competencies that correspond with low self-assessment related to use of IST and factors that improve such self-assessment among medical students.

METHODS

A questionnaire was administered to sixth-year medical students across 82 medical schools in Japan between November 2022 and February 2023.

RESULTS

Three learning objectives were identified as difficult for the students to achieve: (1) provide an overview of the regulations, laws, and guidelines related to IST in medicine; (2) discuss ethical issues, such as social disparities caused by the digital divide that may arise in the use of IST in medicine; and (3) understand IST related to medical care. Further, problem-based learning, engaging with IST beyond class, and learning approach impacted the students' acquisition of competencies related to IST. Furthermore, it was recognized that the competencies required by medical students may change over the course of an updated medical school curriculum.

CONCLUSIONS

It is important for medical students to recognize the significance of learning, establishing active learning methods, and gaining experience in practically applying these competencies.

The digital readiness of future physicians: nurturing the post-pandemic medical education

BACKGROUND

The COVID-19 pandemic has accelerated the integration of digital technologies in the healthcare sector. Telemedicine has notably emerged as a significant tool, offering a range of benefits. However, various barriers, such as healthcare professionals' insufficient technological skills and competencies, can hinder its effective implementation. Scholars have examined the readiness of future physicians, with some studies exploring their readiness before or during the COVID-19 crisis. There is, however, a noteable gap in the literature concerning the post-pandemic period. This study aims to identify gaps in current medical education programs by examining two primary aspects: (1) technical readiness (encompassing general and health-related digital competencies) and (2) behavioural readiness, which includes prior experiences and future intentions related to telemedicine education and implementation among medical students and residents.

METHODS

A cross-sectional study was conducted using a web-based questionnaire administered to medical students and residents at a major Northern Italian university. The survey responses were analyzed to ascertain whether their distributions varied across demographic variables such as gender and level of education.

RESULTS

The most commonly owned technologies were laptops and smartphones, with smartphones perceived as the easiest to use, while desktop computers presented more challenges. Approximately 38% of respondents expressed apprehension about applying digital health information in decision-making processes. There was a significant lack of both personal and academic experience, with only 16% of students and residents having used telemedicine in a university setting. Despite this, 83% of participants expressed a desire for training in telemedicine, and 81% were open to experimenting with it during their academic journey. Moreover, 76% of respondents expressed interest in incorporating telemedicine into their future clinical practice.

CONCLUSIONS

This study highlights the need for medical students and residents to receive specific education in digital health and telemedicine. Introducing curricula and courses in this domain is critical to addressing the challenges of digital healthcare.

Integrating Shared Decision-Making into Undergraduate Oncology Education: A Pedagogical Framework

The integration of shared decision-making (SDM) into undergraduate oncology education represents a critical evolution in medical pedagogy, reflecting the growing complexity and patient-centric focus of contemporary healthcare. This paper introduces a comprehensive pedagogical framework designed to embed SDM within the undergraduate medical curriculum, particularly in oncology, where the multiplicity of treatment options and their profound impact on patient life underscore the necessity of this approach. Grounded in a systematic literature review and aligned with established educational theories, this framework proposes twelve strategic approaches to cultivate future physicians proficient in both clinical acumen and patient-collaborative decision-making. The framework emphasizes real-world clinical experience, role-playing, case studies, and decision aids to deepen students' understanding of SDM. It advocates for the development of communication skills, ethical deliberation, and cultural competence, recognizing the multifaceted nature of patient care. The inclusion of patient narratives and evidence-based decision-making further enriches the curriculum, offering a holistic view of patient care. Additionally, the integration of digital tools within the SDM process acknowledges the evolving technological landscape in healthcare. The paper also addresses challenges in implementing this framework, such as curricular constraints and the need for educator training. It underscores the importance of continual evaluation and adaptation of these strategies to the dynamic field of medical education and practice. Overall, this comprehensive approach aims not only to enhance the quality of oncological care but also to prepare medical students for the complexities of modern medicine, where patient involvement in decision-making is both a necessity and an expectation.

Evaluating the readiness of healthcare administration students to utilize AI for sustainable leadership: a survey study

PURPOSE

This paper explores how healthcare administration students perceive the integration of Artificial Intelligence (AI) in healthcare leadership, mainly focusing on the sustainability aspects involved. It aims to identify gaps in current educational curricula and suggests enhancements to better prepare future healthcare professionals for the evolving demands of AI-driven healthcare environments.

DESIGN/METHODOLOGY/APPROACH

This study utilized a cross-sectional survey design to understand healthcare administration students' perceptions regarding integrating AI in healthcare leadership. An online questionnaire, developed from an extensive literature review covering fundamental AI knowledge and its role in sustainable leadership, was distributed to students majoring and minoring in healthcare administration. This methodological approach garnered participation from 62 students, providing insights and perspectives crucial for the study's objectives.

FINDINGS

The research revealed that while a significant majority of healthcare administration students (70%) recognize the potential of AI in fostering sustainable leadership in healthcare, only 30% feel adequately prepared to work in AI-integrated environments. Additionally, students were interested in learning more about AI applications in healthcare and the role of AI in sustainable leadership, underscoring the need for comprehensive AI-focused education in their curriculum.

RESEARCH LIMITATIONS/IMPLICATIONS

The research is limited by its focus on a single academic institution, which may not fully represent the diversity of perspectives in healthcare administration.

PRACTICAL IMPLICATIONS

This study highlights the need for healthcare administration curricula to incorporate AI education, aligning theoretical knowledge with practical applications, to effectively prepare future professionals for the evolving demands of AI-integrated healthcare environments.

ORIGINALITY/VALUE

This research paper presents insights into healthcare administration students' readiness and perspectives toward AI integration in healthcare leadership, filling a critical gap in understanding the educational needs in the evolving landscape of AI-driven healthcare.

Design, implementation and evaluation of a spiral module combining data science, digital health and evidence-based medicine in the undergraduate medical curriculum: A mixed methods study

BACKGROUND

Digital health, data science and health informatics are increasingly important in health and healthcare, but largely ignored in undergraduate medical training.

METHODS

In a large UK medical school, with staff and students, we co-designed a new, 'spiral' module (with iterative revisiting of content), covering data science, digital health and evidence-based medicine, implementing in September 2019 in all year groups with continuous evaluation and improvement until 2022.

RESULTS

In 2018/19, a new module, 'Doctor as Data Scientist', was co-designed by academic staff (n = 14), students (n = 23), and doctors (n = 7). The module involves 22 staff, 120 h (43 sessions: 22 lectures, 15 group and six other) over a 5-year curriculum. Since September 2019, 5,200 students have been taught with good attendance. Module student satisfaction ratings were 92%, 84%, 84% and 81% in 2019, 2020, 2021 and 2022 respectively, compared to the overall course (81%).

CONCLUSIONS

We designed, implemented and evaluated a new undergraduate medical curriculum that combined data science and digital health with high student satisfaction ratings.

Knowledge Transfer and Networking Upon Implementation of a Transdisciplinary Digital Health Curriculum in a Unique Digital Health Training Culture: Prospective Analysis

Background

Digital health has been taught at medical faculties for a few years. However, in general, the teaching of digital competencies in medical education and training is still underrepresented.

Objective

This study aims to analyze the objective acquisition of digital competencies through the implementation of a transdisciplinary digital health curriculum as a compulsory elective subject at a German university. The main subject areas of digital leadership and management, digital learning and didactics, digital communication, robotics, and generative artificial intelligence were developed and taught in a transdisciplinary manner over a period of 1 semester.

Methods

The participants evaluated the relevant content of the curriculum regarding the competencies already taught in advance during the study, using a Likert scale. The participants' increase in digital competencies were examined with a pre-post test consisting of 12 questions. Statistical analysis was performed using an unpaired 2-tailed Student t test. A P value of <.05 was considered statistically significant. Furthermore, an analysis of the acceptance of the transdisciplinary approach as well as the application of an alternative examination method (term paper instead of a test with closed and open questions) was carried out.

Results

In the first year after the introduction of the compulsory elective subject, students of human medicine (n=15), dentistry (n=3), and medical biotechnology (n=2) participated in the curriculum. In total, 13 participants were women (7 men), and 61.1% (n=11) of the participants in human medicine and dentistry were in the preclinical study stage (clinical: n=7, 38.9%). All the aforementioned learning objectives were largely absent in all study sections (preclinical: mean 4.2; clinical: mean 4.4; P=.02). The pre-post test comparison revealed a significant increase of 106% in knowledge (P<.001) among the participants.

Conclusions

The transdisciplinary teaching of a digital health curriculum, including digital teaching methods, considers perspectives and skills from different disciplines. Our new curriculum facilitates an objective increase in knowledge regarding the complex challenges of the digital transformation of our health care system. Of the 16 student term papers arising from the course, robotics and artificial intelligence attracted the most interest, accounting for 9 of the submissions.

Sharing Digital Health Educational Resources in a One-Stop Shop Portal: Tutorial on the Catalog and Index of Digital Health Teaching Resources (CIDHR) Semantic Search Engine

BACKGROUND

Access to reliable and accurate digital health web-based resources is crucial. However, the lack of dedicated search engines for non-English languages, such as French, is a significant obstacle in this field. Thus, we developed and implemented a multilingual, multiterminology semantic search engine called Catalog and Index of Digital Health Teaching Resources (CIDHR). CIDHR is freely accessible to everyone, with a focus on French-speaking resources. CIDHR has been initiated to provide validated, high-quality content tailored to the specific needs of each user profile, be it students or professionals.

OBJECTIVE

This study's primary aim in developing and implementing the CIDHR is to improve knowledge sharing and spreading in digital health and health informatics and expand the health-related educational community, primarily French speaking but also in other languages. We intend to support the continuous development of initial (ie, bachelor level), advanced (ie, master and doctoral levels), and continuing training (ie, professionals and postgraduate levels) in digital health for health and social work fields. The main objective is to describe the development and implementation of CIDHR. The hypothesis guiding this research is that controlled vocabularies dedicated to medical informatics and digital health, such as the Medical Informatics Multilingual Ontology (MIMO) and the concepts structuring the French National Referential on Digital Health (FNRDH), to index digital health teaching and learning resources, are effectively increasing the availability and accessibility of these resources to medical students and other health care professionals.

METHODS

First, resource identification is processed by medical librarians from websites and scientific sources preselected and validated by domain experts and surveyed every week. Then, based on MIMO and FNRDH, the educational resources are indexed for each related knowledge domain. The same resources are also tagged with relevant academic and professional experience levels. Afterward, the indexed resources are shared with the digital health teaching and learning community. The last step consists of assessing CIDHR by obtaining informal feedback from users.

RESULTS

Resource identification and evaluation processes were executed by a dedicated team of medical librarians, aiming to collect and curate an extensive collection of digital health teaching and learning resources. The resources that successfully passed the evaluation process were promptly included in CIDHR. These resources were diligently indexed (with MIMO and FNRDH) and tagged for the study field and degree level. By October 2023, a total of 371 indexed resources were available on a dedicated portal.

CONCLUSIONS

CIDHR is a multilingual digital health education semantic search engine and platform that aims to increase the accessibility of educational resources to the broader health care-related community. It focuses on making resources "findable," "accessible," "interoperable," and "reusable" by using a one-stop shop portal approach. CIDHR has and will have an essential role in increasing digital health literacy.

Empowering the digital health workforce in Latin America in the context of the COVID-19 pandemic: the Peruvian case

The COVID-19 pandemic has exposed significant gaps in healthcare access, quality, and the urgent need for enhancing the capacity of digital health human resources, particularly in Latin America. During the pandemic, online courses and telehealth initiatives supported by governmental agencies, the Pan American Health Organization, and other public and private resources, have played a crucial role in meeting training demands. This article discusses the role of capacity building programs in digital health within the context of Latin America, with a specific focus on the Peruvian case. We highlight the development of digital health competencies and related policies, while also describing selected experiences related to capacity building in this field. Additionally, we discuss the pivotal role of collaborative partnerships among institutions and countries, emphasizing the importance of culturally relevant training programs in digital health. These initiatives have the potential to accelerate training and research opportunities in Latin America, drawing on the involvement of government agencies, non-governmental organizations, industry, universities, professional societies, and communities.

Fostering Digital Health in Universities: An Experience of the First Junior Scientific Committee of the Brazilian Congress of Health Informatics

OBJECTIVES

Digital health (DH) is a revolution driven by digital technologies to improve health. Despite the importance of DH, curricular updates in healthcare university programs are scarce, and DH remains undervalued. Therefore, this report describes the first Junior Scientific Committee (JSC) focusing on DH at a nationwide congress, with the aim of affirming its importance for promoting DH in universities.

METHODS

The scientific committee of the Brazilian Congress of Health Informatics (CBIS) extended invitations to students engaged in health-related fields, who were tasked with organizing a warm-up event and a 4-hour session at CBIS. Additionally, they were encouraged to take an active role in a workshop alongside distinguished experts to map out the current state of DH in Brazil.

RESULTS

The warm-up event focused on the topic "Artificial intelligence in healthcare: is a new concept of health about to arise?" and featured remote discussions by three professionals from diverse disciplines. At CBIS, the JSC's inaugural presentation concentrated on delineating the present state of DH education in Brazil, while the second presentation offered strategies to advance DH, incorporating viewpoints from within and beyond the academic sphere. During the workshop, participants deliberated on the most crucial competencies for future professionals in the DH domain.

CONCLUSIONS

Forming a JSC proved to be a valuable tool to foster DH, particularly due to the valuable interactions it facilitated between esteemed professionals and students. It also supports the cultivation of leadership skills in DH, a field that has not yet received the recognition it deserves.

Digital learning about patients: An online survey of German medical students investigating learning strategies for family medical video consultations

Objective

Training in video consultations is seldom included in the curriculum for future physicians. Exploration of preferred teaching methods and learning objectives in this context among medical students remains limited. This study addresses this research gap by conducting a survey among medical students in Germany to assess their educational requirements concerning video consultations and patient-centred distance learning.

Methods

This quantitative study employed an online questionnaire designed for German medical students, following the guidelines of the International Association for Health Professions Education. The study primarily focused on discerning the didactic preferences related to patient-centred digital teaching regarding family medical video consultations. We provided a detailed explanation of a concrete learning concept, a family medical synchronous distance learning seminar. Subsequently, we surveyed students to gauge their needs, expectations, and evaluations of this concept. The collected data were subjected to descriptive analysis.

Results

The analysis revealed that students aspire to offer video consulting services to their patients in the future (sample size (n) = 369, median (med) = 68 of 101 Likert scale points, interquartile range (IQR) = 53.75), despite having limited knowledge in this area (n = 353, med = 21, IQR = 33.25). To acquire expertise in telehealth, students favor blended learning models (n = 331, med = 76, IQR = 50). They also recognize the benefits of distance learning, particularly for students with family responsibilities or those who must travel long distances to their learning institutions,. The presented distance seminar concept resonated with them (n = 278, med = 72.5, IQR = 50.5), surpassing five other digital learning models in preference. Furthermore, they expressed a desire for its continued implementation beyond the Coronavirus SARS-CoV-2 pandemic (n = 188, med = 77.5, IQR = 44.75).

Conclusions

The deficiency in medical school education regarding video consultations requires attention. This issue could be resolved by integrating one of the five distance learning concepts outlined in this article.

Comparing the influence of big data resources on medical knowledge recall for staff with and without medical collaboration platform

BACKGROUND

This study aims to examine how big data resources affect the recall of prior medical knowledge by healthcare professionals, and how this differs in environments with and without remote consultation platforms.

METHOD

This study investigated two distinct categories of medical institutions, namely 132 medical institutions with platforms, and 176 medical institutions without the platforms. Big data resources are categorized into two levels-medical institutional level and public level-and three types, namely data, technology, and services. The data are analyzed using SmartPLS2.

RESULTS

(1) In both scenarios, shared big data resources at the public level have a significant direct impact on the recall of prior medical knowledge. However, there is a significant difference in the direct impact of big data resources at the institutional level in both scenarios. (2) In institutions with platforms, for the three big data resources (the medical big data assets and big data deployment technical capacity at the medical institutional level, and policies of medical big data at the public level) without direct impacts, there exist three indirect pathways. (3) In institutions without platforms, for the two big data resources (the service capability and big data technical capacity at the medical institutional level) without direct impacts, there exist three indirect pathways.

CONCLUSIONS

The different interactions between big data, technology, and services, as well as between different levels of big data resources, affect the way clinical doctors recall relevant medical knowledge. These interaction patterns vary between institutions with and without platforms. This study provides a reference for governments and institutions to design big data environments for improving clinical capabilities.

Digital competencies for Singapore's national medical school curriculum: a qualitative study

Studies have shown that national-level initiatives to equip medical students with relevant digital competencies carry many benefits. Yet, few countries have outlined such competencies for clinical practice in the core medical school curriculum. This paper identifies current training gaps at the national level in digital competencies needed by students in the formal curricula of all three medical schools in Singapore from the perspectives of clinical educators and institutional leaders. It bears implications for countries that intend to implement standardized learning objectives for training in these digital competencies. Findings were drawn from in-depth interviews with 19 clinical educators and leaders of local medical schools. Participants were recruited using purposive sampling. Data were interpreted using qualitative thematic analysis. Thirteen of the participants were clinical educators while 6 were deans or vice deans of education from one of the three medical schools in Singapore. While the schools have introduced some relevant courses, they are not standardized nationally. Moreover, the school's niche areas have not been leveraged upon for training in digital competencies. Participants across all schools acknowledged that more formal training is needed in digital health, data management, and applying the principles of digital technologies. Participants also noted that the healthcare needs of the population, patient safety, and safe procedures in the utilisation of digital healthcare technologies should be prioritized when determining the competencies needed by students. Additionally, participants highlighted the need for stronger collaboration among medical schools, and for a stronger link between current curriculum and clinical practice. The findings highlighted the need for better collaboration among medical schools in the sharing of educational resources and expertise. Furthermore, stronger collaborations with professional bodies and the healthcare system should be established to ensure that the goals and outcomes of medical education and the healthcare system are aligned.

The need to strengthen the evaluation of the impact of Artificial Intelligence-based decision support systems on healthcare provision

Despite the renewed interest in Artificial Intelligence-based clinical decision support systems (AI-CDS), there is still a lack of empirical evidence supporting their effectiveness. This underscores the need for rigorous and continuous evaluation and monitoring of processes and outcomes associated with the introduction of health information technology. We illustrate how the emergence of AI-CDS has helped to bring to the fore the critical importance of evaluation principles and action regarding all health information technology applications, as these hitherto have received limited attention. Key aspects include assessment of design, implementation and adoption contexts; ensuring systems support and optimise human performance (which in turn requires understanding clinical and system logics); and ensuring that design of systems prioritises ethics, equity, effectiveness, and outcomes. Going forward, information technology strategy, implementation and assessment need to actively incorporate these dimensions. International policy makers, regulators and strategic decision makers in implementing organisations therefore need to be cognisant of these aspects and incorporate them in decision-making and in prioritising investment. In particular, the emphasis needs to be on stronger and more evidence-based evaluation surrounding system limitations and risks as well as optimisation of outcomes, whilst ensuring learning and contextual review. Otherwise, there is a risk that applications will be sub-optimally embodied in health systems with unintended consequences and without yielding intended benefits.

The need for digital health education among next-generation health workers in China: a cross-sectional survey on digital health education

BACKGROUND

Digital health is important for sustainable health systems and universal health coverage. Since the outbreak of COVID-19, many countries, including China, have promoted the introduction of digital health in their medical services. Developing the next generation of physicians with digital health knowledge and skills is a prerequisite for maximizing the potential of digital health.

OBJECTIVE

We aimed to understand the perception of digital health among Chinese medical students, the current implementation of digital health education in China, and the urgent need of medical students.

METHODS

Our cross-sectional survey was conducted online and anonymously among current medical students in China. We used descriptive statistical analysis to examine participant demographic characteristics and the demand for digital health education. Additional analysis was conducted by grouping responses by current participation in a digital health course.

RESULTS

A total of 2122 valid responses were received from 467 medical schools. Most medical students had positive expectations that digital health will change the future of medicine. Compared with wearable devices (85.53%), telemedicine (84.16%), and medical big data (86.38%), fewer respondents believed in the benefits of clinical decision support systems (CDSS) (63.81%). Most respondents said they urgently needed digital health knowledge and skills, and the teaching method of practical training and internship (78.02%) was more popular than the traditional lecture (10.54%). However, only 41.45% wanted to learn about the ethical and legal issues surrounding digital health.

CONCLUSIONS

Our study shows that the current needs of Chinese medical students for digital health education remain unmet. A national initiative on digital health education, is necessary and attention should be paid to digital health equity and education globally, focusing on CDSS and artificial intelligence. Ethics knowledge must also be included in medical curriculum. Students as Partners (SAP) is a promising approach for designing digital health courses.

Evaluating Change in Student Pharmacists' Familiarity, Attitudes, Comfort, and Knowledge as a Result of Integrating Digital Health Topics Into a Case Conference Series: Cohort Study

BACKGROUND

The use of technology in health care, often referred to as digital health, has expanded rapidly because of the need to provide remote care during the COVID-19 pandemic. In light of this rapid boom, it is clear that health care professionals need to be trained in these technologies in order to provide high-level care. Despite the growing number of technologies used across health care, digital health is not a commonly taught topic in health care curricula. Several pharmacy organizations have called attention to the need to teach digital health to student pharmacists; however, there is currently no consensus on best methods to do so.

OBJECTIVE

The objective of this study was to determine if there was a significant change in student pharmacist scores on the Digital Health Familiarity, Attitudes, Comfort, and Knowledge Scale (DH-FACKS) after exposure to digital health topics in a yearlong discussion-based case conference series.

METHODS

Student pharmacists' initial comfort, attitudes, and knowledge were gathered by a baseline DH-FACKS score at the beginning of the fall semester. Digital health concepts were integrated into a number of cases in the case conference course series throughout the academic year. The DH-FACKS was administered again to students after completion of the spring semester. Results were matched, scored, and analyzed to assess any difference in DH-FACKS scores.

RESULTS

A total of 91 of 373 students completed both the pre- and postsurvey (response rate of 24%). Using a scale from 1 to 10, the mean student-reported knowledge of digital health increased from 4.5 (SD 2.5) before intervention to 6.6 (SD 1.6) after intervention (P<.001) and the mean self-reported comfort increased from 4.7 (SD 2.5) before intervention to 6.7 (SD 1.8) after intervention (P<.001). There was a significant increase in scores for all 4 elements of the DH-FACKS. The mean familiarity scores increased from 11.6 (SD 3.7) to 15.8 (SD 2.2), out of a maximum of 20 (P<.001). The mean attitudes scores increased from 15.6 (SD 2.1) to 16.5 (SD 1.9), out of a maximum of 20 (P=.001). The mean comfort scores increased from 10.1 (SD 3.9) to 14.8 (SD 3.1), out of a maximum of 20 (P<.001). The mean knowledge scores increased from 9.9 (SD 3.4) to 12.8 (SD 3.9), out of a maximum of 20 (P<.001).

CONCLUSIONS

Including digital health topics in a case conference series is an effective and approachable way of providing education on important digital health concepts to students. Students experienced an increase in familiarity, attitudes, comfort, and knowledge after the yearlong intervention. As case-based discussions are an important component of most pharmacy and other medical curricula, this method can be easily applied by other programs that wish to give their students practice applying their knowledge of digital health to complex case-based scenarios.

Smart e-Skin Cancer Care in Europe During and after the Covid-19 Pandemic: a Multidisciplinary Expert Consensus

INTRODUCTION

Melanoma is the deadliest of all the skin cancers and its incidence is increasing every year in Europe. Patients with melanoma often present late to the specialist and treatment is delayed for many reasons (delay in patient consultation, misdiagnosis by general practitioners, and/or limited access to dermatologists). Beyond this, there are significant inequalities in skin cancer between population groups within the same country and between countries across Europe. The emergence of the COVID-19 pandemic only aggravated these health deficiencies.

OBJECTIVES

The aim was to create an expert opinion about the challenges in skin cancer management in Europe during the post COVID-19 acute pandemic and to identify and discuss the implementation of new technologies (including e-health and artificial intelligence defined as "Smart Skin Cancer Care") to overcome them.

METHODS

For this purpose, an ad-hoc questionnaire with items addressing topics of skin cancer care was developed, answered independently and discussed by a multidisciplinary European panel of experts comprising dermatologists, dermato-oncologists, patient advocacy representatives, digital health technology experts, and health technology assessment experts.

RESULTS

After all panel of experts discussions, a multidisciplinary expert opinion was created.

CONCLUSIONS

As a conclusion, the access to dermatologists is difficult and will be aggravated in the near future. This fact, together with important differences in Skin Cancer Care in Europe, suggest the need of a new approach to skin health, prevention and disease management paradigm (focused on integration of new technologies) to minimize the impact of skin cancer and to ensure optimal quality and equity.

Digital Health Training, Attitudes and Intentions to Use It among Romanian Medical Students: A Study Performed during COVID-19 Pandemic

INTRODUCTION

This study focuses on medical students from the University of Medicine and Pharmacy in Cluj-Napoca, Romania, and has three objectives. First, it evaluates the opinions of medical students regarding their previous training as well as their needs for future training in the field of digital health. Second, it assesses their attitudes regarding digital health and their intention to use digital tools as physicians. Lastly, the interrelationship between these issues as well as the socio-demographic factors which influence them are investigated.

MATERIALS AND METHODS

A cross-sectional survey was performed during June-August 2021 among fifth and sixth year students of the Faculty of Medicine from the Iuliu Hațieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania. Anonymous online questionnaires were used which were filled in by 306 students.

RESULTS

Less than half of the participating students declared that they benefited from training or different practical examples during medical education regarding the use of digital tools in different medical areas, while the majority said that they would like to receive more training in the field of digital health. A total of 58.2% said that they totally agree with the introduction of a formal training in the medical curricula regarding digital health. Many students declared positive attitudes toward the use of digital tools in different domains within the medical field and intention to use digital tools as physicians; several differences were noted, including gender, year of study, type of domain, and previous training with regard to the use of digital tools in those domains. Moreover, the need for future training and the desire for the introduction of a formal training program into the medical curricula with regard to this field were stronger among those with more positive attitudes and higher intentions to use digital tools in their medical activity.

CONCLUSIONS

To the best of our knowledge, this is the first study from Romania which investigated the training, attitudes, and intentions regarding the use of digital health among Romanian medical students, and offers valuable information to guide the education of medical students.

Attitude, awareness, and knowledge of telemedicine among medical students: A systematic review of cross‐sectional studies

Background and Aims

The success of every new technology depends on numerous factors, including specialists' knowledge and perceptions of the concept, acquired attitude skills, and work environments. This systematic review aimed to examine medical students' knowledge, attitudes, and perceptions of telemedicine.

Methods

Studies were obtained from the PubMed, Embase, Scopus, and Web of Science databases on June 9, 2022. We followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Cross‐sectional studies that examined medical students' knowledge, attitude, and perceptions of telemedicine approaches were considered inclusion criteria. Titles and abstracts were independently screened based on eligibility criteria. Articles that did not meet the inclusion criteria were excluded from this review. After that, the complete texts were retrieved and screened by two separate researchers based on the eligibility criteria. Disputes were resolved by discussion. The same checklist was used for data extraction. To assess the quality of the studies entering this study, the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross‐sectional studies was used.

Results

In total, 10 eligible articles were found through this review. The sample size of the studies ranged from 60 to 3312 participants, or 6172 participants on the whole. The medical students' attitudes toward telemedicine were evaluated in eight included studies. Many of these studies (seven cases) reported positive and promising perspectives on telemedicine. However, in one study, participants revealed moderate attitudes toward online health information and online health experience sharing (p < 0.05). Students' knowledge of the telemedicine approach was evaluated in eight included studies. Many of these studies (five cases) reported that students possessed an extensively poor knowledge of telemedicine's uses. In three other studies, two reported moderate and one disclosed desirable levels of students' knowledge. All the included studies attributed medical students' poor knowledge to the lack of, and thus failure of, educational courses in this field.

Conclusion

The evidence obtained from this review reveals that medical students possess positive and promising attitudes toward telemedicine technology for education, treatment, and care. However, their knowledge levels were extremely insufficient, and many had not passed any educational courses in this respect. Such results can foreground the health and education policymakers' obligations for planning, training, and empowering digital health and telemedicine literacy among medical students as the primary players in social health.

Computerization of the Work of General Practitioners: Mixed Methods Survey of Final-Year Medical Students in Ireland

BACKGROUND

The potential for digital health technologies, including machine learning (ML)-enabled tools, to disrupt the medical profession is the subject of ongoing debate within biomedical informatics.

OBJECTIVE

We aimed to describe the opinions of final-year medical students in Ireland regarding the potential of future technology to replace or work alongside general practitioners (GPs) in performing key tasks.

METHODS

Between March 2019 and April 2020, using a convenience sample, we conducted a mixed methods paper-based survey of final-year medical students. The survey was administered at 4 out of 7 medical schools in Ireland across each of the 4 provinces in the country. Quantitative data were analyzed using descriptive statistics and nonparametric tests. We used thematic content analysis to investigate free-text responses.

RESULTS

In total, 43.1% (252/585) of the final-year students at 3 medical schools responded, and data collection at 1 medical school was terminated due to disruptions associated with the COVID-19 pandemic. With regard to forecasting the potential impact of artificial intelligence (AI)/ML on primary care 25 years from now, around half (127/246, 51.6%) of all surveyed students believed the work of GPs will change minimally or not at all. Notably, students who did not intend to enter primary care predicted that AI/ML will have a great impact on the work of GPs.

CONCLUSIONS

We caution that without a firm curricular foundation on advances in AI/ML, students may rely on extreme perspectives involving self-preserving optimism biases that demote the impact of advances in technology on primary care on the one hand and technohype on the other. Ultimately, these biases may lead to negative consequences in health care. Improvements in medical education could help prepare tomorrow's doctors to optimize and lead the ethical and evidence-based implementation of AI/ML-enabled tools in medicine for enhancing the care of tomorrow's patients.

Exploring the views of Singapore junior doctors on medical curricula for the digital age: A case study

This study aims to explore the perspectives of medical trainees on the impartation of digital competencies in Singapore's medical school curricula. It also considers how the medical school experience can be strengthened in order to bridge potential gaps in the integration of these competencies in the local curricula. Findings were drawn from individual interviews with 44 junior doctors from Singapore's public healthcare institutions including hospitals and national specialty centers. House officers and residents from different medical and surgical specialties were recruited using purposive sampling. Data was interpreted using qualitative thematic analysis. The doctors were in their first to tenth year of post-graduate training. Thirty of them graduated from the three local medical schools whereas 14 others were trained overseas. Overall, they felt insufficiently prepared to utilize digital technologies in view of their limited exposure to such technologies in medical school. Six key reasons were identified: lack of flexibility and dynamism within the curriculum, dated learning style, limited access to electronic health records, gradual uptake of digital technologies in the healthcare sector, lack of an ecosystem that promotes innovation, and lack of guidance from qualified and available mentors. Equipping medical students with skills relevant to the digital age would benefit from a concerted effort from multiple stakeholders: medical schools, medical educators and innovators, as well as the government. This study bears important implications for countries that seek to bridge the 'transformation gap' brought about by the digital age, which is defined as the sharp divergence between innovations that healthcare providers recognize as important but for which they feel insufficiently prepared.

Putting undergraduate medical students in AI-CDSS designers' shoes: An innovative teaching method to develop digital health critical thinking

INTRODUCTION

Digital health programs are urgently needed to accelerate the adoption of Artificial Intelligence and Clinical Decision Support Systems (AI-CDSS) in clinical settings. However, such programs are still lacking for undergraduate medical students, and new approaches are required to prepare them for the arrival of new and unknown technologies. At University Paris Cité medical school, we designed an innovative program to develop the digital health critical thinking of undergraduate medical students that consisted of putting medical students in AI-CDSS designers' shoes.

METHODS

We followed the six steps of Kern's approach for curriculum development: identification of needs, definition of objectives, design of an educational strategy, implementation, development of an assessment and design of program evaluation.

RESULTS

A stand-alone and elective AI-CDSS program was implemented for fourth-year medical students. Each session was designed from an AI-CDSS designer viewpoint, with theoretical and practical teaching and brainstorming time on a project that consisted of designing an AI-CDSS in small groups. From 2021 to 2022, 15 students were enrolled: they rated the program 4.4/5, and 80% recommended it. Seventy-four percent considered that they had acquired new skills useful for clinical practice, and 66% felt more confident with technologies. The AI-CDSS program aroused great enthusiasm and strong engagement of students: 8 designed an AI-CDSS and wrote two scientific 5-page articles presented at the Medical Informatics Europe conference; 4 students were involved in a CDSS research project; 2 students asked for a hospital internship in digital health; and 1 decided to pursue PhD training.

DISCUSSION

Putting students in AI-CDSS designers' shoes seemed to be a fruitful and innovative strategy to develop digital health skills and critical thinking toward AI technologies. We expect that such programs could help future doctors work in rapidly evolving digitalized environments and position themselves as key leaders in digital health.

Clinical informatics training in medical school education curricula: a scoping review

OBJECTIVES

This scoping review evaluates the existing literature on clinical informatics (CI) training in medical schools. It aims to determine the essential components of a CI curriculum in medical schools, identify methods to evaluate the effectiveness of a CI-focused education, and understand its delivery modes.

MATERIALS AND METHODS

This review was informed by the methodological guidance of the Joanna Briggs Institute. Three electronic databases including PubMed, Scopus, and Web of Science were searched for articles discussing CI between January 2010 and December 2021.

RESULTS

Fifty-nine out of 3055 articles were included in our final analysis. Components of CI education include its utilization in clinical practice, ethical implications, key CI-related concepts, and digital health. Evaluation of educational effectiveness entails external evaluation by organizations external to the teaching institute, and internal evaluation from within the teaching institute. Finally, modes of delivery include various pedagogical strategies and teaching CI using a multidisciplinary approach.

DISCUSSION

Given the broad discussion on the required competencies, we propose 4 recommendations in CI delivery. These include situating CI curriculum within specific contexts, developing evidence-based guidelines for a robust CI education, developing validated assessment techniques to evaluate curriculum effectiveness, and equipping educators with relevant CI training.

CONCLUSION

The literature reveals that CI training in the core curricula will complement if not enhance clinical skills, reiterating the need to equip students with relevant CI competencies. Furthermore, future research needs to comprehensively address current gaps in CI training in different contexts, evaluation methodologies, and delivery modes to facilitate structured training.

Neurology education in the era of artificial intelligence

PURPOSE OF REVIEW

The practice of neurology is undergoing a paradigm shift because of advances in the field of data science, artificial intelligence, and machine learning. To ensure a smooth transition, physicians must have the knowledge and competence to apply these technologies in clinical practice. In this review, we describe physician perception and preparedness, as well as current state for clinical applications of artificial intelligence and machine learning in neurology.

RECENT FINDINGS

Digital health including artificial intelligence-based/machine learning-based technology has made significant inroads into various aspects of healthcare including neurological care. Surveys of physicians and healthcare stakeholders suggests an overall positive perception about the benefits of artificial intelligence/machine learning in clinical practice. This positive perception is tempered by concerns for lack of knowledge and limited opportunities to build competence in artificial intelligence/machine learning technology. Literature about neurologist's perception and preparedness towards artificial intelligence/machine learning-based technology is scant. There are very few opportunities for physicians particularly neurologists to learn about artificial intelligence/machine learning-based technology.

SUMMARY

Neurologists have not been surveyed about their perception and preparedness to adopt artificial intelligence/machine learning-based technology in clinical practice. We propose development of a practical artificial intelligence/machine learning curriculum to enhance neurologists' competence in these newer technologies.

The Current Knowledge, Attitudes, and Practices of the Neglected Methodology of Web-Based Questionnaires Among Chinese Health Workers: Web-Based Questionnaire Study

BACKGROUND

Web-based questionnaire (WBQ) surveys are popular, but the quality of reporting WBQ survey research is uneven and unsatisfactory worldwide. Education and training on WBQ methodology may be necessary. However, the current knowledge, attitudes, and practices (KAP) of its methodology remain unknown.

OBJECTIVE

We investigated the KAP of WBQ methodology among Chinese health workers for the first time to clarify the possible reasons for the unsatisfactory reporting quality of WBQ survey research from China's experience, aiming to provide a basis for improvement.

METHODS

We developed a structured WBQ based on the current recommendations and knowledge and investigated 458 health workers from June 7 to July 6, 2022. A total of 381 valid questionnaires were analyzed after data processing. We defined 50% and 75% as "qualified" and "satisfactory" in knowledge and practice topics to describe the results and analyzed the basic characteristics of the participants who had difficulties in conducting WBQ survey research.

RESULTS

A total of 215 (56.4%) participants had used WBQs for investigation, mostly more than 2 times (88.3%), but only 95 (44.2%) of them had ever received methodological training. A total of 134 (62.3%) users believed that WBQs were practical, but 126 (58.6%) had doubts about the reliability of the results. Most of the knowledge and practice topics did not reach a satisfactory level, and some even did not reach a qualified level. A total of 95 (44.2%)-136 (63.3%) of the users had reported difficulties in conducting WBQ survey research, and different participants could have different difficulties according to their characteristics. In addition, 191 (88.8%) users believed training was necessary.

CONCLUSIONS

We found that Chinese health workers seriously underestimated and neglected the importance of the WBQ methodology, which may be an important reason for the reduced reporting quality of WBQ survey research. Medical educators need to strengthen methodological training on WBQs, which may help to improve the quality of WBQ survey research.

Implementation of a digital health module for undergraduate medical students: A comparative study on knowledge and attitudes

BACKGROUND

Digital competencies are more and more required in everyday work, and training future healthcare professionals in digital health is highly important.

OBJECTIVE

Aim of this study was to assess medical students' gain of knowledge by participation in a teaching module "Digital Health", and to evaluate their attitudes towards digital health and its role in medical education.

METHODS

Students of the module were asked to complete a questionnaire and a multiple-choice-test before and after completing the classes. Students of the same educational level in different modules served as reference group.

RESULTS

34 students took part (n= 17 "Digital Health group"; n= 17 "reference group"). There was no significant difference in pre-existing knowledge between the groups. After having completed the module, participants reached significantly higher scores, compared to their preexisting knowledge (p< 0.05) and the reference group (p< 0.05). Most students found that digital medicine is not sufficiently represented in undergraduate medical education, but will influence everyday work of physicians in the next five years.

CONCLUSIONS

Students showed a high awareness for the impact of digital health on physicians' work. The results suggest that the format can sufficiently transfer knowledge about digital health. Teaching of digital knowledge and competencies should be firmly implemented into medical education to form digitally competent future doctors.

eHealth competence building for future doctors and nurses - Attitudes and capabilities

BACKGROUND

Digitalisation is rapidly changing health care processes and the health care sector, thus increasing the need to improve the digital competence of future health care professionals.

PURPOSE

The aim of this study was to describe the attitudes of medical and nursing students towards digital health based on self-evaluation as well as to compare the differences in perceptions between the two student groups.

METHODS

A cross-sectional study was conducted as an online survey using the Webropol in April 2021 at the University of Oulu and Oulu University of Applied Sciences in Finland. The survey questionnaire consisted of seven background questions and 16 statements on a five-point Likert scale (fully disagree to fully agree) to survey student attitudes towards eHealth, and their digital capabilities.

RESULTS

A total of 250 medical and nursing students were invited to participate in the study and 170 of them took the survey (response rate 68 %). Of those answered, 38 % (n = 64) were nursing and 32 % (n = 106) medical students. Students generally had a positive attitude towards eHealth and health care digitalisation. The differences in perceptions and preparedness between medical and nursing students were surprisingly small in the two student groups. There was a statistically significant difference between the two groups in three out of 16 statements: these were related to changes in the roles of health care professionals and patients as well as the students' knowledge of information contained in the national patient portal.

CONCLUSIONS

The results of this study provide a good starting point for further harmonisation of the curriculum for both health professional groups regarding the teaching of eHealth and telemedicine.

Digital health education and training for undergraduate and graduate nursing students: a scoping review protocol

OBJECTIVE

The objective of this review is to collate and analyze literature reporting on digital health education and training courses, or other pedagogical interventions, for nursing students at the undergraduate and graduate level to identify gaps and inform the development of future educational interventions.

INTRODUCTION

In this era of technology-driven health care, upskilling and/or reskilling the nursing workforce is urgently needed for nurses to lead the digital health future and improve patient care. While informatics competency frameworks serve to inform nursing education and practice, they do not address the entire digital health spectrum.

INCLUSION CRITERIA

This review will include research studies, theoretical/discussion papers, and reports, as well as gray literature from relevant sources published in the last 10 years. Opinion pieces, editorials, conference proceedings, and papers published in languages other than English will be excluded.

METHODS

The JBI methodology for scoping reviews will be followed. Searches will be conducted in Embase, CINAHL, ERIC, MEDLINE, Scopus, and Education Research Complete to retrieve potentially relevant studies. Hand searches of reference lists of included studies will be completed. Two reviewers will independently screen records against predefined eligibility criteria and consult a third reviewer if conflicts arise. Decisions will be documented using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram. Quantitative data will be analyzed using descriptive statistics. Content analysis will be applied to qualitative data to identify categories and themes. Findings will be synthesized and reported in tables and narrative format.

SCOPING REVIEW REGISTRATION

Open Science Framework osf.io/42eug.

Digital health understanding and preparedness of medical students: a cross-sectional study

Digitalisation is changing all areas of our daily life. This changing environment requires new competences from physicians in all specialities. This study systematically surveyed the knowledge, attitude, and interests of medical students. These results will help further develop the medical curriculum, as well as increase our understanding of future physicians by other healthcare market players. A web-based survey consisting of four sections was developed: Section one queried demographic data, section two assessed the current digital health knowledge of medical students, section three queried their attitudes about the future impact of digital health in medicine and section four assessed the recommendations medical students have for the medical curriculum in terms of digital health. This survey was distributed to all (11,978) student at all public Austrian medical schools. A total of 8.4% of the medical student population started the survey. At the knowledge self-assessment section, the medical students reached mean of 11.74 points (SD 4.42) out of a possible maximum of 32 (female mean 10.66/ SD 3.87, male mean 13.34/SD 4.50). The attitude section showed that students see digitalisation as a threat, especially with respect to the patient-physician relationship. The curriculum recommendation section showed a high interest for topics related to AI, a per study year increasing interest in impact of digital health in communication, as well as a decreasing interest in robotic related topics. The attitude towards digital health can be described as sceptical. To ensure that future physicians keep pace with this development and fulfil their responsibility towards the society, medical schools need to be more proactive to foster the understanding of medical students that digital health will persistently alter the medical practice.

Measuring the Digital Skills of Catalan Health Care Professionals as a Key Step Toward a Strategic Training Plan: Digital Competence Test Validation Study

Background

Despite Catalonia being an advanced region in terms of digital health adoption, the “Forum for Professional Dialogue” identified the need to improve information and communication technology (ICT) competences as one of the present and future challenges for health care professionals (HPs).

Objective

We aimed to validate the digital competence test developed ad hoc for this study and to measure the digital competence level of Catalan HPs to establish their current level as the baseline for designing a strategic training plan.

Methods

An exploratory observational study was conducted based on a voluntary survey where sociodemographic, professional and digital tool knowledge, digital tool use, and training needs data were collected and based on the score obtained from a digital competence test developed ad hoc. The digital competence test consisted of 2 “real-life scenarios” with 7 and 11 questions.

Results

In total, 803 HPs, of whom 612 (76.2%) were women, completed the survey between June 28 and July 16, 2021. Most participants self-rated their digital competence level as either intermediate (384/803, 47.8%) or basic (357/803, 44.5%). The mean score in the digital competence test was 22.6 (SD 4.3). Therefore, most participants displayed a basic level of digital competence. The internal consistency of the digital competence test was 0.66, and the discrimination index of all questions was ≥0.2 for all items except for 1 question.

Conclusions

This exploratory study highlights the need to improve the digital competence of HPs working in Catalonia, with special effort being made to provide training according to the specific needs of the different HP profiles. The results have informed the Health Plan for Catalonia 2021-2025 and lay the foundations for the development and deployment of a framework program for the digital competences of HPs. The developed digital competence test shows acceptable consistency for the objective pursued, although improvements are needed to fine-tune its accuracy.

Effect of a flipped classroom course to foster medical students' AI literacy with a focus on medical imaging: a single group pre-and post-test study

BACKGROUND

The use of artificial intelligence applications in medicine is becoming increasingly common. At the same time, however, there are few initiatives to teach this important and timely topic to medical students. One reason for this is the predetermined medical curriculum, which leaves very little room for new topics that were not included before. We present a flipped classroom course designed to give undergraduate medical students an elaborated first impression of AI and to increase their "AI readiness".

METHODS

The course was tested and evaluated at Bonn Medical School in Germany with medical students in semester three or higher and consisted of a mixture of online self-study units and online classroom lessons. While the online content provided the theoretical underpinnings and demonstrated different perspectives on AI in medical imaging, the classroom sessions offered deeper insight into how "human" diagnostic decision-making differs from AI diagnoses. This was achieved through interactive exercises in which students first diagnosed medical image data themselves and then compared their results with the AI diagnoses. We adapted the "Medical Artificial Intelligence Scale for Medical Students" to evaluate differences in "AI readiness" before and after taking part in the course. These differences were measured by calculating the so called "comparative self-assessment gain" (CSA gain) which enables a valid and reliable representation of changes in behaviour, attitudes, or knowledge.

RESULTS

We found a statistically significant increase in perceived AI readiness. While values of CSA gain were different across items and factors, the overall CSA gain regarding AI readiness was satisfactory.

CONCLUSION

Attending a course developed to increase knowledge about AI in medical imaging can increase self-perceived AI readiness in medical students.

An evaluation of undergraduate student nurses' gameful experience whilst playing a digital escape room as part of a FIRST year module: A cross-sectional study

BACKGROUND

The circumstances arising from the COVID-19 pandemic have accelerated the use of digital teaching and learning in health professions education. Digital gamification-based teaching and learning activities are innovative and versatile tools for the acquisition of professional competencies in higher education, which can be used on a range of topics and can be supplemental to other teaching methods.

OBJECTIVES

This study aimed to investigate nursing students' gameful experience whilst playing a digital escape room. In addition, we aimed to analyze the students' motivation, learning experience and outcome of the activity, and the students' perception of the degree of achievement of the intended learning outcomes.

DESIGN

Cross-sectional descriptive study.

PARTICIPANTS

A total of 136 undergraduate first year student nurses enrolled in a "Fundamentals of Nursing" course.

METHOD

The digital escape room game took place online during the academic year 2020-2021. The measures included the GAMEX scale in its Spanish version and a self-reported questionnaire to evaluate the outcome of the scape room game and the degree of achievement of the intended learning outcomes.

RESULTS

More than 80 % of the participants were moderately to very motivated to play the game. Three GAMEX dimensions achieved a mean score of 3 or above 3, namely Enjoyment, Creative Thinking and Absence of Negative effects. The mean score for each of the outcome variables was over 3. However, the degree of achievement of the learning outcomes after exiting the digital escape room was uneven.

CONCLUSION

Gamification-based teaching and learning activities, such as digital escape rooms, can be effective in fostering specific skills, including teamwork, communication and critical thinking. However, they should be designed carefully, and used as a complement, rather than a substitute, of other educational activities.

The Perception of Health Professionals in Bangladesh toward the Digitalization of the Health Sector

Bangladesh is undertaking a major transformation towards digitalization in every sector, and healthcare is no exception. Digitalization of the health sector is expected to improve healthcare services while reducing human effort and ensuring the satisfaction of patients and health professionals. However, for practical and successful digitalization, it is necessary to understand the perceptions of health professionals. Therefore, we conducted a cross-sectional survey in Bangladesh to investigate health professionals' perceptions in relation to various socio-demographic variables such as age, gender, location, profession and institution. We also evaluated their competencies, as digital health-related competencies are required for digitalization. Additionally, we identified major digitalization challenges. Quantitative survey data were analyzed with Python Pandas, and qualitative data were classified using Valence-Aware Dictionary and Sentiment Reasoner (VADER). This study found significant relationships between age χ2(12,N=701)=82.02,p<0.001; location χ2(4,N=701)=18.78,p<0.001; and profession χ2(16,N=701)=71.02,p<0.001; with technical competency. These variables also have similar influences on psychological competency. According to VADER, 88.1% (583/701) of respondents have a positive outlook toward digitalization. The internal consistency of the survey was confirmed by Cronbach's alpha score (0.746). This study assisted in developing a better understanding of how professionals perceive digitalization, categorizes professionals based on competency, and prioritizes the major digitalization challenges.

Empowerment for the Digital Transformation: Results of a Structured Blended-Learning On-the-Job Training for Practicing Physicians in Germany

(1) Background: Practicing physicians have not been in the focus of structured qualifications in basic digital competences so far. However, they are the current gatekeepers to implement digital technologies and need empowerment to proactively take part in the ongoing digital transformation process. The present study investigates if a structured blended-learning training for practicing physicians in Germany enhances both physicians' knowledge about central aspects of the digital transformation (including awareness of personal possibilities to act) and their attitudes towards a more digitally empowered mindset. (2) Methods: Participants (n = 32) self-assessed their knowledge (19 items, 10-point Likert-scale) and attitudes (6 items, 5-point Likert-scale) towards the digital transformation at the beginning and at the end of the training. MANCOVAs were conducted. (3) Results: Participants reported an increase in every knowledge domain, representing large effects (Hedges' g 1.06 to 2.82). Attitudes were partly shifted towards a more empowered mindset with decreased insecurity towards technological, legal, and ethical aspects of the digital transformation (Hedges' g -0.82 to -1.40). However, preparedness for the digital transformation remained low. (4) Conclusions: Generally, the hypotheses were confirmed. The presented on-the-job training had the desired effects on practicing physicians' knowledge and attitudes. Nevertheless, additional empowerment and support are essential.

Medical Students and Their Perceptions of Digital Medicine: a Question of Gender?

Digital technologies play an essential role in the medical sector of today and the future. In a cross-sectional online survey at a German medical university, male students more frequently reported keeping themselves informed about digital medicine outside of their studies across all clinical years of study. While female students self-assessed their knowledge in different fields of digital medicine as worse than their male peers in the first clinical years of study, no more gender differences could be found towards the final year. However, students of both genders showed a strong desire for further education on the topic of digital medicine.

Impact of big data resources on clinicians’ activation of prior medical knowledge

Background

Activating prior medical knowledge in diagnosis and treatment is an important basis for clinicians to improve their care ability. However, it has not been systematically explained whether and how various big data resources affect the activation of prior knowledge in the big data environment faced by clinicians.

Objective

The aim of this study is to contribute to a better understanding on how the activation of prior knowledge of clinicians is affected by a wide range of shared and private big data resources, to reveal the impact of big data resources on clinical competence and professional development of clinicians.

Method

Through the comprehensive analysis of extant research results, big data resources are classified as big data itself, big data technology and big data services at the public and institutional levels. A survey was conducted on clinicians and IT personnel in Chinese hospitals. A total of 616 surveys are completed, involving 308 medical institutions. Each medical institution includes a clinician and an IT personnel. SmartPLS version 2.0 software package was used to test the direct impact of big data resources on the activation of prior knowledge. We further analyze their indirect impact of those big data resources without direct impact.

Results

(1) Big data quality environment at the institutional level and the big data sharing environment at the public level directly affect activation of prior medical knowledge; (2) Big data service environment at the institutional level directly affects activation of prior medical knowledge; (3) Big data deployment environment at the institutional level and big data service environment at the public level have no direct impact on activation of prior knowledge of clinicians, but they have an indirect impact through big data quality environment and service environment at the institutional level and the big data sharing environment at the public level.

Conclusions

Big data technology, big data itself and big data service at the public level and institutional level interact and influence each other to activate prior medical knowledge. This study highlights the implications of big data resources on improvement of clinicians’ diagnosis and treatment ability.

Diabetes Self-management Apps: Systematic Review of Adoption Determinants and Future Research Agenda

BACKGROUND

Most diabetes management involves self-management. Effective self-management of the condition improves diabetes control, reduces the risk of complications, and improves patient outcomes. Mobile apps for diabetes self-management (DSM) can enhance patients' self-management activities. However, they are only effective if clinicians recommend them, and patients use them.

OBJECTIVE

This study aimed to explore the determinants of DSM apps' use by patients and their recommendations by health care professionals (HCPs). It also outlines the future research agenda for using DSM apps in diabetes care.

METHODS

We systematically reviewed the factors affecting the adoption of DSM apps by both patients and HCPs. Searches were performed using PubMed, Scopus, CINAHL, Cochrane Central, ACM, and Xplore digital libraries for articles published from 2008 to 2020. The search terms were diabetes, mobile apps, and self-management. Relevant data were extracted from the included studies and analyzed using a thematic synthesis approach.

RESULTS

A total of 28 studies met the inclusion criteria. We identified a range of determinants related to patients' and HCPs' characteristics, experiences, and preferences. Young female patients were more likely to adopt DSM apps. Patients' perceptions of the benefits of apps, ease of use, and recommendations by patients and other HCPs strongly affect their intention to use DSM apps. HCPs are less likely to recommend these apps if they do not perceive their benefits and may not recommend their use if they are unaware of their existence or credibility. Young and technology-savvy HCPs were more likely to recommend DSM apps.

CONCLUSIONS

Despite the potential of DSM apps to improve patients' self-care activities and diabetes outcomes, HCPs and patients remain hesitant to use them. However, the COVID-19 pandemic may hasten the integration of technology into diabetes care. The use of DSM apps may become a part of the new normal.

Six Drivers to Face the XXI Century Challenges and Build the New Healthcare System: "La Salute in Movimento" Manifesto

The aging of the population, the burden of chronic diseases, possible new pandemics are among the challenges for healthcare in the XXI century. To face them, technological innovations and the national recovery and resilience plan within the European Union can represent opportunities to implement changes and renovate the current healthcare system in Italy, in an effort to guarantee equal access to health services. Considering such scenario, a panel of Italian experts gathered in a multidisciplinary Think Tank to discuss possible design of concepts at the basis of a new healthcare system. These ideas were summarized in a manifesto with six drivers for change: vision, governance, competence, intelligence, humanity and relationship. Each driver was linked to an action to actively move toward a new healthcare system based on trust between science, citizens and institutions.

Medical school curriculum in the digital age: perspectives of clinical educators and teachers

BACKGROUND

There is a need to reexamine Singapore's medical school curricula in light of the increasing digitalization of healthcare. Notwithstanding Singapore's digital competitiveness, there is a perceived gap in preparing its medical students for the digital age. Furthermore, limited research has evaluated the extent to which skills in using digital technologies should be taught to medical students in Asian medical schools to prepare them for future clinical practice- a gap that is filled by this study. Using Singapore as a case study, it explores the views of some local clinical educators and teachers towards the need to impart skills in digital technologies to medical students. It also offers recommendations on ways to balance the clinicians' concerns about these technologies with the digital competencies needed for clinical practice.

METHODS

Findings were drawn from individual interviews with 33 clinical educators and teachers from Singapore's public and private healthcare sectors. They were recruited using purposive sampling. Data were interpreted using qualitative thematic analysis.

RESULTS

Participants included vice deans of education from all three local medical schools and senior consultants from a wide variety of disciplines. Overall, they acknowledged two benefits of equipping students with skills in digital technologies including promoting the culture of innovation and improving work efficiency. However, they also highlighted four main concerns of imparting these skills: (i) erosion of basic clinical skills, (ii) neglect of a generalist approach to healthcare characterized by holistic management of patients, inter-professional collaboration, and commitment to breadth of practice within each specialty, (iii) rapid pace of technological advances, and (iv) de-personalisation by technology.

CONCLUSIONS

The findings show that medical students in Singapore would benefit from a curriculum that teaches them to use digital technologies alongside core clinical skills.

How far has the digitization of medical teaching progressed in times of COVID-19? A multinational survey among medical students and lecturers in German-speaking central Europe

BACKGROUND

To ensure successful medical education despite the COVID-19 pandemic, the demand for online instruction has substantially increased. Fast and efficient teaching in a digital format poses a great challenge for medical students and lecturers as well as the universities.

OBJECTIVE

The aim of this study is to capture the readiness of medical students and faculty members to participate in rapidly- evolving online education.

METHODS

This cross-sectional study is based on two questionnaires distributed among medical students and associate deans for education in Germany, Austria and Switzerland. Questions included decision- making questions, categorical questions, and open-ended questions, all addressing the frequency and format of the digital education offered, the perceived quality of digital education, and medical student satisfaction with digital education. Questions about missing content and areas for improvement from the perspectives of medical students were included. The associate deans were asked for their opinions about the impact of the pandemic on teaching, the organizational setup and implementation of digital education by universities, and plans for future initiatives.

RESULTS

Three thousand and thirty medical students (m = 752 and f = 2245) from 53 universities participated in the study. The study showed that 92% of students were affected by the pandemic, and 19% of the students viewed the changes as entirely negative. 97% of the medical students were able to participate in digital courses, but only 4% were able to learn exclusively online. For 77% of the medical students, digital offerings accounted for over 80% of the education offered. In terms of content, medical students complained about a lack of practical teaching, such as contact with patients, lecturers, fellow medical students, and a poor perceived quality of teaching due to dubbing, frequent changeover of seminars, problem-oriented learning groups and in-person teaching, a lack of interaction possibilities and a lack of technical equipment, such as lecturers' knowledge and server capacities, at the universities. Overall, almost half of the medical students (42%) rated the implementation of digital teaching at their universities as good or very good. Forty-one of the 53 associate deans responded to the questionnaire, and 35 felt medical education was influenced by the pandemic. The associate deans (80%; 33/41) felt that the digitalization of medical education was negatively influenced by the pandemic. Only 44% (18/41) felt that their universities were well or very well positioned for digital teaching. All the associate deans believe that digital teaching in medicine will continue after the pandemic.

CONCLUSIONS

In the German-speaking world, the rapid conversion of medical teaching to a digital format has been well implemented in many cases. The perceived quality of the implementation of digital education still lacks practical relevance and the use of new digital media, such as learning games, VR, and online question time. The digital format of medical education will likely continue beyond the COVID-19 pandemic.

Digital Health and Learning in Speech-Language Pathology, Phoniatrics, and Otolaryngology: Survey Study for Designing a Digital Learning Toolbox App

BACKGROUND

The digital age has introduced opportunities and challenges for clinical education and practice caused by infinite incoming information and novel technologies for health. In the interdisciplinary field of communication sciences and disorders (CSD), engagement with digital topics has emerged slower than in other health fields, and effective strategies for accessing, managing, and focusing on digital resources are greatly needed.

OBJECTIVE

We aimed to conceptualize and investigate preferences of stakeholders regarding a digital learning toolbox, an app containing a library of current resources for CSD. This cross-sectional survey study conducted in German-speaking countries investigated professional and student perceptions and preferences regarding such an app's features, functions, content, and associated concerns.

METHODS

An open web-based survey was disseminated to professionals and students in the field of CSD, including speech-language pathologists (SLPs; German: Logopäd*innen), speech-language pathology students, phoniatricians, otolaryngologists, and medical students. Insights into preferences and perceptions across professions, generations, and years of experience regarding a proposed app were investigated.

RESULTS

Of the 164 participants, an overwhelming majority (n=162, 98.8%) indicated readiness to use such an app, and most participants (n=159, 96.9%) perceived the proposed app to be helpful. Participants positively rated app functions that would increase utility (eg, tutorial, quality rating function, filters based on content or topic, and digital format); however, they had varied opinions regarding an app community feature. Regarding app settings, most participants rated the option to share digital resources through social media links (144/164, 87.8%), receive and manage push notifications (130/164, 79.3%), and report technical issues (160/164, 97.6%) positively. However, significant variance was noted across professions (H3=8.006; P=.046) and generations (H3=9.309; P=.03) regarding a username-password function, with SLPs indicating greater perceived usefulness in comparison to speech-language pathology students (P=.045), as was demonstrated by Generation X versus Generation Z (P=.04). Participants perceived a range of clinical topics to be important; however, significant variance was observed across professions, between physicians and SLPs regarding the topic of diagnostics (H3=9.098; P=.03) and therapy (H3=21.236; P<.001). Concerns included technical challenges, data protection, quality of the included resources, and sustainability of the proposed app.

CONCLUSIONS

This investigation demonstrated that professionals and students show initial readiness to engage in the co-design and use of an interdisciplinary digital learning toolbox app. Specifically, this app could support effective access, sharing, evaluation, and knowledge management in a digital age of rapid change. Formalized digital skills education in the field of CSD is just a part of the solution. It will be crucial to explore flexible, adaptive strategies collaboratively for managing digital resources and tools to optimize targeted selection and use of relevant, high-quality evidence in a world of bewildering data.

Effects of a video intervention on physicians' acceptance of pain apps: a randomised controlled trial

OBJECTIVES

The aim of our study was to determine and enhance physicians' acceptance, performance expectancy and credibility of health apps for chronic pain patients. We further investigated predictors of acceptance.

DESIGN

Randomised experimental trial with a parallel-group repeated measures design.

SETTING AND PARTICIPANTS

248 physicians working in various, mainly outpatient settings in Germany.

INTERVENTION AND OUTCOME

Physicians were randomly assigned to either an experimental group (short video about health apps) or a control group (short video about chronic pain). Primary outcome measure was acceptance. Performance expectancy and credibility of health apps were secondary outcomes. In addition, we assessed 101 medical students to evaluate the effectiveness of the video intervention in young professionals.

RESULTS

In general, physicians' acceptance of health apps for chronic pain patients was moderate (M=9.51, SD=3.53, scale ranges from 3 to 15). All primary and secondary outcomes were enhanced by the video intervention: A repeated-measures analysis of variance yielded a significant interaction effect for acceptance (F(1, 246)=15.28, p=0.01), performance expectancy (F(1, 246)=6.10, p=0.01) and credibility (F(1, 246)=25.61, p<0.001). The same pattern of results was evident among medical students. Linear regression analysis revealed credibility (β=0.34, p<0.001) and performance expectancy (β=0.30, p<0.001) as the two strongest factors influencing acceptance, followed by scepticism (β=-0.18, p<0.001) and intuitive appeal (β=0.11, p=0.03).

CONCLUSIONS AND RECOMMENDATIONS

Physicians' acceptance of health apps was moderate, and was strengthened by a 3 min video. Besides performance expectancy, credibility seems to be a promising factor associated with acceptance. Future research should focus on ways to implement acceptability-increasing interventions into routine care.

Differences in digital health literacy and future anxiety between health care and other university students in England during the COVID-19 pandemic

Background

This study investigates university students’ digital health literacy and web-based information-seeking behaviours during the early stages of the COVID-19 pandemic in England. It compares undergraduate and postgraduate students in non-health related subjects with health care students, many of whom were preparing for, or working in, frontline roles. The survey was conducted as part of a wider study by the COVID-HL research consortium.

Methods

A cross-sectional study was conducted among n = 691 university students aged ≥18 years from 25 universities across England using an adapted digital survey developed by COVID-HL. Data were collected regarding sociodemographic characteristics and specific measures drawn from the Future Anxiety Scale and the Digital Health Literacy Instrument (DHLI). These had been adapted for use in an English setting and to the specific context of the COVID-19 pandemic. Other data collected included students’ anxiety or worries about the future using the Dark Future Scale as well as behaviours in online information-seeking. Data were analysed using correlations to test for relationships between constructs and also between group comparisons to test for differences between students studying health and non-health related subjects.

Results

Across digital health literacy dimensions, there was no significant difference between students studying health-related subjects and other students. Health care students did report greater difficulties in relation to how to behave online. They also relied less on public body sources for information about the pandemic. A significant difference was found between the two student populations in relation to their anxiety about the future with health care students reporting fewer fears about the future.

Conclusions

Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with evaluating online information which may frustrate public health efforts. This could be addressed by ensuring health students’ curriculum in particular encompasses digital health literacy.

Assessment of information literacy skills and knowledge-based competencies in using electronic resources among medical students

Purpose

This paper aims to focus on the information literacy skills and how the resources are being used by medical students of Mahatma Gandhi Medical College and Research Institute (MGMCRI), Pondicherry, India. The main aim is to determine the medical students use, purpose, search strategies and sources through which aware and literacy skills acquired. Further, this paper aims to bring out the problems faced.

Design/methodology/approach

A survey method was conducted through a structured questionnaire distributed among 120 medical students from first year to fourth year. Stratified random sampling was used for selection of students.

Findings

Findings of the study revealed that medical students largely used medical databases such as Bentham Sciences, ProQuest, PubMed and MedlinePlus. Further, the paper reveals that majority used health information for updating their knowledge and to acquire general information. The students’ information literacy level found minimal, which may be the reason majority of the students found difficulty in locating the desired materials followed by irrelevant information, inadequate e-resources and lack of awareness reported some extent.

Originality/value

The recommendations made based on the study are expected to be beneficial to the authorities and library administration of the surveyed institution to take appropriate measures for effective utilization of resources.