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

1.Background

The past decade was characterized by a global paradigm shift in the perception and estimation of digitalization in healthcare [1]. It is commonly postulated that the COVID-19-Pandemic has acted as a catalyst of digitalization in healthcare and has sped up a development that had started long before [2, 3]. When first digital technologies emerged around fifty years ago, their use for healthcare was mainly seen in accelerating and optimizing analogous tools and communication [4]. In the last decade, it became apparent that digitalization can meet the demand for ubiquitous data availability in healthcare - one example being the conversion of paper files into digital files, and plans for the implementation of electronic health records in various countries [5]. Digital tools, subsumed by the term health information technology, seem indispensable for today’s patient management and professional communication. Meanwhile, “Digital Health” implies a lot more. Mobile medical applications (apps), wearable devices, digital therapeutics, telehealth/telemedicine or digital biomarkers have a formative influence on medical care, making some authors naming digital health as “cultural transformation of traditional healthcare” [6]. Some innovations, such as the use of artificial intelligence in analyzing big data even have the potential to change established ways of diagnostics or therapies to such an extent that they may be referred to as disruptive technologies [7, 8].

Consequently, digital competencies are more and more required in everyday work [9]. Hence, training future healthcare professionals in the field of digital health in understanding, using, and developing digital health applications is of utmost importance [10, 11]. Various international examples have already reported on courses and electives in undergraduate medical education, usually with a focus on a defined field of the digital health sector. Examples include the use of the internet and gamification [12] and telehealth [13]. In postgraduate and undergraduate teaching for other health professions e.g. for pharmacy [14], nursing [15], and psychiatry [16], digital aspects of the working environment are taught at some institutions. In the United States, some medical schools have been reported to offer digital health teachings, reaching from support for individual research and development projects to formal curricular integration as a “digital health track” [17]. In Germany, the Federal Government had made considerable investments in the fields of digital education and issued a “Digital Agenda”, aiming to increase digital competence and – amongst others – research into digital learning and teaching processes [18]. Some German medical schools have already begun to teach digital health courses or electives [19]. Yet teaching of digital health topics still does not have its regular place in medical education in Germany and Europe [19, 20, 21, 22].

After first experiences with a new elective study module on digital health [20], this study aimed at assessing medical students’ gain of knowledge and their attitude toward digital health related topics, compared to students who had not participated in the module.

2.Methods

3.Results

3.2Questionnaires on attitude regarding digital health

Regarding the questions on attitude regarding digital health as a baseline, over 90% of all students (31/34) agreed or strongly agreed that digital medicine will influence everyday work of physicians in the next five years. In the “Digital Health” group this number was even greater with almost 95% (16/17) (see Fig. 1).

Figure 1.

Students’ responses to the evaluation questions concerning the meaning of digital medicine in undergraduate studies (n= 17 per group).

When asked about the situation in current undergraduate medical education, more than 85% of all students (29/34) found that digital medicine is not sufficiently engrained within current undergraduate medical curricula. When asked about their opinion on their fellow students’ knowledge about digital health, answers of students differed considerably: about 29% (10/34) agreed or strongly agreed, 41% (14/34) disagreed or strongly disagreed, and 29% (10/34) were undecided when asked whether they perceive their fellow students to be literate of “Digital Health” (see Fig. 1).

While most students (91%, 31/34) agreed or strongly agreed that future physicians should be educated regarding aspects of digital health early and specifically during medical education, for the question of whether digital medicine should be mandatory during undergraduate medical education, more students were indecisive (18%, 6/34 students). Yet the majority (79%, 27/34 students) still agreed or strongly agreed to this statement (see Fig. 1). In the group of “Digital Health” participants, this picture was painted more clearly.

4.Discussion

The present study amongst third year medical students provides the missing proof of an efficient transmission of knowledge by an undergraduate module in digital health. In brief, it showed increased awareness for the importance and potential future impact of digital health on physicians’ work and a strong agreement amongst students that digital health should be part of the education of future doctors, while its implementation in the actual German undergraduate medical education is not perceived as sufficient. This is in line with previous findings [25]. The evaluation of pre- and post-test-results of medical students participating in the course showed a significant increase in knowledge, also compared to a control group without particular teaching on the topic.

The here presented module has been able to provide the participating medical institutes of the medical school with first-hand experience in the teaching of digital health which they may benefit from for further teaching formats. This can be especially important since a timely inclusion of digital health into the curriculum has been demanded by students’ and faculties’ organizations for some years now [25, 26] and is planned to be introduced as a requirement with the implementation of the new German National Catalogue of Competency-based Learning Goals NKLM [27] for all German medical schools. This will also bring the need, the requirement, and subsequently the implementation of standardized testing of the medical students’ digital literacy.

Education in general and medical education in particular always faces the problem of measuring and proving the success of educational methods through different means of assessment. When introducing the elective class “Digital Health” into the medical school’s curriculum first subjective general information on students’ and teachers’ perception of the topic and the way it was taught was collected [20]. In a response to that paper, Grzeska et al. recommended assessing individual knowledge by a standardized exam before and after participating in the elective rather than merely enquiring subjective opinions [28]. As all educational efforts aim on increasing students’ knowledge and skills in a particular field, we hope to have found a way of assessing knowledge in a standardized way.

Even though there are growing numbers of European and international examples of implemented digital health courses and classes at medical schools, a preexisting standardized tool to measure the grade of general digital literacy of medical students or doctors is still not known to the authors of this paper. Such as in this paper, teaching and research projects usually establish their own way of assessing or certifying specifically their formulated teaching goals [12, 17, 29]. Here, focusing on the mere gain of knowledge, specifically created multiple-choice tests were used [26]. Having participated and completed the elective “Digital Health” resulted in significantly better results of the MC-test, suggesting that the format of the module and the chosen teaching methods prove sufficient to actually transfer the specific knowledge. The pre-test results were comparable between students who chose the elective “Digital Health” and those who chose different subjects, suggesting the effectiveness of the course format itself. The test questions covered many different topics, including artificial intelligence, law and robotics, as well as the presence of a specific mindset. They were therefore suitable to not only prove the learning of the specific knowledge, but in its sum allows for attesting the students’ general basic knowledge of digital health and its real-life applications. Still, future studies will also have to include analysis of students’ gain in skills and competencies [21].

Students’ answers to the questionnaire on attitude regarding digital health revealed a high awareness of the importance of the topic regardless of the group. This is in line with findings from a study on European level that has shown the gap between students’ perceived need and academic offers of digital health teaching [25]. Since both groups shared these attitudes, it can be postulated that a higher intrinsic motivation and interest in the topic was not the reason for better results in the post-test, which could have been assumed among students choosing an elective module voluntarily. In contrary, it has earlier been reported that students enrolling in digital health elective classes do not necessarily have advanced skills in the field, but can learn them as a measurable learning outcome [30].

5.Conclusion

Digital health is gaining in importance, and digital competencies are more and more required in everyday work. Although medical students seem to have accepted this fact and find that digital health is underrepresented during medical education, teaching of digital competencies does not yet have its regular place in medical education Elective teaching formats like the here presented one can lead to a measurable increase in students’ knowledge about the topic and should be taken as basis for strengthening overall curricular approaches to educate digitally competent future doctors.