Thursday, 30 April 2009

Are you a digitially competent doctor? Do you need to be?

I was talking to a colleague in the last few days about digital competencies. He wondered if we should be exploring developing a set of competencies for medical students.

I started this blog more than 6 months ago as part of my learning journey on the use of web 2.0 (or whatever term you prefer) technologies and to meet other people who were on the same journey in medical education. I know that I could not yet say what the competencies needed for medicine are. I work with and know many good doctors providing good quality care and they do not blog, or use social networks, or collaborate online in wikis, or use rss feeds, or save or share links in social bookmarking tools. Would they be better doctors if they did?

And if I am not competent yet myself how could I decide that these, or others, are areas which students need to be competent in. How could I assess if they are competent?

Yesterday I was co-ordinating 3rd year exams assessing students skills in clinical examinations. Competency in clinical examination has been regarded as essential for doctors for many years. Maybe in the future it will be irrelevant. But for the moment we, as a profession, hold that it is important.

Will we ever have the same agreement about digital competency?


  1. Why not just go ahead and agree a set of digital competencies? They'll be out of date next week, then you can make up a new set! ;-)

  2. Yes, that's what I thought:)

    Would you say you have been trying to go down this line with exposing students to PLEs? Is it different?

  3. We're not trying to be comprehensive or prescriptive with our PLE strategy, just to give students a set of useful tools in the expectation that what we cover will almost certainly change from year to year.

  4. In response to the second question - Do you need to be?

    I think that the health/medical web is just emerging. At present the quality of content is pretty variable, with most of the good stuff still based around research databases, but there are some examples of quality emerging.
    Medpedia The visible body projectThe current medical/health students will probably be the ones who will create the bulk of the medical/health content on the web. It's kind of a catch-22. While there is some benefit to students becoming networked and digitally competent, this benefit will grow hugely as more health practitioners, teachers & researchers become networked.

    As health instructors, who are engaged with these emerging technologies we can help to facilitate this shift by encouraging medical/health students to engage with networks and contribute to the emerging knowledge base.

    So yes I think it's important.

    Deciding how to define digital competency is another story. It's tricky with such an ever-changing field. Currently we teach our students how to blog, how to use a feed reader, how to use google docs, and my intention is to bring in at some stage in the future when the dust's settled a little. But of course I'm introducing these because I've personally found them to be useful in finding information & making connections on the web. With so many digital communication options, digital literacy needs to be defined in a way which is platform independent. Some of my colleagues have been working on the creation of a digital information literacy learning resource. Within that resource a set of learning outcomes are defined, however the learning outcomes are really based on a set of expectations about types of communication platforms which people should be familiar with.

    So no answers from me, only more questions. :-)

  5. David,
    That's a great response. Thank you very much.
    Writing this and reflecting has made me realise that when I think about competency in medical education, I implicitly move towards the model of minimum competency which would we would agree is the minimum standard for a new doctor- an outcomes based model of medical education. It is certainly the way I have written about it here.
    Within that model I don't think we are ready for digital competencies yet but I am of course very happy to keep exploring.

    Thanks again

  6. I'm not a fan of competency-based education.

    For the first two years of teaching here, our programme used pure competency-based assessment (i.e. achieved vs. not achieved). I found that when the assessment was focussed on achievement of a baseline, that students didn't really bother to achieve beyond that baseline. Why would they, when they didn't get any extrinsic reward for their efforts?

    We moved the programme to a mixed model where students could achieve the baseline, but could also achieve marks contributing towards a merit. This has been better in encouraging achievement, however it's a little complex to administer and mark.

    I'm thinking that the next stage of assessment is to move back to a normative model. We'll still need to have some competency measures to ensure safe practice, but I actually think that normative assessment is pretty good after using a range of options with our students.

  7. It is sure very important I think. MDs can't be australopitheci when it comes to the web. But we definitely need more evidence on its time-efficiency. I guess that as a practicing MD you have less time than as a student to follow all these web 2.0 tools.

  8. Hello Alberto!,

    OK, I challenge you! Can you tell me some of what you think are the necessary digital competencies for a doctor graduating in 2-5 years time?

    I use the web a LOT in my work but I am not sure that this is what people usually mean when they refer to digital competencies or literacies. But it would be great to hear your ideas.

    Anne Marie

    PS Feel free to post on your own blog and link to here so that I don't miss it!

  9. It is hard to tell. As a start, I think I must say I believe that the "blogosphere" is biased. I don't believe we are the ordinary internet users, we are technology geeks who are excited about the web 2.0 revolution. Maybe we are another population, the gaussian tail?
    Some of my classmates have difficulties in sending email attachments, I am not kidding.
    The BASIC digital competencies that come to my mind right now are:
    - basic email (attachments) and browser use (know how to set on/off cookies)
    - search pubmed / OVID and be able to use the filters and the MyNCBI feature. Be able to login is with an academic proxy to access journals with subscription.
    - know what is RSS and how it makes you save time not going on every single website, know how to use efficiently a feed client.

    What do you think about this?

  10. Hi - I'm a medical student from Malta with an interest in MedEd, and came across this very interesting blog: couldn't resist leaving a comment.

    I think certain skills should be mandatory competencies when it comes to training doctors - perhaps using the 'minimum competency' principle suggested above could go some way to instituting this. However, you'd need to differentiate between global competencies, and those which are job specific.

    For example, time will come when patient notes are digitalised - this already happens in a variety of public health systems across Europe (eg Finland is one I'm familiar with). A network is created which both hospital docs and NHS GPs can access and update. This would obviously require quite a level of IT competence - as an example of a job-related competency, this needn't be taught in medical school, but be part of a Foundation Programme (as done in the UK). All new doctors would have to go through this, and will practice its use day-in, day-out. You'd need to recall the older docs to retrain them, though.

    Examples of global skills might include web-based research competencies (use of PubMed etc, critical appraisal of web-based resources, access to online discussion forums and so on). Also, something which will eventually catch on is video-conferencing, both between doctors, as well as with patients.

    When it comes to starting this sort of thing up, there has to be a 'first wave' of users, who will then propogate the use of tech. If you teach students that the most effective way is X, then they will use X, and the people still using Y will have to adapt to X if they want to keep up.

    And yes, they should.

  11. Great start. Currently we ask students to write pieces of work which assume that they know how to do literature searches. We could be more explicit in assessment- get them to list search strategy as part of the work- that would help to meet that competency.

    The use of RSS is interesting. I don't use RSS feeds for my own clinical work. A few months ago I tried to establish if any doctors used a social-bookmarking tool to save information related to clinical work and drew a blank. I'm not sure why that is. Ideally we would all be tagging and sharing but we are not.

    Personally as a GP/family doctor I am a generalist. I need to stay up to date with guidelines on common conditions ( and to recognise what I don't know about less common conditions and then have efficient ways of addressing those gaps. Those knowlege gaps are likely to be of the nature- when do I refer? what initial tests should I do? who do I refer to?
    The answers to these questions have a very local flavour and this is the area that I think we need to develop most- the interface between primary and secondary care.

    I don't think that digital competencies can be seen as standing alone. Students should understand why being able to collaborating on a document in their working lives may be necessary (eg producing a local practice protocol on diabetes management) as well as which tools may be useful in facilitating this.

    What will the digital competencies allow doctors to do better? I think this is where we need to start/continue the conversation.

    Thanks again
    Anne Marie

  12. Dear Pawlu,

    Fantastic to see another medical student here.
    You make some excellent points. To be honest, working with undergraduate students I am perhaps not as familiar with the foundation programme as I should be. But I can see little mention in the current sylabus of anything I would recognise as digital competencies.
    There is mention of keeping a portfolio and demonstrating that one can address learning needs and this is likely an area where digital competency would help if not be entirely necessary.

    We currently do use electronic records in UK general practice, and together with the use of clinical coding this is analgous (though more constrained!) to the way that we use tags to help retrieve digital content online. You are absolutely correct that this is an are that is not talked about a lot in undergraduate courses. The clinical systems that we use can be so different that I'm not even sure if the principles are completely the same.

    I'm not aware of a clinical information management system that allows free-form tagging and I'm not sure if it would be a help or a hindrance to actually use one.

    Thanks so much again.

  13. I guess I can't speak for the medical profession exactly, but I'd tend to agree with what's been said here in terms of generic digital competencies.

    I see the most critical digital literacies as being
    1) Basic use of a computer (probably most med students are fine with this, but many of our students are 30+, and some have tended to avoid computers like the plague)
    2) Confidence in your ability to find a solution to computer-based barriers
    3) Use of email including attachments
    4) Use of MS Word
    5) Web search & the ability to be critical of the quality of information sources
    6) Effective use of whatever the most relevant research databases are to the profession in question.
    7) Collaborative document editing (Not a big step for most people, and so useful)
    8) Understanding RSS & use of a feed reader
    9) Social bookmarking
    10) Could easily keep going - VOIP, FTP, Internet video, Digital copyright....where do you stop?

    These macro-competencies are complicated by the fact that each platform has it's own micro-competencies. Hopefully the skills developed in one area will be transferable if the student has a general idea of how things work, and they are happy enough with their troubleshooting abilities.

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  15. I'm not sure they would be better doctors if they used social media, but they might be better educators. I'm not sure a practicing physician needs to be a producer of web-content - although they should be good a using web-content.


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