In relation to doctors, what is meant by resident

Medical training: which digital skills do doctors need?

THEMES OF THE TIME

Digital skills must be systematically integrated into medical training. Close interprofessional cooperation between medical informatics and medicine is necessary in order to develop catalogs of learning objectives and prepare prospective doctors for digital medicine.

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The rapid development of digital technologies and the associated transformation of existing work and organizational processes have long since reached medicine (1). However, apart from a few pilot projects and model study programs, the medical curricula have not yet been adapted to future digital challenges (41, 2, 3, 4). A standardized, uniform procedure for imparting digital skills in human medicine studies has not yet been identified (42, 3). Neither the master plan for medical studies 2020 nor the national competency-based catalog of learning objectives (43) address which competencies need to be imparted with regard to the continuous development of medical IT. Corresponding guidelines have been in existence for a long time: Since the dawn of the computer age, various, especially medical IT specialist societies, have tried to implement digital skills in the curriculum of human medicine around the world (2, 5, 6).

For the majority of doctors - and especially for today's medical students - the question nevertheless arises: What challenges does digitalized everyday work bring with it and which skills will doctors need in the future? After a general assessment of the doctor's attitude towards digitization, the importance of digital skills in medical education is examined based on the three domains of health care, research, and training and further education.

Despite the almost inflationary use, the term digitization is often not precisely defined, and it remains unclear what specific content is meant. For the following explanations, we define digitization as the process of converting, generating and displaying data and processes in such a way that they can be stored, processed, presented and used in terms of information technology using a computer (7). In addition to the digital use of data and information, the digitization process is characterized by the networking of devices, mobility in use and the miniaturization of technology.

Ambivalent attitudes in everyday medical work

It is generally assumed that doctors have mastered the safe and adequate handling of the tools and utensils that they use on a daily basis. However, dealing with digital technologies has so far not been an originally medical task area. In view of the dynamic in which information technology is developing, the question arises of how and when should digital competence be acquired? Is it expedient if doctors learn the necessary skills in a “learning by doing” style while working and in a needs-based manner? Or does it make more sense to integrate digital skills into the medical curriculum? Should there even be special specialists with a digital focus (8, 9, 10)? In Germany, there is a broad spectrum of attitudes towards the digital transformation represented in the medical profession, from “early adopters” to “e-health refusers”.

On the one hand, 40.4 percent of resident doctors in Germany deal with IT systems themselves and regularly check the doctor information systems used in their practice (44). The independent examination of digital systems demands practicing physicians time and the willingness for continuous further training in this topic area (44). In 2016, however, one in ten doctors still had no concrete idea of ​​whether or not digitization would affect their work (45, 46).

Studies within the framework of EU projects such as the "Advanced Informatics in Medicine (AIM)" initiative show that the majority of medical staff have large knowledge gaps and uncertainties with regard to the potentials and limitations as well as when dealing with information systems and databases (2, 11 , 12). If the medical staff has little computer skills and experience with technology, this has a negative effect on the willingness to use new technologies (13). Where there is no intensive and differentiated preoccupation with the digitization processes taking place, reactive action remains instead of active discussion, which is essential for helping to shape future developments (14, 15). In addition, a lack of knowledge in dealing with digital technologies can trigger increasing stress levels and contribute to burnout (1, 16).

Impact on the quality of patient care

If new digital systems are not developed by doctors, their acceptance by the medical profession will be difficult (47). Analyzes of the quality of treatment under the aspect of the use of electronic systems demonstrate the need for medical professionals to be able to deal adequately with new technologies. You must have a basic understanding of the digital tools available that goes beyond the pure application level (17).

If doctors apply the available technological developments, for example the electronic drug prescription, inadequately, treatment errors can arise (18). A retrospective multivariate analysis in a children's hospital in Pittsburgh, USA, which was carried out between 2001 and 2003 over 18 months, indicates an increase in hospital mortality by more than double after the introduction of new software for electronic drug prescription (19). A lack of knowledge of the software on the part of the medical staff led, among other things, to the fact that drugs such as antibiotics were not administered without the staff registering this (19).

Other studies suggest that the lower the medical knowledge about the digital tools available, the lower the benefits (20). The same applies to the quality of data: so that data acquired by the patient and checked and entered by doctors can be used optimally for clinical care and research, doctors need an understanding of the underlying functionality of electronic data collection, networking and analysis (21) .

For example, in order to be able to select suitable IT systems for clinical or practice operations and to structure the medical documentation in a target-oriented manner, in-depth knowledge of the effects both the type and structure of the medical documentation on the electronic exchange of patient data within is required a hospital or practice and between different health care facilities (48, 22, 23).

The digital change also has a significant impact on the doctor-patient relationship. Only those who are able to confidently survey the broad spectrum of media and differentiate them in terms of their quality and added value can also teach patients how to use digital offers appropriately. Correspondingly, well-trained doctors can use skills such as media competence and conscious engagement with digital information sources and health apps, for example, to increase the quality of the patient-doctor relationship and sometimes achieve greater therapeutic success (24, 25, 26).

Influences of digital skills in research

In a networked health care system, prospective doctors need not only skills in relation to aspects of digital data processing, but also scientific skills that enable them to deal with future challenges in a differentiated and critical manner (27). Digital systems have become indispensable in research these days. Large stocks of digital data can use artificial intelligence methods such as machine learning and deep learning to provide new insights that could not be generated without digital technologies. This is where the medical informatics initiative of the Federal Ministry of Research and Education comes in (49), in which technological solutions are to be developed that enable the cross-location exchange of medical data to improve research and patient care.

While digital systems are already in full use in clinics and research, the topic of “digital competence” is only gradually finding its way into medical curricula at universities (28). In surveys, doctors and students alike found it extremely sensible to introduce structured training courses for skills that are required in the changing health system (29, 30). Initial surveys indicate that targeted teaching units during studies can improve safety and competence in dealing with digital applications, for example with the electronic patient file or with telemedical procedures (31, 32, 33).

As early as 1999, the "International Medical Informatics Association" (IMIA) published its recommendations on teaching content and objectives in the health professions, which are considered an international standard and were revised again in 2010 (34). With the aim of writing a nationally agreed overview of the medical informatics competencies that medical students should acquire during their studies, the working group "Medical Informatics (MI) - Teaching in Medicine" of the German Society for Medical Informatics, Biometry and Epidemiology developed a " Catalog of learning objectives in medical informatics ”for studies in human medicine. For each of the 42 learning objectives, reasons were given as to why it is necessary at the beginning of the medical activity (22, table). International analyzes declare similar core competencies for future doctors (13, 35).

Anticipate emerging technologies

The challenge that arises in terms of dealing with “new technological achievements” (table) is the identification of competencies that will be needed as long as possible in the future, even among the continuously and dynamically developing digital achievements . For example, aspiring physicians should be able to anticipate emerging technologies and further strengthen the medical role in the dynamically changing future medicine (36).

Both young professionals and students still find it difficult to make clinical decisions (37). This illustrates the general need for decision-making skills training. It is all the more important to learn how to use digital decision support systems differently and the functional principles on which they are based (38) so that prospective doctors do not blindly trust the technology, but can confidently use it as a supporting aid.

The human component that defines a doctor-patient relationship is something that even robots can hardly replace. It is therefore important that the skills for social interaction and the awareness of target-oriented communication are trained in the digital era. It is important here to draw attention to particularities in communication within the framework of digital possibilities (such as the use of telecommunications) and to train prospective doctors in this regard in a structured manner (39).

Phenomena such as increasing frustration, stress and a high expenditure of time, which often arise when dealing with new technical aids, could be reduced by systematically integrating digital skills into medical training (27).

In order to be able to efficiently exploit synergies, a close interprofessional cooperation between medical informatics and medicine is required: Doctors can estimate which developments will be needed in the future to improve patient care, and medical informatics can provide the relevant know-how (9).

In the USA there has been a specialist in clinical informatics since 2013 (47). These are medical specialists for medical informatics who assist doctors in everyday use with digital aids and work on the optimization and further development of digital systems within clinical facilities. The need for specialists - for example for the development of an improved digital infrastructure in hospitals - cannot be covered by the approximately 1,700 specialists in clinical IT (as of 2017) (9). To what extent this model could also work in Germany remains to be seen.

Conclusion and recommendations

New technologies are permanently changing the medical profession. Studies that work out the competencies that doctors will need in the future in view of digital change are rare (3). Medical students are 'digital natives'. They grew up with the Internet and smartphones and are used to using apps, but usually do not yet have the skills that enable them to optimally use digital tools in clinical work and to help improve them further. Against the background of the exponential increase in knowledge, skills must be imparted at an early stage in order to adequately manage data, information and knowledge (50, 40). Prospective doctors should deal critically and reflectively with innovative technical achievements and be able to use them both for high-quality health care and for innovative research in the sense of the continuous improvement of patient care.

There is no need to start from scratch when determining the skills required. Rather, it seems expedient if medical IT specialists and doctors jointly create standardized learning target catalogs for medical studies on digital, medical competencies in order to adequately convey such competencies.

At the Medical University of Hanover (MHH), the project "DigiWissMed" ("Digitization and Scientific Approach in Medicine") was initiated in April 2019. The project, funded by the Lower Saxony Ministry of Science and Culture, aims to integrate digital skills across all grades and subjects into the curriculum at the MHH (graphic).

Based on the National Competence-Based Catalog of Learning Objectives for Medicine (NKLM), the recommendations of the national and international medical informatics societies and an analysis of previously published learning objective catalogs, a competence-based learning objective catalog was created with a focus on digital competencies, tailored to teaching at the MHH. Its contents are currently being gradually anchored in existing courses in the compulsory curriculum. A virtual learning area is intended to serve as an exchange platform for students and lecturers and enable students to independently document their learning progress in the form of e-portfolios.

  • How this article is cited:
    Dtsch Arztebl 2020; 117 (12): A 596-600

Address for the authors
Priv.-Doz. Dr. med. Nilufar Foadi
Dean's office of the Hannover Medical School
Carl-Neuberg-Strasse 1, 30625 Hanover
[email protected]

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Mesko B, Győrffy Z: The rise of the empowered physician in the digital health era. J Med Internet Res 2019; 21 (3): e12490 CrossRefMEDLINEPubMed Central
Hasman A, Sosa M: Review of the state-of-the-art in education and training of health informatics in Europe. Comput Methods Programs Biomed 1995; 48 (1-2): 183-8 CrossRef
Haag M, Igel C, Fischer MR: Digital teaching and digital medicine: A national initiative is needed. GMS J Med Educ 2018; 35 (3).
Buckeridge DL, Goel V: Medical informatics in an undergraduate curriculum: a qualitative study. BMC Med Inform Decis Mak 2002; 2 (1): 6 CrossRefMEDLINEPubMed Central
Graham-Jones P, Jain SH, Friedman CP, Marcotte L, Blumenthal D: The need to incorporate health information technology into physicians ’education and professional development. Health Affairs 2012; 31 (3): 481-7 CrossRefMEDLINE
Shortliffe EH: Medical informatics meets medical education. Jama 1995; 273 (13): 1061 CrossRefMEDLINE
Wolf T, Strohschen J: Digitization: Definition and Maturity. Computer Science Spectrum 2018; 41: 56-64 CrossRef
Edirippulige S, Brooks P, Carati C, et al .: It's important, but not important enough: eHealth as a curriculum priority in medical education in Australia. J Telemed Telecare 2018; 24 (10): 697-702 CrossRef MEDLINE
Fridsma DB: Health informatics: a required skill for 21st century clinicians. BMJ 2018; 362: k3043 CrossRefMEDLINE
Chen M, Safdar N, Nagy P: Should medical schools incorporate formal training in informatics? J Digit Imaging 2011; 24 (1): 1-5 CrossRefMEDLINE PubMed Central
Krause ND, Roulette GD, Papp KK, Kaelber D: Assessing Medical Informatics Confidence Among 1st and 2nd Year Medical Students. AMIA Annu Symp Proc 2006; 2006: 989.
McGowan JJ, Passiment M, Hoffman HM: Educating medical students as competent users of health information technologies: The MSOP Data. Stud Health Technol Inform 2007; 129 (Pt 2): 1414-8.
Konttila J, Siira H, Kyngäs H, et al .: Healthcare professionals ’competence in digitalization: A systematic review. J Clin Nurs 2019; 28 (5-6): 745-61 CrossRefMEDLINE
Kuhn S: Transformation through education. Deutsches Ärzteblatt 2018; 115: A633-8 FULL TEXT
Frenk J, Chen L, Bhutta ZA, et al .: Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376 (9756): 1923-58 Cross Ref
Downing NL, Bates DW, Longhurst CA: Physician burnout in the electronic health record era. Ann Intern Med 2019; 170 (3): 216-7 CrossRefCrossRefMEDLINE
McClaran J, Snell L, Duarte-Franco E: Continuing educational needs in computers and informatics. McGill survey of family physicians. Can Fam Physician 2000; 46 (4): 839-47.
Villamañán E, Larrubia Y, Ruano M, et al .: Potential medication errors associated with computer prescriber order entry. Int J Clin Pharm 2013; 35 (4): 577-83 CrossRef MEDLINE
Han YY, Carcillo JA, Venkataraman ST, et al .: Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116 (6): 1506-12 CrossRefMEDLINE
Vialle V, Tiphine T, Poirier Y, Raingeard E, Feldman D, Freville JC: [To know, understand and combating medication errors related to computerized physician order entry]. Ann Pharm Fri 2011; 69 (3): 165-76 CrossRefMEDLINE
Wysham NG, Howie L, Patel K, et al .: Development and refinement of a learning health systems training program. EGEMS (Wash DC) 2016; 4 (1): 1236 CrossRefMEDLINEPubMed Central
Dugas M, Röhrig R, Stausberg J: Which competencies in medical informatics do doctors need? Presentation of the catalog of learning objectives for medical informatics for students of human medicine. GMS Med Inform Biom Epidemiol 2012; 8 (1): Doc04.
Ammenwerth E, Spötl HP: The time needed for clinical documentation versus direct patient care. Methods Inf Med 2009; 48 (01): 84-91 Cross Ref
Shachak A, Reis S: The impact of electronic medical records on patient – ​​doctor communication during consultation: a narrative literature review. J Eval Clin Pract 2009; 15 (4): 641-9 CrossRefMEDLINE
Shaw N: Medical education & health informatics: time to join the 21st century? Stud Health Technol Inform 2010; 160 (Pt 1): 567-71.
Segal MM, Rahm AK, Hulse NC, et al .: Experience with integrating diagnostic decision support software with electronic health records: Benefits versus risks of information sharing. eGEMs 2017; 5 (1) CrossRefMEDLINEPubMed Central
Matusiewicz D, Aulenkamp J, Werner JA: Effects of the digital transformation of the hospital on the change in the medical profession. In: Klauber J, Geraedts M, Friedrich J, Wasem J (eds.): Hospital Report 2019: The digital hospital. Springer Berlin Heidelberg; 2019: 101–14 CrossRef
Waseh S, Dicker AP: Telemedicine training in undergraduate medical education: Mixed-methods review. JMIR Med Educ 2019; 5 (1): e12515 CrossRefMEDLINEPubMed Central
Briscoe GW, Arcand LGF, Lin T, Johnson J, Rai A, Kollins K: Students ’and residents’ perceptions regarding technology in medical training. Acad Psychiatry 2006; 30 (6): 470-9 CrossRefMEDLINE
Finocchio LJ, Bailiff PJ, Grant RW, O'Neil EH: Professional competencies in the changing health care system: physicians ’views on the importance and adequacy of formal training in medical school. Acad Med 1995; 70 (11): 1023-8 CrossRefMEDLINE
Kuhn S, Jungmann F: Medicine in the digital age. Radiologist 2018; 58 (3): 236-40 CrossRefMEDLINE
Morrow JB, Dobbie AE, Jenkins C, Long R, Mihalic A, Wagner J: First-year medical students can demonstrate EHR-specific communication skills: a control-group study. Fam Med 2009; 41 (1): 28.
Wald HS, George P, Reis SP, Taylor JS: Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient- and relationship-centered care in the computerized setting. Acad Med 2014; 89 (3): 380 CrossRefMEDLINE
Mantas J, Ammenwerth E, Demiris G, et al .: Recommendations of the International Medical Informatics Association (IMIA) on education in biomedical and health informatics. Methods Inf Med 2010; 49 (2): 105-20 CrossRefMEDLINE
Jidkov L, Alexander M, Bark P, et al .: Health informatics competencies in postgraduate medical education and training in the UK: a mixed methods study. BMJ Open 2019; 9 (3): e025460 CrossRefMEDLINEPubMed Central
McClaran J, Snell L, Duarte-Franco E: Continuing educational needs in computers and informatics. McGill survey of family physicians. Can Fam Physician 2000; 46 (4): 839-47.
Brown CA, Dickson R: Healthcare students ’e-literacy skills. J Allied Health 2010; 39 (3): 179-84.
Seyhan AA, Carini C: Are innovation and new technologies in precision medicine paving a new era in patients centric care? J Transl Med 2019; 17 (1): 114 CrossRefMEDLINE PubMed Central
Lee WW, Alkureishi ML, Wroblewski KE, Farnan JM, Arora VM: Incorporating the human touch: piloting a curriculum for patient-centered electronic health record use. Med Educ Online 2017; 22 (1): 1396171 CrossRefMEDLINEPubMed Central
Ward JP, Gordon J, Field MJ, Lehmann HP: Communication and information technology in medical education. Lancet 2001; 357 (9258): 792-6 Cross Ref
Hilty DM, Hales DJ, Briscoe G, et al. APA Summit on Medical Student Education Task Force on Informatics and Technology: Learning about computers and applying computer technology to education and practice. Acad Psychiatry 2006; 30 (1): 29-35 CrossRefMEDLINE
Schünemann I, Budde J. University strategies for teaching in the digital age: No strategy like any other !, Working paper No. 38. Berlin: University Forum Digitization at the Stifterverband für die Deutsche Wissenschaft e.V. 2018.
NKLM 2015. www.nklm.de (last accessed on 6 January 2020).
Obermann K, Müller P, Woerns S: Doctors in the future health market 2015: The
eHealth Study - The Digitization of Outpatient Medicine. Health Foundation (publisher), Hamburg. 2016.
Obermann K, Müller P: Doctors in the future health market 2016: Digitization of the medical profession. Health Foundation (publisher), Hamburg. 2017.
Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H: Do German physicians want electronic health services? A characterization of potential adopters and rejectors in German ambulatory care. Third International Conference on Health Informatics (HealthInf) 2010. Valencia. www.alexandria.unisg.ch/publications/220658 (last accessed on 6 January 2020).
Ertl G: [Do We Need a Specialist Physician for Digital Medicine?]. German Med Wochenschr 2018; 143 (20): 1421 CrossRefMEDLINE
Blum K, Müller U: Documentation expenditure in the medical service of the hospitals. The hospital in 2003; 7: 544-8.
Federal Ministry of Education and Research: Medical Informatics Initiative. www.medizininformatik-initiative.de (last accessed on 6 January 2020).
Schüller K, Busch P: Data literacy: A systematic review of the definition of terms, competence framework and test instruments. Working paper No. 46. Berlin: University Forum Digitization 2019.
Dean's office, Hannover Medical School, Priv.-Doz. Dr. med. Nilufar Foadi, Christian Koop

Peter L. Reichertz Institute for Medical Informatics at the TU Braunschweig and Hannover Medical School: Marianne Behrends