Digital health: a neglected part of health curricula?

Current problems and attempts to progress

Crucially, however, despite its potential benefits, digital health adoption has clear accompanying challenges. Greater automation risks dehumanising patient care, and the four pillars of medical ethics are more relevant in this digital age than ever before. To do no harm, HCPs must be sufficiently trained in digital health use, effective data management, and awareness of the accompanying risks. These risks include data and automation biases, where data and algorithms may mirror human biases in decision making, and HCPs may accept machine advice without clinical validation.¹ Justice in resource allocation must also be considered to prevent widening the digital divide and further reinforcing existing social inequalities. Simultaneously, patient autonomy must remain a priority. Anonymised patient data is the first step towards privacy, however, patient trust will likely also depend on concrete measures of accountability and transparency regarding data management.⁷ Before engaging with and prescribing digital interventions, HCPs must not just be able to assess the digital literacy of their patients, including their willingness to engage and possible barriers to uptake (eg accessibility and cost), but also assess their own digital literacy and abilities to navigate the nuances of digital health interventions.

Notably, there have been clear, concerted efforts made in the UK healthcare system to adopt innovative models of digital care and better train their staff. Governmental bodies such as NHSX and NHS Digital, due to merge with NHS England, have been tasked with driving digital transformation programmes, while HCPs, benefiting from leadership opportunities (such as the Topol fellowships and Health Education England (HEE) NHS Digital Academy Digital Health Leadership programme) are expected to meet an array of new standards including HEE's digital capabilities framework and the General Medical Council's generic capabilities framework. Importantly, however, accessibility to training remains one major barrier to the universal uptake of digital health by HCPs, prompting The Topol Review to highlight the need for improved access to training and support if we are to create a digitally literate workforce.¹ Consequently, despite the creation of these postgraduate digital health courses, flexible portfolio training and the introduction of formal digital health and entrepreneurship training posts in the UK, opportunities remain skewed towards those with prior qualifications, understanding or interest.^8,9 Arguably, this then only serves to highlight the lack of a standardised approach to postgraduate digital health education, risking further inequitable digital health literacy in the workforce. Awareness of required competencies, and access to training and support, will thus need to be improved as a fundamental shift in the delivery of healthcare takes place over the next 2 decades.

The undergraduate curriculum as a means of change

To circumvent this issue, and develop key digital competences prior to entering clinical practice, we argue that we should look to the very foundation of each HCP's career: the undergraduate health curricula. Few medical schools, as one such example of a provider of the undergraduate health curriculum, have incorporated digital health education into their curricula, potentially missing out on a key opportunity to encourage digital health literacy from the very beginning. Key exceptions are Barts and The London School of Medicine and Dentistry, University College London Medical School and Warwick Medical School, all of which have launched digital health courses in recent years, with Warwick students in particular benefiting from the Institute of Digital Healthcare. ‘Barts X Medicine’, for example, involves a series of seminars from global digital health influencers, patient representatives and entrepreneurs, alongside a 2-month-long competition where students can develop their own digital health business model. By demonstrating the importance of technology in an increasingly digital healthcare service, and developing key entrepreneurial skills, the project hopes to encourage future HCPs to not only advocate for digital health but also to innovate themselves.

Rather than hope for other medical schools to follow suit, however, perhaps what would be most beneficial is to standardise a nationwide digital health curriculum for all medical schools and allied health courses. This would ensure equal baseline digital health training for all future practitioners, with further opportunities available down the line for those more inclined. Understandably, this would be no small undertaking and research into what should be included in such a curriculum would be sorely needed. The needs of students, educators and experts in the digital health field would need to be comprehensively mapped in order to determine how best to align any potential curriculum with the existing postgraduate digital capabilities framework. Similarly, the method by which such teaching is delivered and assessed must be carefully considered, for example, whether by formative or summative assessments. As of 2021, just one UK study has attempted to assess these needs, an ongoing study by the Faculty of Digital Health, highlighting the need for further work in this area.¹⁰

Acknowledgements

We would like to thank Prof Shafi Ahmed (Founder, Barts X Medicine) and Dr Sandeep Bansal (Faculty, Barts X Medicine) for their valuable advice during the production of this manuscript.

Conflicts of interest

Mrudula Utukuri, Alexander Deighton, Elizabeth PV Le, Benedict Osei-Boadu, Nishita Gadi, Ariana Axiaq, Yuri YM Aung, Bridget Agboola, Chandini Parsan Chand, Chandni R Patel, Mohsin Abedi, Johnathan Hirniak, Ngan H Ta and Rajiv Sethi report involvement in The Faculty of Digital Health UK Steering Group.

Rajiv Sethi is a faculty member of Barts X Medicine. Alexander Deighton and Chandni Rajesh Patel are previous participants of the Barts X Medicine scheme and medical students at Barts and The London School of Medicine and Dentistry. Felecia D'souza is a medical student at Barts and The London School of Medicine and Dentistry.