Review published on current status of digital tech and skills in health and care education

NHS England has recently published a review of the current status of digital technology and skills in health and care education.

Across a series of online surveys, focus groups and case studies, the review presents key findings on current use of digital technologies, digital literacy, and methodologies currently used in health and care education. It also presents findings on the types of specialist and technical skills needed by both faculty, clinical and academic staff.

Digital technologies and methodologies currently in use to deliver health and care education

One of the main areas the report set out to assess was the current use of digital technologies and methodologies in undergraduate health and care education.

Whilst almost 70% of students questioned for the purposes of the report answered that they engaged with digital technologies as part of their education either “always” or “often”, findings indicated that this use was largely down to platforms such as Microsoft Teams, Zoom, Google Docs and other communication or collaboration methods. Almost all respondents reported using a VLE such as Moodle or Blackboard to support their learning.

Virtual reality and virtual simulation were identified as themes in 170 and 120 responses respectively, as a means of supporting safe practice. Virtual placements were also identified as a means of increasing student’s opportunities to engage with digital technologies.

Elsewhere, other technologies identified as being used included immersive technologies such as augmented reality; wearables such as Go-Pro; robotics; record-keeping technologies; cloud-based storage; and online assessment software.

Importantly, qualitative data collected for the report indicated that the exposure students get to different digital technologies varies according to their institution, staff confidence and experience. One particular response from a member of staff at a university identified that staff groups who are less confident in using digital technologies themselves are less likely to view them as a “necessary part of the curriculum”.

Whilst the integration of clinical digital technologies such as EPR into the curriculum was seen as beneficial, barriers again were identified as a lack of knowledge and/or engagement with necessary digital technologies from staff.

“We are pushing this agenda via our Electronic Practice assessment documentation, however there is reluctance and lack of digital skills in the nursing workforce – this requires a lot of support for our admin to manage.”

Among other responses, a lack of digital expertise from staff was a repeated theme.

“This is an area of disparity. I lead on digital simulation and have introduced several VR/mixed reality (MR)/augmented reality (AR) platforms for students to practice decision making skills and approaches to deteriorating patients and managing specific presentations of conditions – this is done through both VR and MR across 2 different platforms. The disparity is that within our Nursing department, there is only myself with the expertise in these areas, therefore the experience is different amongst other staff groups and digital technology is generally viewed as an add on and something that is not necessary within the curriculum.”

When talking about why digital technologies are used, a series of important findings were discovered. Firstly, findings showed that the COVID-19 pandemic rapidly accelerated the roll-out of digital technologies, particularly in universities who had to quickly adapt their teaching methods. This seemed to have led to varying levels of success.

“There were many benefits and advantages described from introducing digital technologies into education, but equally there was citing of poor experiences from receiving or delivering learning using digital technology. These existing tensions must be fully explored and carefully managed, both locally and nationally to ensure the quality of learning is not negatively impacted.”

That digital technologies offered students a safe environment in which to practice and build repetition without risk to patients, was a key benefit identified by the report. Saving resources and enhancing learning experiences were also points brought up as advantages of digital technologies.

Limitations and drawbacks of digital technologies in learning were also found, with respondents concerned about the dehumanising effect they had, noting the lack of infrastructure to support them, and the potential for access difficulties to create social divisions between wealthy and less wealthy students.

Digital literacy, digital skills and techniques currently being taught

The report next moved on to consider levels of digital literacy and exactly what kind of digital skills and techniques were currently being taught.

A preliminary discussion of responsibility showed that three quarters of students felt they were responsible for their own digital literacy learning, and that only 15% felt “completely prepared” to use digital technologies in a clinical environment. Students reported feeling much more prepared to use digital technologies in a university environment.

“Therefore, there is an argument for exploring a broad range of digital technologies in a university environment to allow students to use them in a safe setting where they feel confident, and in turn, this will prepare them for using these technologies in a clinical environment. Also, this may indicate an underuse of digital technologies in practice due to poor digital literacy capabilities.”

Many staff reported that clinical placements have little or no focus on digital skills or knowledge, recognising that the level of support and training differs between clinical providers. Others felt that although there may not be a focus on digital skills and knowledge specifically, these were still part of wider passive learning through technologies such as e-prescribing systems and handheld ultrasound scanners.

“This almost happens without the student being aware – placements are using digital technology all the time, from e-prescribing systems, telemetry, handheld ultrasound scanners for venous access, Teams meetings for training. Students need to be made more aware that this is part of digital skills acquisition by the placement areas.”

It was also reported that the lack of digital skills education meant that there was a potential for programmes to assume pre-existing digital knowledge.

“This assumption can increase stress for students, which may have a consequential impact on knowledge retention.”

The report notes a “distinct lack of support for both students and staff” in using digital technologies and developing digital literacy skills, with students often assumed to already be digitally competent due to their young age.

“Most staff at higher education institutions report in the survey that they were able to find the support they need to design education programmes using digital education. However, a large portion of staff also reported they could not which suggests further signposting of support is necessary to increase confidence.”

The potential for digital skills training to be embedded within the curriculum was acknowledged by several participants, whilst the need for basic digital skills training was reported by more than 68 respondents.

“Where support is available, it often comes from information technology teams. Additionally, library staff are commonly cited as sources of support, but many students and staff also reported feeling uncertain about where they could find additional support.”

Lack of time, lack of training, failure to keep pace with developments in digital technologies and resistance to change, were all barriers to developing digital literacy identified by the report.

“Fear of new technologies or technophobia can result in a lack of confidence which may hinder progress. It may be particularly challenging to embed digital technologies into the curriculum if staff and students are unwilling to engage.”

Specialist, technical and digital skills required by faculty staff

The report identifies a distinct need for basic digital skills development amongst staff at higher education institutions.

“The reported training currently provided in the survey includes virtual workshops, user guides, eLearning, and training videos. These are predominantly self-guided forms of learning, which suggests that many faculty are responsible for their own digital skills training. This was re-enforced by the focus groups’ discussions.”

Many staff reported that they had received no training at all in relation to digital skills. Others pointed to the fact that where training is available, it is self-guided or optional in-house training, meaning that it is not applied consistently across the faculty.

“Almost half of the staff at higher education institutions who responded to the survey indicated that they support others in their institution with technical issues. This suggests that not only is training self-guided, but the responsibility to resolve technical issues falls onto staff, rather than dedicated support teams.”

Despite limited training, almost three quarters of staff reported that they felt they could resolve day-to-day technical challenges or issues with devices, software or applications without support.

The report showed that there was a lot of awareness of the need for digital skills across professions.

“Many of the commonly mentioned skills were around Information Governance and data protection, which includes areas such as safety online, confidentiality and security. When asked if they were aware of the possible IG implications of using digital technologies in education and practice, most participants, across professions indicated that they are.”

Information governance (IG) in particular was identified by participants as an important skill, in light of the demands for GDPR compliance. Interestingly, IG limitations were also identified by one participant as preventing some Trusts from using specific digital technologies for health and care education.

The need to use EPR was another important consideration relating to the need for digital literacy and skills.

“This is a skill which many Practice Education Leads highlighted as a key skill for their profession. This is because it is a technology typically used in a clinical environment. Electronic patient records are set to be rolled out to 90% of Trusts by December 2023 to allow NHS staff to access relevant patient information quickly. Therefore, it will become an increasingly necessary skill.”

Other noteworthy skills identified by participants included data analysis, data interpretation, and critical appraisal. The need for educators to have the skills to resolve technical issues when they arose whilst delivering digital education was seen as important for faculty.

Many respondents spoke of the disparities arising within faculties with relation to digital literacy and digital technologies.

“There is a big disparity of technical skills, and the academics who are interested in tech like virtual reality end up taking on responsibility for training and use as a whole and end up teaching the rest of the faculty.”

Generational differences and differences in access were considered to be the leading reasons for these disparities in digital abilities.

“One way to increase confidence in faculty to develop specialist and technical skills could be to involve them in the selection and implementation of new technologies. This might empower them and give them ownership over the technologies they are using.”

National Competency Frameworks were another topic for discussion. Participants from the report’s focus groups noted the lack of coherency of approach amongst these frameworks.

“Several competency frameworks seem to be available but there was no knowledge in the focus groups about how these were being implemented. This introduces a significant barrier to faculty development because it results in a lack of structure and inconsistency across organisations. During the focus groups, participants said they felt there were lots of recommendations and priorities coming out of different reports and they did not know which one to follow.”

Recommendations and next steps

Recommendations included using digital education to embed a digital culture; creating an effective digital education strategy; collaboration, sharing best practice and peer to peer learning; and improving organisation’s digital infrastructure and specialist resources.

The report also acknowledged limitations of the research it presented, noting the difficulty in obtaining representation across professions, as well as the difficulty in achieving this representation across the 4 groups it targeted: students, staff in HEI’s, practice education leads, and members of professional groups or regulatory bodies.

In terms of next steps, the report notes the rapid development of technology and the imminent introduction of things like the Metaverse, 6G connectivity, and Quantum Computing.

“Failure to recognise, respond and adapt to these advances would be disastrous, and education providers and learners will need to be proactive in engaging with them. We cannot afford to wait for another pandemic to stimulate a rush to technological solutions – we need to control the agenda.”

The need for new pedagogies to meet the emergence of these kinds of technological advances was also mentioned.

“It is important to recognise that there is not one ‘true’ underlying educational theory that will deliver the future of health and care education, but it is also important to recognise that learners will increasingly adopt different ways to meet their learning needs. Institutions and educators must be prepared for these changes and be able to respond to the demands of the learners as well as the demands of the technology.”

Further research into the experiences of underrepresented professions and the potential to undertake projects researching the experiences of one professional group at a time, were recommended next steps for researchers on this topic.

To read the report in full, please click here.