JMIR Publications

ABSTRACT

Background:

Digital technologies have impacted healthcare delivery globally and are increasingly used in clinical practice. Despite this, guidelines for implementing training in digital health competencies (DHC) in medical schools, especially for clinical practice, are scarce. A lack of sustained integration of DHC runs the risk of creating knowledge gaps owing to a limited understanding of how DT should be utilized in healthcare. Furthermore, few studies have explored reasons for this lag, both within and beyond the medical school curriculum. Current frameworks to address these barriers are often specific to countries or schools and focus primarily on curriculum design and delivery. A comprehensive framework is needed to ensure consistent implementation of DHC across various contexts and times.

Objective:

Using Singapore as a case study, this paper examines the perspectives of doctors in organizational leadership positions to identify and analyse the barriers to DHC implementation in the undergraduate curriculum of Singapore’s medical schools. It also seeks to apply May and Finch’s (2009) Normalization Process Theory (NPT) to address these barriers and bridge any divide between healthcare systems and DHE training.

Methods:

Individual interviews were conducted with doctors in executive and organizational leadership roles. Purposive sampling was used to recruit participants, and the data were interpreted using qualitative thematic analysis.

Results:

Thirty-three doctors participated, with 26 currently and 7 formerly in organizational leadership roles. Six barriers were identified: bureaucratic inertia, lack of opportunities to pursue non-traditional career pathways, limited protective mechanisms for experiential learning and experimentation, lack of clear policy guidelines for clinical practice, insufficient integration between medical school education and clinical experience, and poor Information Technology integration within the healthcare industry.

Conclusions:

These barriers are also present in other developed countries experiencing healthcare digitalization, highlighting the need for a theoretical framework that broadens the generalizability of existing recommendations. Applying the NPT underscores the importance of addressing various barriers to effectively integrate DHC into the curriculum. Involvement of multiple stakeholders and continuous feedback are essential. Our proposed framework may guide medical schools, professional bodies, and healthcare systems with concrete, evidence-based, and step-by-step recommendations for implementation practice, facilitating the introduction of DHC in undergraduate medical education. Clinical Trial: Not applicable.