ABSTRACT
ObjectiveDigital health (DH) is the integration of technologies to tackle challenges in healthcare. Its applications include mobile health, remote & wireless healthcare, artificial intelligence, and robotics. Digital technologies are increasingly being used to deliver routine care, whilst simultaneously patients are increasing their uptake of DH solutions (e.g. wearables).With the adoption of DH increasing across the NHS, there is a growing need for a digitally literate workforce. However, there are no national standards on DH education for UK medical students. Consequently, this study sought to assess the current provisions, perceptions and challenges regarding DH education in the undergraduate medical curriculum.MethodsAn anonymous cross-sectional online survey was developed following a literature search and by collecting iterative feedback from both researchers and external collaborators. The survey consisted of questions in 6 areas: (a) understanding of DH;(b) existing provision of DH education;(c) interest in DH education;(d) preferred means of delivering and assessing DH education;(e) impact of the COVID-19 pandemic on DH;and (f) demographic information.The survey was administered via Qualtrics from March to October 2021, and disseminated to UK medical students via university mailing lists, social media and student representatives. Quantitative and qualitative data were collected pertaining to demographics, attitudes, preferences, and current provisions regarding DH education. Qualitative responses underwent thematic analysis. For quantitative analysis, R (version 3.5.0) and R Studio (version 1.1a) were used.Results514 complete responses were received from 39 UK medical schools in 2021. 57.2% of respondents were female, with a mean age of 22.9 ± 3.2. 65.8% of students considered DH ‘extremely important’ to future clinical practice, particularly the domains of electronic patient records, telehealth and smartphone applications. However, only 18.1% felt aware of the DH competencies required in clinical medicine. 70.2% of students reported receiving some DH education, with the highest proportion being in the form of lectures or seminars (30.5%, n=157), e-learning modules (28.6%, n=147) and ad hoc teaching during clinical placements (22.8%, n=117). However, only 25.7% felt satisfied with these provisions. Themes for student satisfaction related to a practical teaching approach, delivery of content appropriate for their training stage and coverage of topics in student interest. Conversely, student dissatisfaction originated from inadequate teaching, and subsequent fears of falling behind. 56.1% preferred DH education to be mandatory rather than elective, ideally through hands-on workshops (75.8%) and lectures and seminars (60.4%). 65.4% thought DH proficiency should be assessed in some capacity, of which 75.6% preferred formative assessment.ConclusionThis study represents the first national survey of UK medical students on DH education. Overwhelmingly, the results indicate that medical students recognise the significance of DH and would appreciate better formal integration into their curriculum;which is supported by previous similar studies in the literature. This study also identified how students would prefer to be taught and assessed on DH, in particular that they would prefer it be mandatory yet remain formative at present. Given the increasing ubiquity of DH in clinical practice, it is therefore crucial that universities and wider medical education organisations work to improve and standardise DH education, to better prepare medical students to adapt to the continuously developing digital landscape. This rings especially true in light of the recent COVID-19 pandemic which has highlighted the quintessential nature of DH to medical practice. Our intended future research from this study includes undergraduate focus groups for greater qualitative depth of information, and Delphi panels from wider medical education stakeholders into what should be included in DH education, with the eventual goal of devel ping a comprehensive and standardised national DH curriculum.
ABSTRACT
Background/Aims Coronavirus-2 (SARS-CoV-2) has become a disastrous pandemic since its first outbreak in December 2019. Until 8th of October, 2021, more than 239 million people were infected by COVID-19 leading to over 4.8 million deaths. While vaccines and drugs are two arms in controlling the pandemic, safe and effective vaccines are one of the most reliable interventions to suppress viral transmission. Patients with specific immunological deficits, such as patients with autoimmune diseases or those receiving immunosuppressive need special attention. Besides, vaccination in these patients is problematic due to the probable suppression or over-activation of the immune system. However, there still remain questions about the efficacy and safety of vaccination in immunocompromised patients. Studies are ongoing into the safety and immunogenicity of approved of SARS-CoV-2 vaccines, with regards to immuno-deficient individuals. The aim of this audit was to check the uptake and side effects of the BNT162b2 and ChAdOx1 vaccines. Methods We collected data on 352 patients from routine clinics which included diagnosis, type of vaccine, number of doses, side effects of the vaccines and flare up of arthritis or underlying autoimmune condition. Descriptive statistics were used to analyse the data. Results Of the 352,174 (49%) were Males and 178 (51%) Females. Most common diagnosis was Rheumatoid Arthritis 181 (51%), Axial spondyloarthropathy, 80(23%), Psoriatic Arthritis 65 (18%), GCA 10 (3%), Non-Radiographic Axial Spondyloarthropathy 5 (1.4%), JIA 3 (0.9%), Sarcoidosis 1 (0.3%), and overlap 6 (2%). Medications: 227(65%) patients were on Biosimilars, 26 (7%) on Biologics, 28 (8%) Certolizumab pegol, 21 (6%) Secukinumab, 2 (0.6%) Baricitinib, 3 (0.8%) Abatacept, 29 (8%) Tocilizumab and 16 (4.5%) on Tofacitinib. Vaccination uptake: 329 patients received double dose and 8 received single dose. 15 (4.3%) patients didn't take vaccine. Reasons for not taking vaccine were severe reactions to Arthritis medication and biologics, concerned they may have severe reaction with the vaccine. Some were worried that vaccine may trigger flares, COVID-19 vaccine potentially has tracking chips, didn't trust the vaccine as not gone through enough clinical trialling, lack of any statistics on side effects of the vaccines in immunocompromised patients. Side effects: 146 patients experienced mild side effects based on CTAE5 criteria. Only 3 (2.1%) had severe side effects Grade 3 or above, this included Pulmonary embolism, Stroke, and symptomatic pleural effusion. 15(10%) reported Arthritis flare. Most common side effects were Headache 50(34%), Fatigue 32(22%, Myalgia 32(22%), Fever 30(21%), Chills 30(21%), Injection site pain 28(19%), Rhinorrhoea 11(7.5%), Lethargy 11(7.5%) and maculopapular rash 5(3.4%). Conclusion This audit highlights both the ChAdOx1 and BNT162b2 are safe for use in immune-deficient patients. Immunocompromised patients should be encouraged to take vaccines as benefits of the COVID-19 vaccination outweigh the risks and might reduce the risk of developing severe complications due to COVID-19.