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INTRODUCTION
The use of Information and Communication Technologies (ICTs) for purposes related to undergraduate school has become increasingly frequent among medical students, either as tools directly linked to teaching or as digital assistants capable of assisting in daily tasks1.
Not only that, but the number and variety of available ICTs has also grown in recent years, changing the use profile of these technologies, as well as diversifying the scenarios in which they are used2),(3.
These modifications occur quickly and cause many doubts regarding the benefits, damages, advantages and disadvantages of using these technologies. However, regardless of any doubts, ICTs are now an inseparable element of medical education, and thus, regulating them and training teachers and students to use them is of great importance1),(2.
Specifically regarding the use of ICTs in Brazilian medical education, the first steps have already been taken, but more still needs to be done. ICTs are already recognized in the National Curriculum Guidelines (NCG) of the Medical course as essential tools to be mastered during undergraduate school; however, most medical schools are yet to formally include them in their pedagogical projects, leaving the responsibility regarding the regulation of the technology use at the discretion of the current hidden curriculum in each institution1),(4.
Therefore, this study aimed at characterizing the profile of ICT use among medical students, in addition to identifying possible stimuli and impediments to their use.
METHOD
This is an analytical, cross-sectional observational study. The study data were collected through an online form, prepared by the researchers themselves, using the Google Forms® platform, and sent to students of the Faculdade de Medicina e Cirurgia da Universidade Federal do Pará (UFPA) through text messaging apps, e- mail and social networks, from October 2020 to February 2021. It is worth noting that although the UFPA Medical Course supports the incorporation of new technologies into the educational process, does not have a training program or teacher training in this regard, resulting in its own initiatives and specific approaches by each teacher.
Considering the total number of 914 medical students enrolled at the institution, with a margin of error of 5% or so and a confidence level of 90%, a minimum sample size of 210 students was calculated as significant for this study. A total of 216 students who met the following inclusion criteria were included: 18 years of age or older; being a medical student at UFPA, attending from the first to the twelfth semester of the medical course; be regularly enrolled in the institution.
This study was carried out in accordance with the principles of the Declaration of Helsinki and Resolution n. 466/2012 of the National Health Council, receiving a favorable Opinion from the Research Ethics Committee of the Institute of Health Sciences of UFPA on September 30, 2020, under number 4.311.422 (CAAE 38444020.5.0000.0018).
To analyze and quantify the use of ICTs among the participants, the researchers and the statistician responsible for the study analyses created the Use of Technological Resources (UTR) score. This score analyzes the students’ responses to the form and uses the variables “electronic devices to which they have access”; “purpose of the ICT use”; “Most frequently used ICTs”; “Identified impediments to ICT use” and “Identified benefits regarding ICT use” to estimate the degree of use of ICTs in each of the students. Their values range from 1 to 100, and the lower the value, the lower the use of ICTs, and the higher the value, the greater the use of ICTs. To calculate the URT score, the following formula was applied:
URT: Use of Technological Resources
APS: Sum of devices
FINS: Sum of purposes
TICS: Sum of the most often used ICTs
BARR: Sum of impediments
BEN: Sum of benefits
Qualitative variables were presented as the distribution of absolute and relative frequencies and quantitative variables as measures of central tendency and variation. The normality of the variables was assessed using the D’Agostino-Pearson test. The distribution of qualitative variables was assessed using the Chi-square test5. Comparisons involving quantitative variables were performed using Student’s t test and ANOVA with Tukey’s post-test5, as the variables Age and URT showed a Gaussian distribution. An alpha error was previously set at 5% to reject the null hypothesis and statistical analysis was performed using the BioEstat software, version 5.3.
RESULTS
The 216 participants were mostly female (60.6%), predominantly aged between 20 and 24 years (65.3%) (mean age of 23.6±3.7 years) and were mostly from families with an income < 3 minimum wages (36.1%) (Table 1).
Table 1 General characteristics of medical students, related to the URT score.
| N | % | URT | SD | p-value | |
|---|---|---|---|---|---|
| Age Group | 0.5766 | ||||
| Lower than 20 | 13 | 6.0 | 49.8 | 11.1 | |
| From 20 to 24 | 141 | 65.3 | 55.3 | 12.1 | |
| From 25 to 29 | 51 | 23.6 | 54.3 | 10.3 | |
| 30 or older | 11 | 5.1 | 55.0 | 11.8 | |
| Gender | 0.8987 | ||||
| Female | 131 | 60.6 | 54.4 | 11.6 | |
| Male | 85 | 39.4 | 55.3 | 11.8 | |
| Semester | 0.0179* | ||||
| 01st | 6 | 2.8 | 51.0* | 9.0 | |
| 02nd | 15 | 6.9 | 55.2 | 12.1 | |
| 03rd | 18 | 8.3 | 51.8 | 9.7 | |
| 04th | 22 | 10.2 | 50.1 | 11.8 | |
| 05th | 28 | 13.0 | 59.7 | 11.4 | |
| 06th | 23 | 10.6 | 55.3 | 12.7 | |
| 07th | 17 | 7.9 | 58.1 | 8.2 | |
| 08th | 25 | 11.6 | 55.7 | 12.0 | |
| 09th | 21 | 9.7 | 58.2 | 13.0 | |
| 10th | 19 | 8.8 | 56.0 | 7.2 | |
| 11th | 16 | 7.4 | 52.4 | 12.0 | |
| 12th | 6 | 2.8 | 60.4* | 14.2 | |
| Family income (MW) | 0.0785 | ||||
| Less than 3 MW | 78 | 36.1 | 54.0 | 10.2 | |
| Between 3 and 6 MW | 61 | 28.2 | 56.4 | 12.3 | |
| Between 6 and 10 MW | 33 | 15.3 | 50.8 | 12.7 | |
| More than 10 MW | 44 | 20.4 | 56.8 | 11.6 | |
| Overall | 216 | 100 | 54.8 | 11.6 |
* ANOVA, with Tukey’s post-test. URT: Use of Technological Resources.
The URT score showed no statistical difference regarding the use of ICTs according to the age group (p = 0.5766), gender (p = 0.8987) and family income (p = 0.0785). However, when analyzing the school semester, a statistically significant difference was observed regarding the use of these resources (p = 0.0179*) in relation to the first semester, with an URT of 51.0 (significantly lower) and the twelfth semester with an URT of 60.4 (significantly higher) (Table 1).
In the analysis of electronic devices to which the participants have access, it was clear that access to video games and smart TVs is significantly lower than the others, while access to smartphones is significantly higher. Regarding the frequency of use of ICTs, there was a statistically significant trend towards the frequent use of this type of technology (Table 2).
Table 2 Accessed electronic devices and frequency of use by medical students.
| N | % | |
|---|---|---|
| Electronic device(s) to which they have access | ||
| Smartphone* | 147 | 68.1 |
| Notebook | 137 | 63.4 |
| Desktop | 21 | 9.7 |
| Tablet | 20 | 9.3 |
| Videogame* | 1 | 0.5 |
| Smart TV* | 1 | 0.5 |
| Frequency of ICT use | ||
| Frequently* | 184 | 85.2 |
| Moderately | 28 | 13.0 |
| Rarely | 4 | 1.9 |
p-value <0.0001*, Chi-square for adherence, expected equal proportions.
ICTs: Information and Communication Technologies.
In the analysis of the purpose of using ICTs, it was clear that their use for personal planning is significantly lower than other uses. In the analysis of which ICTs are commonly used, the statistical test showed that the use of specialized calculators and medication apps is significantly lower than the others, while the use of text messaging apps, internet browsers and reading tools is significantly higher (Table 3).
Table 3 Purpose of the use of ICTs and which ICTs are most commonly used by medical students.
| N | % | |
|---|---|---|
| For what purposes do you usually use ICTs? | ||
| Study | 134 | 62.0 |
| Communication | 131 | 60.6 |
| Leisure | 125 | 57.9 |
| Preparing assignments | 124 | 57.4 |
| Quick Information Check | 113 | 52.3 |
| Personal Planning* | 66 | 30.6 |
| Which ICTs do you normally use? | ||
| Text Messaging Apps* | 215 | 99.5 |
| Internet browsers* | 209 | 96.8 |
| Reading Tools* | 209 | 96.8 |
| 205 | 94.9 | |
| Social networks | 203 | 94.0 |
| University Platforms | 189 | 87.5 |
| Clock | 178 | 82.4 |
| Annotation and/or Recording Tools | 170 | 78.7 |
| Calendars and/or Agendas | 138 | 63.9 |
| GPS | 120 | 55.6 |
| Medication and/or Procedure Apps* | 104 | 48.1 |
| Specialized Calculators* | 67 | 31.0 |
p-value <0.0001*, Chi-square for adherence, expected equal proportions. ICTs: Information and Communication Technologies. GPS: Global Positioning System.
In the analysis of impediments to ICT use, it was observed that restrictions due to lack of training and lack of internet access are significantly less common than the others, while restrictions due to security reasons are significantly more prevalent than the others. Considering the benefits identified in the use of ICTs, the analysis showed that distance communication is significantly more frequently mentioned than the others (Table 4).
Table 4 Impediments to the use and benefits identified in the use of ICTs by medical students.
| N | % | |
|---|---|---|
| Impediments and/or restrictions to the use of ICTs? | ||
| Security* | 162 | 75.0 |
| Distractions | 150 | 69.0 |
| ICT dependence | 115 | 53.2 |
| Device with Appropriate Settings | 35 | 16.2 |
| Internet access* | 28 | 13.0 |
| Lack of training in the use of ICTs* | 26 | 12.0 |
| Identified benefits of using ICTs? | ||
| Distance communication** | 208 | 96.3 |
| Quick Access to Information | 207 | 95.8 |
| Logistic practicality | 204 | 94.4 |
| Democratization of Knowledge | 179 | 82.9 |
| Data management | 155 | 71.8 |
p-value <0.0001*, p-value = 0.0234**, Chi-square for adherence, expected equal proportions. ICTs: Information and Communication Technologies.
In the analysis of warnings and encouragements to the use of ICTs, the statistical test showed that there is a significant tendency for students not to be warned (73.1%), in addition to a significant tendency for the student to be encouraged (93.1%) (Table 5).
Table 5 Warnings and encouragements related to the use of ICTs by medical students.
| Yes | % | No | % | p-value | |
|---|---|---|---|---|---|
| Have you ever been warned for using them? | 58 | 26.9 | 158 | 73.1 | <0.001* |
| Have you been encouraged to use them? | 201 | 93.1 | 15 | 6.9 | <0.001* |
*Chi-square test for adherence, expected equal proportions. ICTs: Information and Communication Technologies.
DISCUSSION
The present study showed that, although the use of ICTs is frequent and even encouraged among students, purposeful training for teachers and students, aiming at the best use of these technologies is necessary, given the little use of important tools in medical practice, such as medication apps and specialized calculators.
As in other studies published in the literature, the present research did not identify significant differences in the frequency of ICT use between men and women, or between younger and older individuals6)-(9.
Pereira et. al.8 even reported in their work a lower use of ICTs among older individuals; however, the analyzed population was different (teachers) and the age variation among the participants was significantly greater, which is why the obtained results must have been discordant
Discrepancies in family income were not statistically relevant either, corroborating the findings that ICT use is quite prevalent in medical education, even in settings with limited resources10)-(13.
As a differential of this study, when analyzing the URT scores between the first and twelfth semesters of the analyzed sample, there was a significant difference in the mean values, i.e., lower and higher, respectively. Such observation, using another methodology, was also made by other authors, such as Ellaway et. al.14, who showed in their investigation a lower use of certain ICTs, such as e-mail and digital readers, among students in the first years of undergraduate school.
The explanation for this phenomenon is not clear; however, some points are raised in the literature. The use of ICTs in medical education, as it is not formally regulated in most cases, involves a great degree of student autonomy. However, most students, when starting college/university, do not have a significant mastery of these technologies, consequently failing to use them in different scenarios, whereas students attending more advanced semesters would find situations to use them. It is only with the progress of the course and the effects of the hidden curriculum that these students will start fully using them in their activities1),(14.
A similar reasoning can also be applied to understand the increased use of ICTs among students attending the twelfth semester. Because these students have already attended practically the entire course, their degree of maturity in relation to the use of ICTs is significantly higher, and they are able to take advantage of these tools without so many reservations or insecurities. However, precisely because they have already experienced almost the entirety of their undergraduate course, these same students are also aware of the gaps in their training. Consequently, as an attempt to remedy deficiencies and reduce insecurities when facing the imminent entry into the labor market, these students use ICTs as complementary training tools14)-(16.
At first, this finding seems to disagree with the study by Rashid-Doubell et. al.17, which showed a progressively lower use of ICTs as students advanced in the course, but the aforementioned study focused only on the use of ICTs in clinical contexts, whereas the present study addresses the use of ICTs in different scenarios and situations.
In parallel to the way students use ICTs, it is important to highlight the role of the teacher in this process, who can be a facilitator for a more adequate use of these technologies; however, the most efficient use of these technologies requires significant mobilization by the institution and the teaching staff to incorporate them18),(19. The lack of adequate teacher training and the compulsory introduction of ICTs in the educational environment can result in considerable frustration for both teachers and students19),(20.
It was observed that only a small number of students reported having video games and smart TVs and using them as auxiliary learning tools, a fact that is in line with the literature, as both ICTs are not even mentioned in most studies, as they do not have many apps in the health area2.
Additionally, there was a significantly high prevalence of smartphone ownership among students, a finding that has also been extensively described by other authors. The reasons for the preference for this device are: portability, internet connection, multiple apps that are useful in the medical and personal area, distance communication, relatively affordable price, when compared to other ICTs, and the fact that they easy to use, among others12),(16),(17),(21.
No statistically significant correlation was observed in relation to tablets, notebooks and desktops, but it is worth mentioning that these devices are widely used in the medical field and can also have several advantages12),(14),(17),(21.
When analyzing the frequency of ICT use, the absolute majority of participants reported that they often used these technologies, in addition to feeling quite disadvantaged in their absence. Similar findings are found in the literature and, although some studies do not show such a strong trend towards their frequent use, it is a consensus that these tools are increasingly present in medical education1),(2),(14),(22),(23.
A possible explanation for the high prevalence of frequent ICT use in the present study is the SARS-CoV-2 pandemic, which occurred concurrently with the study, and the consequent social distancing measures that were implemented, transforming a large part of the undergraduate activities into online dynamics24),(25.
When analyzing the reasons why the students used ICTs, their use for personal planning was significantly when lower compared to the other items. Surprisingly, the justification for this finding lies in the probable fact that the participants did not understand what “personal planning” meant. Some students contacted the researchers to ask what the personal planning item was, as it was not explained in details in the form. In addition, none of the analyzed studies obtained results similar to those described in the present one.
Regarding the other uses, no statistically relevant correlation was identified, with the findings of a high prevalence of ICT use for leisure, study, communication, preparation of assignments and quick checking of information being in agreement with the literature6),(13),(14),(26.
In the analysis of the most often used ICTs, statistical relevance was observed in relation to the use of text messaging apps, suggesting a strong participation of hidden and informal curricula in the academic medical education in the analyzed sample. Moreover, the wide use of internet browsers (search engines) and the use of reading tools (bibliographic repository) are also in line with the literature, as it indicates that the main purpose of using ICTs encompasses a bibliographic repository. On the other hand, the use of special calculators, such as for calculating drug doses, was not an important feature for the participants, which is in contrast with the results of other studies, where this tool occupies a prominent position, mainly as an aid to clinical decision making2),(22),(27.
Regarding the impediments to ICT use identified by the participants, there was a statistical relevance related to restrictions due to security reasons. This finding is probably associated with the fact that the main device used by the students is the smartphone. According to Maudsley et. al.2, because the smartphone has a camera, patients may object to its use for ethical reasons, in addition to offering a potential instrument for breach of the doctor-patient confidentiality. Issues related to the physical security of the device (theft, damage, etc.) are also of great relevance when talking about the use of these technologies in developing countries such as Brazil12),(13),(28),(29.
On the other hand, the statistical significance of the present study in relation to the minimal restrictions due to lack of training or lack of internet access diverges from that of the literature, as some authors even recommend that there should be more recommendations not on “how” to use these tools, but “when”1),(2. Moreover, most of the studies analyzed by Mi et. al.30 indicate that internet connection and access problems constitute impediments that are frequently faced by students.
Among the mentioned benefits with statistical significance, it was observed that distance communication is the main advantage of using ICTs. According to the literature, this benefit is justified by the easy communication with preceptors14, in addition to the easy orientation exchange among the students themselves, as well as the sharing of didactic materials2),(31.
Regarding the warnings about the use of ICTs, the pattern found in this investigation differs from most of the literature, considering that there was a greater tendency for the student not to be warned, rather than the opposite. Not only that, but in addition to the student not being warned, there is still a tendency to encourage the use of these technologies, a result that is quite different from some other studies that demonstrate greater resistance by the teachers to use these tools during classes or in clinical practice10),(14.
Among the main limitations of the study, it can be inferred that the platform used in the investigation, Google Forms®, a priori excludes people who do not know how to use it, in addition to excluding students who do not have access to the internet. Moreover, with the online questionnaire template, it is not possible to know the actual circumstances in which the questionnaire was answered. That said, this type of data collection also impairs the possibility of a prompter assistance to the participant regarding possible doubts related to a certain item on the form, in addition to making the results subject to questions related to the objectivity.
Also as a limitation of this study, it is pertinent to emphasize that this study was carried out in a single institution, thus showing a more direct picture of the reality observed there; however, the method used and the coherence with other observations in the literature allow us to consider that the results can be extrapolated to other realities or even used in the comparison with similar investigations carried out in other educational institutions.
FINAL CONSIDERATIONS
This study showed that the use of ICTs by the assessed medical students is quite frequent and varied. Several ICTs that are used by these students, but the most common ones are text messaging apps, internet browsers and reading tools.
As the main stimulus identified for the use of these technologies, communication stands out, either to keep in touch with teachers, friends, family, or simply to share information with other users.
Regarding the identified impediments to the ICT use, the main concern was that related to security, whether physical (theft, robbery, damage, etc.) or digital (data privacy).
Finally, it is concluded that although the use of ICTs is frequent and encouraged among students, the evidence of the scarce use of important resources for medical practice, such as medication apps and specialized calculators, suggests the need for purposeful training, of both teachers and students, aiming at better use of the available technologies.
