3.0 Literature review findings

An overview of the literature review findings. The full literature review is available upon request.

3.1 Key findings

Several key reports and policies were identified at the start of the review and informed this literature review in addition to research evidence.

The literature review aimed to outline the current state of research around the digital technologies being used and taught in preregistration and undergraduate health and care education, as well as the technical skills needed by faculty (clinical and medical) to deliver digital health and care education.

It is important to note that the terms ‘digital literacy’ and ‘digital competence’ are often used in research around digital health and care education, but they are often poorly defined or used interchangeably. Other terms also used interchangeably, including ‘digital skills’ or ‘21st Century digital skills’.

The literature review identified a range of technologies currently being used in health education, including the below.

1. eLearning.
2. Pre-recorded videos/tutorials.
3. Live video conferencing.
4. Virtual Reality (VR) and simulation.
5. Online question banks.
6. Remote examinations.
7. Serious gaming.
8. Mobile digital education (mLearning).
9. Podcasts, webinars, social media.
10. ePortfolios.

However, these technologies are used inconsistently across countries, professions, and institutions. Student and staff satisfaction with these technologies were inconsistent and satisfaction is determined by the degree to which students like the modality.

The additional literature review identified the following digital techniques suitable for use in education.

1. Agile (Agile Schools).
2. Scrum (eduScrum).
3. Instructional models (Examples are: Design process from the Joint Information Systems Committee (JISC), Carpe Diem, Viewpoints, Integrated, Collaborative, Engaging, Balanced, Economical, Reflective and Gradual (ICEBERG), Antecedent, Behaviour and Consequence (ABC), Teeside Learning design toolkit, Enable, University of Brighton Co-Lab Approach).
4. Co-design and collaboration.

The review found little on the teaching of digital techniques to students, however it is acknowledged that digital techniques provide a framework to support curriculum and education design, including digitally enhanced learning. 

There are several stakeholders in digital education, including policymakers in education and managers in private organisations. These groups should be aware that implementing digital education is a complex, multi-dimensional process. If they understand student experience, they can begin to engineer the process to maximise the effect on learning.

Regarding student experience and digital capabilities, the following key points were identified in the literature review.

• Blended learning has been identified as positive in emergency education, nursing education and medical education but findings in other professions are limited.
  • Frameworks for evaluating the effectiveness of blended learning are needed if its use is to be continued in health and care education.
• A significant number of studies in England do not assess the digital literacy or digital readiness of health and care students.
• Many students learn digital literacy skills passively through practice, such as using simulation-based learning and Virtual Reality (VR).
• Assumptions are made about the digital literacy of students, labelling them ‘digital natives'.
  • Providing no digital literacy training on the grounds of assumed digital competence may result in poor quality digital health education.

Regarding the digital literacy and technical skills needed by faculty to deliver digital health and care education, the following key points were identified in the literature review.

• Prior to coronavirus (COVID-19), 74% of teaching staff had no experience teaching in a synchronous online environment and only 34% of staff had regular opportunity to develop digital skills.
• Educators reported experiencing technical issues such as poor Wi-Fi connectivity, and a lack of support in accessing online platforms.
• Culture is a key barrier to the success of online learning. Educators lack the technical skills needed and this results in a negative attitude towards online learning.
• Sharing successful digital teaching in a way that is replicable and develops basic digital skills, including computer mastery, is key to success.
• Educators need institutional support.
  • Training should consider new competency frameworks and pedagogical models for online teaching, so educators do not experience burnout or technophobia.
• Training for educators should explain how technological knowledge and skills are developed because this will give educators a clear structure for transferring this knowledge and skills to students.
• Blended learning has been identified as positive in emergency education, nursing education and medical education but findings in other professions are limited. Frameworks for evaluating the effectiveness of blended learning are needed if its use is to be continued in health and care education.

3.2 Limitations

The broad scope of the research project resulted in an unbalanced identification of studies across all professions and failed to identify articles related to specific professions or articles identified were limited.

There are very few studies in this field based only in England. Some professions are also more heavily studied than others, with dentistry and medicine being the most cited groups. Therefore, there is sufficient argument for the need to research the experiences of health and care students and educators in England, particularly amongst those professions which have been understudied.