Executive summary

Read the executive summary for this report.

Technological advancements have resulted in seismic shifts in how we live, work, communicate and learn. The NHS have been considering the implications of digital technology for some time, with the NHS Long Term People Plan 2019 outlining ambitious but realistic practical priorities for further, systemic digital transformation.

The Topol Review recognises the role academic institutions, educators, and providers will play in preparing the future health and care workforce, not only with the right skills, but aptitude and mindset for a technology enhanced NHS.

Understanding the current state of digital health and care undergraduate and preregistration education is crucial in identifying the extent to which digital technologies are already being introduced, taught, and embedded into curricula and practice learning, as well as the technical and specialist skills required by faculty and placement staff to teach digitally enabled healthcare education.

This review into the current status of digital technology and skills in undergraduate and pre-registration health and care education comprises a literature review to outline the current state of research, as well as rich data from a targeted online survey, focussed workshops and case study interviews; provided voluntarily by students, educators, and staff from health and social care organisations, academic institutions, and regulatory and professional bodies in England.

The evidence collected from this review suggests variations in practice, with some positive experiences and benefits and others less so. This must be fully explored and managed locally and nationally if the NHS is to capitalise on technological advances (Topol, 2019) but also, to enhance the use and experience of digital technologies in healthcare education and training.

Our findings

Digital technology enhances opportunities for flexibility, accessibility and collaboration, but can potentially reduce engagement, learner experience, and equity of access to education.

Almost all academic institutions who took part reported some level of digital technologies use within teaching, primarily for collaboration and communication. Flexibility and improved accessibility were given as 2 of the greatest benefits by students and staff, but this must be monitored and adapted regularly to ensure inclusivity and equity of access. Students and staff participants related lack of equity to poor connectivity, lack of digital literacy, unequal access to equipment or lack of adapting to specific learner needs. The growing use of digital technology for online learning was reported to impact on social experience, leading to feelings of social isolation and less enjoyment. Engagement is a critical pre-requisite for learning to take place and the relationship between the pedagogy and technology should be well considered (Gilly Salmon, 2022).

Digital technologies are being used to simulate ‘safe’ practice and this is enriching experiences and developing competencies but risks dehumanising practice.

Technology is being used to varying degrees in health and care professionals’ education to simulate or ‘augment’ reality, providing safe environments for practice, introducing novel or rare scenarios, and building confidence and competency at early stages. This should amplify real experiences with guided experiences and not risk dehumanising practice by limiting exposure to patients and clinical environments. Effective communication, developing trust, and demonstrating empathy to deepen relationships were identified in the review as key skills for health and care workers. 

There were many examples given of innovative and effective use of digital technologies to develop and grow clinical competencies, but the evidence suggests its effectiveness can be linked to the digital knowledge maturity of the educators and staff. Educators need to effectively navigate the many digital technologies which exist; selecting technology which may have multiple uses or applications, evaluating their effectiveness, viability, and use.

Organisational infrastructure and training to support effective use of technology is just as important as the technology itself.

The technology will only be as good as the infrastructure and training which surrounds it. Outdated systems, lack of compatibility between digital technologies or trying to navigate multiple, complex systems are current challenges being experienced by students and staff. Adequate information technology (IT) support and staff training were identified as key areas to be improved by most participants which may mean technology is not fully enabled or used as effectively as it could be. Both educators and students primarily identified themselves as ‘self-taught’ with their digital literacy, which, while useful, was identified as risking unequal levels of knowledge, a lack of consistent or strategic application of technologies for education, and thus, a varied experience for the learner, with exposure to technology linked to educator confidence or knowledge.  

The evidence suggests there are very mixed approaches in academic institutions and organisations for improving digital literacy, competence, and confidence, although these are identified as critical skills for the future, both within this review, but also more broadly within academic and industry research. At its best, there are wide ranging suites of support for students and staff, offered through masterclasses, workshops, training, eLearning, help-guides and passionate advocates who can support informally (lecturers) or formally (IT technicians). Some participants reported little to no support, relying on technologically curious innovators or early adopters to seek out their own development, or offer this informally to others. Some academic institutions are making assumptions about student digital literacy levels, and there is very little assessment of digital literacy prior to, or after learning for students or staff taking place.

Digital techniques are most useful in the design of educational products.

The literature review found no examples of the teaching of digital techniques but highlighted that digital techniques could be useful in the design of education. The teaching of digital techniques was not specifically included in the survey questions and focus groups, however they were used by some tutors in the design of courses, for example the use of iterative techniques to refine learning tools. (See case study - Mike Bellis at Chester University).

Generally, there was consensus between all groups on the most important skills needed for the future, which included information governance, online safety, confidentiality, data analytics, and critical appraisal of data and sources. This aligns to the Topol findings, which identified data analytics and online safety as key digital skills for the future NHS workforce.

The recommendations within this report centre around 5 key themes.

This review has provided a cross-sectional overview of the status of digital technology and skills in undergraduate and pre-registration health and care education. Further and extensive research is required to ensure full engagement and expertise is continually gathered from the many academic institutions, students, staff and regulatory bodies who will benefit from its findings.