Medical Education 1991, 25, 191-195

Computer literacy among medical, nursing, dental and veterinary undergraduates

R. B. JONES, L. M. NAVIN, J. BARRIE, E. HILLAN 81 D. KINANE

Departments ofPublic Health, Veterinary Medicine, Nursing Studies and Oral Medicine G. Pathology, University of Glasgow

Summary. Universities need to ensure that clinical undergraduates are educated in the use of computers in medical, nursing, dental and veterinary practice. We surveyed 875 students at Glasgow University to determine their computer literacy and attitudes to the use of computers.

One in five students had not used a computer during the last year and 16% thought themselves to be a complete novice with computers. Medical students were more likely to have used a computer recently compared to dental and nurs- ing students. For one in four students, the idea of working with a computer makes them anxious. Seventy per cent of students wanted more use of computers in the curriculum and 30% applied to attend an optional computing course in the summer. Although a third of students had not used a computer at school, the proportion had increased a little in recent years.

At Glasgow University, changes need to be made to the undergraduate curriculum to teach students the use of computers in clinical practice. With a few exceptions, there is no reason to believe that this does not apply to other British universities.

Key words: *computer literacy; *attitude to computers; *attitude of health personnel; *students, health occupations; students, medical; students, nursing; students, dental; education, veterinary; education, medical, undergraduate; Scotland

Correspondence: R. B. Jones, Department of Public Health, University of Glasgow, 2 Lilybank Gardens, Glasgow G12 8RZ, UK.

Introduction

The use ofcomputers in medical, nursing, dental and veterinary practice is increasing and with it the need for practitioners to have knowledge and skills in informatics. (The World Health Organ- ization (1988) defines health informatics as the combination of technology and methodology which makes possible the computer-assisted col- lection, storage, processing, retrieval, distribu- tion and management of information.) Universities should therefore be reviewing their curricula to ensure that clinical undergraduates are trained in the skills required for their future employment.

However, a survey of British medical schools in 1987 showed that apparently little health informatics was included in the undergraduate curriculum (Jones et al. 1989) in contrast to some other countries (Jones 1990). The question arises as to how informatics and the use of computers should be developed in the curriculum. To help answer this, we have carried out a survey of the current level of computer use and computer literacy among medical, nursing, dental and veterinary undergraduates.

Methods

In May 1990, a questionnaire was handed to students at the beginning or end of lectures and students either completed and returned it immediately or returned it by post later. For logistical reasons, only years 1-4 of medical students (medics), years 3-4 of dental students (dentists), years 1-3 of nursing students (nurses) and years 2-4 of veterinary students (vets) were surveyed. Not all students were at their lectures

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and some did not return their questionnaire. For medics only, a reminder was sent to their term- time address.

The questionnaire (available on request) con- sisted of 10 questions asking about previous use of computers, self-perceived computer literacy, attitudes to the relevance of computers and ‘computer anxiety’, and knowledge of how computers may be used in the health service. All students, apart from the vets, were offered the possibility of a 1-week optional computing course at the beginning of September.

Results

Response

In total, 875 students completed questionnaires, a response rate of 71% from all potential responders. The response rate among these students who were at their lectures, although not measured, was estimated at over 90%. Among medics, the response rate to the questionnaire handed out at lectures was 65% and to the reminders 15%, with an overall response rate of 70%. There was no difference in results between early and late responders.

Computer U S K

Overall, 19% of students had not used a computer during the last year. Among the medics, students in the earlier years were more likely to have used a computer recently (Table 1). Eighty-two per cent of first-year students had used one within the last week and only 4% had not used one within the last year, whereas 22% of third-year and 25% of fourth year students had not used one within the last year. Medics were

more likely to be computer users compared to nurses and dentists.

Apart from computer games, the software which had been used by most students was a word processor (500/,), a computer simulation (49%), a database (280/,), a statistics package (21%), MEDLINE (20%) and a spreadsheet (15y0). Few students had used e-mail (4%) or an expert system ( ~ O / O ) . Among medics, first years were more likely to have used a data base, spreadsheet or statistics package than later years. O n the other hand, the use of MEDLINE was higher for later years.

Self-perceived computer literacy

O n a 5-point scale from ‘novice’ to ‘expert’, 16% of students (8% vets; 15% medics; 24% nurses; 29% dentists) rated themselves as being ‘a complete novice with computers, never used one and would not know where to start’. Self- perception of computer literacy corresponded fairly well to actual computer use, with the use of a word-processor showing the strongest associ- ation (x2 = 152; 4 d c P < 0.001). Although 49% of students had used a computer simulation, this had a much weaker association with self-per- ceived computer literacy, for example, 39% of ‘computer novices’ had used a simulation.

Student demand for informatics

Seventy per cent of students wanted more use of computers in the curriculum (Table 2). In particular, 14 nurses wanted more for every 1 who wanted less and among medics, this ratio was 9 to 1. There was little difference in the perception of the relevance of the different

Table 1. Percentage of students who had not used a computer during the last year (total number of students responding shown in parenthesis)

Year 1 Year 2 Year 3 Year 4 Overall

Medics 4 (165) 10 (126) 22 (163) 25 (142) 15 (596) Dentists - - 19 (31) 40 (55) 33 (86) Nurses 42 (31) 27 (22) 38 (13) - 36 (66)

- 49 (39) 14 (45) 20 (127) Vets 0 (43) All 10 (196) 10 (191) 27 (246) 26 (242) 19 (875)

Computer literacy among undergraduates

Table 2. Number wanting more use of computers in the curriculum

Medics Dentists Nurses Vets All

Less 50 19 4 43 116 Unsure 105 12 6 23 146 More 436 54 56 61 607 Ratio more/less 8.7 2.8 14.0 1.4 5.2

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Table 3. Number of students who had used a computer at school

Used computer at school

Yes No Total

School in Scotland 430 (68%) 201 (32%) 63 1 School outwith Scotland 113 (75%) 38 (25%) 151 School outside UK 24 (53%) 21 (47%) 45 Location not known 3 (14%) 19 (86%) 22 All 570 (67%) 279 (33%) 849

(26 did not answer this question)

packages between the four student groups except for an aversion to statistics packages among dentists and (perhaps understandable) doubt about the use of MEDLINE for vets. Excluding these two, 81% of students thought a word- processor was relevant, 33% a drawing package, 74% a data base, 67% a statistics package and

Perhaps the best indication of student demand for more use of computers is the number who wanted to come on the 1-week optional comput- ing course held in the holidays and with a small charge for students. In total, 223 (30%) wanted to attend the course. These were more likely to be students who had not used a computer recently (x2 = 12.2; 4df; P < 0.025). There was no significant difference among medics, dentists and nurses.

84% MEDLINE.

Use of computers at school

Sixty-seven per cent of students had used a computer at school (Table 3) and these were more likely to have used a computer recently as an undergraduate (x2 = 55; 5df; P < 0.001). There was a steady increase in computer use at school by students’ year of birth, from 54% of those born in 1966 or before, to 77% of those born in 1971 or 1972. As would be expected for

Glasgow University, the majority came from schools in Scotland (76% of those students for whom the location of school was known). In fact, 11 schools accounted for 16% ofall students and yet, interestingly, among these 11, the proportion who had used a computer was only 59%, which is less than the 71% among other Scottish schools (x2 = 5.7; 1 df; P < 0.025).

Computer anxiety

For one in four students, the idea of working with a computer makes them anxious. There was no difference in this proportion of students by age, but there was a marked gender difference, with females 2.5 times as likely (x2 = 25.7; 1 df; P < 0.001) as males to be anxious. Although, as might be expected, students who had used a computer within the last month were less likely to be anxious ( x 2 = 9.7; 1 df; P < 0.005), the odds ratio was only 1.7. Five per cent had never used a cash machine and 7% did not feel at ease using one, but there was no association between this and computer anxiety.

Role of computers in health

Medical students were asked to list as many separate uses ofcomputers in the health service as

194 R. B.Jones et al.

they could think of. Seventy-four (12%) did not answer, 163 (27%) listed one or two, 224 (38%) three or four and 135 (23%) five or more uses. Students in earlier years were more likely not to name any use of computers (x2 = 43.6; 9df; P < 0.001). The use of computers for storing clinical records was the most frequently cited use (72%) with ‘audit’ (including epidemiology and clinical trials) being cited by half the students. It was interesting to note that despite 49% of students having claimed to have used a simulation, only 2% thought ofthis as being a ‘use ofcomputers in health service’. Similarly, only 6% thought that the use of computers for education was a health service use.

Discussion

In the 1990s any health professionals who do not understand how computers work and what they can be used for will be severely disadvantaged. Furthermore, the ability to use a computer as a ‘desk-top tool’ will greatly increase their ability to collect and analyse data and to communicate with their colleagues. However, a common argument is that students now learn about computers at school and therefore there is no need to teach these basic skills at university. O n the other hand, of course, the teaching of further aspects of health informatics is almost non- existent in British medical schools (Jones et al . 1989).

This survey has shown that, currently, there is a demand from the students for the teaching of basic computer literacy. Despite having commit- ments for electives, other courses and holidays, 30% ofthe students wished to attend an optional 1-week introductory computer course in their own time. Although two-thirds of the students had used a computer at school, 16% still thought themselves to be ‘computer novices’ who would ‘not know where to start’ with a computer, including 18% of fourth-year medics, 35% of fourth-year dentists and 38% of third-year nurses. Furthermore, students recognized the relevance of the use of computers and perhaps they could follow the example of students in the Netherlands who petitioned their faculty for the inclusion of medical informatics in the curricu- lum (Grashuis & Verweij 1989).

Should a medical, dental or veterinary faculty teach computer literacy? There are many basic skills which students should have when they arrive at university. However, we all know that many students do not write well, communicate well, or have a basic knowledge of biology or mathematics. In the early years ofuniversity, we try to remedy this and we need to do the same for computer literacy. The scale of the problem at the moment is huge but it will get less. The use of computers at school had increased from 53% in those born in 1966 to 77% in those born in 1971. We might hope that by 1995, all students will have used a computer at school, but colleagues from the school sector think that this is unlikely. Certainly, as is the case at Glasgow University, where a significant minority of students come from a few schools, these schools can be re- quested to improve the computer literacy of candidates.

However, improving computer use before coming to university is not enough. One in five students had not used a computer in the last year. If computers are to be seen as a basic tool, students need to be given more opportunities to use them and this should be integrated in a consistent theme throughout the curriculum.

In the Netherlands and the former West Ger- many, all medical schools have a department of medical informatics and in West Germany, medical informatics is a compulsory part of the state regulated degree examination (Jones 1990). Some doctors are worried by the increased resources devoted to medical informatics and the potential loss of control to specialists in this area (Editorial 1990). However, if they wish to keep up with these developments they need to ensure that undergraduates have knowledge and skills in this area. Certainly, students who graduate still feeling anxious about working with a computer are less likely to develop a regular use of computers in their clinical practice.

Acknowledgements

We would like to thank Rebecca Flanagan, Jan Giles, Keith Murray and Linda Boyle for their help with this survey.

C o m p u t e r literacy among undergraduates 195

References

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Jones R.B., Hedley A.J., Navin L.M., Murray K.J. & Knill-Jones R.P. (1989) Medical informatics edu- cation in medical schools in the UK. In: Conference Proceedings, ‘International Symposium of Medical Informatics and Education (ed. by R. Salaman, D.

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Jones R.B. (1990) Education in medical informatics in the undergraduate medical curriculum: a review. In: Lecture Notes in Medical Informatics, Vol. 40 (ed. by R. O’Moore, S. Bergtsson, H.R. Bryant & J. S. Bryden), pp. 422-429. Springer Verlag, Berlin.

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Received 24 September 1990; editorial comments t o authors 7 December 1990; accepted f o r publication 4 January 1991