Barriers to the Incorporation of Digital Health Competencies in the Medical School Curriculum: A Qualitative Study of Doctors in Organizational Leadership

Abstract Purpose Digital technologies have influenced healthcare delivery worldwide and are increasingly being used in clinical practice. However, studies have shown a lag in the implementation of guidelines for the training of digital health competencies (DHC) in medical schools. Furthermore, few existing frameworks on DHC have examined barriers commonly faced by developed countries to equip medical students with DHC. Using Singapore as a case study, and by exploring the perspectives of doctors in organizational leadership positions, this paper identifies reasons for this lag and a common framework that can help overcome these barriers. Methods Findings were drawn from individual semi-structured interviews with 33 doctors in executive and organizational leadership roles. Participants were recruited using purposive sampling. Data were interpreted using qualitative thematic analysis. Results Participants were currently (n = 26) or formerly (n = 7) in organizational leadership. They highlighted six reasons for the lag in DHC integration in the curricula: bureaucratic inertia, expectations to pursue traditional career pathways, lack of protective mechanisms for experiential learning and experimentation, lack of clear policy guidelines for clinical practice, need for more evidences on the effectiveness of digital technologies, and need for a strong and integrated IT infrastructure in healthcare institutions. Conclusions Applying Damschroder et al.’s (2009) Consolidated Framework for Implementation Research (CFIR) would illuminate the importance of considering both structural and institutional barriers to training students with relevant DHC. Showing how relevant CFIR constructs might be applied to integrating DHC in the medical school curriculum would help ensure consistency of implementation across time and contexts.