Assessment of the current computer literacy and future computer needs of emergency medicine residents and faculty

Assessment of the Current Computer Literacy and Future Computer Needs of Emergency Medicine Residents and Faculty DANIEL J. DEBEHNKE, MD, VERENA T. VALLEY, MD The purpose of this study was to assess the current computer literacy and future computer needs of emergency medicine residents and faculty to aid in developing a computer literacy curriculum. All emergency medicine residents and full-time faculty from a random sample of emergency medicine residencies were mailed questlonnatresassessing current computer famlliarity and future computer needs. Twenty-one residencies were surveyed; 15 resident and 17 faculty questionnaires were returned. Thirtyseven percent (116 of 314) faculty and 29% (135 of 470) resident questionnaires were completed and returned. Eighty percent (12 of 15) of residencies had a designated computer for resident use; 93% (14 of 15) had a computerfor use in the emergency department. Forty-sevenpercent of residents owned their own computer; 66% of faculty had a computer in their home, and 52% had computers in their office. Less than 30% of realdents end faculty had formal computer training. Residents and faculty rated the current familiarity and future needs for various software applications on a five-polnt scale. Data were analped using the WilcoxonRank Sum Test. Residents and faculty had the most anticipated need for word processing, graphics, literature searching, data base, and patient management programs. Future computer need was rated significantly hlgher than current computer familiarity in all computer application areas (P QgO2). It seems that emergency medicine residents and faculty have adequate access to computers, but minlmal computer training. Resldents and faculty have a high anticipated need for various basic computer applications. Despite recent recommendations that computer literacy be taught in medical school, many emergency medicine residents and faculty have not been taught bask computer applications. Until a uniform knowledge base Is taught in undergraduate medical education, a residency-based computer cunlculum Is necessary to teach bask computer applications to those wlthout previous computer training. (Am J Emerg Med lgg3;11:371-373. Copyright 0 1993 by W.B. Saunders Company) Since we have entered the “Informational Age,” the use of computers in medicine has skyrocketed. Despite this technological explosion, computer education in medicine has not received much emphasis. In 1984, the report on the General Professional Education of the Physician recommended that computer training be introduced into medical education.‘*2 Although several medical schools have begun to integrate this training into their curricula, the teaching of basic computer skills has not been accepted uniformly.3,4 Consequently, many residents, faculty, and practicing physicians do not possess basic computer skills. The specialty of emer-

From the Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI. Manuscript received November 18, 1992; accepted January 11, 1993. Address reprint requests to Dr DeBehnke, Medical College of Wisconsin, 8700 W Wisconsin Ave, Box 204, Milwaukee, WI 53226. Key Words: Computer literacy, emergency medicine education, microcomputers. Copyright 6 1993 by W.B. Saunders Company 07356757/93/l 104-0011$5.00/0

gency medicine has recognized

this lack of training, but minimal efforts in computer education have been undertaken. The core content in emergency medicine includes a section on computer use and application; however, no formal guidelines or acceptable curricula have been developed.5 The purpose of this study was to determine the current computer familiarity and future computer needs of emergency medicine residents and faculty to aid in developing a residencybased computer literacy curriculum. METHODS A 48-item questionnaire was developed to assess the current computer familiarity and future computer needs of emergency medicine residents and faculty (a copy of the questionnaire is available on request). This questionnaire detailed resident and faculty demographic data and general computer familiarity and access. Residents and faculty were asked to rank their current familiarity with various software applications on a scale of 1 (not familiar) to 5 (very familiar). Participants were also asked to rank their anticipated future need for these same software applications on an identical 1 (no anticipated need) to 5 (large anticipated need) scale. Residents and faculty were asked if they had any formal computer training and, if so, at what educational level this training occurred. The availability of a formal computer literacy curriculum was assessed at each residency. If none was present, participants were asked to rank their interest in having a computer literacy curriculum available on a 1 (not interested) to 5 (very interested) scale. The questionnaire was mailed to 21 emergency medicine residencies (25%) randomly selected from the 1991 Society for Academic Emergency Medicine Handbook of Emergency Medicine Residencies. Questionnaires were mailed to all residents and full-time faculty at each institution. The questionnaire was anonymous and required approximately 15 minutes to complete. A follow-up letter was sent to those institutions not responding 1 month after the original mailing. Nonsurveyed and nonresponding residencies were compared with responding residencies with respect to age of residency, number of residents, number of faculty, type of residency (PGY-I thru PGYIII; PGY-I thru PGY-IV; PGY-II thru PGY-IV), and hospital type (university, university-affiliated, private, county) to assure that the randomly selected group was representative of all United States emergency medicine residencies. Data was analyzed between responding and nonresponding residencies using the r test and x2 analysis. Nonparametric data was analyzed using the Wilcoxon-Rank Sum test or the Kruskal-Wallis analysis of variance.

RESULTS General Twenty-one residencies were surveyed with 15 returning resident questionnaires and 17 returning faculty questionnaires. There was no significant difference between respond371

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AMERICAN JOURNAL OF EMERGENCY MEDICINE ??Volume 11, Number 4 ??July 1993

ing and nonrespondinglnonsurveyed residencies with respect to age of residency, number of residents and faculty, type of residency, and hospital type. Resident

Data

A total of 470 resident questionnaires were mailed; 135 completed resident questionnaires were returned (29% response rate). Of the 15 responding residencies, only three (20%) did not have a dedicated computer for resident use, and one (6.7%) did not have a computer in the emergency department for resident use. Forty-seven percent (63) of residents owned their own computer. Twenty-nine percent (39) of residents stated they had formal computer training. Of this group, 64% (25) received training during their undergraduate years, 8% (3) during graduate school, 10% (4) during medical school, 2.6% (1) during postgraduate training, and 15.4% (6) at some other time. Of the 1.5 responding residencies, nine (60%) unanimously stated that there was no computer literacy curriculum available at their institution. In the remaining residencies, less than 20% of the responding residents stated that there was a computer literacy course available. In those programs without formal computer training, residents had a significant interest in having a computer literacy curriculum available for use, as noted by high mean (3.7) and median (4.0) scores on a 1 (no interest) to 5 (high interest) scale. Table 1 summarizes the mean and median resident scores for current familiarity and future need with respect to various software applications. Residents rated their future needs significantly higher than their current familiarity for all software applications (P < .0002). Residents rated their future need for scheduling software significantly higher than faculty (Table 1). Faculty

Data

A total of 314 questionnaires were mailed with 116 completed questionnaires returned (37% response rate). Eightyfive percent (98) of faculty respondents were residency trained, whereas 78.4% (91) were board certified in emergency medicine. Sixty-eight percent (79) of faculty had a computer in their home; 52% (60) had a computer in their personal office. Twenty-nine percent (34) of faculty had formal computer training. Of this group, 59% (20) received unTABLE1.

dergraduate, 5.9% (2) received graduate school, and 41.4% (14) received other computer training. No faculty member received computer training in medical school or residency. In those programs without formal computer training, faculty had a significant interest in having a computer literacy course available, which was noted by high mean (3.7) and median (4.0) scores on a 1 (no interest) to 5 (high interest) scale. Table 1 summarizes the mean and median faculty scores for current familiarity and future need for various software applications. Faculty rated their future needs significantly higher than their current familiarity for all software applications (P < .0002). Faculty had significantly higher current familiarity with quality assurance software when compared to residents, but there was no difference in future need for this software application (Table 1). DISCUSSION It seems almost impossible to practice medicine today and not be exposed to computer technology in some form. To keep pace with this growth, physicians need training in the use of computers both in daily life and in the practice of medicine. There have been attempts to incorporate computer technology into medical education. Harvard Medical School undertook an extensive project to introduce information technology into their medical school curriculum.6 The emphasis of this project was to use computers for the actual education of the medical student and not to educate the student on basic computer use and application. Some medical schools have begun to teach computer literacy in their curricula. The Medical University of South Carolina began a curriculum teaching computer applications in medicine to their first year students. The topics covered included the use of computers in clinical decision making, word processing, telecommunications, accessing data bases, and bibliographic searching. The overall response to this program was quite positive.3 The University of California, San Francisco, began a similar program teaching basic computer bibliographic searching to first- and third-year medical students. The skills taught in this course were used extensively throughout the students education.4 Although several medical schools have begun teaching basic computer skills to their students, this has not been im-

Mean and (Median) Scores for Various Software Applications

Software Application

Resident Current Familiarity

Resident Future Need’

Faculty Current Familiarity

Faculty Future Need’

Word processing Literature searching Patient management Graphics Database Scheduling Educational Quality assurance Statistics Spreadsheets

3.3 (4.0) 3.3 (3.0) 3.0 (3.0) 2.3 (2.0) 1.9 (1.0) 1.4 (1.O) 1.7 (1.0) 1.4 (1.O) 1.8 (1.O) 1.8 (1.O)

4.7 (5.0) 4.3 (5.0) 4.3 (5.0) 4.1 (5.0) 3.7 (4.0) 3.6 (4.0)$ 3.5 (3.0) 3.5 (3.0) 3.4 (3.0) 3.4 (4.0)

3.6 (4.0) 3.0 (3.0) 3.2 (3.0) 2.7 (3.0) 2.4 (2.0) 1.7 (1.O) 2.2 (2.0) 2.0 (2.0)t 2.2 (2.0) 1.4 (2.0)

4.3 (5.0) 4.1 (4.0) 3.9 (4.0) 4.1 (4.0) 3.8 (4.0) 2.5 (2.0) 3.3 (3.0) 3.3 (3.0) 3.5 (4.0) 3.4 (3.0)

NOTE.Current familiarity scores are on a 1 (no familiarity) to 5 (high familiarity) scale. Future need scores are on a 1 (no future need) to 5 (large future need) scale. * P zz .0002 comparing current familiarity to future need for all software applications. t P = .02 compared with resident current familiarity. $ P 5 .OOOlcompared with faculty future need.

DEBEHNKE AND VALLEY ??COMPUTER LITERACY

plemented uniformly. Consequently, many residents and faculty have not received basic computer education. The core content in emergency medicine includes sections on the use and application of computers in emergency medicine practice and research.5 A recent article proposing an emergency medicine research curriculum stressed basic computer skills as a necessary component of emergency medicine resident and fellow education.’ Despite recognition of this need, no formal guidelines for an acceptable computer education curriculum have been developed. Overton et al described a computer-based microcomputer curriculum teaching basic microcomputer applications, word processing, data base, and spreadsheets and found resident acceptance of this curriculum to be high.8 The main obstacle in developing a useful computer literacy curriculum for emergency medicine residents has been determining what computer applications are most relevant. This study was undertaken to develop a logical framework for developing a computer literacy curriculum. Our results show that both residents and faculty have adequate access to computers. Nearly half of all residents and faculty had computer access in their home or office. Furthermore, more than 80% of residencies had a computer for resident use in either the residency or emergency department. What seems to be lacking is formal computer education. Despite the availability of computers, less than one third of residents and faculty received formal computer education. Residents reported minimal computer training in medical school or residency. In view of the core content recommendations for computer education in emergency medicine, it is disconcerting that 60% of responding residencies unanimously stated there was no formal computer education curriculum at their institution. Both residents and faculty uniformly expressed a high interest in having a computer literacy curriculum available for their use. Because there is a wide variety of computer software programs with emergency medicine applications, it is important to determine which applications emergency medicine residents and faculty feel they will need in the future. The fact that future need for word processing, literature searching, and graphic applications was highly ranked is not surprising. Residents and faculty are constantly engaged in lecture preparation and writing projects that easily incorporate these computer applications. Patient management, quality assurance, and scheduling software are used in the day-to-day practice of emergency medicine, both clinically and administratively. Educational programs can be used by residents and faculty for board preparation and continuing medical education. The high anticipated need for data base, spreadsheet, and statistical applications is interesting and most likely reflects the continued advancement of emergency medicine research and research education. Because formal computer education seems to be the problem, the best solution would be to incorporate basic computer education into undergraduate and/or medical school curricula. Educators in emergency medicine, as well as other specialties, need to be actively involved in development of medical school curricula to ensure that these basic skills are taught to all medical students. Until this goal is achieved, the development of a formal residency-based computer education curriculum is both timely and necessary for emergency medicine education. This curriculum should include educa-

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tion in basic computer applications, including word processing, graphics, literature searching, data base, spreadsheets, and statistics, as well as applications that are emergency medicine specific, such as patient management, scheduling and quality assurance programs. This curriculum will ensure that no emergency medicine practitioner will complete residency without a basic knowledge of computer use and application. There are several limitations to our study. Because only 25% of residencies were surveyed our results may have some degree of responder bias. To address this problem, we compared responding and nonrespondinglnonsureyed residencies with respect to age of residency, number of faculty and residents, and hospital type and found no significant difference between responders and nonresponders. We believe our random sample is representative of the nations’ emergency medicine residencies. Our response rate is low (29% resident and 37% faculty response rate), and, again, responder bias may be present. Certainly, a larger response rate would have been optimal. However, we believe our results provide insight into the lack of computer education and anticipated educational needs of emergency medicine physicians. Also, we did not survey emergency medicine physicians in private practice. At this point, our efforts should be directed at educating potential young medical specialists (medical students) and future emergency medicine providers and teachers (emergency medicine residents and faculty). We can only assume the computer literacy of the practicing emergency physician would reflect that of the residents and faculty. Further investigation on this topic will need to be performed. CONCLUSION Emergency medicine residents and faculty have adequate access to computers, but minimal formal computer education. Both residents and faculty anticipate a high future need for several basic computer applications. A residency-based curriculum encompassing these basic computer applications would address these needs until a uniform computer knowledge base is taught in undergraduate medical education. REFERENCES 1. Muller S: Physicians for the twenty-first century/Report of the Project Panel on the General Professional Education of the Physician and College Preparation for Medicine. J Med Educ 1984;59:13 (part 1) 2. Matheson N,.Lindberg D: Subgroup report on medical information science skills. J Med Educ 1984:59:155-159 roart 2) 3. Knapp RG, Miller MC, Wise C, et al: Computer ingtruction as part of a course on analytic medicine for first-year students. J Med Educ 1987;82:111-114 4. Rodnick JE, Simrin SM, Yang MG, et al: Teaching medical students to do bibliographic searching. J Med Educ 1988;83: 128-130 5. American College of Emergency Physicians, American Board of Emergency Medicine, Society for Academic Emergency Medicine: Core content for emergency medicine. Ann Emerg Med 1991;20:920-934 6. Masys DR: Information technology and undergraduate medical education. Acad Med 1989;64:187-190 7. Cline D, Henneman P, Van Ligten P, et al: A model research curriculum for emergency medicine. Ann Emerg Med 1992;21: 184-l 92 8. Overton DT: A microcomputer application curriculum for emergency medicine residents using computer-assisted instruction. Ann Emerg Med 1990;19:584-586