what is medical technology essay

We use cookies to offer you a better browsing experience and analyse our website performance. We also use third-party cookies to further customise your experience showing relevant content while you are navigating on third-party platforms.

Our Priorities MedTech Europe strives to support our dynamic sector in meeting the needs of patients and health systems. To achieve this, we focus on engaging with healthcare stakeholders on key issues from regulations and market access to digital health and Brexit, among others.

• COVID-19 Information Hub
• Interactions with the Medical Community
• Access to Medical Technology
• Medical Technology Regulations
• Digital Health
• International
• Environmental and Social Sustainability
• Market Data
• Research and Innovation
• Innovative Health Initiative (IHI)

Sector Groups MedTech Europe sector groups bring together company experts to drive forward key healthcare domains, helping to address issues facing these sectors and shaping their future. We have dedicated groups focused on cardiovascular health, ophthalmology, diabetes, orthopaedics, and AMR/HAI.

• Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAIS)
• Cardiovascular
• Homecare & Community Care
• Orthopaedic

Real stories of people’s lives transformed by medtech.

Your platform for dialogue about medical technologies.

Search on this website

About the industry

Value of Medical Technology

Medical technologies can save lives, improve health and contribute to sustainable healthcare. Through innovative devices and diagnostics, the industry delivers value to patients, healthcare professionals, and healthcare systems and society. Medical technology companies are also drivers of economic growth and job creation across Europe.

We help PATIENTS

Medical technologies enable the early and accurate diagnosis of health problems, facilitating timely intervention and improving outcomes. Innovative products can replace, repair and sustain failing body functions, while telemedicine and connected devices allow remote monitoring of patient’s conditions. By accelerating recovery and keeping people healthy, modern medical technologies support people in living full and active lives.

We support HEALTHCARE PROFESSIONALS

Timely and accurate diagnostic information empowers healthcare professionals to make clinical decisions that optimize patient outcomes. By reducing patient recovery times and surgical complication rates, the medical technology sector helps ease the pressure on healthcare professionals by reducing demand. In addition, by freeing healthcare professionals to focus on tasks where they add most value, we support workplace satisfaction.

We improve HEALTHCARE SYSTEMS AND SOCIETY

By helping citizens to stay socially and economically active, and by preventing serious complications of chronic disease, medical technologies can add value to healthcare systems and to society. Medical technology innovations help to deliver efficiency and enhance the sustainability of healthcare. Our industry is facilitating advances in healthcare deliver by bringing the latest benefits of big data and machine learning to clinics all sizes.

MedTech Europe Value initiatives

Learn more about the Value of medical technologies and the MedTech Europe initiatives to raise awareness about it.

"Shining A Light on Medical Technologies" campaign

Medical technologies often go unnoticed. But, where there is a need to prevent, diagnose, treat or cure conditions, medical technology plays a key role. Have a look at our campaign and connect with us using #ShiningALight on social media.

SEE OUR CAMPAIGN MATERIAL

"Connecting the Dots" campaign

Connecting the Dots is an exciting online video series, exploring the ways medical technologies – medical devices and diagnostics – are meeting these challenges – from diagnosis to cure.

Videos were produced in partnership with BBC StoryWorks.

MedTechViews blog

MedTech Views is a platform for dialogue about medical technologies.

GO TO MEDTECHVIEWS

This is MedTech blog

GO TO OUR BLOG

Share this page

MedTech Europe Flagship Brochure

Document paper - Posted on 18.10.2018

Facts & Figures

The medical technology industry is one of Europe’s most diverse and innovative sectors. Data on employment, trade flows and the high number of patents filed by medtech companies reveal the value our sector delivers to patients, health systems and economies in Europe.

What is Medical Technology?

Medical technologies are products, services or solutions used to save and improve people’s lives.

MedTech Europe Manifesto for 2024 – 2029

Empowering Patients, Inspiring Innovation

Sign up for your monthly newsletter

By clicking the Subscribe button, you give consent to MedTech Europe AISBL to use of the information you provided and send you content on the services you selected. We will ensure that the information is processed confidentially, and will only share it with third party providers that assist in providing these services. These providers may be located outside the EU; in this case, we will ensure that they are subject to a legal framework adequate in safeguarding your data, in compliance with European data protection law. You can unsubscribe, change your preferences or update your information at any time by clicking on the unsubscribe button available on all messages. For more information on how MedTech Europe will handle your personal data, please refer to our Privacy Policy . You can contact us at [email protected] for further questions related to your privacy and your rights.

• Type 2 Diabetes
• Heart Disease
• Digestive Health
• Multiple Sclerosis
• Diet & Nutrition
• Supplements
• Health Insurance
• Public Health
• Patient Rights
• Caregivers & Loved Ones
• End of Life Concerns
• Health News
• Thyroid Test Analyzer
• Doctor Discussion Guides
• Hemoglobin A1c Test Analyzer
• Lipid Test Analyzer
• Complete Blood Count (CBC) Analyzer
• What to Buy
• Editorial Process
• Meet Our Medical Expert Board

What Is a Medical Technologist?

These professionals analyze body fluid and tissue samples

• What They Do
• Subspecialties
• Training and Certification

A medical technologist is a highly trained health professional who tests blood and tissue samples in a lab along with urine, stool, amniotic fluid , cerebrospinal fluid , and other body fluids or specimens.

Medical technologists are responsible for operating and maintaining the equipment used to examine samples or specimens. They ensure that all tests are performed in a precise and timely manner so that the results and interpretations are accurate.

This article describes what a medical technologist does. It also explains the different paths a person can take to become a medical technologist, including the educational requirements and process of certification.

Also Known As

• Clinical laboratory scientist
• Medical laboratory scientist
• Medical laboratory technologist

What Do Medical Technologists Do

Medical technologists are healthcare professionals who hold at minimum a bachelor’s degree in medical laboratory technology or a similar field. The main purpose of their work is to help healthcare providers make diagnoses.

Medical technologists work in a pathology lab. They prepare samples, slides, and cultures for the medical pathologist to review. They typically work under a pathologist.

Although lab directors are ultimately in charge of the lab and its staff, the medical technologist will generally be the one who ensures that the lab runs smoothly and safely on a day-to-day basis. This includes setting up, calibrating, and sterilizing lab equipment, as well as analyzing and checking the accuracy of lab reports.

Most medical technologists work behind the scenes and do not interact with patients.

Medical Technologist vs. Lab Technician

A medical technologist’s training is more extensive than a lab technician’s. While both perform lab tests, a technologist’s training allows them to do more complex tasks, such as molecular, genetic , or genomic testing . Lab technicians typically need an associate’s degree to practice.

Medical technologists can participate in many different fields of pathology, including immunology , microbiology , genetics , histology , hematology , and blood banking .

The role of a medical technologist is usually determined by the branch of pathology that their lab specializes in but is otherwise limited only by the tools available to them.

Clinical Pathology

In clinical pathology, a medical technologist conducts and oversees lab tests done on body fluids and tissues. The tests are done to look for markers of infectious and non-infectious diseases.

The kinds of specimens a medical technologist will look at include:

• Spinal fluid
• Pleural fluid
• Peritoneal fluid
• Joint fluid
• Bone marrow

Anatomic Pathology

In anatomic pathology, a medical technologist would look at tissues taken during a biopsy or surgery. While some of the tests can be done by the technologist, others require the expertise of a pathologist.

The technologist can help with exams including:

• Gross examination : Looking at tissues with the naked eye
• Histology : Looking at tissues under a microscope
• Cytopathology : Looking at loose cells under a microscope
• Electron microscopy : Using special high-resolution microscopes to look at samples
• Cytogenetics : Looking at chromosomes with special technology

Medical Technology Subspecialties

Some technologists work solely in clinical or anatomic pathology. Others participate in both, referred to as general pathology. Others still work in a narrow field of practice.

According to the U.S. Office of Personnel Management (OPM), the major subspecialties are:

• Clinical chemistry
• Immunohematology (blood banking)
• Microbiology

How Do You Become a Medical Technologist?

There are three general steps that you need to take if you decide to become a medical technologist. The path to certification generally takes around five years. Those who decide to pursue a subspecialty may take an additional six months to one year.

Get a Degree

To become a medical technologist, you need at least a bachelor’s degree, preferably in medical technology. Most bachelor’s degrees are completed in four years.

Students who majored in another science—such as biology, microbiology, or biochemistry—can often take hospital-based courses during their senior year to meet the requirements of post-graduate training programs.

Complete a Program

Before working as a medical technologist, a person is required to either complete a medical technologist program accredited by NAACLS or meet other requirements (such as working in an accredited lab for a certain number of years and obtaining relevant certification).

Certificate programs for medical technologists can last for several weeks or months, while diploma programs can last up to a year. Different states have different laws governing the types of certificates or diplomas needed to get certified within that state.

Get Certified

Medical technologists need to get certified once they have completed all of their educational and training requirements.

Certain states require licensing for all medical lab personnel, while others do not. Because the requirements can vary by state, contact your local state board or Department of Health for details.

The American Society for Clinical Pathology (ASCP) offers a national certification exam for medical technologists, which would need to be renewed every three years. This certifies that a medical technologist is very skilled in their field.

Online Training

There are many online certificate and diploma programs available for medical technologists. Before enrolling, be sure that the program is accredited by the NAACLS. Certificate courses require fewer credits than diploma courses and may not meet the criteria for the specialty you hope to be employed in. Check before enrolling to know what is required.

What Salary Do Medical Technologists Make?

The salary for a medical technologist can vary by state, city, institution, and subspecialty.

According to the ASCP 2021 Wage Survey of Medical Laboratories in the United States, the average annual salary ranged from $60,162 for a histology technologist to $80,139 for a cytologist. For lead or coordinator roles, salaries for these jobs increased to $66,129 and $90,488, respectively.

The majority (more than 70%) of medical technologists in the United States are employed in academic and non-academic hospitals.

A medical technologist is a health professional who has been trained to do tests on samples of fluids and tissue to help diagnose diseases. While they do not usually interact with patients, the work they do in the lab is very important for patient care.

Medical technologists need a lot of education, training, and certification to do their job well. They can also choose to focus on a certain area of medical technology that they are especially interested in, like forensic pathology or transfusion medicine.

American Society for Clinical Pathology Board of Certification. BB and SBB practice analysis report .

U.S. Office of Personnel Management. Medical technologist series, 0644 .

Bureau of Labor Statistics. Occupational Outlook Handbook: clinical laboratory technologists and technicians .

American Society for Clinical Pathology Board of Certification. U.S. procedures for examination & certification .

Garcia E, Kundu I, Fong K. The American Society for Clinical Pathology’s 2021 wage survey of medical laboratories in the United States . Am J Clin Pathol. 2022;158(6):702-22. doi:10.1093/ajcp/aqac116

Bureau of Labor Statistics. Occupational employment and wages, May 2022: 29-2010 clinical laboratory technologists and technicians .

By Andrea Clement Santiago Andrea Clement Santiago is a medical staffing expert and communications executive. She's a writer with a background in healthcare recruiting.

Modern Medical Technologies Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Introduction to Medical Technologies

Determining the right technologies to use, determining if it integrates with existing technologies, determining if the system is intuitive or user friendly, determining the costs of the technology and system, determining the benefits of the technology and system, roles and responsibilities as a manager in evaluating healthcare technology, data sources used in evaluating the effectiveness of implemented technology.

Technology is an imperative aspect of society since the advent of the industrial revolution. One of the areas which have immensely benefited from the arrival of advanced technologies is the healthcare industry. For example, state-of-the-art equipment is available for improving patient care with the goal of enhancing the quality of life. Moreover, technology is significant because it increases patient access with the introduction of telemedicine and remote monitoring (Jacques & Waston, 2017). Technology has also enabled healthcare practitioners to decrease instances of medical errors, ultimately leading to improved patient care across various cultures.

A health care manager should have specific criteria for evaluating the right technology to use. In particular, the cost of maintaining these technologies should be reasonable and within the current budget of a clinic, hospital, or any other medical organization. Moreover, the device or software should also provide appropriate and relevant features that meet the hospitals’ requirements (Jacques & Waston, 2017). However, if such elements are not sufficient, the gaps can be filled through configuration. Since the user-friendliness of a device or software is imperative, a healthcare manager should ensure that the user-interface and user-experience of the technology can be easily understood. Lastly, the cost of installation should be relatively low as it also provides the security of patient or staff data.

Integrating new technologies with the existing systems is often a challenge for healthcare organizations. Therefore, it is recommended that they should be investigated to consider if current problems will be solved. Moreover, assembling an implementation team is imperative in determining if the technology will integrate with the existing infrastructure. Having a pilot program can also be effective in assessing the feasibility of implementing medical technologies. In addition, employees should be trained to facilitate the experimental trial, thereby giving the healthcare manager a chance to determine the integration process (Jacques & Waston, 2017). Lastly, information technology (IT) experts can consider launching the new technology to investigate its flexibility with existing tools.

Another significant step in determining if a medical technology can integrate with existing infrastructure is to determine the compatibility of new equipment or software. Compatibility and portability testing will allow professionals to evaluate the likeliness of implementing the latest technology and successfully integrating it with the current infrastructure. Moreover, a healthcare manager can conduct a consensus test to explore the chances of the workers acknowledging the new technology. Medical institutions should have the required resources while also revamping current software to facilitate smooth IT integration (Busdicker & Upendra, 2017). Lastly, the healthcare manager should consider determining if workers can incorporate new capabilities to supplement the integration process.

A user-friendly technology should have the following characteristics. New technologies should be easy to install, thereby making the entire process simple and well documented. Moreover, intuitive software should have auto-update features where the user is excluded from constantly checking for updates (Busdicker & Upendra, 2017). In addition, such software should come with a simple Graphical User Interface allowing the user to customize it whenever they want. The user-friendliness of technology is also based on its efficiency and effectiveness. It should be designed for seamless interaction with current systems (Busdicker & Upendra, 2017). Furthermore, an intuitive technology should be visually appealing and easy-to-navigate with pleasant experiences. Lastly, its installation process should be easy and not time-consuming, and complex.

A user-friendly software does not require third-party applications. The latter refers to anti-spyware and other security tools used for data protection. Additionally, a user should also find it easy to contact its technical team for IT support. However, if the technology does not offer anything as a means of troubleshooting, the end-user will solve in other ways (Busdicker & Upendra, 2017). Intuitive technology adheres to industry standards for quality. Therefore, software applications should meet business benchmarks for quality of service (Busdicker & Upendra, 2017). In addition, users should find the process of error handling easy as the system should also be responsive. Lastly, an intuitive software should be easily maintained.

Healthcare managers can also develop a criterion for determining the costs of healthcare technology. For example, technology should help in lowering the cost of treating patients. However, in some scenarios, patients’ treatment costs are increased due to the presence of robotic surgeries and other advanced technologies. In addition, technology may also become disadvantageous if it shows the wrong results of patient condition (Busdicker & Upendra, 2017). Furthermore, some healthcare databases may not show patient information, thereby leading to delays and unnecessary inconveniences (Busdicker & Upendra, 2017). Lastly, a healthcare manager should ensure machines and gadgets are properly maintained to avoid malfunction while also ensuring that they do not cause harm to patient cells and organs.

There is a criterion that healthcare managers can adopt in determining the benefits of technology. For example, appropriate technologies should help in minimizing the cost of healthcare operations. According to a survey, applicable technologies should help in shifting from paper to electronic records, thereby lowering costs by 3% (Busdicker & Upendra, 2017). In addition, experts should be able to utilize such technologies in predicting epidemics. Appropriate technologies enhance the efficiency and quality of healthcare, thereby improving the quality of patients’ lives (Busdicker & Upendra, 2017). Moreover, it should also be applied in developing new drugs and treatments while also improving lean management by minimizing wastes in hospitals. An appropriate example is in solving the problem of long queues in emergency departments.

A healthcare IT manager performs various functions in hospitals. For example, a managerial role involves supervising and developing IT infrastructure with the staffing group. It also incorporates testing the integrity and performance of different networks. Their operational part involves handling end-to-end IT operations. In addition, it comprises the installation and troubleshooting of network topologies. As a web master, the manager is in charge of updating the hospital’s connectivity and internet features (Busdicker & Upendra, 2017). The manager also acts as a consultant and educator while working together with the hospital staff. Lastly, they are responsible for ensuring the security of healthcare networks and systems.

The healthcare manager can also participate in leadership activities. For example, they are in charge of leading the IT team in the medical institution, which involves collaborating software, hardware, and database professionals. Moreover, the manager also handles the needs of different specialists and the well-balanced functioning of the technology group (Busdicker & Upendra, 2017). Their vendor management role includes approving and handling IT suppliers and support agreements. In addition, their supplier relationship helps in obtaining low prices from vendors to facilitate cost-effectiveness (Jacques & Waston, 2017). Lastly, IT managers in the clinic helps in ensuring licensing laws in IT and software management are observed.

Several data sources can be utilized by healthcare IT managers to evaluate the technology. For example, Health Insurance Portability and Accountability Act (HIPAA), also referred to as the Obama Care, provides various stipulations on patient data privacy (Jacques & Waston, 2017). Moreover, United States federal data sources provide information related to patient data. Apart from these, healthcare managers can utilize data from surveys to accomplish the process of evaluating technologies. In addition, administrative and medical records can be utilized to access records tracking events and transactions between medical institutions and patients (Jacques & Waston, 2017). Lastly, peer-reviewed literature is vital in the evaluation process because they are verified sources of information. Examples include research of scholars, methodologies, and many other sources.

This paper has explored the role of technology in improving healthcare practices. For example, new technologies should be integrated with the existing systems, and therefore, the process should be a smooth transition. Healthcare managers should also be able to evaluate the user-friendliness of technology based on features such as installation, user-interface, navigation, and many more. New technologies also come with several pros and cons, as addressed in the presentation. In addition, the roles and responsibilities of the healthcare manager in regard to evaluating technology have been covered. Lastly, managers can utilize various data sources such as the HIPAA, peer-reviewed literature, medical records, and many more.

Busdicker, M., & Upendra, P. (2017). The role of healthcare technology management in facilitating medical device cybersecurity . Biomedical Instrumentation & Technology , 51 (6), 19-25.

Jacques, S., & Watson, A. (2017). Proactive vendor management for healthcare technology . Biomedical Instrumentation & Technology , 51 (2), 116-119.

• Windows XP Operating System's Installation Process
• Solar Energy Installation Project Management
• Installation Art Movement Overview
• The Vacuum Chamber Access System
• Research at Historically Black and Tribal Colleges
• The Usage of VR Technologies in Football
• Instruction Manual for Canon EOS Rebel T3/1100D
• How Do Vacuum Cleaners Work?
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2022, October 2). Modern Medical Technologies. https://ivypanda.com/essays/modern-medical-technologies/

"Modern Medical Technologies." IvyPanda , 2 Oct. 2022, ivypanda.com/essays/modern-medical-technologies/.

IvyPanda . (2022) 'Modern Medical Technologies'. 2 October.

IvyPanda . 2022. "Modern Medical Technologies." October 2, 2022. https://ivypanda.com/essays/modern-medical-technologies/.

1. IvyPanda . "Modern Medical Technologies." October 2, 2022. https://ivypanda.com/essays/modern-medical-technologies/.

Bibliography

IvyPanda . "Modern Medical Technologies." October 2, 2022. https://ivypanda.com/essays/modern-medical-technologies/.

We are currently upgrading our website. Please bear with us if you are experiencing any loading issues.

Transformation Advancing Innovative Healthcare in Asia Pacific

The Voice of MedTech in Asia

Home » The MedTech Industry » What is Medical Technology

What is Medical Technology

Medical devices, every day, medical devices help save the lives of patients across asia pacific..

Medical Technology can be defined as the technologies that diagnose, treat and/or improve a person’s health and wellbeing, encompassing both low- and high-risk medical devices – products that can be as varied from tongue depressors, surgical gloves and medical thermometers to insulin pumps, pacemakers and in vitro diagnostics – and used to save the lives of patients everywhere across Asia Pacific every day.

Medical devices assist healthcare professionals to diagnose and treat patients with a higher level of accuracy and in a timelier fashion, and help patients overcome sickness or disease, improving their quality of life.

And while a global definition of what defines as a medical device is difficult to establish due to the various regulatory bodies worldwide that oversee the use and categorisation of medical devices, there is a very high likelihood that people are surrounded by medical devices without even realising it.

The following is the World Health Organization’s definition of what is a medical device:

‘Medical device’ means any instrument, apparatus, implement, machine, appliance, implant, reagent for in vitro use, software, material or other similar or related article, intended by the manufacturer to be used, alone or in combination, for human beings, for one or more of the specific medical purpose(s) of:

Care Providing continued day-to-day care to increase the standard of living.

Reproductive Health Supporting reproductive health.

Supporting Life Supporting or sustaining life.

Disinfection Disinfection of medical devices.

Information Providing information by means of in vitro examination of specimens derived from the human body.

Investigation Investigation, replacement, modification, or support of the anatomy or of a physiological process.

Diagnosis Diagnosis, monitoring, treatment, alleviation of or compensation for an injury.

Prevention Prevention, monitoring, treatment or alleviation of disease.

APACMed provides a unifying voice for the medical devices and in-vitro diagnostics industry in Asia Pacific. Founded in 2014, APACMed strives to promote innovation and impact policy that advances healthcare access for patients.

© Asia Pacific Medical Technology Association Ltd. All rights reserved.  Read Our Terms Of Use

• 2 Science Park Drive #01-06 Ascent, Science Park 1 Singapore 118222
• +65 6816 3180
• [email protected]

Quick Links

• Board of Directors
• Become a Member

Advertisement

Medical Technologies Past and Present: How History Helps to Understand the Digital Era

• Published: 07 July 2021
• Volume 43 , pages 343–364, ( 2022 )

Cite this article

• Vanessa Rampton   ORCID: orcid.org/0000-0003-4445-8024 1 ,
• Maria Böhmer 2 &
• Anita Winkler 2  

31k Accesses

5 Citations

2 Altmetric

Explore all metrics

This article explores the relationship between medicine’s history and its digital present through the lens of the physician-patient relationship. Today the rhetoric surrounding the introduction of new technologies into medicine tends to emphasize that technologies are disturbing relationships, and that the doctor-patient bond reflects a more ‘human’ era of medicine that should be preserved. Using historical studies of pre-modern and modern Western European medicine, this article shows that patient-physician relationships have always been shaped by material cultures. We discuss three activities – recording, examining, and treating – in the light of their historical antecedents, and suggest that the notion of ‘human medicine’ is ever-changing: it consists of social attributions of skills to physicians that played out very differently over the course of history.

Similar content being viewed by others

ChatGPT: towards AI subjectivity

A systematic review on digital literacy

Societal and ethical issues of digitization.

Avoid common mistakes on your manuscript.

Human beings have their own goals and intentions, and products should help them to realize them in an optimal way. In many cases, though, these goals and intentions do not exist independently from the technologies that are used. [Technologies] do much more than merely function – they help to shape human existence. Peter-Paul Verbeek (2015, 28)

Introduction

A wide range of novel digital technologies related to medicine and health seem poised to change medical practice and to challenge traditional notions of the patient-physician relationship (Boeldt et al. 2015; Loder 2017; Fagherazzi 2020). A number of recent pieces have explored the ethical implications of this, asking, for example, whether new means of delivering ‘greater efficiency, consistency and reliability might do so at the expense of meaningful human interaction in the care context’ (Topol Review 2019, 22). Various contributions from patients, physicians, bioethicists, and social scientists have warned that computer technologies somehow stand between the physician and the patient and that there is a fundamentally human aspect of medicine that coexists uneasily with machines (e.g. Gawande 2018; Verghese 2017). As a remedy, recent contributions call for ‘clinical empathy’ not only as a desirable characteristic trait of future physicians, but even as a selection criterion for medical students (Bartens 2019). The role history plays in these discussions is striking. Commentators often assume that current concerns about how technologies may lead to the ‘de-humanisation of care’ (Topol Review 2019, 22) are the unprecedented products of technological, social, and cultural transformations in the late twentieth-/early twenty-first centuries. When the history of medicine is referenced, it is largely in one of the following ways: first, to emphasize that today ‘[w]e are at a unique juncture […] with the convergence of genomics, biosensors, the electronic patient record[,] smartphone apps, [and AI]’ (Ibid., 6), whereby the singularity of the digital era makes historical comparisons with antique predecessors seemingly irrelevant. Second, the history of medicine is used in a nostalgic manner to refer to past medical practices, seemingly grounded in the ability of a doctor to ‘liste[n] well and sho[w] empathy,’ as having a fundamentally human element that is threatened by the digital era (Liu, Keane and Denniston 2018, 113; see also Johnston 2018). With some notable exceptions (e.g. Greene 2016, Kassell 2016, Timmermann and Anderson 2006), historians of medicine have largely refrained from attempting to interpret recent digital developments within their broader historical contexts. The historicity of digital medicine in its various forms and the insights of the history of medicine for contextualising the patient-physician relationship in the digital era have yet to be fully fleshed out.

In this contribution, we draw on historical examples and the work of historians of medicine to highlight how all technological devices are ‘expressions of medical change’ (Timmermann and Anderson 2006, 1), and to show how past analogue objects shaped physician-patient relationships in ways that remain relevant today. Our focus is on Western European medicine since the early modern period. While acknowledging the profound differences between medicines in particular historical times and places, we argue, first, that patients and doctors have always interacted in complex relationships mediated by objects. Medical objects and technologies are not only aids for performing certain human tasks, but themselves have a mediating function and impact how physicians and patients alike perceive illness and treatment. We then contend, second, that history helps inform current discussions because it highlights the plurality of ways in which the physician-patient relationship has been conceived in different eras. In particular, the ability of the physician to listen well and show empathy seems to be not so much a historical constant but rather a social attribution of certain skills to physicians that played out very differently over the course of history. Both points help us to show that some of the hopes and fears related to digital technologies are not so entirely new after all.

We work through these hypotheses in relation to three activities in the clinical encounter that have been significantly affected by digital medical technologies, namely i) recording (Electronic Health Records), ii) examining (Telemedicine), and iii) treating (Do-It-Yourself medical devices). In each case, we begin with a specific contemporary technology and the debates around it before showing how a historical perspective can contribute to our understanding of them. First, we discuss electronic health records in the light of current criticisms which maintain that this technology cuts valuable time the doctor should be spending with the patient, thereby threatening an assumed core responsibility of the physician, namely listening empathetically to the patient. History shows that physicians have not always seen administrative record-keeping as foreign to their main work with patients; rather, it has been a formative part of their professional identity at different times. Moreover, the value that both physicians and patients ascribed to empathic listening has varied substantially over time. Second, in the case of examining, we start from the observation that current debates about telemedicine focus on the greater distance between patients and physicians this technology brings about. The historical perspective demonstrates that these debates are but one example of how changing examination technologies affect both physical distance and reciprocal understanding in the patient-physician relationship. Our examples illuminate that physical proximity in the medical encounter is a modern phenomenon, and that it did not always imply a meeting of the minds between physician and patient and vice versa. Finally, our third section on self-treatment demonstrates that Do-It-Yourself devices have the potential to challenge medical authority and, by giving patients more power, alter those power balances between physician and patient that are constitutive of an idealised view of the patient-physician relationship. Yet here too there are significant historical precedents for thinking of doctors and patients as but two players within complex networks of people and technologies, in which patients ascribe value to a multiplicity of relationships.

Record-keeping: computers and the administered patient

Electronic health records (EHRs), that is computer-based patient records, have transformed the way contemporary medicine is practiced (see, for example, Topol, Steinhubl and Torkamani 2015, 353). While the electronic recording of patient files by individual health care providers has become common practice since the 1990s, a central virtual collection and storage of all health data relating to an individual patient is a rather new development which is currently being debated and technically introduced in various states. This virtual patient file is of secondary order because it is fed with original electronic files derived from various primary recording systems (GP, clinic etc.), and it follows a population health surveillance logic rather than the logic of the treatment of individual cases. The main idea is that both patients and health care providers have access to a corpus of health documents, which is as complete as possible, to make diagnosis and treatment more efficient, more precise and safer for patients, and less costly for the health system. While patients may make use of this possibility on a voluntary basis and are asked to distribute access rights to providers, healthcare providers are obliged to cooperate and feed the system with relevant data (for a local example see current implementation efforts in Switzerland and its pitfalls as described in Wüstholz and Stolle 2020). One of the main premises of supporters is that EHRs will facilitate not only networking and interprofessional cooperation but also enhance communication between doctors and patients: they ‘provide health care teams with a more complete picture of their patients’ health [and] improve communication among members of the care team, as well as between them and their patients’ (Canada Health Infoway; see also Porsdam, Savulescu and Sahakian 2016).

Yet critical discussions surrounding the introduction of EHRs doubt exactly that. They suggest that the increasing documentation, virtual storage and sharing of sensitive patient data threatens an assumed historical core value of the doctor-patient relationship, namely the possibility of physicians establishing an intimate and ‘deeper connection’ with their patients (Ratanawongsa et al. 2016, 127). From the perspective of healthcare providers, professionals criticise the time-consuming nature of EHRs, arguing that this technology supplants the time the doctor has for direct communication and time spent ‘in meaningful interactions with patients’ (Sinsky et al. 2016, 753). That screens are coming ‘in between doctors and patients’ is a widespread notion (Gawande 2018). In addition, medicine’s increasing dependence on screens is perceived as undermining important social rituals, such as exchanges between physicians and other healthcare colleagues who used to discuss their cases in more informal ways (Verghese 2017). Last but not least, EHRs are seen as a major factor contributing to declining physician health and professional satisfaction because of their time-consuming data entry that reduces face-to-face patient care (Friedberg et al. 2013). This last point seems to be crucial as the digital interfaces of EHRs indeed require a maximum of standardisation, homogenisation and formalisation of recording styles that necessarily conflicts with more informal, individual recording techniques. On the one hand, doctors are forced to fill in fields and checkboxes that do not correspond to their own knowledge priorities, that is the things they would want to highlight in a certain case from the perspective of their specialty. On the other hand, they have difficulties in identifying relevant information when too much data on an individual patient has been entered by too many people. The desired interprofessional collaboration thus runs the risk of complicating instead of facilitating the making of a diagnosis. Surgeon Atul Gawande maintains that in the past, analogue documentation forced physicians to bring essential points into focus: ‘[d]octors’ handwritten notes were brief and to the point. With computers, however, the shortcut is to paste in whole blocks of information […] rather than selecting the relevant details. The next doctor must hunt through several pages to find what really matters’ (2018). Together, these points of critique suggest not only a certain fear that the increasing digitisation of patient records might disturb relationships that in the pre-digital era were based on professional intuition and meaningful, trust-building face-to-face communication. The critique also suggests that what is threatened is the meaning and satisfaction a physician takes from his/her recording work.

From the perspective of patients, other concerns related to EHRs are more relevant, among them the safety of personal health data. But while notions of privacy – who has control over the data, who owns the patient history – are important for patients, a number of studies also show that patients perceive the careful digital documentation of their case as something positive (Assis-Hassid et al. 2015; Sobral, Rosenbaum and Figueiredo-Braga 2015). ‘Forced to choose between having the right technical answer and a more human interaction, [patients] picked having the right technical answer,’ reports Gawande (2018; see also Hammack-Aviran et al., 2020). It thus seems that as long as patients think EHRs are providing them with a higher quality of care, they readily accept EHRs and their doctors’ dependence on screens – hence adapting their expectations to technological change.

In order to scrutinize these purported threats and attitudes towards EHRs, the rich history of patient records provides a relevant historical backdrop. In studying patient records, historians have addressed exactly these issues: they have examined how the patient-physician relationship has changed over time and have used medical records to gain insights into how past physicians documented medical knowledge, how this influenced their perceptions of their professional identity, and their obligations vis-à-vis patients (Risse and Warner 1992). As a first step, it is important to see that even though EHRs pose new challenges because of their digital form, recording individual patients’ histories as part of medical practice and ‘thinking in cases’ as a form of epistemic reasoning are a historical continuum (Forrester 1996; Hess and Mendelsohn 2010). The patient history dates to ancient Hippocratic medicine when detailed medical records were written on clay tablets and handed down for centuries to preserve the esteemed knowledge of antiquity (Pomata 2010). Yet the content and form of medical records, as well as the practices producing them have changed remarkably over time (Behrens, Bischoff, and Zelle 2012). In Western Europe, physicians in sixteenth-century Italy re-appropriated the ancient practice and typically recorded their cases in paper notebooks, as part of a larger trend to systematize and record information (Kassell 2016; see also Pomata 2010). As Lauren Kassell notes, the records of early modern practitioners ‘took the form of diaries, registers or testimonials, often they were later ordered, through indexing or commonplacing, by patient, disease or cure, providing the basis for medical observations, sometimes printed as a testimony to a doctor’s expertise as well as his contribution to the advancement of science’ (2016, 122). The historical perspective reveals that the rationale for a particular type of medical record-keeping always developed in tandem with the technical capabilities for its enactment, changing ideas of how diseases should be recorded, as well as with the preferences of individual physicians (ibid. 120). Crucially, as the organization of these collections of patient histories changed, so too did medical knowing and normative ideas about the physician-patient relationship (Hess and Mendelsohn 2010; Dinges et al. 2016).

As shown above, current critical discussions about EHRs tend to evoke a medical past in which patients were given time to talk about their illness, doctors listened and engaged in meaningful interactions, and record-keeping did not interfere with these processes. Allegedly, there were few concerns over misuse of data as there was less data produced and fewer players in the game. How does this popular nostalgic view correspond to research findings in the history of medicine? To some extent, the context of ‘bedside medicine’ comes close to these ideas. This model of care remained dominant in Western Europe until the nineteenth-century. One of the main ways in which physicians generated medical knowledge at the bedside of patients was to conduct ‘verbal analysis of subjectively defined sensations and feelings’ by patients (Jewson 1976, 229-230), and these patient testimonials provided the details recounted in physicians’ notes (Fissell 1991, 92). This is partly because the early modern doctor-patient relationship was based on a ‘horizontal’ model of healing (Pomata 1998, 126-27, 135) and a legally binding ‘agreement for a cure’ (ibid., 25 passim), which gave considerable power to patients, placing them on ‘near-equal hermeneutic footing’ with doctors (Fissell 1991, 92). Physician and patron (patient) made a contract in which the mostly upper class-patient would only pay fees after ‘successful’ treatment; vice versa, doctors were not obliged to treat a patient but would rather take on patients whose potential cure, and ability to pay fees, could be foreseen. Patients’ verbal satisfaction and willingness to conduct word-of-mouth publicity for a practicing physician were key to his reputation at that time and influenced physicians’ relationships with their clients.

However, it is problematic to project today’s vision of a desirable empathic relation between doctors and patients back into the past. Although upper-class patients clearly had some power in their relationship with physicians, the dominance of patients’ speech in medical records as such should not be interpreted as proof that doctors cared about their patients in the modern sense of showing understanding. With respect to nineteenth-century bourgeois medicine, Roy Porter noted that flattery and attention in the medical encounter were calculated practices of physicians concerned to secure clients and that ‘solemn bedside palaver[,] a grave demeanour, an air of benign and unflappable authority’ were all part of the prized ‘art of never leaving without a favourable prognosis’ (1999, 672). In a similar vein, Iris Ritzmann has emphasized that eighteenth-century doctors were eager to adhere to a certain ‘savoir faire,’ that is rules of conduct that would allow them to obscure the fact that in many cases, their abilities to heal were very limited (1999). And in Paul Weindling’s assessment of German medical routines, physicians’ desires to satisfy the patient subjectively were even purely instrumental: ‘[s]ympathy with the feelings of the sick was an economic necessity owing to the competition between practitioners’ (1987, 409). In all these cases, the value ascribed to direct physician-patient dialogue was very different from today’s ideas about an empathic encounter between physicians and patients; an engaged bedside manner often had more to do with calculated support for an upper class and sometimes hypochondriac clientele.

Similarly, as concerns the careful documentation of a patient’s medical condition and history, historical evidence shows that doctors did not do it primarily for their patients’ needs but for purposes of professional standing. This was important at a time when physicians’ scientific authority still needed to be established. The fact that in many cases there were several physicians involved in the treatment of the same case made documentation and communication between physicians (and sometimes for the public) especially relevant – and especially conflictual. Eighteenth-century case histories reflecting the context of bedside medicine indeed suggest that doctors were sometimes eager to publish case histories of patients that would bespeak their ability to heal by highlighting the misfortune of their competitors in order to enhance their own reputation. This shows how misleading the popular nostalgic view of a past intimate and unbroken bond between physicians and patients is, and that analogue paper technology did not necessarily strengthen this bond but could also be used in ways that were not beneficial for patients. Unlike today, this was an era in which practices of record-keeping mirror multiple, local and highly individual ways of documentation; the formalisation and standardisation of patient files which 19 th -century hospital medicine would trigger was yet to come.

As hospitals and laboratories became important institutions for medicine in the century roughly between 1770 and 1870, they also changed the practices of record-keeping, as the customary interrogation of patients’ accounts of the course of their disease did not coincide with changing understandings of disease, scientific interests and cultural expectations (see Granshaw 1992). For instance, French anatomist and pathologist Xavier Bichat (1771-1802) dismissed note-keeping based on patients’ narratives as an obsolete method for knowledge-making. He observed in his Anatomie générale (1801), ‘you will have taken notes for twenty years from morning to night at the bedside of the sick [and] it will all seem to you but confusion stemming from symptoms that fail to coalesce, and therefore provide a sequence of incoherent phenomena’ (1801, xcix, our translation). The kind of medicine favoured by Bichat and like-minded physicians focused on gaining anatomical and physiological insights directly from the body, using both physical examination and remote techniques in the laboratory. One way in which record-keeping changed to accommodate these interests was in the use of a more technical language to describe the experiences and expressions of patients. Mary Fissell argues that with the rise of hospital medicine, ‘doctors begin to sound like doctors, and patients’ voices disappear’ because doctors interpret patients’ words and replace them with medical equivalents (1991, 99). More generally, historians have shown that during the nineteenth century, medical culture changed in a way that gradually diminished the importance of patient narratives in medical writing (Nolte 2009).

How did these changes in recording practices play out for patients in the medical encounter ? From the historical perspective, the fact that physicians adopted a more technical language in their interactions and records should not be taken as evidence for a loss of human interaction or as something that patients necessarily disliked. On the contrary, the more systematised and formalised type of record-keeping was considered state of the art and was in accordance with a rapidly growing belief in the natural sciences among both patients and the general public (Huerkamp 1989, 64). This is related to the emergence of a specific concept of scientific reasoning that, in turn, fostered a sense of ‘scientific objectivity’ that called for dispassionate observation and accurate recording (Daston and Gallison 2010; Kennedy 2017). By the end of the nineteenth century, academic physicians had managed to create such professional authority that the ‘horizontal model of healing,’ in which the physician courted his upper-class clients, was replaced by a vertical model, in which the patient subjected himself to the authority of the physician. A Berlin doctor advised his fellow colleagues in 1896 that they should communicate their medical prescriptions to patients in a way that ‘prevents any misunderstandings and so that no further question can be addressed to him’ (cited in Huerkamp 1989, 66, our translation). For patients, this growing scientific authority and paternalism meant very different things, depending on class and social status. While medical services became accessible to more people, in particular thanks to the introduction of obligatory health insurance for workers, lower classes often experienced medicine as an instrument of power rather than benevolence (Huerkamp 1989). But even for the well-to-do, who undoubtedly benefitted from newly developed medical techniques, in particular in the realm of surgery, the acceptance of medical paternalism, male rhetoric and heroic cures came with high costs. This is suggested, for instance, in a famous letter by the court lady and writer Frances (Fanny) Burney who underwent a mastectomy in 1811, a rare document offering a patient’s perspective on these matters (Epstein, 1986).

From the perspective of doctors at the turn of the nineteenth century, record-keeping was associated not only with professional obligations but also with personal fulfilment. In many European countries, physicians were asked to provide expert opinion for juridical and administrative regulations as the state was increasingly interested in tracking its population’s health (Ruckstuhl and Ryter 2017; Schmiedebach 2018). In her study of Swiss physician Caesar Adolf Bloesch’s private practice (1804-1863), Lina Gafner shows the extent to which he perceived medical practice documentation as constitutive of his professional role and self-understanding as a medical expert. Bloesch’s patient journal ‘constitutes one single gigantic research report’ (2016, 265) because it was key for allowing him to generalize from the experiences gained in his practice in order to produce knowledge to contribute to contemporary scientific discussions. Gafner notes that the ‘format he gave his journals [leads] us to assume that scientific or public health-related ambitions were part of Bloesch’s professional self-image’ (263). In contrast to this historical example, where patient care and journal keeping were combined in the light of professional ambition, it stands out that healthcare providers of today tend to see their administrative work as opposed to patient care, even as separate and conflicting tasks; it is assumed that for physicians ‘seeing patients doesn't feel like work in the way that data entry feels like work’ (Amenta 2017). This is probably related to the fact that many physicians experience the requirement of working with a given software as a limiting restraint, which they are not really able to control, while they experience working with patients as something they have learned to master. As Gawande admits: ‘a system that promised to increase my mastery over my work has, instead, increased my work’s mastery over me’ (2018). It thus seems that it is primarily the question of ownership that distinguishes past recording styles from today’s recording systems: it is difficult to individually appropriate something which is designed to harmonize if not eliminate individual recording styles.

Yet even as Bloesch and contemporaries embraced the administrative tasks associated with medical note-taking as an opportunity to become a medical expert, other nineteenth-century physicians had different views of its value. But their criticisms of record-keeping were not motivated by the inherent value they saw in interactions with patients. Rather, their critiques were linked to a notable shift during the nineteenth century as scientific interest, triggered by administrative requirements as well as different disease conceptions and methods (e.g. in epidemiology research), changed its focus from the individual case study to population studies (see Hess and Mendelsohn 2010). In Nikolas Rose’s words, ‘the regularity and predictability of illness, accidents and other misfortunes within a population’ became ‘central vectors in the administration of the biopolitical agendas of the emerging nation states’ (2001, 7). Bound up with a new emphasis on tabulation, as well as ‘precision and reliability,’ various German-speaking hospitals instigated a new tabular format designed to enable physicians to compile their observations of patients into ward journals organized into columns and, eventually, generate an annual account of the course of disease (Hess and Mendelsohn 2010, 294). Yet in response some physicians rejected what they saw as excessively confining recording requirements. Volker Hess and J. Andrew Mendelsohn describe how the chief physician at a Berlin clinic ranted about the ‘inadequacy of our [tabular] journals’ and their inability to produce medical knowledge (295). While Mendelsohn and Hess themselves remark that such tabular ward journals were very ‘far from the patient history as observation, as prose narrative’ (293), the physicians’ rejection of the use of columns to record cases was not motivated by a concern to recover patients’ own narrations of their ailments or the feeling that record-keeping prevented them from properly attending to their patients’ needs. On the contrary, these physicians were concerned with producing an annual disease history and were frustrated that ‘the ultimately administrative format’s own rigid divisions blocked the writing of a synoptic history’ (296). Rather than recovering a face-to-face encounter with patients, they were interested in finding a recording format that would allow them to present a more compelling and sophisticated general description of disease, relying on mass information.

The current consensus among historians of medicine is that we should neither conceive medical records as ‘unmediated records of experiences of illness and healing’ (Kassell 2016, 126) nor as disentangled from the medical encounter itself. Rather, ‘processes of record-keeping were integral to medical consultations’ because ‘as ritualised displays and embodied knowledge, case books shaped the medical encounters that they recorded’ (122; see also Warner 1999). In relation to how ‘computerization’ is shaping contemporary medical encounters, three main points are of note. First, physicians have not always seen time spent writing and recording patient histories as in competition with interacting with patients themselves. At various times in history, the careful documentation of individual cases was perceived as a fundamental resource for generating medical knowledge and time spent doing so as part of the self-identity of physicians. Against the repudiation of digital record-keeping by today’s physicians, historical evidence shows that to the extent that physicians saw record-keeping as coinciding with their overall knowledge objectives, they accepted and even embraced it. This is linked to a second point, namely that prolonged time spent listening to the patient talk was not historically seen as evidence of good medical practice. For example, in an era when listening at length to patients was associated with the obsequious physician catering to the ego of the upper-class patient, the sober inscription in a nineteenth-century casebook noted that ‘too much talking showed that little was wrong’ with the patient (Weindling 1987, 395). Finally, patients too accepted administrative work by doctors as a sign of expertise and not necessarily as something that reduced the doctor’s attention to them. While the power balance changed in favour of doctors and ascribed less epistemic value to patients’ words, this was not necessarily negatively received by patients. History therefore shows that we should not view technological changes as isolated from the broader medical culture surrounding them but rather as shaping and co-constructing this culture. Today’s fear that the introduction of EHRs might change the communication and relation between physicians and patients for the worse tends to blame technology for a broader cultural and medical change of which it is just one tiny aspect, that is the growing belief in data and the logic of gaining stratified knowledge to provide relevant information about any one patients’ condition. Given that patients’ expectations exist in a dynamic relationship with how physicians learn, make decisions and interact with them, EHRs are themselves bound up with creating new conditions for the physician-patient relationship.

Examining: telemedicine and the distant patient

A further way in which digitalization has influenced the medical encounter is that it has emerged as the new virtual consulting room, thereby radically transforming the settings and procedures of physical examination. Although most people still go to ‘see the doctor,’ medical encounters today no longer have to take place in physical spaces but can occur via telephone or internet – what is broadly referred to as telemedicine, literally healing at a distance (from the Greek ‘tele’ and Latin ‘medicus’) (Strehle and Shabde 2006, 956). According to the World Health Organization, as a global phenomenon, telemedicine is more widespread than EHRs with more than half of responding member states having a telehealth component in their national health policy (WHO 2016). In the context of the COVID-19 pandemic, telemedicine has been overwhelmingly seen as ‘[a]n opportunity in a crisis’ and has further gained in popularity (Greenhalgh et al., 2020; see also Chauhan et al., 2020). A senior NHS official cited by The Economist called the widespread adoption of remote care (viz. telemedicine) a ‘move away from the dominant mode of medicine for the last 5,000 years’ (2020, 55). In the virtual examination room, patients can ask a physician for a diagnosis, a prescription and a treatment plan and send information about diseased body parts via digital media. When inquiring about the health conditions of their patients from a virtual consultation room, physicians sometimes need to ask their patients for certain practices of self-examination and self-treatment (Mathar 2010, section III). Advocates of telemedicine emphasize that there is no risk of mutual infection, advantages of cost savings, convenience, and better accessibility to medical care generally and for people living in rural and remote areas in particular. In Switzerland, for instance, the Medgate Tele Clinic promises to ‘bring the doctor to you, wherever needed’ (2019) while the U.S. Doctor on Demand characterizes itself as ‘[a] doctor who is always with you’ (2019). Patients, meanwhile, appreciate the greater availability of physicians, less travel time and better overall experience (Abrams and Korba 2018). However, telemedicine also raises various critical questions about the effects of physical distance on the physician-patient relationship. In particular, can the quality of the examination and diagnosis be high enough if a physician only sees his/her patient via screen but cannot smell, palpate and auscultate him/her? Furthermore, how can a trusting doctor-patient relationship be established virtually and at a distance? (see Mathar 2010, 13). While some of these critiques are based on the assumption that a fitting medical encounter between physician and patient should be a ‘good, old-fashioned, technology-free, dialogue between physician and patient’ (Sanders 2003, 2), we show below that all encounters inevitably ‘pass through a cultural sieve’ (Mitchell and Georges 2000, 387). Not only has the perceived need for the physical proximity of physician and patient varied substantially over history, but historical physicians and patients have not seen physical distance as preventing them from achieving emotional understanding. Whether physical examinations took place in-person or remotely, at each point in history doctors relied on their knowledge and its applications, that is a cultural lens through which s/he gazes on, over or into the human body. Regardless if examined remotely or closely, changes in examination procedures always challenge the established sense of the emotional bond between patient and physician, which therefore needs to be defined anew.

The standard physical examination as we know it today was considered less important in Europe up to roughly 1800 because of the conventions governing the relationship between physician and patient/patron, and also because of the conventions governing the relationship between male doctor and female patients. Many physicians considered physical examination morally inappropriate and saw it as dispensable for making a diagnosis. Physicians of upper-class patients generally considered their task more to advise than to examine and treat (Ritzmann 1999, 203). From his close analysis of a casebook by a seventeenth-century English physician, Stanley Joel Reiser concludes that the ‘maintenance of human dignity and physical privacy placed limits on human interaction through touch’ (1978, 4). Given the desirability of maintaining physical distance, physicians relied on and developed other sources of knowledge than their own sense of touch. The physical examination was ‘the method least used’ by the seventeenth-century physician who rather favoured ‘the patient’s narrative and [his] own visual [outward] observations’ of the patient’s body. In her study of a manuscript authored by a surgeon-apothecary of the same historical period, Fissell singles out blood-letting as one ‘of the few occasions on which a professional […] might routinely touch a patient’ and notes that it was necessarily ‘transformed into a careful ritual, one which attempted to compensate for the transgressive nature of the encounter. The blood-letter's courteous attention to returning the patient to his or her un-touched status underlines the mixture of courtesy and technique which made good medical practice’ (1993, 23). In ways now unfamiliar to us, manners and morals interacted to make physical examination and touching patients an ancillary part of the desirable patient-doctor encounter at that time.

Regular in-person physical examination as a routine practice and diagnostic technology is a rather recent development that came along with a new anatomical understanding of disease during the course of the nineteenth century, namely that diseases can be traced to individual body parts such as organs, tissues and cells, rather than unbalanced bodily humours (Reiser 1978, 29). It was at this time that the doctor’s examination skills no longer depended on the patient’s word and the surface of the (possibly distant) body, but started relying on what the doctor could glean from the patient’s organic interior (Kennedy 2017). In order to ‘get’ to the physical conditions of the body’s interior, a number of instruments were developed to facilitate the new credo of examination. The most famous example of such a nineteenth-century examination technology is the stethoscope, invented by French physician René Laennec (1781-1826). ‘By giving access to body noises – the sounds of breathing, the blood gurgling around the heart – the stethoscope changed approaches to internal disease,’ wrote Roy Porter, ‘the living body was no longer a closed book: pathology could now be done on the living’ (1999, 208). Crucially, technologies like the stethoscope brought the physician and patient into the examination room together but by providing physicians with privileged access to the seat of disease did not necessarily bring them closer in terms of understanding. Doctors now heard things that remained unheard to the patient, and this provoked a distancing in terms of illness perceptions. In Reiser’s account, the stethoscope ‘liberated doctors from patients and, by doing so, paradoxically enabled doctors to think they helped them better. […] Listening to the body seemed to get one further diagnostically than did listening to the patient’ (2009, 26).

The result is visible in the resistance surrounding some examination technologies that allowed physicians to delve into the body’s interior in order to gain new anatomical and pathological insights but that proved too transgressive for some existing physician-patient contacts. The vaginal speculum, introduced into examination procedures in Paris in the early-nineteenth century, may have fitted well with physicians’ new commitments to empiricism and observation. But at the time of the speculum’s introduction, female genital organs, in contrast to other organs, were regarded ‘as so mysterious and so sacred that no matter how serious the disease that afflicted them might be, it was no justification for an examination either by sight or touch’ (Murphy 1891, cited in Moscucci 1990, 110). Although the speculum was in line with pathological disease concepts and close, interior observation, moral considerations continued to undermine its suitability in the clinical context. At a meeting of the Royal Medical and Chirurgical Society, chronicled in the Lancet , commentators associated the speculum with both female and physician corruption, and the loss of moral virginity and innocence caused by its insertion into the body (Anon. 1850). In Margarete Sandelowski’s estimation, the vaginal speculum ‘required physicians not only to touch women’s genitals, but also to look at them, and thus imperiled the relationship male physicians wanted to establish with female patients’ (2000, 75). Here was a case in which technology challenged the socially accepted relationship between (male) physicians and (female) patients of a particular class because its application demanded increased physical closeness, and therefore was seen as undesirable and transgressive. As Claudia Huerkamp notes, it took a long time to establish a specific ‘medical culture’ in which the physical examination of female parts by a male physician was not perceived as breaking a taboo (1989, 67).

In other instances, the use of the speculum and the unprecedented access it provided to women’s anatomy mirrored existing power structures. The first uses of the speculum were justified in reference to and tested on the most vulnerable members of society. Deirdre Cooper Owens (2017) has demonstrated that in the U.S., racist arguments helped to defend the speculum’s application and experimentation on black, enslaved women as they were deemed to have a particularly ‘robust’ constitution, high tolerance of pain, and so on. Medical men such as James Marion Sims, who by his own account was the inventor of the speculum, combined his privileged access to enslaved women’s bodies with intrusive forms of examination in order to gain new knowledge crucial for the emerging field of gynaecology. This was also true for Irish immigrants in the U.S. (Owens 2017) and in the case of prostitutes in France and Germany, where the speculum was used as an instrument of the medical police (Moscucci 1990, 112). Prostitutes were screened using this new instrumentation as supposed carriers of venereal disease, whereas male clients did not need to undergo any screening. This highlights how intrusion into the body in the name of more accurate examination was frequently bound up with power and control, especially of marginalized groups.

Even as the seat of disease became increasingly associated with specific locations inside the body, this coexisted with the notion that medicine could still be conducted ‘at a distance.’ The example of the telephone demonstrates how tele-instruments worked alongside close examination devices that adhered to the principle of disease as located in particular interior body parts. In fact, the potentiality of the telephone for the medical profession was apparent from its invention in 1876; 4  as Michael Kay notes, the first inter-connected users were doctors, pharmacists, hospitals and infirmaries (2012). Practitioners used the technology, which enabled the clear transmission and reproduction of complex sounds for the first time, to improve existing instruments, or to devise entirely new examination methods. For instance, in November 1879, the Lancet published the case of an American doctor who, when phoned in the middle of the night by a woman anxious about her granddaughter’s cough, asked for the child to be held up to the telephone so that he could hear it (Anon. 1879). A group of physicians predicted in 1880 that home telephones would allow a new specialty of long-distance practitioners to ‘each settle themselves down at the centre of a web of wires and auscult at indefinite distances from the patients,’ potentially replacing the traditional stethoscope (cited in Greene 2016, 306). The telephone was also lauded for its potential to uncover foreign objects lodged in patients’ bodies, for example by acting as a metal detector (see Kay 2012). In line with the belief that a ‘good examination’ required a physician having access to the body’s interior in order to discover the seat of disease according to the localisation principle, the telephone was seen as an extension of the doctor’s ear that could improve examination and diagnosis.

In this context, reactions to the increased physical distance between physician and patient varied. The benefits of using a telephone instead of the more traditional speaking tube, which allowed breath to pass from one speaker to another, when communicating with patients with contagious diseases were recognised very early (Aronson 1977, 73). A testimonial letter, written by the Lady Superintendent at the Manchester Hospital for Sick Children in 1879, stated: ‘[The recently installed telephone] is of the greatest value in connection with the Fever Ward, enabling me to always be in communication without risk of infection’ (cited in Kay 2012). Yet some physicians worried that telephone technology had effectively ‘shrunk’ perceived social distance between them and the working classes, making them liable to be overly contacted by the general public. As one doctor complained in the Lancet in 1883: ‘[a]s if the Telegraph and the Post Office did not sufficiently invade and molest our leisure, it is now proposed to medical men that they should become subscribers to the Telephone Company, and so lay themselves open to communications from all quarters and at all times. […] The only fear we have is that when people can open up a conversation with us for a penny, they will be apt to abuse the privilege […] ’ (cited in Kay 2012) . Not only were doctors concerned about the telephone invading their ‘leisure,’ they worried that they might be overrun by the public, and their medical expertise would be needlessly exploited. Because of the inherent fear of doctors that an excessively frequent use of the telephone could flatten the social order and their standing within society, it is not surprising that the public use of the telephone came under critical medical scrutiny. This is visible in the way that telephones themselves came to be seen as seats of infection. At the end of the nineteenth century when most telephones were for public use (Fischer 1992), the British Medical Journal cautioned there was a need to curtail ‘the promiscuous use of the mouth-pieces of public telephones’ (Anon. 1887, 166). In general, the use of the telephone was informed by insights from bacteriology, which transformed individual disease ‘into a public health event affecting communities and nations’ (Koch 2011, 2), and placed new emphasis on the need to keep potentially infectious bodies as well as social classes at clear distance from one another (see Peckham 2015).

In relation to the pitfalls of today’s telemedicine and the fundamental questions of physical distance and emotional rapprochement in the medical encounter, these historical findings demonstrate that what was perceived as the ‘normal’ setting and procedure of medical examination could change remarkably within a rather short time. Before the nineteenth century, close physical examination generally played a less prominent role while patients’ illness accounts had a greater weight in the medical encounter. Indeed, in some contexts physical distance was seen as the prerogative of good medical practice. Post-1800, by contrast, is characterized by the standardisation of physical close examination, but also by the introduction of new technologies into the patient-physician relationship that themselves challenged socially-accepted degrees of physical closeness. However, this does not necessarily mean that such technologies disturbed a former unbroken bond, rather, various technologies became players in the game and could (or not) be appropriated by patients and doctors alike. Technology did not simply affect the physician-patient relationship, rather, existing societal and moral understandings influenced how technologies came into being and how they were used (Peckham 2015, 153). Our historical examples suggest that rather than seeing telemedicine as something fundamentally new and potentially threatening because it seemingly undermines a personal relationship, it may be more useful to acknowledge that technologies and cultural understandings always govern the degree of physical closeness and distance in medical encounters, and that this has had manifold implications for the emotional doctor-patient bond. The success of telepsychotherapy during the Covid-19 pandemic is perhaps a case in point. Even as it is unique among medical specialities because of the extent to which it considers the human relationship as fundamental for healing, psychotherapy via phone or video link has increased dramatically during the public health crisis, and also had good results (Békés and Aafjes-van Doorn 2020). This points not only to how physician-patient closeness and emotional understanding can exist in times of physical distance, but also to the constantly variable ways in which both the cultural imagination and experience of distance manifest themselves (Kolkenbrock 2020).

Self-treatment: do-it-yourself medical devices and the expert patient

The third field of digital medicine that we would like to put into historical perspective is one of the fastest growing fields of eHealth, namely do-it-yourself (DIY) health technologies. Such technologies broadly refer to the mobile devices that ‘now allow consumers to diagnose and treat their own medical conditions without the presence of a health professional’ (Greene 2016, 306). Silicon Valley firms sell ‘disintermediation,’ that is the possibility of cutting out middlemen – physicians – and allowing consumers to better control their health via their devices (Eysenbach 2007). Significant private investments have been driving these changes which, in the forms of smart devices and wearable technologies, often imply purchasing a product (e.g. a smartphone) and related applications and tools (see Greene 2016; Matshazi 2019). The website Digital Trends 2019 ranking of ‘the 10 best health apps’ range from Fitocracy, a running app that allows you to track your progress and that promises a fitness experience with a ‘robust community of like-minded individuals’, to Carbs that transfers the meals you have eaten into charts of calories, to Fitbit Coach that promises you the experience of having a personal trainer on your smartphone (de Looper 2019). 5 Health systems have bought on and increasingly ask patients to observe and monitor themselves with the help of these technologies, and in some cases, the use of apps to measure blood pressure, pulse and body weight such as Amicomed and Beurer HealthManager are closely connected to the possibilities of sharing one’s data remotely with a physician. In terms of reception, the delegation of tasks to digital devices is associated with patients having new options and new knowledge of their own health. In the estimation of one hospital CEO, this dramatic ‘democratization’ of technology and of knowledge signals ‘a true coming of age of the patient at the centre of the healthcare universe’ (Rosenberg 2019). In the words of chronic patient and patients’ rights advocate Michael Mittleman, while there may be benefits for patients when technologies take over certain tasks that were previously the prerogative of physicians, such technologies nevertheless pose a fundamental challenge to the ‘golden bond’ that previously characterized the patient physician-relationship, for example in the age of the house call (conversation with the author, 2019). It is clear from these statements that DIY devices – because they suggest that the more beneficial relationship is that between the patient/consumer and his/her devices – challenge previous assumptions about the inherent value of the physician-patient relationship as well as the balance of power between those two actors (see Obermeyer and Emmanuel 2016).

Both the notion that patients inherently benefit from circumventing physicians and taking their health into their own hands, as well as the idea of a close, almost familial bond that characterized the physician-patient relationship prior to contemporary DIY practices can be nuanced if we acknowledge that do-it-yourself medical practices have a long and varied history. As Roy Porter has noted, in the eighteenth-century, ‘ordinary people mainly treated themselves, at least in the first instance[,] “medicine without doctors” [was] a necessity for many and a preference for some’ (1999, 281). Only in the nineteenth-century did the medical profession establish a monopoly in health care and have the official power to determine what was ‘health’ and ‘sickness’. In the previous centuries, local and pluralistic ‘medical markets’ embraced far more providers of health services and their varied tools, including barbers, surgeons, quacks and charlatans, so that patients chose among the options that most convinced them or that were affordable to them (Ritzmann 2013, 418). But patients also had the option to help and treat themselves using the means at their disposal – Fissell argues that a person who fell ill in 1500 and still in 1800 almost always first sought medical treatment in a domestic context: ‘[h]e or she relied upon his or her own medical knowledge of healing plants and procedures, consulted manuscript or printed health guides, and asked family, neighbors, and friends for advice’ (2012, 533). As Fissell points out, the enormous diffusion and importance of self-therapy at the time meant that the ‘boundary between patients and practitioners was hard to pin down’ (534). While current depictions of an idealised interaction between physician and patient assume a physician who through his/her knowledge examines, advises and treats the non-knowing patient, history shows that the presumed boundaries between the expert and lay person are far more blurred than is usually assumed.

The presumed novelty of a de-centralised market for DIY devices that potentially threatens the dual relationship between physicians and patients can be put into perspective when considering historical examples. Due to a fairly unregulated medical market in the early modern period, competition was high and the business of medicinal recipes lucrative. In this context, profit-motivated apothecaries benefited from offering new recipes made from exotic products: as of the fifteenth century European pharmacies stocked many wares with medicinal properties – including spices, elements such as sulphur, and plants, for examplemastic and sundew – and these were bought by people who gathered and dealt in medicinal plants (or ‘simples’) and other apothecaries, who made them into medicines. In the wake of the European voyages of discovery, the range of products became ever wider and more expensive, and apothecaries were a very profitable business branch for a long time (Ehrlich 2007, 51-55). King and Weaver have used evidence from remedy books in eighteenth-century England to show how families purchased recipes for remedies, and resold both the recipes and the medicines they brewed to other local people (2000, 195). Until the nineteenth century the medical market flourished and was accessible and lucrative for many participants, while the demand for ‘medical’ services was high, particularly in towns and cities. Access to the technologies of healing – whether domestic medical guides or healing herbs – allowed patients to control their health and treatments according to a wide range of scientific explanations. In contrast to other European countries that meanwhile had developed some restrictions for apothecaries and their suppliers, in Britain the market-place was remarkably varied in the light of the free-market principle caveat emptor (let the buyer beware). ‘In English conditions,’ wrote Porter, ‘irregulars, quacks and nostrum-mongers seized the opportunities a hungry market offered’ (1995, 460). In these conditions of market-oriented healing, both patients and healers alike believed, sometimes fervently, in the effectiveness of the remedies on offer. Moreover, the network of relationships in which such transactions took place was remarkably fluid, with patients using the services of several health professionals in succession or simultaneously.

In the following centuries, medical practice and science would change dramatically due to the rise of academic training as a prerequisite to enter the medical profession, a development seen across Europe, as well as the integration of physicians into national health agendas. A growing belief in science and a paternalistic ideal of the academic physician attributed to him the sole power over medical practice and technologies. It became more difficult for other healers to participate in the health market, and the knowledge of the self-treating patient was diminished as well. As part of the attempt to counteract competition from non-educated or apprenticed healers, in the United Kingdom only registered doctors could hold various public posts, such as public vaccinator, medical officer and the like (Bynum 2006, 214). Yet ‘alternative’ medicine, a term that contained all those healers not licenced and accepted by the respective medical registers, continued to satisfy patients’ needs, although to a lesser extent. In Weindling’s assessment of the prospects of university-educated physicians to attract clients in nineteenth-century Berlin, ‘[f]ierce competition from a range of unorthodox practitioners must be assumed’ (1987, 398). The popularity of hydropathic doctors and water cures, mud-bathing and vegetarianism are but some examples of how alternative medicines co-existed alongside official ones and were increasingly popular treatments even though they did not meet the contemporary academic criteria of standards regarding safety and efficacy (Ko 2016). Thus patients often looked beyond qualified physicians to other practitioners, and their own sensibilities played a considerable role in which relationships they chose to develop.

A look into twentieth-century history shows that DIY practices were integrated into official medicine as well (Timmermann 2010; Falk 2018). The significant rise of chronic diseases and life-long treatment, for instance, required the co-operation of patients in the form of self-tracking and observation of their bodies since it could not be done by medical experts alone. In the first decades of the twentieth century, DIY methods and technologies for measuring blood pressure or sugar became particularly vital, transforming the roles of ‘patient’ and ‘doctor’ and relationship between them. Examining the history of self-measuring blood pressure, Eberhard Wolff notes that patients doing so in the 1930s required both patience and training, and also were pushed into a more active and participatory role during medical treatment: it was not the doctor anymore but the patient who produced and controlled relevant data that were decisive for further medical decisions and treatment (2014, 2018). With the rise of the risk factor model in mid-twentieth century – the identification of factors in patient’s behaviour and habits that were suspected of contributing to the development of a chronic disease – DIY practices grew ever more important and so did its technologies. From this moment, the idea of preventing disease shifted towards individual, possibly damaging behaviours such as smoking and diet that could trigger a number of different diseases. As a consequence, the patient received more responsibility in order to live up to the new credo of maintaining his or her personal health (Lengwiler and Madarász 2010). Optimizing a personal healthy life style hence did not necessarily occur in direct consultation with a doctor but rather in conjunction with health products available on the market. In the words of sociologist Nikolas Rose, in the course of the twentieth century:

[t]he very idea of health was re-figured – the will to health would not merely seek the avoidance of sickness or premature death, but would encode an optimization of one’s corporeality to embrace a kind of overall “well-being” … It was this enlarged will to health that was amplified and instrumentalized by new strategies of advertising and marketing in the rapidly growing consumer market for health (2001, 17-18).

According to Rose, by such developments, ‘selfhood has become intrinsically somatic – ethical practices increasingly take the body as a key site for work on the self’ (18). But he also argues that by linking our well-being to the quality of our individual biology we have not become passive in the face of our biological fate. On the contrary, biological identity has become ‘bound up with more general norms of enterprising, self actualizing, responsible personhood’ (18-19). By considering ourselves responsible for our own biology as key to our health, we have come to depend on ‘professionals of vitality’ (22) whether they be purveyors of DIY devices, genetic counsellors, drug companies or doctors.

With respect to contemporary debates over DIY practices, some have argued that they allow both doctors and patients to be ‘experts’ and call for ‘a relationship of interactive partnership,’ not only because patients today are often informed but also because ideally they know best their own bodies and ailments (Kennedy 2003). Against this idealising assessment, the historical perspective makes us aware that while self-help and self-treatment have been an important dimension of past medical cultures, it appears that historically, patients have not relied as much on a face-to-face empathetic encounter with any one physician as today’s debates suggest. Moreover, today as in the past, the mere existence of markets for medical devices influences how consumers/patients decide whether to resist or embrace the various possibilities of self-treatment as well as their relationships with those who provide it. As Porter has argued, purveyors of ‘alternative’ medicines rationalised their therapeutic effects in ways that differed from official scientific methods and using arguments that likewise changed over time. Depending on the perspective of whose model of evidence users deemed most credible, the co-existence of diverse models for practicing medicine must be assumed throughout history and despite nineteenth-centuries attempts to eliminate unorthodox medicines (Timmermann 2010). The result was a diverse network of fast-changing relationships in which no single one was ascribed the ultimate power to heal. Reflecting on this history, historian of medicine and physician Jeremy Greene has stated that contemporary DIY devices therefore appear ‘neither wholly new nor wholly liberating’ (2016, 308). Our analysis corroborates Greene’s, in that it shows how those who use new DIY technologies may free themselves from their traditional relationship of dependence on physicians, while also creating new relationships with those actors who produce apps or conduct marketing. Yet our study also suggests that there is no one ethical conclusion about whether DIY or physician-dominated care is a better way of living up to a more humane medicine. Ethical arguments and the grounds on which we are supposed to resolve them are complex and variable. As seen in these historical examples, they have changed profoundly over time with each technology and medical concept challenging and refashioning the doctor-patient bond anew. Furthermore, there is no such thing as a ‘timeless’ doctor’s healing presence, or even medical expertise, or an ill person/patient. As shown above, as health and illness are defined, redefined and challenged throughout history, this process creates both expert and patient, as well as shapes the relationship between them.

An oft-heard concern about ‘computerization’ in medicine is that digital objects are changing human interactions. While various representatives from the tech side are optimistic about the effects of increasingly dynamic and intelligent objects in the medical encounter, some patients and physicians are more skeptical and see their social relationships as disturbed by new technologies. ‘Doctors don’t talk to patients’ is the most common complaint the CEO at a Montreal hospital recounted hearing from current patients (conversation between the author and Lawrence Rosenberg, 2019). Fears that increasing digitization of medicine will disturb the relationship that can potentially make the patient ‘whole’ again are not without foundation (King 2020). However, without a clear baseline for assessing changes we have limited scope for drawing conclusions about present day realities or long-term trends. Given the appeal of using the past to suggest a more ‘human’ but lost era of medical practice, a less nostalgic but more sophisticated understanding of the past as provided by historical research would serve us well. In this sense, history can counteract a characteristically modern myopia, namely, as intellectual historian Teresa Bejan has put it, our ‘endearing but frustrating tendency to view every development in public life as if it were happening for the first time’ (2017, 19).

As we saw in the examples dealing with record keeping, examining and self-treatment, trends that consider the patient as an object – a diseased lung, or a malfunctioning heart valve – and the concomitant use of technologies to record, examine and treat physical symptoms were necessarily in tension with patients’ own accounts of how they became ill and of the symptoms they experienced. In fact, concerns about the loss of meaningful personal contact in the medical encounter are incomprehensible without reference to a historical trend dating back to the beginning of the nineteenth century which seems to undermine the patient’s perspective by focusing on increasingly specialised processes within the body. Yet neither before nor after that time is there an unmediated patient’s voice that we are able to recover: the medical record as historical source has its own distinct material history, and patients’ expectations were always bound up with broader societal views about acceptable standards of healing. The historical perspective also shows that we should not take for granted the linear narrative of the technological as adverse to human relations and reducing empathetic understanding in the medical encounter – to paraphrase Lauren Kassell, the digital is not just the enemy of the human (2016, 128). Rather, it makes us aware that our understanding of the doctor-patient relationship and of its role in healing are themselves historically contingent. The idea of ‘a friendly, family doctor “being there”’ and the association of medicine with a ‘desirable clinical relationship’ (as opposed to e.g. perfect health) is an idea that has played out very differently in the course of history (Porter 1999, 670). There were times in which listening to patients was bound up with completely different expectations from both sides, and there were times in which physical examination was not seen as an indispensable part of medical practice. Moreover, while the monopoly of the physician in matters of health care and the focus on the (exclusive) healing potential of the clinical relationship is of relatively recent origin, we have seen that the popularity and economy of DIY devices has a much longer history, one that resists a linear account of DIY devices as something purely liberating. Hence, in contrast to idealised and simplified historical narratives that lament the loss of human relationships, more sophisticated accounts should acknowledge that medical objects and technologies are not the strange and disturbing ‘other’ in the medical encounter but rather integral players therein. As Frank Trentmann has put it, ‘things and humans are inseparably interwoven in mutually constitutive relationships’ (2009, 307). While the authors of a recent study suggest that ‘the traditional dyadic dynamics of the medical encounter has been altered into a triadic relationship by introducing the computer into the examination room’ (Assis-Hassid et al. 2015, 1), it seems more likely that the dyadic relationship has never existed.

Abrams, Ken and Casey Korba. 2018. "Consumers are on Board with Virtual Health Options. Can the Health Care System Deliver?” https://www2.deloitte.com/insights/us/en/industry/health-care/virtual-health-care-consumer-experience-survey.html .

Amenta, Conrad. 2017. “What’s Digitization Doing to Health Care?” Vice . https://motherboard.vice.com/en_us/article/785v3z/whats-digitization-doing-to-health-care.

Amicomed. 2018-2019. San Francisco, CA. https://www.amicomed.us/ .

Anon. 1879. “Practice by Telephone.” The Lancet 2: 819.

Google Scholar  

Anon. 1850. “Proceedings of a Meeting of the Royal Medical and Chirurgical Society on the Use of the Speculum, 28 May 1850, and Relevant Correspondence.” The Lancet 1: 701-06.

Anon. 1887. “The Telephone as a Source of Infection.” British Medical Journal : 166.

Aronson, Sidney H. 1977. “The Lancet on the Telephone 1876-1975.” Medical History 21: 69-87.

Article   Google Scholar  

Assis-Hassid, Shiri, et al. 2015. “Enhancing Patient-Doctor-Computer Communication in Primary Care: Towards Measurement Construction.” Israel Journal of Health Policy Research 4 (4): 1-11. https://doi.org/10.1186/2045-4015-4-4 .

Bartens, Werner. 2019. ”Angehende Ärzte müssen Empathie Zeigen.“ Süddeutsche Zeitung . 31 July. https://www.sueddeutsche.de/gesundheit/medizinstudium-empathie-auswahlverfahren-1.4546284 .

Behrens R., N. Bischoff and C. Zelle, eds. 2012. Der ärztliche Fallbericht. Epistemische Grundlagen und textuelle Strukturen dargestellter Beobachtung . Wiesbaden: Harrassowitz.

Bejan, Teresa M. 2017. Mere Civility: Disagreement and the Limits of Toleration . Harvard: Harvard University Press.

Book   Google Scholar  

Békés, V. and K. Aafjes-van Doorn. 2020. “Psychotherapists’ Attitudes toward Online Therapy during the COVID-19 Pandemic.” Journal of Psychotherapy Integration 30 (2): 238-247. https://doi.org/10.1037/int0000214 .

Beurer HealthManager. 2018-2019. Ulm: Beurer GmbH. https://www.beurer.com/web/gb/ .

Bichat, Xavier. 1801. Anatomie générale, appliquée à la physiologie et à la médecine. Paris: Brosson.

Bijker, Wiebe E., Thomas P. Hughes and Trevor Pinch, eds. 2012 [1987]. The Social Construction of Technological Systems: New Directions in the Sociology and History of Technology . Cambridge: The MIT Press.

Boeldt, D. L. et al. 2015. “How Consumers and Physicians View New Medical Technology: Comparative Survey.” Journal of Medical Internet Research 17 (9): e215. doi: 10.2196/jmir.4456: https://doi.org/10.2196/jmir.4456 .

Bynum, W. F. 2006. “The Rise of Science in Medicine, 1850-1913.” In The Western Medical Tradition, 1800-2000 , edited by W. F. Bynum et al., 111-239. Cambridge: Cambridge University Press.

Canada Health Infoway. 2001-2019. Toronto: Canada Health Infoway. https://www.infoway-inforoute.ca/en/solutions/digital-health-foundation/electronic-medical-records/benefits-of-emrs .

Chauhan, Vivek et al. 2020. “Novel Coronavirus (COVID-19): Leveraging Telemedicine to Optimize Care While Minimizing Exposures and Viral Transmission.” J Emerg Trauma Shock 13 (1): 20–24.

Colombat, de l’Isère, Marc. 1838. Traité des maladies des femmes et de l’hygiène spéciale de leur sexe , vol. 1 Paris: Libraire médicale de labé.

Cooper Owens, Deirdre. 2017. Medical Bondage: Race, Gender, and the Origins of American Gynecology . Atlanta: University of Georgia Press.

Daston, Lorraine J., and Peter Galison. 2010. Objectivity . New York: Zone.

de Looper, Christian. 2019. “The 10 Best Health Apps.” Digital Trends , 5 January. https://www.digitaltrends.com/mobile/best-health-apps/ .

Dinges, Martin, Kay Peter Jankrift, Sabine Schlegelmilch, and Michael Stolberg, eds. 2016. Medical Practice, 1600-1900: Physicians and their Patients . Translated by Margot Saar. Clio Medica, volume 96. Leiden: Brill Rodopi.

Doctor On Demand. 2012-2019. San Francisco, CA. https://www.doctorondemand.com/ .

Ehrlich, Anna. 2007. Ärzte, Bader, Scharlatane. Die Geschichte der österreichischen Medizin . Wien: Amalthea.

Economist, The . “How Covid-19 Unleashed the National Health Service.” 3 December 2020: 55-56. https://www.economist.com/britain/2020/12/03/how-covid-19-unleashed-the-nhs .

Ekeland, Anne G., Alison Bowes, and Signe Flottorp. 2010. “Effectiveness of Telemedicine: A Systematic Review of Reviews.” Int J Med Inform 79:736–771.

Epstein, Julia L. 1986. “Writing the Unspeakable: Fanny Burney's Mastectomy and the Fictive Body.” Representations 16:131–166.

Eysenbach, G. 2007. “From Intermediation to Disintermediation and Apomediation: New Models for Consumers to Access and Assess the Credibility of Health Information in the Age of Web 2.0.” Stud Health Technol Inform 129 (Pt 1): 162-6.

Fagherazzi, Guy. 2020. “Digital Health Strategies to Fight COVID-19 Worldwide: Challenges, Recommendations, and a Call for Papers.” Journal of Medical Internet Research 22 (6): e19284.

Falk, Oliver. 2018. “Der Patient als epistemische Größe. Praktisches Wissen und Selbsttechniken in der Diabetestherapie 1922-1960." Medizinhistorisches Journal 53 (1): 36-58.

Fischer, Claude S. 1992. America Calling: A Social History of the Telephone to 1940 . Berkley: University of California Press.

Fissell, Mary E. 1991. “The Disappearance of the Patient’s Narrative and the Invention of Hospital Medicine.” In British Medicine in an Age of Reform , edited by A. Wear and R. French, 92-109. London: Routledge.

---- 1993. “Innocent and Honorable Bribes: Medical Manners in Eighteenth-Century Britain.” In The Codification of Medical Morality: Historical and Philosophical Studies of the Formalization of Western Medical Morality in the Eighteenth and Nineteenth Centuries . Volume 1: Medical Ethics and Etiquette in the Eighteenth Century , edited by Robert Baker, Dorothy Porter and Roy Porter, 19-46. Dordrect: Springer Science + Business Media.

---- 2012. “The Medical Marketplace, the Patient, and the Absence of Medical Ethics in Early Modern Europe and North America.” In The Cambridge History of World Medical Ethics , edited by Robert Baker and Laurence McCullough, 533-39. Cambridge: Cambridge University Press.

Forrester, John. 1996. “If p, then what? Thinking in Cases.” History of the Human Sciences 9 (3): 1-25.

Friedberg, Mark W. et al. 2013. “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy.” Santa Monica, CA: RAND Corporation. https://www.rand.org/pubs/research_reports/RR439.html .

Gafner, Lina. 2016. “Administrative and Epistemic Aspects of Medical Practice: Caesar Adolf Bloesch (1804-1863).” In Medical Practice, 1600-1900: Physicians and their Patients , edited by Martin Dinges et al., 253-70. Leiden: Brill Rodopi.

Gawande, Atul. 2018. “Why Doctors Hate Their Computers.” The New Yorker . 12 November. https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers .

Granshaw, Linda. 1992. “The Rise of the Modern Hospital in Britain.” In Medicine in Society , edited by Andrew Wear, 197-218. Cambridge: Cambridge University Press.

Chapter   Google Scholar  

Greene, Jeremy. 2016. “Do-it-Yourself Medical Devices: Technology and Empowerment in American Health Care.” New England Journal of Medicine 374:305-9.

Greenhalgh, Trisha et al. 2020. “Video Consultations for Covid-19: An Opportunity in a Crisis?” BMJ , 368: m998. doi: https://doi.org/10.1136/bmj.m998 .

Hammack-Aviran, Catherine M. et al. 2020. “Research Use of Electronic Health Records: Patients’ Views on Alternative Approaches to Permission.” AJOB Empirical Bioethics 11 (3): 172-186. doi: https://doi.org/10.1080/23294515.2020.1755383 .

Heinrich, Christian. 2017. “Treffen im virtuellen Sprechzimmer.“ Die Zeit 22 (24 May): 33. https://www.zeit.de/2017/22/telemedizin-sprechstunde-arzt-krankenkasse-erstattung-video .

Hess, V. and J. Andrew Mendelsohn. 2010. “Case and Series: Medical Knowledge and Paper Technology, 1600–1900.” History of Science 48 (3-4): 287–314. https://doi.org/10.1177/007327531004800302 .

Huerkamp, Claudia. 1989. “Ärzte und Patienten. Zum strukturellen Wandel der Arzt-Patient-Beziehung vom ausgehenden 18. bis zum frühen 20. Jahrhundert.“ In Medizinische Deutungsmacht im sozialen Wandel des 19. und frühen 20. Jahrhunderts , edited by Alfons Labisch und Reinhard Spree, 57-73. Bonn: Psychiatrie-Verlag.

Jewson, Nicholas D. 1976. “The Disappearance of the Sick-Man from Medical Cosmology, 1770-1870.” Sociology 10: 225-44.

Johnston, S. C. 2018. “Anticipating and Training the Physician of the Future: The Importance of Caring in an Age of Artificial Intelligence.” Acad Med 93 (8): 1105-1106. doi: https://doi.org/10.1097/ACM.0000000000002175 .

Kassell, Lauren, 2016. “Paper Technologies, Digital Technologies: Working with Early Modern Medical Records.” In The Edinburgh Companion to the Critical Medical Humanities , edited by S. Atkinson, J. Macnaughton and J. Richards, 120-135. Edinburgh: Edinburgh University Press. http://www.jstor.org/stable/10.3366/j.ctt1bgzddd .

Kay, Michael. 2012. “Give the Doc a Phone: A Historical long-view of Telephone Use and Public Health in Britain.” https://michaelakay.wordpress.com/2012/02/14/give-the-doc-a-phone-a-historical-long-view-of-telephone-use-and-public-health-in-britain/ .

Kennedy, I. 2003. “Patients are Experts in their own Field.” BMJ 326 (7402): 1276-7.

Kennedy, Meegan. 2017. “Technology.” In The Routledge Research Companion to Nineteenth-Century British Literature and Science , edited by John Holms and Sharon Ruston, 3011-328. London: Routledge.

King, Steven and Alan Weaver. 2000. “Lives in Many Hands: The Medical Landscape in Lancashire, 1700-1820.” Medical History 44 (2): 173-200.

King, Martina. 2020. “"Nach Aufnahme arterielle Hypotonie": Personenkonzept und Kommunikationsformen in der Experten-Medizin.” Gesnerus 77 (2): 411-37.

Ko, Y. 2016. “Sebastian Kneipp and the Natural Cure Movement of Germany: Between Naturalism and Modern Medicine.” Uisahak 25(3): 557-590. doi: 10.13081/kjmh.2016.25.557.

Koch, Tom. 2011. Disease Maps: Epidemics on the Ground . Chicago: University of Chicago Press.

Kolkenbrock, Marie. 2020. “The Dance of the Porcupines. On Finding the Balance between Proximity and Distance in Times of Pandemic.” The Hedgehog Review Blog: Critical Reflections on Contemporary Culture . 21 April. https://hedgehogreview.com/blog/thr/posts/the-dance-of-the-porcupines .

Kruse, Clemens S. et al. 2017. “The Effectiveness of Telemedicine in the Management of Chronic Heart Disease: A Systematic Review.” J R Soc Med Open 8 (3): 1–7. doi: https://doi.org/10.1177/2054270416681747 .

Lee, Shaun Wen Huey et al. 2017. “Comparative Effectiveness of Telemedicine Strategies on Type 2 Diabetes Management: A Systematic Review and Network Meta-analysis.” Scientific Reports 7:12680. doi: https://doi.org/10.1038/s41598-017-12987-z .

Lengwiler, Martin, and Jeannette Madarász. 2010. “Präventionsgeschichte als Kulturgeschichte der Gesundheitspolitik.” In Das präventive Selbst: Eine Kulturgeschichte moderner Gesundheitspolitik , edited by Martin Lengwiler and Jeannette Madarász, 11-28. Bielefeld: Transcript.

Liu, Xiaoxuan, Pearse A. Keane and Alastair K Denniston. 2018. “Time to Regenerate: The Doctor in the Age of Artificial Intelligence.” Journal of the Royal Society of Medicine 11 (4): 113-116.

Loder, Natasha. 2017. “Is There a Doctor in my Pocket?” 1843 Magazine, The Economist . https://www.1843magazine.com/technology/is-there-a-doctor-in-my-pocket .

Mathar, Thomas. 2010. Der digitale Patient. Zu den Konsequenzen eines technowissenschaftlichen Gesundheitssystems . Bielefeld: Transcript.

Matshazi, Nqaba. 2019. “Digital Health Funding Breaks New Record in 2018.” 24 January. https://healthcareweekly.com/digital-health-funding/ .

Medgate Tele Clinic. 2000-2019. Basel: Medgate AG. https://www.medgate.ch/ .

Mitchell, Lisa and Eugenia Georges. 2000. “Cross-Cultural Cyborgs: Greek and Canadian Women’s Discourses on Fetal Ultrasound.” In Bodies of Technology: Women’s Involvement with Reproductive Medicine , edited by Ann Rudinow Saetnan, Nelly Oudshoorn, and Marta Kirejczyk, 384-409. Columbus: Ohio State University Press.

Moscucci, Ornella. 1990. The Science of Woman: Gynaecology and Gender in England, 1800–1929 . Cambridge: Cambridge University Press.

Nolte, Karen. 2009. “Vom Verschwinden der Laienperspektive aus der Krankengeschichte: Medizinische Fallberichte im 19. Jahrhundert.” In Zum Fall machen, zum Fall werden. Wissensproduktion und Patientenerfahrung in Medizin und Psychiatrie des 19. und 20. Jahrhunderts , edited by S. Brändli-Blumenbach, B. Lüthi, and G. Spuhler, 33-61. Frankfurt, New York: Campus.

Obermeyer, Ziad, and Ezekiel J. Emanuel. 2016. “Predicting the Future – Big Data, Machine Learning, and Clinical Medicine.” NEJM 375:1216-19.

Peckham, Robert. 2015. “Panic Encabled: Epidemics and the Telegraphic World.” In Empires of Panic: Epidemics and Colonial Anxieties , edited by Robert Peckham, 131-54. Hong Kong: Hong Kong University Press.

Pomata, Gianna. 1998. Contracting a Cure. Patients, Healers and the Law in Early Modern Bologna . Baltimore: Johns Hopkins University Press.

---- 2010. “Sharing Cases: The Observationes in Early Modern Medicine.” Early Science and Medicine 15:193-236.

---- 2014. “The Medical Case Narrative: Distant Reading of an Epistemic Genre.” Literature and Medicine 32 (1): 1-23.

Porsdam, Sebastian Mann, Julian Savulescu, and Barbara J. Sahakian. 2016. “Facilitating the Ethical Use of Health Data for the Benefit of Society: Electronic Health Records, Consent and the Duty of Easy Rescue.” Phil Trans R Soc A 374:20160130. https://doi.org/10.1098/rsta.2016.0130 .

Porter, Roy. 2011 [1995]. “The Eighteenth Century.” In The Western Medical Tradition, 800 BC to AD 1800 , 10th edition, edited by Conrad Lawrence, Michael Neve, Vivian Nutton, Roy Porter, and Andrew Wear, 371-475. Cambridge: Cambridge University Press.

---- 1999. The Greatest Benefit to Mankind. A Medical History of Humanity from Antiquity to the Present . Fontana Press.

Ratanawongsa, Neda et al. 2016. “Association between Clinician Computer Use and Communication with Patients in Safety-Net Clinics.” JAMA Intern Med 176 (1): 125-128. doi: https://doi.org/10.1001/jamainternmed.2015.6186 .

Reiser, Stanley Joel. 1978. Medicine and the Reign of Technology . Cambridge: Cambridge University Press.

---- 2009. Technological Medicine: The Changing World of Doctors and Patients . Cambridge: Cambridge University Press.

Risse, Guenter B. and John Harley Warner. 1992. “Reconstructing Clinical Activities: Patient Records in Medical History.” Social History of Medicine 5 (2): 183-205.

Rose, Nikolas. 2001. “The Politics of Life Itself.” Theory, Culture & Society 18 (6): 1-30.

Rosenberg, Lawrence. 8 May 2019. “Disintermediation.” Presentation given at Workshop: Medicine without Doctors? Disintermediation and Patient Agency . 4 th Workshop in the series on the Impact of Technological Change on the Surgical Profession. Jewish General Hospital, Montreal.

Ruckstuhl, Brigitte and Elisabeth Ryter. 2017. Von der Seuchenpolizei zu Public Health. Öffentliche Gesundheit in der Schweiz seit 1750 . Chronos: Zurich.

Ritzmann, Iris. 2013. “Vom gemessenen zum angemessenen Körper. Human Enhancement als historischer Prozess.” Schweizerische Ärztezeitung 94 (11): 410-22.

---- 1999. “Der Verhaltenskodex des “Savoir faire” als Deckmantel ärztlicher Hilflosigkeit? Ein Beitrag zur Arzt-Patient-Beziehung im 18. Jahrhundert.” Gesnerus 56:197-219.

Russey, Cathy. 2019. “Healthcare Wearables are Becoming Important for Staying Alive.” 15 January. https://www.wearable-technologies.com/2019/01/healthcare-wearables-are-becoming-important-for-staying-alive/ .

Sandelowski, Margarete. 2000. “This Most Dangerous Instrument: Propriety, Power, and the Vaginal Speculum”. Journal of Obstetric, Gynecologic & Neonatal Nursing 29 (1): 73-82.

Sanders, R. 2003. “Medical Technology: A Critical Perspective.” The Internet Journal of Medical Technology 2 (1): 1-7. https://print.ispub.com/api/0/ispub-article/4943 .

Schmiedebach, Heinz-Peter, ed. 2018. Medizin und öffentliche Gesundheit: Konzepte, Akteure, Perspektiven . Oldenbourg: De Gruyter.

Sinsky, Christine et al. 2016. “Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.” Annals of Internal Medicine 165 (11): 753-760.

Sobral, Dilermando, Marcy Rosenbaum, and Margarida Figueiredo-Braga. 2015. “Computer Use in Primary Care and Patient-Physician Communication.” Patient Education and Counseling 98 (12): 1568-76.

Strehle, E. M. and N. Shabde. 2006. “One Hundred Years of Telemedicine: Does this new Technology have a place in Paediatrics?” Archives of Disease in Childhood 91:956-959.

“The Topol Review: Preparing the Healthcare Workforce to Deliver the Digital Future. An Independent Report on Behalf of the Secretary of State for Health and Social Care.” 2019. Published by Health Education England. https://topol.hee.nhs.uk/ .

Timmermann, Carsten. 2010. “Risikofaktoren: Der scheinbar unaufhaltsame Erfolg eines Ansatzes aus der amerikanischen Epidemiologie in der deutschen Nachkriegszeit.” In Das präventive Selbst: Eine Kulturgeschichte moderner Gesundheitspolitik , edited by Martin Lengwiler and Jeannette Madarász, 251-277. Bielefeld: Transcript.

Timmermann, Carsten, and Julie Anderson, eds. 2006. Devices and Designs. Medical Technologies in Historical Perspective . London: Palgrave MacMillan.

Toombs, S. Kay. 1992. The Meaning of Illness: A Phenomenological Account of the Different Perspectives of Physician and Patient . Dordrecht: Springer-Science+Busniess Media.

Topol, Eric J., Steven R. Steinhubl, and Ali Torkamani. 2015. “Digital Medical Tools and Sensors.” JAMA 313 (4): 353-354.

Trentmann, Frank. 2009. “Materiality in the Future of History: Things, Practices, and Politics.” Journal of British Studies 48 (29): 283-307.

U.S. Food and Drug Administration. ca. 1995-2019. Silver Spring: U.S. Food and Drug Administration; U.S. Department of Health and Human Services. https://www.fda.gov/medical-devices/digital-health#mobileapp .

Verbeek, Peter-Paul. 2015. “Beyond Interaction: A Short Introduction to Mediation Theory.” Interactions 22 (3): 26-31.

Verghese, Abraham. 2017. “What this Computer needs is a Physician: Humanism and Artificial Intelligence.” JAMA 319 (1): 19-20.

Warner, John Harley. 1999. “The Uses of Patient Records by Historians: Patterns, Possibilities and Perplexities.” Health and History 1 (2/3): 101-11

Weindling, Paul. 1987. “Medical Practice in Imperial Berlin: The Casebook of Alfred Grotjahn.” Bulletin of the History of Medicine 61 (3): 391-410.

Wolff, Eberhard. 2014. “Über das Blutdruckmessen, einen Selbstversuch und ärztliches Alltagshandeln.” Schweizerische Ärztezeitung 95(11): 460. https://www.zora.uzh.ch/id/eprint/107023/1/saez-02492.pdf .

---- 2018. “Das ʻQuantified Selfʼ als historischer Prozess. Die Blutdruck-Selbstmessung seit dem frühen 20. Jahrhundert zwischen Fremdführung und Selbstverortung.” Medizin, Gesellschaft und Geschichte 36:43-83.

World Health Organization. 2016. “Global Diffusion of eHealth: Making Universal Health Coverage Achievable.” Report of the third global survey on eHealth. Geneva: WHO Document Production Services. https://apps.who.int/iris/handle/10665/252529 .

Wüstholz, Florian, and Daniel Stolle. 2020. “Das kranke Dossier.” Republik . 27 July. https://www.republik.ch/2020/07/27/das-kranke-dossier .

Download references

Vanessa Rampton received funding from the Branco Weiss Fellowship – Society in Science.

Author information

Authors and affiliations.

Institute for Health and Social Policy and Department of Philosophy, McGill University, Montréal, Canada

Vanessa Rampton

Center for Medical Humanities, History of Medicine Section, University of Zurich, Zürich, Switzerland

Maria Böhmer & Anita Winkler

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Vanessa Rampton .

Ethics declarations

1 We rely on a definition used by science and technology scholars whereby the term ‘technology’ operates on three levels (see Bijker, Hughes and Pinch 2012, xlii). First, there is the physical level, referring to tangible objects such as a smartphone, wellness band, or stethoscope. The second level of meaning concerns activities or processes, such as 3D printing or creating X-rays. The third level refers to knowledge people have in addition to what they do, for example the knowledge that underpins the conduct of a surgical procedure. This approach shows the extent to which specific tools and techniques, knowledge, and rationales for intervention are intricately bound together. Our use of the term ‘digital,’ that is involving computer technology, in relation to medicine ‘includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine’ (U.S. Food and Drug Administration).

2 As a rule, while systematic reviews of telemedicine generally portray it as effective as in-person consultation or promising, evidence is limited and fast-evolving (Ekeland, Bowes and Flottorp 2010; Kruse et al. 2017; Lee et al. 2017).

3 In Germany, legislators have reacted to these concerns by limiting video consultation to cases in which physician and patient have physically met before, and primarily using it for monitoring the course of disease, including chronic ones, or the healing of an injury (Heinrich 2017).

4 Scottish-born US inventor Alexander Graham Bell was the first to be awarded the U.S. patent for the invention of the telephone in 1876 (Fischer 1992).

5 Interestingly, and probably most important for their users, nine out of ten among the ranked apps are available as free downloads ( https://www.digitaltrends.com/mobile/best-health-apps/ , June 16, 2019).

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Rampton, V., Böhmer, M. & Winkler, A. Medical Technologies Past and Present: How History Helps to Understand the Digital Era. J Med Humanit 43 , 343–364 (2022). https://doi.org/10.1007/s10912-021-09699-x

Download citation

Accepted : 12 May 2021

Published : 07 July 2021

Issue Date : June 2022

DOI : https://doi.org/10.1007/s10912-021-09699-x

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Digital technologies
• Telemedicine
• Do-it-yourself
• Find a journal
• Publish with us
• Track your research

10 Successful Medical School Essays

Sponsored by.

-- Accepted to: Harvard Medical School GPA: 4.0 MCAT: 522

Sponsored by A ccepted.com : Great stats don’t assure acceptance to elite medical schools. The personal statement, most meaningful activities, activity descriptions, secondaries and interviews can determine acceptance or rejection. Since 1994, Accepted.com has guided medical applicants just like you to present compelling medical school applications. Get Accepted !

I started writing in 8th grade when a friend showed me her poetry about self-discovery and finding a voice. I was captivated by the way she used language to bring her experiences to life. We began writing together in our free time, trying to better understand ourselves by putting a pen to paper and attempting to paint a picture with words. I felt my style shift over time as I grappled with challenges that seemed to defy language. My poems became unstructured narratives, where I would use stories of events happening around me to convey my thoughts and emotions. In one of my earliest pieces, I wrote about a local boy’s suicide to try to better understand my visceral response. I discussed my frustration with the teenage social hierarchy, reflecting upon my social interactions while exploring the harms of peer pressure.

In college, as I continued to experiment with this narrative form, I discovered medical narratives. I have read everything from Manheimer’s Bellevue to Gawande’s Checklist and from Nuland’s observations about the way we die, to Kalanithi’s struggle with his own decline. I even experimented with this approach recently, writing a piece about my grandfather’s emphysema. Writing allowed me to move beyond the content of our relationship and attempt to investigate the ways time and youth distort our memories of the ones we love. I have augmented these narrative excursions with a clinical bioethics internship. In working with an interdisciplinary team of ethics consultants, I have learned by doing by participating in care team meetings, synthesizing discussions and paths forward in patient charts, and contributing to an ongoing legislative debate addressing the challenges of end of life care. I have also seen the ways ineffective intra-team communication and inter-personal conflicts of beliefs can compromise patient care.

Writing allowed me to move beyond the content of our relationship and attempt to investigate the ways time and youth distort our memories of the ones we love.

By assessing these difficult situations from all relevant perspectives and working to integrate the knowledge I’ve gained from exploring narratives, I have begun to reflect upon the impact the humanities can have on medical care. In a world that has become increasingly data driven, where patients can so easily devolve into lists of numbers and be forced into algorithmic boxes in search of an exact diagnosis, my synergistic narrative and bioethical backgrounds have taught me the importance of considering the many dimensions of the human condition. I am driven to become a physician who deeply considers a patient’s goal of care and goals of life. I want to learn to build and lead patient care teams that are oriented toward fulfilling these goals, creating an environment where family and clinician conflict can be addressed efficiently and respectfully. Above all, I look forward to using these approaches to keep the person beneath my patients in focus at each stage of my medical training, as I begin the task of translating complex basic science into excellent clinical care.

In her essay for medical school, Morgan pitches herself as a future physician with an interdisciplinary approach, given her appreciation of how the humanities can enable her to better understand her patients. Her narrative takes the form of an origin story, showing how a childhood interest in poetry grew into a larger mindset to keep a patient’s humanity at the center of her approach to clinical care.

This narrative distinguishes Morgan as a candidate for medical school effectively, as she provides specific examples of how her passions intersect with medicine. She first discusses how she used poetry to process her emotional response to a local boy’s suicide and ties in concern about teenage mental health. Then, she discusses more philosophical questions she encountered through reading medical narratives, which demonstrates her direct interest in applying writing and the humanities to medicine. By making the connection from this larger theme to her own reflections on her grandfather, Morgan provides a personal insight that will give an admissions officer a window into her character. This demonstrates her empathy for her future patients and commitment to their care.

Her narrative takes the form of an origin story, showing how a childhood interest in poetry grew into a larger mindset to keep a patient's humanity at the center of her approach to clinical care.

Furthermore, it is important to note that Morgan’s essay does not repeat anything in-depth that would otherwise be on her resume. She makes a reference to her work in care team meetings through a clinical bioethics internship, but does not focus on this because there are other places on her application where this internship can be discussed. Instead, she offers a more reflection-based perspective on the internship that goes more in-depth than a resume or CV could. This enables her to explain the reasons for interdisciplinary approach to medicine with tangible examples that range from personal to professional experiences — an approach that presents her as a well-rounded candidate for medical school.

Disclaimer: With exception of the removal of identifying details, essays are reproduced as originally submitted in applications; any errors in submissions are maintained to preserve the integrity of the piece. The Crimson's news and opinion teams—including writers, editors, photographers, and designers—were not involved in the production of this article.

-- Accepted To: A medical school in New Jersey with a 3% acceptance rate. GPA: 3.80 MCAT: 502 and 504

Sponsored by E fiie Consulting Group : “ EFIIE ” boasts 100% match rate for all premedical and predental registered students. Not all students are accepted unto their pre-health student roster. Considered the most elite in the industry and assists from start to end – premed to residency. EFIIE is a one-stop-full-service education firm.

"To know even one life has breathed easier because you have lived. This is to have succeeded." – Ralph Waldo Emerson.

The tribulations I've overcome in my life have manifested in the compassion, curiosity, and courage that is embedded in my personality. Even a horrific mishap in my life has not changed my core beliefs and has only added fuel to my intense desire to become a doctor. My extensive service at an animal hospital, a harrowing personal experience, and volunteering as an EMT have increased my appreciation and admiration for the medical field.

At thirteen, I accompanied my father to the Park Home Animal Hospital with our eleven-year-old dog, Brendan. He was experiencing severe pain due to an osteosarcoma, which ultimately led to the difficult decision to put him to sleep. That experience brought to light many questions regarding the idea of what constitutes a "quality of life" for an animal and what importance "dignity" plays to an animal and how that differs from owner to owner and pet to pet. Noting my curiosity and my relative maturity in the matter, the owner of the animal hospital invited me to shadow the professional staff. Ten years later, I am still part of the team, having made the transition from volunteer to veterinarian technician. Saving a life, relieving pain, sharing in the euphoria of animal and owner reuniting after a procedure, to understanding the emotions of losing a loved one – my life was forever altered from the moment I stepped into that animal hospital.

As my appreciation for medical professionals continued to grow, a horrible accident created an indelible moment in my life. It was a warm summer day as I jumped onto a small boat captained by my grandfather. He was on his way to refill the boat's gas tank at the local marina, and as he pulled into the dock, I proceeded to make a dire mistake. As the line was thrown from the dock, I attempted to cleat the bowline prematurely, and some of the most intense pain I've ever felt in my life ensued.

Saving a life, relieving pain, sharing in the euphoria of animal and owner reuniting after a procedure, to understanding the emotions of losing a loved one – my life was forever altered from the moment I stepped into that animal hospital.

"Call 911!" I screamed, half-dazed as I witnessed blood gushing out of my open wounds, splashing onto the white fiberglass deck of the boat, forming a small puddle beneath my feet. I was instructed to raise my hand to reduce the bleeding, while someone wrapped an icy towel around the wound. The EMTs arrived shortly after and quickly drove me to an open field a short distance away, where a helicopter seemed to instantaneously appear.

The medevac landed on the roof of Stony Brook Hospital before I was expeditiously wheeled into the operating room for a seven-hour surgery to reattach my severed fingers. The distal phalanges of my 3rd and 4th fingers on my left hand had been torn off by the rope tightening on the cleat. I distinctly remember the chill from the cold metal table, the bright lights of the OR, and multiple doctors and nurses scurrying around. The skill and knowledge required to execute multiple skin graft surgeries were impressive and eye-opening. My shortened fingers often raise questions by others; however, they do not impair my self-confidence or physical abilities. The positive outcome of this trial was the realization of my intense desire to become a medical professional.

Despite being the patient, I was extremely impressed with the dedication, competence, and cohesiveness of the medical team. I felt proud to be a critical member of such a skilled group. To this day, I still cannot explain the dichotomy of experiencing being the patient, and concurrently one on the professional team, committed to saving the patient. Certainly, this experience was a defining part of my life and one of the key contributors to why I became an EMT and a volunteer member of the Sample Volunteer Ambulance Corps. The startling ring of the pager, whether it is to respond to an inebriated alcoholic who is emotionally distraught or to help bring breath to a pulseless person who has been pulled from the family swimming pool, I am committed to EMS. All of these events engender the same call to action and must be reacted to with the same seriousness, intensity, and magnanimity. It may be some routine matter or a dire emergency; this is a role filled with uncertainty and ambiguity, but that is how I choose to spend my days. My motives to become a physician are deeply seeded. They permeate my personality and emanate from my desire to respond to the needs of others. Through a traumatic personal event and my experiences as both a professional and volunteer, I have witnessed firsthand the power to heal the wounded and offer hope. Each person defines success in different ways. To know even one life has been improved by my actions affords me immense gratification and meaning. That is success to me and why I want to be a doctor.

This review is provided by EFIIE Consulting Group’s Pre-Health Senior Consultant Jude Chan

This student was a joy to work with — she was also the lowest MCAT profile I ever accepted onto my roster. At 504 on the second attempt (502 on her first) it would seem impossible and unlikely to most that she would be accepted into an allopathic medical school. Even for an osteopathic medical school this score could be too low. Additionally, the student’s GPA was considered competitive at 3.80, but it was from a lower ranked, less known college, so naturally most advisors would tell this student to go on and complete a master’s or postbaccalaureate program to show that she could manage upper level science classes. Further, she needed to retake the MCAT a third time.

However, I saw many other facets to this student’s history and life that spoke volumes about the type of student she was, and this was the positioning strategy I used for her file. Students who read her personal statement should know that acceptance is contingent on so much more than just an essay and MCAT score or GPA. Although many students have greater MCAT scores than 504 and higher GPAs than 3.80, I have helped students with lower scores and still maintained our 100% match rate. You are competing with thousands of candidates. Not every student out there requires our services and we are actually grateful that we can focus on a limited amount out of the tens of thousands that do. We are also here for the students who wish to focus on learning well the organic chemistry courses and physics courses and who want to focus on their research and shadowing opportunities rather than waste time deciphering the next step in this complex process. We tailor a pathway for each student dependent on their health care career goals, and our partnerships with non-profit organizations, hospitals, physicians and research labs allow our students to focus on what matters most — the building up of their basic science knowledge and their exposure to patients and patient care.

Students who read her personal statement should know that acceptance is contingent on so much more than just an essay and MCAT score or GPA.

Even students who believe that their struggle somehow disqualifies them from their dream career in health care can be redeemed if they are willing to work for it, just like this student with 502 and 504 MCAT scores. After our first consult, I saw a way to position her to still be accepted into an MD school in the US — I would not have recommended she register to our roster if I did not believe we could make a difference. Our rosters have a waitlist each semester, and it is in our best interest to be transparent with our students and protect our 100% record — something I consider a win-win. It is unethical to ever guarantee acceptance in admissions as we simply do not control these decisions. However, we respect it, play by the rules, and help our students stay one step ahead by creating an applicant profile that would be hard for the schools to ignore.

This may be the doctor I go to one day. Or the nurse or dentist my children or my grandchildren goes to one day. That is why it is much more than gaining acceptance — it is about properly matching the student to the best options for their education. Gaining an acceptance and being incapable of getting through the next 4 or 8 years (for my MD/PhD-MSTP students) is nonsensical.

-- Accepted To: Imperial College London UCAT Score: 2740 BMAT Score: 3.9, 5.4, 3.5A

My motivation to study Medicine stems from wishing to be a cog in the remarkable machine that is universal healthcare: a system which I saw first-hand when observing surgery in both the UK and Sri Lanka. Despite the differences in sanitation and technology, the universality of compassion became evident. When volunteering at OSCE training days, I spoke to many medical students, who emphasised the importance of a genuine interest in the sciences when studying Medicine. As such, I have kept myself informed of promising developments, such as the use of monoclonal antibodies in cancer therapy. After learning about the role of HeLa cells in the development of the polio vaccine in Biology, I read 'The Immortal Life of Henrietta Lacks' to find out more. Furthermore, I read that surface protein CD4 can be added to HeLa cells, allowing them to be infected with HIV, opening the possibility of these cells being used in HIV research to produce more life-changing drugs, such as pre-exposure prophylaxis (PreP). Following my BioGrad laboratory experience in HIV testing, and time collating data for research into inflammatory markers in lung cancer, I am also interested in pursuing a career in medical research. However, during a consultation between an ENT surgeon and a thyroid cancer patient, I learnt that practising medicine needs more than a scientific aptitude. As the surgeon explained that the cancer had metastasised to her liver, I watched him empathetically tailor his language for the patient - he avoided medical jargon and instead gave her time to come to terms with this. I have been developing my communication skills by volunteering weekly at care homes for 3 years, which has improved my ability to read body language and structure conversations to engage with the residents, most of whom have dementia.

However, during a consultation between an ENT surgeon and a thyroid cancer patient, I learnt that practising medicine needs more than a scientific aptitude.

Jude’s essay provides a very matter-of-fact account of their experience as a pre-medical student. However, they deepen this narrative by merging two distinct cultures through some common ground: a universality of compassion. Using clear, concise language and a logical succession of events — much like a doctor must follow when speaking to patients — Jude shows their motivation to go into the medical field.

From their OSCE training days to their school’s Science society, Jude connects their analytical perspective — learning about HeLa cells — to something that is relatable and human, such as a poor farmer’s notable contribution to science. This approach provides a gateway into their moral compass without having to explicitly state it, highlighting their fervent desire to learn how to interact and communicate with others when in a position of authority.

Using clear, concise language and a logical succession of events — much like a doctor must follow when speaking to patients — Jude shows their motivation to go into the medical field.

Jude’s closing paragraph reminds the reader of the similarities between two countries like the UK and Sri Lanka, and the importance of having a universal healthcare system that centers around the just and “world-class” treatment of patients. Overall, this essay showcases Jude’s personal initiative to continue to learn more and do better for the people they serve.

While the essay could have benefited from better transitions to weave Jude’s experiences into a personal story, its strong grounding in Jude’s motivation makes for a compelling application essay.

-- Accepted to: Weill Cornell Medical College GPA: 3.98 MCAT: 521

Sponsored by E fie Consulting Group : “ EFIIE ” boasts 100% match rate for all premedical and predental registered students. Not all students are accepted unto their pre-health student roster. Considered the most elite in the industry and assists from start to end – premed to residency. EFIIE is a one-stop-full-service education firm.

Following the physician’s unexpected request, we waited outside, anxiously waiting to hear the latest update on my father’s condition. It was early on in my father’s cancer progression – a change that had shaken our entire way of life overnight. During those 18 months, while my mother spent countless nights at the hospital, I took on the responsibility of caring for my brother. My social life became of minimal concern, and the majority of my studying for upcoming 12th- grade exams was done at the hospital. We were allowed back into the room as the physician walked out, and my parents updated us on the situation. Though we were a tight-knit family and my father wanted us to be present throughout his treatment, what this physician did was give my father a choice. Without making assumptions about who my father wanted in the room, he empowered him to make that choice independently in private. It was this respect directed towards my father, the subsequent efforts at caring for him, and the personal relationship of understanding they formed, that made the largest impact on him. Though my decision to pursue medicine came more than a year later, I deeply valued what these physicians were doing for my father, and I aspired to make a similar impact on people in the future.

It was during this period that I became curious about the human body, as we began to learn physiology in more depth at school. In previous years, the problem-based approach I could take while learning math and chemistry were primarily what sparked my interest. However, I became intrigued by how molecular interactions translated into large-scale organ function, and how these organ systems integrated together to generate the extraordinary physiological functions we tend to under-appreciate. I began my undergraduate studies with the goal of pursuing these interests, whilst leaning towards a career in medicine. While I was surprised to find that there were upwards of 40 programs within the life sciences that I could pursue, it broadened my perspective and challenged me to explore my options within science and healthcare. I chose to study pathobiology and explore my interests through hospital volunteering and research at the end of my first year.

Though my decision to pursue medicine came more than a year later, I deeply valued what these physicians were doing for my father, and I aspired to make a similar impact on people in the future.

While conducting research at St. Michael’s Hospital, I began to understand methods of data collection and analysis, and the thought process of scientific inquiry. I became acquainted with the scientific literature, and the experience transformed how I thought about the concepts I was learning in lecture. However, what stood out to me that summer was the time spent shadowing my supervisor in the neurosurgery clinic. It was where I began to fully understand what life would be like as a physician, and where the career began to truly appeal to me. What appealed to me most was the patient-oriented collaboration and discussions between my supervisor and his fellow; the physician-patient relationship that went far beyond diagnoses and treatments; and the problem solving that I experienced first-hand while being questioned on disease cases.

The day spent shadowing in the clinic was also the first time I developed a relationship with a patient. We were instructed to administer the Montreal cognitive assessment (MoCA) test to patients as they awaited the neurosurgeon. My task was to convey the instructions as clearly as possible and score each section. I did this as best I could, adapting my explanation to each patient, and paying close attention to their responses to ensure I was understood. The last patient was a challenging case, given a language barrier combined with his severe hydrocephalus. It was an emotional time for his family, seeing their father/husband struggle to complete simple tasks and subsequently give up. I encouraged him to continue trying. But I also knew my words would not remedy the condition underlying his struggles. All I could do was make attempts at lightening the atmosphere as I got to know him and his family better. Hours later, as I saw his remarkable improvement following a lumbar puncture, and the joy on his and his family’s faces at his renewed ability to walk independently, I got a glimpse of how rewarding it would be to have the ability and privilege to care for such patients. By this point, I knew I wanted to commit to a life in medicine. Two years of weekly hospital volunteering have allowed me to make a small difference in patients’ lives by keeping them company through difficult times, and listening to their concerns while striving to help in the limited way that I could. I want to have the ability to provide care and treatment on a daily basis as a physician. Moreover, my hope is that the breadth of medicine will provide me with the opportunity to make an impact on a larger scale. Whilst attending conferences on neuroscience and surgical technology, I became aware of the potential to make a difference through healthcare, and I look forward to developing the skills necessary to do so through a Master’s in Global Health. Whether through research, health innovation, or public health, I hope not only to care for patients with the same compassion with which physicians cared for my father, but to add to the daily impact I can have by tackling large-scale issues in health.

Taylor’s essay offers both a straightforward, in-depth narrative and a deep analysis of his experiences, which effectively reveals his passion and willingness to learn in the medical field. The anecdote of Taylor’s father gives the reader insight into an original instance of learning through experience and clearly articulates Taylor’s motivations for becoming a compassionate and respectful physician.

Taylor strikes an impeccable balance between discussing his accomplishments and his character. All of his life experiences — and the difficult challenges he overcame — introduce the reader to an important aspect of Taylor’s personality: his compassion, care for his family, and power of observation in reflecting on the decisions his father’s doctor makes. His description of his time volunteering at St. Michael’s Hospital is indicative of Taylor’s curiosity about medical research, but also of his recognition of the importance of the patient-physician relationship. Moreover, he shows how his volunteer work enabled him to see how medicine goes “beyond diagnoses and treatments” — an observation that also speaks to his compassion.

His description of his time volunteering at St. Michael's Hospital is indicative of Taylor's curiosity about medical research, but also of his recognition of the importance of the patient-physician relationship.

Finally, Taylor also tells the reader about his ambition and purpose, which is important when thinking about applying to medical school. He discusses his hope of tackling larger scale problems through any means possible in medicine. This notion of using self interest to better the world is imperative to a successful college essay, and it is nicely done here.

-- Accepted to: Washington University

Sponsored by A dmitRx : We are a group of Chicago-based medical students who realize how challenging medical school admissions can be, so we want to provide our future classmates with resources we wish we had. Our mission at AdmitRx is to provide pre-medical students with affordable, personalized, high-quality guidance towards becoming an admitted medical student.

Running has always been one of my greatest passions whether it be with friends or alone with my thoughts. My dad has always been my biggest role model and was the first to introduce me to the world of running. We entered races around the country, and one day he invited me on a run that changed my life forever. The St. Jude Run is an annual event that raises millions of dollars for St. Jude Children’s Research Hospital. My dad has led or our local team for as long as I can remember, and I had the privilege to join when I was 16. From the first step I knew this was the environment for me – people from all walks of life united with one goal of ending childhood cancer. I had an interest in medicine before the run, and with these experiences I began to consider oncology as a career. When this came up in conversations, I would invariably be faced with the question “Do you really think you could get used to working with dying kids?” My 16-year-old self responded with something noble but naïve like “It’s important work, so I’ll have to handle it”. I was 16 years young with my plan to become an oncologist at St. Jude.

As I transitioned into college my plans for oncology were alive and well. I began working in a biochemistry lab researching new anti-cancer drugs. It was a small start, but I was overjoyed to be a part of the process. I applied to work at a number of places for the summer, but the Pediatric Oncology Education program (POE) at St. Jude was my goal. One afternoon, I had just returned from class and there it was: an email listed as ‘POE Offer’. I was ecstatic and accepted the offer immediately. Finally, I could get a glimpse at what my future holds. My future PI, Dr. Q, specialized in solid tumor translational research and I couldn’t wait to get started.

I was 16 years young with my plan to become an oncologist at St. Jude.

Summer finally came, I moved to Memphis, and I was welcomed by the X lab. I loved translational research because the results are just around the corner from helping patients. We began a pre-clinical trial of a new chemotherapy regimen and the results were looking terrific. I was also able to accompany Dr. Q whenever she saw patients in the solid tumor division. Things started simple with rounds each morning before focusing on the higher risk cases. I was fortunate enough to get to know some of the patients quite well, and I could sometimes help them pass the time with a game or two on a slow afternoon between treatments. These experiences shined a very human light on a field I had previously seen only through a microscope in a lab.

I arrived one morning as usual, but Dr. Q pulled me aside before rounds. She said one of the patients we had been seeing passed away in the night. I held my composure in the moment, but I felt as though an anvil was crushing down on me. It was tragic but I knew loss was part of the job, so I told myself to push forward. A few days later, I had mostly come to terms with what happened, but then the anvil came crashing back down with the passing of another patient. I could scarcely hold back the tears this time. That moment, it didn’t matter how many miraculous successes were happening a few doors down. Nothing overshadowed the loss, and there was no way I could ‘get used to it’ as my younger self had hoped.

I was still carrying the weight of what had happened and it was showing, so I asked Dr. Q for help. How do you keep smiling each day? How do you get used to it? The questions in my head went on. What I heard next changed my perspective forever. She said you keep smiling because no matter what happened, you’re still hope for the next patient. It’s not about getting used to it. You never get used to it and you shouldn’t. Beating cancer takes lifetimes, and you can’t look passed a life’s worth of hardships. I realized that moving passed the loss of patients would never suffice, but I need to move forward with them. Through the successes and shortcomings, we constantly make progress. I like to imagine that in all our future endeavors, it is the hands of those who have gone before us that guide the way. That is why I want to attend medical school and become a physician. We may never end the sting of loss, but physicians are the bridge between the past and the future. No where else is there the chance to learn from tragedy and use that to shape a better future. If I can learn something from one loss, keep moving forward, and use that knowledge to help even a single person – save one life, bring a moment of joy, avoid a moment of pain—then that is how I want to spend my life.

The change wasn’t overnight. The next loss still brought pain, but I took solace in moving forward so that we might learn something to give hope to a future patient. I returned to campus in a new lab doing cancer research, and my passion for medicine continues to flourish. I still think about all the people I encountered at St. Jude, especially those we lost. It might be a stretch, but during the long hours at the lab bench I still picture their hands moving through mine each step of the way. I could never have foreseen where the first steps of the St. Jude Run would bring me. I’m not sure where the road to becoming a physician may lead, but with helping hands guiding the way, I won’t be running it alone.

This essay, a description of the applicant’s intellectual challenges, displays the hardships of tending to cancer patients as a milestone of experience and realization of what it takes to be a physician. The writer explores deeper ideas beyond medicine, such as dealing with patient deaths in a way to progress and improve as a professional. In this way, the applicant gives the reader some insight into the applicant’s mindset, and their ability to think beyond the surface for ways to become better at what they do.

However, the essay fails to zero in on the applicant’s character, instead elaborating on life events that weakly illustrate the applicant’s growth as a physician. The writer’s mantra (“keep moving forward”) is feebly projected, and seems unoriginal due to the lack of a personalized connection between the experience at St. Jude and how that led to the applicant’s growth and mindset changes.

The writer explores deeper ideas beyond medicine, such as dealing with patient deaths in a way to progress and improve as a professional.

The writer, by only focusing on grief brought from patient deaths at St. Jude, misses out on the opportunity to further describe his or her experience at the hospital and portray an original, well-rounded image of his or her strengths, weaknesses, and work ethic.

The applicant ends the essay by attempting to highlight the things they learned at St. Jude, but fails to organize the ideas into a cohesive, comprehensible section. These ideas are also too abstract, and are vague indicators of the applicant’s character that are difficult to grasp.

-- Accepted to: New York University School of Medicine

Sponsored by MedEdits : MedEdits Medical Admissions has been helping applicants get into medical schools like Harvard for more than ten years. Structured like an academic medical department, MedEdits has experts in admissions, writing, editing, medicine, and interview prep working with you collaboratively so you can earn the best admissions results possible.

“Is this the movie you were talking about Alice?” I said as I showed her the movie poster on my iPhone. “Oh my God, I haven’t seen that poster in over 70 years,” she said with her arms trembling in front of her. Immediately, I sat up straight and started to question further. We were talking for about 40 minutes, and the most exciting thing she brought up in that time was the new flavor of pudding she had for lunch. All of sudden, she’s back in 1940 talking about what it was like to see this movie after school for only 5¢ a ticket! After an engaging discussion about life in the 40’s, I knew I had to indulge her. Armed with a plethora of movie streaming sights, I went to work scouring the web. No luck. The movie, “My Son My Son,” was apparently not in high demand amongst torrenting teens. I had to entreat my older brother for his Amazon Prime account to get a working stream. However, breaking up the monotony and isolation felt at the nursing home with a simple movie was worth the pandering.

While I was glad to help a resident have some fun, I was partly motivated by how much Alice reminded me of my own grandfather. In accordance with custom, my grandfather was to stay in our house once my grandmother passed away. More specifically, he stayed in my room and my bed. Just like grandma’s passing, my sudden roommate was a rough transition. In 8th grade at the time, I considered myself to be a generally good guy. Maybe even good enough to be a doctor one day. I volunteered at the hospital, shadowed regularly, and had a genuine interest for science. However, my interest in medicine was mostly restricted to academia. To be honest, I never had a sustained exposure to the palliative side of medicine until the arrival of my new roommate.

The two years I slept on that creaky wooden bed with him was the first time my metal was tested. Sharing that room, I was the one to take care of him. I was the one to rub ointment on his back, to feed him when I came back from school, and to empty out his spittoon when it got full. It was far from glamorous, and frustrating most of the time. With 75 years separating us, and senile dementia setting in, he would often forget who I was or where he was. Having to remind him that I was his grandson threatened to erode at my resolve. Assured by my Syrian Orthodox faith, I even prayed about it; asking God for comfort and firmness on my end. Over time, I grew slow to speak and eager to listen as he started to ramble more and more about bits and pieces of the past. If I was lucky, I would be able to stich together a narrative that may or may have not been true. In any case, my patience started to bud beyond my age group.

Having to remind him that I was his grandson threatened to erode at my resolve.

Although I grew more patient with his disease, my curiosity never really quelled. Conversely, it developed further alongside my rapidly growing interest in the clinical side of medicine. Naturally, I became drawn to a neurology lab in college where I got to study pathologies ranging from atrophy associated with schizophrenia, and necrotic lesions post stroke. However, unlike my intro biology courses, my work at the neurology lab was rooted beyond the academics. Instead, I found myself driven by real people who could potentially benefit from our research. In particular, my shadowing experience with Dr. Dominger in the Veteran’s home made the patient more relevant in our research as I got to encounter geriatric patients with age related diseases, such as Alzhimer’s and Parkinson’s. Furthermore, I had the privilege of of talking to the families of a few of these patients to get an idea of the impact that these diseases had on the family structure. For me, the scut work in the lab meant a lot more with these families in mind than the tritium tracer we were using in the lab.

Despite my achievements in the lab and the classroom, my time with my grandfather still holds a special place in my life story. The more I think about him, the more confident I am in my decision to pursue a career where caring for people is just as important, if not more important, than excelling at academics. Although it was a lot of work, the years spent with him was critical in expanding my horizons both in my personal life and in the context of medicine. While I grew to be more patient around others, I also grew to appreciate medicine beyond the science. This more holistic understanding of medicine had a synergistic effect in my work as I gained a purpose behind the extra hours in the lab, sleepless nights in the library, and longer hours volunteering. I had a reason for what I was doing that may one day help me have long conversations with my own grandchildren about the price of popcorn in the 2000’s.

The most important thing to highlight in Avery’s essay is how he is able to create a duality between his interest in not only the clinical, more academic-based side of medicine, but also the field’s personal side.

He draws personal connections between working with Alice — a patient in a hospital or nursing home — and caring intensely for his grandfather. These two experiences build up the “synergistic” relationship between caring for people and studying the science behind medicine. In this way, he is able to clearly state his passions for medicine and explain his exact motives for entering the field. Furthermore, in his discussion of her grandfather, he effectively employs imagery (“rub ointment on his back,” “feed him when I came back from school,” etc.) to describe the actual work that he does, calling it initially as “far from glamorous, and frustrating most of the time.” By first mentioning his initial impression, then transitioning into how he grew to appreciate the experience, Avery is able to demonstrate a strength of character, sense of enormous responsibility and capability, and open-minded attitude.

He draws personal connections between working with Alice — a patient in a hospital or nursing home — and caring intensely for his grandfather.

Later in the essay, Avery is also able to relate his time caring for his grandfather to his work with Alzheimer’s and Parkinson’s patients, showcasing the social impact of his work, as the reader is likely already familiar with the biological impact of the work. This takes Avery’s essay full circle, bringing it back to how a discussion with an elderly patient about the movies reminds him of why he chose to pursue medicine.

That said, the essay does feel rushed near the end, as the writer was likely trying to remain within the word count. There could be a more developed transition before Avery introduces the last sentence about “conversations with my own grandchildren,” especially as a strong essay ending is always recommended.

-- Accepted To: Saint Louis University Medical School Direct Admission Medical Program

Sponsored by Atlas Admissions : Atlas Admissions provides expert medical school admissions consulting and test preparation services. Their experienced, physician-driven team consistently delivers top results by designing comprehensive, personalized strategies to optimize applications. Atlas Admissions is based in Boston, MA and is trusted by clients worldwide.

The tension in the office was tangible. The entire team sat silently sifting through papers as Dr. L introduced Adam, a 60-year-old morbidly obese man recently admitted for a large open wound along his chest. As Dr. L reviewed the details of the case, his prognosis became even bleaker: hypertension, diabetes, chronic kidney disease, cardiomyopathy, hyperlipidemia; the list went on and on. As the humdrum of the side-conversations came to a halt, and the shuffle of papers softened, the reality of Adam’s situation became apparent. Adam had a few months to live at best, a few days at worst. To make matters worse, Adam’s insurance would not cover his treatment costs. With no job, family, or friends, he was dying poor and alone.

I followed Dr. L out of the conference room, unsure what would happen next. “Well,” she muttered hesitantly, “We need to make sure that Adam is on the same page as us.” It’s one thing to hear bad news, and another to hear it utterly alone. Dr. L frantically reviewed all of Adam’s paperwork desperately looking for someone to console him, someone to be at his side. As she began to make calls, I saw that being a physician calls for more than good grades and an aptitude for science: it requires maturity, sacrifice, and most of all, empathy. That empathy is exactly what I saw in Dr. L as she went out of her way to comfort a patient she met hardly 20 minutes prior.

Since high school, I’ve been fascinated by technology’s potential to improve healthcare. As a volunteer in [the] Student Ambassador program, I was fortunate enough to watch an open-heart surgery. Intrigued by the confluence of technology and medicine, I chose to study biomedical engineering. At [school], I wanted to help expand this interface, so I became involved with research through Dr. P’s lab by studying the applications of electrospun scaffolds for dermal wound healing. While still in the preliminary stages of research, I learned about the Disability Service Club (DSC) and decided to try something new by volunteering at a bowling outing.

As she began to make calls, I saw that being a physician calls for more than good grades and an aptitude for science: it requires maturity, sacrifice, and most of all, empathy.

The DSC promotes awareness of cognitive disabilities in the community and seeks to alleviate difficulties for the disabled. During one outing, I collaborated with Arc, a local organization with a similar mission. Walking in, I was told that my role was to support the participants by providing encouragement. I decided to help a relatively quiet group of individuals assisted by only one volunteer, Mary. Mary informed me that many individuals with whom I was working were diagnosed with ASD. Suddenly, she started cheering, as one of the members of the group bowled a strike. The group went wild. Everyone was dancing, singing, and rejoicing. Then I noticed one gentleman sitting at our table, solemn-faced. I tried to start a conversation with him, but he remained unresponsive. I sat with him for the rest of the game, trying my hardest to think of questions that would elicit more than a monosyllabic response, but to no avail. As the game ended, I stood up to say bye when he mumbled, “Thanks for talking.” Then he quickly turned his head away. I walked away beaming. Although I was unable to draw out a smile or even sustain a conversation, at the end of the day, the fact that this gentleman appreciated my mere effort completely overshadowed the awkwardness of our time together. Later that day, I realized that as much as I enjoyed the thrill of research and its applications, helping other people was what I was most passionate about.

When it finally came time to tell Adam about his deteriorating condition, I was not sure how he would react. Dr. L gently greeted him and slowly let reality take its toll. He stoically turned towards Dr. L and groaned, “I don’t really care. Just leave me alone.” Dr. L gave him a concerned nod and gradually left the room. We walked to the next room where we met with a pastor from Adam’s church.

“Adam’s always been like that,” remarked the pastor, “he’s never been one to express emotion.” We sat with his pastor for over an hour discussing how we could console Adam. It turned out that Adam was part of a motorcycle club, but recently quit because of his health. So, Dr. L arranged for motorcycle pictures and other small bike trinkets to be brought to his room as a reminder of better times.

Dr. L’s simple gesture reminded me of why I want to pursue medicine. There is something sacred, empowering, about providing support when people need it the most; whether it be simple as starting a conversation, or providing support during the most trying of times. My time spent conducting research kindled my interest in the science of medicine, and my service as a volunteer allowed me to realize how much I valued human interaction. Science and technology form the foundation of medicine, but to me, empathy is the essence. It is my combined interest in science and service that inspires me to pursue medicine. It is that combined interest that makes me aspire to be a physician.

Parker’s essay focuses on one central narrative with a governing theme of compassionate and attentive care for patients, which is the key motivator for her application to medical school. Parker’s story focuses on her volunteer experience shadowing of Dr. L who went the extra mile for Adam, which sets Dr. L up as a role model for Parker as she enters the medical field. This effectively demonstrates to the reader what kind of doctor Parker wants to be in the future.

Parker’s narrative has a clear beginning, middle, and end, making it easy for the reader to follow. She intersperses the main narrative about Adam with experiences she has with other patients and reflects upon her values as she contemplates pursuing medicine as a career. Her anecdote about bowling with the patients diagnosed with ASD is another instance where she uses a story to tell the reader why she values helping people through medicine and attentive patient care, especially as she focuses on the impact her work made on one man at the event.

Parker's story focuses on her volunteer experience shadowing of Dr. L who went the extra mile for Adam, which sets Dr. L up as a role model for Parker as she enters the medical field.

All throughout the essay, the writing is engaging and Parker incorporates excellent imagery, which goes well with her varied sentence structure. The essay is also strong because it comes back full circle at its conclusion, tying the overall narrative back to the story of Dr. L and Adam, which speaks to Parker’s motives for going to medical school.

-- Accepted To: Emory School of Medicine

Growing up, I enjoyed visiting my grandparents. My grandfather was an established doctor, helping the sick and elderly in rural Taiwan until two weeks before he died at 91 years old. His clinic was located on the first floor of the residency with an exam room, treatment room, X-ray room, and small pharmacy. Curious about his work, I would follow him to see his patients. Grandpa often asked me if I want to be a doctor just like him. I always smiled, but was more interested in how to beat the latest Pokémon game. I was in 8th grade when my grandfather passed away. I flew back to Taiwan to attend his funeral. It was a gloomy day and the only street in the small village became a mourning place for the villagers. Flowers filled the streets and people came to pay their respects. An old man told me a story: 60 years ago, a village woman was in a difficult labor. My grandfather rushed into the house and delivered a baby boy. That boy was the old man and he was forever grateful. Stories of grandpa saving lives and bringing happiness to families were told during the ceremony. At that moment, I realized why my grandfather worked so tirelessly up until his death as a physician. He did it for the reward of knowing that he kept a family together and saved a life. The ability for a doctor to heal and bring happiness is the reason why I want to study medicine. Medical school is the first step on a lifelong journey of learning, but I feel that my journey leading up to now has taught me some things of what it means to be an effective physician.

With a newfound purpose, I began volunteering and shadowing at my local hospital. One situation stood out when I was a volunteer in the cardiac stress lab. As I attached EKG leads onto a patient, suddenly the patient collapsed and started gasping for air. His face turned pale, then slightly blue. The charge nurse triggered “Code Blue” and started CPR. A team of doctors and nurses came, rushing in with a defibrillator to treat and stabilize the patient. What I noticed was that medicine was not only about one individual acting as a superhero to save a life, but that it takes a team of individuals with an effective leader, working together to deliver the best care. I want to be a leader as well as part of a team that can make a difference in a person’s life. I have refined these lessons about teamwork and leadership to my activities. In high school I was an 8 time varsity letter winner for swimming and tennis and captain of both of those teams. In college I have participated in many activities, but notably serving as assistant principle cellist in my school symphony as well as being a co-founding member of a quartet. From both my athletic experiences and my music experiences I learned what it was like to not only assert my position as a leader and to effectively communicate my views, but equally as important I learned how to compromise and listen to the opinions of others. Many physicians that I have observed show a unique blend of confidence and humility.

What I noticed was that medicine was not only about one individual acting as a superhero to save a life, but that it takes a team of individuals with an effective leader, working together to deliver the best care.

College opened me up to new perspectives on what makes a complete physician. A concept that was preached in the Guaranteed Professional Program Admissions in Medicine (GPPA) was that medicine is both an art and a science. The art of medicine deals with a variety of aspects including patient relationships as well as ethics. Besides my strong affinity for the sciences and mathematics, I always have had interest in history. I took courses in both German literature and history, which influenced me to take a class focusing on Nazi neuroscientists. It was the ideology of seeing the disabled and different races as test subjects rather than people that led to devastating lapses in medical ethics. The most surprising fact for me was that doctors who were respected and leaders in their field disregarded the humanity of patient and rather focused on getting results from their research. Speaking with Dr. Zeidman, the professor for this course, influenced me to start my research which deals with the ethical qualms of using data derived from unethical Nazi experimentation such as the brains derived from the adult and child euthanasia programs. Today, science is so result driven, it is important to keep in mind the ethics behind research and clinical practice. Also the development of personalized genomic medicine brings into question about potential privacy violations and on the extreme end discrimination. The study of ethics no matter the time period is paramount in the medical field. The end goal should always be to put the patient first.

Teaching experiences in college inspired me to become a physician educator if I become a doctor. Post-MCAT, I was offered a job by Next Step Test Prep as a tutor to help students one on one for the MCAT. I had a student who stated he was doing well during practice, but couldn’t get the correct answer during practice tests. Working with the student, I pointed out his lack of understanding concepts and this realization helped him and improves his MCAT score. Having the ability to educate the next generation of doctors is not only necessary, but also a rewarding experience.

My experiences volunteering and shadowing doctors in the hospital as well as my understanding of what it means to be a complete physician will make me a good candidate as a medical school student. It is my goal to provide the best care to patients and to put a smile on a family’s face just as my grandfather once had. Achieving this goal does not take a special miracle, but rather hard work, dedication, and an understanding of what it means to be an effective physician.

Through reflecting on various stages of life, Quinn expresses how they found purpose in pursuing medicine. Starting as a child more interested in Pokemon than their grandfather’s patients, Quinn exhibits personal growth through recognizing the importance of their grandfather’s work saving lives and eventually gaining the maturity to work towards this goal as part of a team.

This essay opens with abundant imagery — of the grandfather’s clinic, flowers filling the streets, and the village woman’s difficult labor — which grounds Quinn’s story in their family roots. Yet, the transition from shadowing in hospitals to pursuing leadership positions in high schools is jarring, and the list of athletic and musical accomplishments reads like a laundry list of accomplishments until Quinn neatly wraps them up as evidence of leadership and teamwork skills. Similarly, the section about tutoring, while intended to demonstrate Quinn’s desire to educate future physicians, lacks the emotional resonance necessary to elevate it from another line lifted from their resume.

This essay opens with abundant imagery — of the grandfather's clinic, flowers filling the streets, and the village woman's difficult labor — which grounds Quinn's story in their family roots.

The strongest point of Quinn’s essay is the focus on their unique arts and humanities background. This equips them with a unique perspective necessary to consider issues in medicine in a new light. Through detailing how history and literature coursework informed their unique research, Quinn sets their application apart from the multitude of STEM-focused narratives. Closing the essay with the desire to help others just as their grandfather had, Quinn ties the narrative back to their personal roots.

-- Accepted To: Edinburgh University UCAT Score: 2810 BMAT Score: 4.6, 4.2, 3.5A

Exposure to the medical career from an early age by my father, who would explain diseases of the human body, sparked my interest for Medicine and drove me to seek out work experience. I witnessed the contrast between use of bone saws and drills to gain access to the brain, with subsequent use of delicate instruments and microscopes in neurosurgery. The surgeon's care to remove the tumour, ensuring minimal damage to surrounding healthy brain and his commitment to achieve the best outcome for the patient was inspiring. The chance to have such a positive impact on a patient has motivated me to seek out a career in Medicine.

Whilst shadowing a surgical team in Texas, carrying out laparoscopic bariatric procedures, I appreciated the surgeon's dedication to continual professional development and research. I was inspired to carry out an Extended Project Qualification on whether bariatric surgery should be funded by the NHS. By researching current literature beyond my school curriculum, I learnt to assess papers for bias and use reliable sources to make a conclusion on a difficult ethical situation. I know that doctors are required to carry out research and make ethical decisions and so, I want to continue developing these skills during my time at medical school.

The chance to have such a positive impact on a patient has motivated me to seek out a career in Medicine.

Attending an Oncology multi-disciplinary team meeting showed me the importance of teamwork in medicine. I saw each team member, with specific areas of expertise, contributing to the discussion and actively listening, and together they formed a holistic plan of action for patients. During my Young Enterprise Award, I facilitated a brainstorm where everyone pitched a product idea. Each member offered a different perspective on the idea and then voted on a product to carry forward in the competition. As a result, we came runners up in the Regional Finals. Furthermore, I started developing my leadership skills, which I improved by doing Duke of Edinburgh Silver and attending a St. John Ambulance Leadership course. In one workshop, similar to the bariatric surgeon I shadowed, I communicated instructions and delegated roles to my team to successfully solve a puzzle. These experiences highlighted the crucial need for teamwork and leadership as a doctor.

Observing a GP, I identified the importance of compassion and empathy. During a consultation with a severely depressed patient, the GP came to the patient's eye level and used a calm, non-judgmental tone of voice, easing her anxieties and allowing her to disclose more information. While volunteering at a care home weekly for two years, I adapted my communication for a resident suffering with dementia who was disconnected from others. I would take her to a quiet environment, speak slowly and in a non-threatening manner, as such, she became talkative, engaged and happier. I recognised that communication and compassion allows doctors to build rapport, gain patients' trust and improve compliance. For two weeks, I shadowed a surgeon performing multiple craniotomies a day. I appreciated the challenges facing doctors including time and stress management needed to deliver high quality care. Organisation, by prioritising patients based on urgency and creating a timetable on the ward round, was key to running the theatre effectively. Similarly, I create to-do-lists and prioritise my academics and extra-curricular activities to maintain a good work-life balance: I am currently preparing for my Grade 8 in Singing, alongside my A-level exams. I also play tennis for the 1st team to relax and enable me to refocus. I wish to continue my hobbies at university, as ways to manage stress.

Through my work experiences and voluntary work, I have gained a realistic understanding of Medicine and its challenges. I have begun to display the necessary skills that I witnessed, such as empathy, leadership and teamwork. The combination of these skills with my fascination for the human body drives me to pursue a place at medical school and a career as a doctor.

This essay traces Alex's personal exploration of medicine through different stages of life, taking a fairly traditional path to the medical school application essay. From witnessing medical procedures to eventually pursuing leadership positions, this tale of personal progress argues that Alex's life has prepared him to become a doctor.

Alex details how experiences conducting research and working with medical teams have confirmed his interest in medicine. Although the breadth of experiences speaks to the applicant’s interest in medicine, the essay verges on being a regurgitation of the Alex's resume, which does not provide the admissions officer with any new insights or information and ultimately takes away from the essay as a whole. As such, the writing’s lack of voice or unique perspective puts the applicant at risk of sounding middle-of-the-road.

From witnessing medical procedures to eventually pursuing leadership positions, this tale of personal progress argues that Alex's life has prepared him to become a doctor.

The essay’s organization, however, is one of its strengths — each paragraph provides an example of personal growth through a new experience in medicine. Further, Alex demonstrates his compassion and diligence through detailed stories, which give a reader a glimpse into his values. Through recognizing important skills necessary to be a doctor, Alex demonstrates that he has the mature perspective necessary to embark upon this journey.

What this essay lacks in a unique voice, it makes up for in professionalism and organization. Alex's earnest desire to attend medical school is what makes this essay shine.

-- Accepted To: University of Toronto MCAT Scores: Chemical and Physical Foundations of Biological Systems - 128, Critical Analysis and Reading Skills - 127, Biological and Biochemical Foundations of Living Systems - 127, Psychological, Social, and Biological Foundations of Behavior - 130, Total - 512

Moment of brilliance.

Revelation.

These are all words one would use to describe their motivation by a higher calling to achieve something great. Such an experience is often cited as the reason for students to become physicians; I was not one of these students. Instead of waiting for an event like this, I chose to get involved in the activities that I found most invigorating. Slowly but surely, my interests, hobbies, and experiences inspired me to pursue medicine.

As a medical student, one must possess a solid academic foundation to facilitate an understanding of physical health and illness. Since high school, I found science courses the most appealing and tended to devote most of my time to their exploration. I also enjoyed learning about the music, food, literature, and language of other cultures through Latin and French class. I chose the Medical Sciences program because it allowed for flexibility in course selection. I have studied several scientific disciplines in depth like physiology and pathology while taking classes in sociology, psychology, and classical studies. Such a diverse academic portfolio has strengthened my ability to consider multiple viewpoints and attack problems from several angles. I hope to relate to patients from all walks of life as a physician and offer them personalized treatment.

I was motivated to travel as much as possible by learning about other cultures in school. Exposing myself to different environments offered me perspective on universal traits that render us human. I want to pursue medicine because I believe that this principle of commonality relates to medical practice in providing objective and compassionate care for all. Combined with my love for travel, this realization took me to Nepal with Volunteer Abroad (VA) to build a school for a local orphanage (4). The project’s demands required a group of us to work closely as a team to accomplish the task. Rooted in different backgrounds, we often had conflicting perspectives; even a simple task such as bricklaying could stir up an argument because each person had their own approach. However, we discussed why we came to Nepal and reached the conclusion that all we wanted was to build a place of education for the children. Our unifying goal allowed us to reach compromises and truly appreciate the value of teamwork. These skills are vital in a clinical setting, where physicians and other health care professionals need to collaborate as a multidisciplinary team to tackle patients’ physical, emotional, social, and psychological problems.

I hope to relate to patients from all walks of life as a physician and offer them personalized treatment.

The insight I gained from my Nepal excursion encouraged me to undertake and develop the role of VA campus representative (4). Unfortunately, many students are not equipped with the resources to volunteer abroad; I raised awareness about local initiatives so everyone had a chance to do their part. I tried to avoid pushing solely for international volunteerism for this reason and also because it can undermine the work of local skilled workers and foster dependency. Nevertheless, I took on this position with VA because I felt that the potential benefits were more significant than the disadvantages. Likewise, doctors must constantly weigh out the pros and cons of a situation to help a patient make the best choice. I tried to dispel fears of traveling abroad by sharing first-hand experiences so that students could make an informed decision. When people approached me regarding unfamiliar placements, I researched their questions and provided them with both answers and a sense of security. I found great fulfillment in addressing the concerns of individuals, and I believe that similar processes could prove invaluable in the practice of medicine.

As part of the Sickkids Summer Research Program, I began to appreciate the value of experimental investigation and evidence-based medicine (23). Responsible for initiating an infant nutrition study at a downtown clinic, I was required to explain the project’s implications and daily protocol to physicians, nurses and phlebotomists. I took anthropometric measurements and blood pressure of children aged 1-10 and asked parents about their and their child’s diet, television habits, physical exercise regimen, and sunlight exposure. On a few occasions, I analyzed and presented a small set of data to my superiors through oral presentations and written documents.

With continuous medical developments, physicians must participate in lifelong learning. More importantly, they can engage in research to further improve the lives of their patients. I encountered a young mother one day at the clinic struggling to complete the study’s questionnaires. After I asked her some questions, she began to open up to me as her anxiety subsided; she then told me that her child suffered from low iron. By talking with the physician and reading a few articles, I recommended a few supplements and iron-rich foods to help her child. This experience in particular helped me realize that I enjoy clinical research and strive to address the concerns of people with whom I interact.

Research is often impeded by a lack of government and private funding. My clinical placement motivated me to become more adept in budgeting, culminating in my role as founding Co-President of the UWO Commerce Club (ICCC) (9). Together, fellow club executives and I worked diligently to get the club ratified, a process that made me aware of the bureaucratic challenges facing new organizations. Although we had a small budget, we found ways of minimizing expenditure on advertising so that we were able to host more speakers who lectured about entrepreneurship and overcoming challenges. Considering the limited space available in hospitals and the rising cost of health care, physicians, too, are often forced to prioritize and manage the needs of their patients.

No one needs a grand revelation to pursue medicine. Although passion is vital, it is irrelevant whether this comes suddenly from a life-altering event or builds up progressively through experience. I enjoyed working in Nepal, managing resources, and being a part of clinical and research teams; medicine will allow me to combine all of these aspects into one wholesome career.

I know with certainty that this is the profession for me.

Jimmy opens this essay hinting that his essay will follow a well-worn path, describing the “big moment” that made him realize why he needed to become a physician. But Jimmy quickly turns the reader’s expectation on its head by stating that he did not have one of those moments. By doing this, Jimmy commands attention and has the reader waiting for an explanation. He soon provides the explanation that doubles as the “thesis” of his essay: Jimmy thinks passion can be built progressively, and Jimmy’s life progression has led him to the medical field.

Jimmy did not make the decision to pursue a career in medicine lightly. Instead he displays through anecdotes that his separate passions — helping others, exploring different walks of life, personal responsibility, and learning constantly, among others — helped Jimmy realize that being a physician was the career for him. By talking readers through his thought process, it is made clear that Jimmy is a critical thinker who can balance multiple different perspectives simultaneously. The ability to evaluate multiple options and make an informed, well-reasoned decision is one that bodes well for Jimmy’s medical career.

While in some cases this essay does a lot of “telling,” the comprehensive and decisive walkthrough indicates what Jimmy’s idea of a doctor is. To him, a doctor is someone who is genuinely interested in his work, someone who can empathize and related to his patients, someone who can make important decisions with a clear head, and someone who is always trying to learn more. Just like his decision to work at the VA, Jimmy has broken down the “problem” (what his career should be) and reached a sound conclusion.

By talking readers through his thought process, it is made clear that Jimmy is a critical thinker who can balance multiple different perspectives simultaneously.

Additionally, this essay communicates Jimmy’s care for others. While it is not always advisable to list one’s volunteer efforts, each activity Jimmy lists has a direct application to his essay. Further, the sheer amount of philanthropic work that Jimmy does speaks for itself: Jimmy would not have worked at VA, spent a summer with Sickkids, or founded the UWO finance club if he were not passionate about helping others through medicine. Like the VA story, the details of Jimmy’s participation in Sickkids and the UWO continue to show how he has thought about and embodied the principles that a physician needs to be successful.

Jimmy’s essay both breaks common tropes and lives up to them. By framing his “list” of activities with his passion-happens-slowly mindset, Jimmy injects purpose and interest into what could have been a boring and braggadocious essay if it were written differently. Overall, this essay lets the reader know that Jimmy is seriously dedicated to becoming a physician, and both his thoughts and his actions inspire confidence that he will give medical school his all.

The Crimson's news and opinion teams—including writers, editors, photographers, and designers—were not involved in the production of this content.

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Published: 27 May 2024

How medical schools can prepare students for new technologies

• Chantal Mathieu 1  

Nature Medicine ( 2024 ) Cite this article

296 Accesses

4 Altmetric

Metrics details

• Biomedical engineering
• Type 1 diabetes
• Type 2 diabetes

Patient educators and nurses can demonstrate the real-life use of health technologies.

You have full access to this article via your institution.

Technologies are changing the face of medicine. In my specialty of diabetes care, continuous glucose monitoring, decision-assisting apps and hybrid closed-loop insulin delivery systems have been introduced for people living with type 1 diabetes and are now being used by people living with other forms of diabetes as part of their treatment. The role of technology in diabetes is evolving rapidly, with new hardware, concepts and terminology around glucose control being introduced at a rapid pace. These technologies require multidisciplinary teams to support those living with diabetes.

Education and training of medical students and doctors on these new technologies and concepts is crucial. The time allotted for diabetes training in many medical curricula has remained constant as this brave new world of technology has been introduced. Many of us who teach these courses feel that simply introducing the available technologies does not do justice to the new treatment tools. We need teaching tools and techniques that help students see the new face of diabetes and understand why concepts such as ‘time in range’ are often more relevant than hemoglobin A1c. Simply showing students new hardware will not necessarily help them, as these technologies will probably already be obsolete by the time they graduate.

The answer to this challenge may well lie with patients. Introducing students to the lives of those affected by the disease can illustrate the impact of technology on daily life. Those who use these technologies can introduce their benefits and undesired aspects, leading to more effective learning. Sharing the experiences of people living with disease should be an effective way to make a long-lasting impression on our young students. During the COVID-19 pandemic in-person teaching stopped and students missed out on direct interactions that could illustrate lived experiences. However, creative virtual solutions also emerged during the pandemic, and these are now available for medical education and are almost as valuable as in-person teaching for bringing the voices of those living with disease to students.

Many medical schools already work with patient experts in teaching, particularly for diseases where clinical signs and symptoms are essential for diagnosis and where patients can more clearly illustrate them to students than any picture could. The role of patients in medical education is increasingly recognized — for example, through the ‘Where’s the Patient’s Voice in Health’ conference.

As well as patients, other members of the multidisciplinary team, such as diabetes educator nurses, dieticians or psychologists could also have a prime role in teaching medical students about the role of technology. These health professionals can teach students how new technologies work and illustrate metrics that matter to clinicians and to the people using the technologies. This will illustrate how technologies impact the daily lives of people living with diabetes, such as how they sleep with hybrid closed loop systems, how they handle these technologies during exercise, how apps function if the patient is offline, the pros and cons of specific types of hardware (such as comparing a patch pump to a catheter pump), and the use of software features (such as whether alarms should beep or not beep when glucose values are high or whether food apps are useful for vegans).

Bringing members of the team and those living with the technologies to medical courses will also demonstrate to student doctors the need for continuing medical education and how treatment varies from person to person, illustrating the need for personalization of therapeutic approaches. Such a discussion should also include societal, financial and access issues, which will vary depending on location.

Most importantly, this multi-faceted approach to teaching will amplify the voices of the people who live with these technologies and use them daily, whose voices are at least as important in the treatment of the disease as that of the doctor.

Author information

Authors and affiliations.

Department of Endocrinology, UZ Leuven, University of Leuven, Leuven, Belgium

Chantal Mathieu

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Chantal Mathieu .

Ethics declarations

Competing interests.

C.M. serves or has served on advisory panels for Novo Nordisk, Sanofi, Eli Lilly and Company, Novartis, Boehringer Ingelheim, Roche, Medtronic, Imcyse, Insulet, Biomea Fusion and Vertex, with financial compensation received by KU Leuven. KU Leuven has also received research support from Medtronic, Imcyse, Novo Nordisk, Sanofi and ActoBio Therapeutics. C.M. serves or has served on the speakers bureau for Novo Nordisk, Sanofi, Eli Lilly and Company, Medtronic and Boehringer Ingelheim, with financial compensation received by KU Leuven. C.M. is president of the European Association for the Study of Diabetes .

Rights and permissions

Reprints and permissions

About this article

Cite this article.

Mathieu, C. How medical schools can prepare students for new technologies. Nat Med (2024). https://doi.org/10.1038/s41591-024-03041-3

Download citation

Published : 27 May 2024

DOI : https://doi.org/10.1038/s41591-024-03041-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

• Open access
• Published: 30 May 2024

Enhancing AI competence in health management: students’ experiences with ChatGPT as a learning Tool

• Lior Naamati-Schneider 1  

BMC Medical Education volume  24 , Article number:  598 ( 2024 ) Cite this article

45 Accesses

Metrics details

The healthcare industry has had to adapt to significant shifts caused by technological advancements, demographic changes, economic pressures, and political dynamics. These factors are reshaping the complex ecosystem in which healthcare organizations operate and have forced them to modify their operations in response to the rapidly evolving landscape. The increase in automation and the growing importance of digital and virtual environments are the key drivers necessitating this change. In the healthcare sector in particular, processes of change, including the incorporation of artificial intelligent language models like ChatGPT into daily life, necessitate a reevaluation of digital literacy skills.

This study proposes a novel pedagogical framework that integrates problem-based learning with the use of ChatGPT for undergraduate healthcare management students, while qualitatively exploring the students’ experiences with this technology through a thematic analysis of the reflective journals of 65 students.

Through the data analysis, the researcher identified five main categories: (1) Use of Literacy Skills; (2) User Experiences with ChatGPT; (3) ChatGPT Information Credibility; (4) Challenges and Barriers when Working with ChatGPT; (5) Mastering ChatGPT-Prompting Competencies . The findings show that incorporating digital tools, and particularly ChatGPT, in medical education has a positive impact on students’ digital literacy and on AI Literacy skills.

Conclusions

The results underscore the evolving nature of these skills in an AI-integrated educational environment and offer valuable insights into students’ perceptions and experiences. The study contributes to the broader discourse about the need for updated AI literacy skills in medical education from the early stages of education.

Peer Review reports

Introduction

In recent years, the healthcare sector has undergone significant shifts in both local and global contexts. These shifts are primarily attributed to demographic, technological, economic, and political factors. These changes have had a profound impact on the healthcare ecosystem, requiring organizations to adapt their operations and strategies to this evolving landscape [ 1 , 2 ]. In response, healthcare organizations have had to modify their behavior to adapt to this ever-changing reality [ 3 ]. Among the factors that have most significantly affected the healthcare system are technological advancements, automation, and the rise of digital and virtual environments. The impact of these factors gained momentum in December 2019, primarily due to the COVID-19 pandemic. Technological advances, particularly the rise of artificial intelligence (AI) and digital tools, have been central to this transformation, with the COVID-19 pandemic accelerating the need for healthcare systems to adapt and innovate [ 3 , 4 , 5 , 6 , 7 , 8 ]. The integration of AI in healthcare, including the deployment of chatbots like ChatGPT that utilize the Generative Pre-trained Transformer (GPT)—a type of large language model (LLM)—underscores a shift toward digital and AI literacy in medical education and practice. [ 9 , 10 ].

The adoption of AI in healthcare, highlighted by the use of systems like ChatGPT, marks a pivotal shift towards greater digital and AI literacy in medical education and practice [ 9 , 10 , 11 , 12 ]. This reflects the healthcare sector’s broader move towards technological innovation, aiming to enhance patient care and revolutionize healthcare professional training. Incorporating AI, such as ChatGPT, into educational frameworks prepares students for the complexities of modern healthcare, demonstrating AI’s potential to transform both healthcare delivery and professional skill development [ 11 , 12 ].

In the rapidly evolving landscape of AI, where technological developments are occurring at an accelerated pace, there is a significant need for comprehensive research to navigate this ever-changing landscape. In particular, research into the impact of AI on healthcare is still limited, highlighting the urgent need for more focused studies on the implications for medical education and the effective training of healthcare professionals in the use of AI technologies [ 13 , 14 ]. The emergence of LLMs, such as GPT, and their applications in educational frameworks, including chatbots like ChatGPT, has increased the urgency of reassessing the skills required, with a particular focus on digital literacy. This reassessment is essential to determine the continued relevance of these skills or whether a fundamental refocusing is required. Such a re-examination is essential to ensure that the healthcare workforce is adequately prepared for the challenges and opportunities presented by the integration of AI into healthcare practice [ 11 ].

Studies [ 15 , 16 , 17 , 18 ] have identified a significant gap in understanding how digital literacy skills—such as accessing, analyzing, evaluating, and creating digital content—play a role in effectively leveraging LLMs like GPT and their applications, including chatbots such as ChatGPT, within educational frameworks. Furthermore, the successful integration of ChatGPT into educational settings may potentially lessen the reliance on traditional digital literacy skills, prompting a reevaluation of their ongoing relevance [ 19 , 20 ]. This gap underscores the need for more research into the critical role that digital literacy skills hold in the efficient use of technologies like ChatGPT for educational aims, as highlighted by recent literature [ 15 , 17 , 18 ]. ChatGPT’s access to accurate medical information could reduce the need for individual data analysis skills [ 21 , 22 ]. Yet, concerns persist among researchers that its content generation might hinder critical thinking development, including source evaluation and idea generation [ 23 , 24 ].

This qualitative study introduces a pedagogical framework that synergizes problem-based learning with the application of ChatGPT among undergraduate healthcare management students. It aims to qualitatively examine their interactions with this technology, focusing on the transition from traditional digital literacy towards a more advanced AI literacy. This evolution in educational focus is poised to revolutionize the requisite competencies for navigating the dynamic healthcare sector of today.

The rationale behind focusing on ChatGPT stems from its notable accessibility, user-friendly design, and versatility as a comprehensive tool in healthcare settings. Its capability to simulate human-like dialogues positions it as a prime resource for educational initiatives, thereby enriching the pedagogical domain of healthcare management and clinical practices. The unrestricted access to ChatGPT, along with its wide-ranging utility in executing diverse healthcare operations, underscores its capacity to significantly contribute to and spearhead innovation within healthcare education and practices. The selection of ChatGPT, attributed to its approachability and adaptability, marks a strategic endeavor to investigate the impact of artificial intelligence amidst the shifting paradigms of healthcare requirements. Yet, despite the widespread integration of ChatGPT in healthcare, research into the long-term effects and the necessary adaptation of skills and methods remains lacking. [ 11 , 12 ].

Literature review

Ai tools in medical settings.

AI involves creating systems that mimic human cognitive functions such as perception, speech recognition, and decision-making through machine learning. It excels in analyzing data, identifying patterns, and making predictions, offering improvements over traditional data processing. AI’s applications span multiple sectors, including healthcare, at various levels from individual to global [ 25 , 26 ]. The integration of AI into healthcare enhances diagnostic, treatment, and patient care, offering advanced decision-making and predictions [ 9 , 10 , 25 , 27 ].AI technologies enhance clinical decision-making, diagnosis, and treatment by analyzing patient data through machine learning for informed decisions, offering 24/7 support via AI chatbots, and enabling remote monitoring with AI-powered devices like wearable sensors [ 9 , 28 ].

AI facilitates remote patient monitoring, minimizing in-person healthcare visits [ 29 ]. It improves service personalization, with AI assistants managing appointments and reminders, and chatbots streamlining insurance claims, easing provider workloads [ 9 ]. AI automates routine administrative tasks, freeing providers to concentrate on patient care. It streamlines operations, cuts bureaucracy, and analyzes data to improve healthcare management and predict service demand, allowing for better resource allocation. AI’s analysis of patient feedback further aids in enhancing service delivery [ 10 ]. AI integration can transform patient-caregiver dynamics, enhancing diagnosis, treatment, and self-management of health conditions [ 30 ]. While AI integration in healthcare promises significant advancements, it presents challenges, including data management issues and the need for specialized skills.

Sallam [ 14 ] highlights ChatGPT’s potential advantages in healthcare, including enhancing clinical workflows, diagnostics, and personalized medicine. However, challenges such as ethical dilemmas, interpretability issues, and content accuracy must be tackled. In healthcare education, although ChatGPT holds promise for customized learning and creating lifelike clinical scenarios, concerns about bias, plagiarism, and content quality persist. Addressing these concerns necessitates preparing healthcare professionals and students through education and training to navigate the complexities of AI. Additionally, extensive research in these domains is essential [ 6 , 9 , 14 , 31 , 32 ].

Teaching with AI and about AI: advancing education in the digital age

To be able to utilize AI tools effectively and integrate them seamlessly into their everyday work, healthcare professionals need early exposure to AI tools in their education to boost their proficiency and confidence, understanding both their potential and limitations [ 9 , 32 , 33 ]. York et al. [ 32 ] explored medical professionals’ attitudes towards AI in radiology, revealing a positive outlook on AI’s healthcare benefits but also highlighting a notable gap in AI knowledge. This emphasizes the need for enhanced AI training in medical education.

According to Sallam [ 14 ], ChatGPT and other models based on lLLMs have significantly improved healthcare education. They customize responses to student inquiries, curate relevant educational material, and tailor content to individual learning styles. For instance, ChatGPT generates personalized quiz questions, suggests resources to fill knowledge gaps, and adjusts explanations to suit diverse learning preferences. Moreover, it simplifies complex medical concepts, employs analogies and examples for clarity, and offers supplementary materials to enhance comprehension.

Breeding et al. [ 11 ] argued that in medical education, ChatGPT should be viewed as a supplementary tool rather than a substitute for traditional sources. While it offers clear and organized information, medical students still perceive evidence-based sources as more comprehensive. Eysenbach [ 33 ] engaged in a series of dialogues with ChatGPT to explore its integration into medical education. ChatGPT demonstrated proficiency in various tasks, such as grading essays, providing feedback, creating virtual patient scenarios, enhancing medical textbooks, summarizing research articles, and explaining key findings. Nevertheless, it also demonstrated a tendency to produce erroneous responses and fabricated data, including references. Such inaccuracies have the potential to generate student misconceptions, spread misinformation, and cause a decline in critical thinking skills [ 33 ]. Han et al. [ 34 ] conducted a comprehensive examination of ChatGPT’s effectiveness as a pedagogical tool in medical education, focusing on the chatbot’s interaction with delineated educational objectives and tasks. Their findings suggest that while ChatGPT is capable of providing elementary data and explanations, it is not impervious to constraints and sometimes provides incorrect or partial information. The study stresses active learning and analytical reasoning in medical education, emphasizing the importance of understanding basic sciences and the need for expert oversight to ensure AI-generated information accuracy [ 34 ].

Das et al. [ 35 ] evaluated ChatGPT’s efficacy in medical education, focusing on microbiology questions at different difficulty levels. They found that ChatGPT could answer basic and complex microbiology queries with roughly 80% accuracy, indicating its potential as an automated educational tool in medicine. The study underscores the importance of ongoing improvements in training language models to enhance their effectiveness for academic use [ 35 , 36 ].AI implementation in healthcare must be carefully managed to maximize benefits and minimize risks [ 11 , 12 , 35 , 36 ]. With the rapid development of digital technologies and AI tools, particularly in healthcare, students need appropriate resources to use these technologies effectively [ 37 ]. Digital literacy is essential in the 21st century, including skills for interacting with digital content [ 16 , 18 ]. Hence, medical literacy skills should start early in the education of healthcare students.

Digital literacy and eHealth literacy skills

Digital literacy skills encompass a collection of essential abilities necessary for using digital technologies effectively in accessing and retrieving information [ 38 ]. These skills are often viewed as foundational digital literacies that are critical for full participation in the digital era [ 39 ]. The European Commission emphasizes the importance of digital literacy for employability and citizenship. They advocate for policies and programs to enhance digital skills across all segments of society. The EU aims for 70% of adults to have basic digital skills by 2025, focusing on analytical, evaluative, and critical thinking abilities crucial for assessing digital information’s quality and credibility [ 40 ]. Individuals need these skills to discern biases and misinformation in various media formats [ 16 , 17 , 41 ] and evaluate the credibility of online sources [ 42 ]. Critical thinking is crucial for distinguishing between accurate information and misinformation [ 43 ], while data literacy is essential for interpreting data and detecting misleading statistics [ 44 ]. These competencies are fundamental for navigating today’s complex digital information landscape.

eHealth literacy, which incorporates the digital skills needed to access and utilize medical information from digital platforms [ 45 ], is gaining recognition as an integral component of overall health literacy. Enhanced online medical literacy is vital for healthcare professionals and administrators [ 46 ] to adapt to changing demands and improve care management within evolving healthcare paradigms [ 47 ]. Additionally, acquisition of digital competencies has been identified as a valuable strategy that healthcare providers and managers can use to manage the psychological effects of heightened workloads and uncertainty, such as the fear, stress, and anxiety emerging from the COVID-19 pandemic [ 48 ]. These skills enable individuals to use AI as both an independent tool and a supplementary aid in decision-making. However, addressing challenges like bias and academic integrity is crucial when integrating AI into medical education [ 32 , 33 , 49 ]. Critical thinking skills are essential for analyzing digital information, identifying inconsistencies, and evaluating arguments. In today’s era of misinformation, users must verify the accuracy of online content and distinguish between reliable sources and hoaxes [ 43 ]. Data literacy skills are also crucial for interpreting data accurately, detecting misleading statistics, and making informed decisions based on credible sources in the digital age [ 44 ].

Research on digital literacy emphasizes the importance of analytical and evaluative skills. Morgan et al. [ 17 ] found that higher education students struggle most with evaluating digital content for bias and quality. They excel in social literacy skills like communication. This highlights the need to prioritize adaptability in digital literacy, integrating industry-relevant experiences into education to ensure students can navigate and critically assess digital information for real-world applications.

Indeed, since the introduction of ChatGPT in 2022, it has been beneficial in various educational contexts. Nevertheless, concerns have been raised about potential inaccuracies and misinformation that may affect student learning and critical thinking [ 20 ]. Moreover, the potential redundancy of certain digital skills as a result of ChatGPT’s capabilities has also sparked discussions on changing educational objectives [ 19 , 21 , 22 ]. The development of ChatGPT may replace some digital skills as it takes over tasks previously expected of students. Researchers [ 21 , 22 ] argue that it is constantly improving its ability to access accurate medical information, providing reliable advice and treatment options from reputable sources. This ability may render the need for individuals to be adept at information retrieval and evaluation redundant. In other words, ChatGPT’s growing proficiency in tasks such as translation, text summarization, and sentiment analysis, and its ability to generate content like movies [ 23 ] may potentially lead to the underdevelopment of critical thinking skills, including the ability to evaluate source quality and reliability, formulate informed judgments, and generate creative and original ideas [ 24 ]. Indeed, the integration of AI into the healthcare sector raises critical questions about the nature and scope of the digital skills required in the future [ 19 , 20 ].

As AI advances, essential digital competencies may need reassessment to keep pace with technology. This requires forward-thinking digital literacy initiatives, particularly in healthcare education and practice. Proactively addressing the potential impact of AI on human interactions with digital healthcare technologies is critical. This will ensure that healthcare professionals and students are skilled in current digital practices, and prepared for the evolving role of AI in the sector. Despite the swift integration of AI tools in healthcare, and applications like ChatGPT, research on their long-term impacts, effects on users, and the necessary adaptation of skills and methodologies in the ever-evolving learning environment remains insufficient [ 11 , 12 , 15 , 17 , 18 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ].

This study aims to address the intersection of AI adoption in healthcare and its implications for medical education, specifically focusing on the skills required by healthcare professionals. With the rapid incorporation of AI, into healthcare settings, there is an urgent need to reassess the digital literacy skills traditionally emphasized in medical education. This reassessment prompts questions about the ongoing relevance of these skills as AI technologies continue to evolve and expand their role in healthcare [ 13 , 15 , 16 , 17 , 18 , 19 , 20 ].

Research questions

Given the context, this study aims to explore the following qualitative research questions:

How does a pedagogical framework integrating problem-based learning with ChatGPT affect healthcare management undergraduates’ digital literacy skills?

What are students’ experiences with the combined use of problem-based learning and ChatGPT in their healthcare management education?

How do students perceive the shift towards AI-relevant skills as a result of engaging with this integrated pedagogical approach?

Methodology

Methodological approach.

The present research adopts the case study methodology, which entails in-depth empirical research of a current phenomenon within its real-world context [ 50 ]. This approach involves collecting data on human activities within a defined time and space setting, thereby facilitating an understanding of the various processes occurring within the research case. In qualitative research, and particularly in case study research, themes are formulated from the participants’ narratives, thus allowing for the development of arguments or generalizations derived deductively from participants’ statements [ 51 ]. By focusing on our research questions and using a methodological framework that emphasizes depth and context, the study aims to shed light on the transformative impact of AI on medical education and the development of the skills required for future healthcare professionals.

The research was conducted and analyzed by the researcher, who has a PhD in Healthcare Management and over 15 years of experience in qualitative analysis. Her expertise ensures a deep understanding of the study’s qualitative data. Throughout the research, she engaged in continuous reflexive practices to evaluate how her subjectivity and context influenced the study. This included reflecting on her assumptions, considering power dynamics with participants, aligning research paradigms and methods, and understanding the research context [ 59 ].

Participants and research population

The study involved 89 third-year undergraduate students enrolled in a Health System Management degree program, specifically participating in a course on Service Quality in the Healthcare System during the 2023 academic year. The researcher, serving as the lecturer for this course, integrated writing reflective journals into the curriculum as part of the learning process. Following the course’s conclusion and after grades were distributed, the researcher asked students, in adherence to ethical guidelines, if they consented to have their reflective journals analyzed for research purposes, as outlined in the data collection section. Only students who completed all components of the intervention plan outlined for the class were considered potential participants in the research population.

From this group, qualitative data was extracted from the reflective journals of 65 students who consented to participate. The demographic breakdown of this participant subset included 80% females, with an average age of 24.26 years (Standard Deviation = 3.80).

Data collection

Throughout the course, participants were required to keep a reflective journal documenting their learning journey, to be submitted at the end of the semester. The aim of writing the journal was to capture their personal perceptions of their learning experience. They were encouraged to articulate various challenges, obstacles, and positive and negative aspects they encountered [ 52 ]. Specifically, they were asked to describe the main challenges they faced and the obstacles they overcame, and to provide an introspective account of their experiences. The practice of writing a personal journal not only served as a tool for reflection but also helped them adopt a comprehensive perspective on their educational process [ 53 ].

The credibility of the reflective journal prompts was assured by grounding their development in an extensive literature review and expert consultations within the field of healthcare education. This process ensured that the prompts accurately reflected the constructs of interest, facilitating consistent and meaningful student reflections. Content validity was emphasized to ensure the journal prompts were aligned with the study’s objectives and relevant to students’ experiences in healthcare management education. Refinement of these prompts to effectively meet research objectives was facilitated through expert input. A detailed coding scheme was developed, featuring definitions and categories reflecting the study’s aims and insights from the journals. The coding was applied to a subset of journals by the researcher to ensure credibility.

The data were collected from the reflective journals in accordance with the intervention plan outlined in the Instructional Method section. The study carefully complied with several ethical guidelines for research with human subjects. The nature and purpose of the research were fully explained to the students, with particular emphasis on the use of reflective journals to evaluate the intervention plan. The students gave their informed consent and signed consent forms. To ensure confidentiality, participants were informed that all names would be replaced by pseudonyms and all identifying details would be removed from the final research report. They were also explicitly told that the journal entries would be processed anonymously. The research was approved by the college’s Ethics Committee.

Instructional method procedure (intervention plan)

The focus of this study is a required course titled Introducing Quality into the Health System, which had formerly been taught using traditional frontal teaching methods. The study examines the transformation of this course into a course taught using ChatGPT-mediated online guided learning. This innovative learning approach provides learners a comprehensive experience that entails self-directed learning. The approach emphasizes problem-based learning and focuses on identifying ethical dilemmas and analyzing them within organizational contexts. The intervention plan was strategically organized into five primary stages. Each stage comprised a series of carefully constructed steps that were specifically designed to build upon the knowledge and skills acquired in the previous stages, thus ensuring a coherent and cumulative educational progression. Figure  1 summarizes the instructional method.

Initial Familiarization with ChatGPT

At the beginning of the course, students were introduced to ChatGPT to develop their understanding and proficiency with the tool. This involved providing them detailed instructions on effective usage and encouraging them to engage in interactive dialogues with ChatGPT. The aim was to foster a sense of familiarity and ease, thereby facilitating an informal, hands-on learning experience.

Exploratory Analysis of a Dilemma using ChatGPT

In this exploratory stage, students began to examine the topic of hospital accreditation. Through interactions with ChatGPT, they were introduced to the pros and cons of the accreditation process and to the dilemmas posed by following the accreditation guidelines. The issue of accreditation is central to the discourse on how to improve healthcare quality, but it is also fraught with challenges, such as staff shortages and funding issues. Hospitals have had to make significant changes to meet accreditation standards, leading to debates about possible abolition of the accreditation system. While accreditation is crucial for quality control, its associated costs, particularly those related to inspections and the need for additional staff, pose significant challenges. Without proportional funding, compulsory accreditation has placed financial pressures on hospitals, creating a complex dynamic for both the Ministry of Health and healthcare institutions as they navigate the accreditation process.

To explore the topic of accreditation in depth, students were instructed to develop a series of questions to input to ChatGPT aimed at extracting detailed information about the accreditation dilemma. Students engaged with ChatGPT by posing questions and critically analyzing the answers from three perspectives: organizational, healthcare worker, and patient/customer. They iteratively refined their queries to increase precision until they achieved a comprehensive understanding. Following guidelines, they condensed and reorganized the information into a structured paragraph, incorporating the core dilemmas and arguments from each perspective. To meet objectives, students demonstrated digital media skills, including locating and sharing relevant materials, analyzing ChatGPT responses, verifying sources, and assessing content credibility.

Synthesis and Documentation of Concepts Emerging through ChatGPT Interaction

In the third stage, students were required to submit a comprehensive list detailing new concepts, themes, and sub-themes that emerged from their learning experience with ChatGPT. Their submitted list was not limited to the final results, but also included documentation of all stages of their work, including their initial set of questions, their subsequent refinement of these questions, and the process of their development throughout the learning journey. In addition, they were required to provide a final section summarizing the culmination of their exploration and learning process with ChatGPT. This comprehensive approach was designed to demonstrate the students’ engagement and progression with the tool and to highlight their ability to develop their inquiries and synthesize information effectively.

Analytical Structuring of Learning Outcomes

In the fourth stage, students attempted to refine the learning outcomes they had previously generated. Following the established guidelines, their main objective was to identify and highlight the pros and cons of the various arguments related to the dilemmas they had studied, making sure to consider them from different perspectives. The challenge was to present their arguments in a coherent and logical order, for example by comparing budgetary considerations with quality considerations. They were also expected to support each argument with scientific evidence, thereby aligning their analysis with academic accuracy and empirical research. This stage was crucial in developing their ability to critically evaluate and articulate complex issues, particularly in the field of healthcare.

Final project: Integrative Analysis and multidimensional presentation

In the final stage, students developed and presented a final project, building upon their prior work to explore a comprehensive research question or delve into a specific aspect of their study. This included presenting organizational and managerial viewpoints. The choice of format and tools for their project and presentation—ranging from e-posters and slides to video clips, using familiar technologies like PowerPoint and ThingLink—was left to the students. This method fostered diversity and empowered students by allowing them to select their preferred presentation technique. Moreover, the project featured a peer review phase where students critiqued each other’s work through insightful questions and suggestions, enhancing the discussion. This interactive element aimed to bolster critical thinking and collaborative learning.

Summary of instructional method

Reflective Journaling: documenting the Learning Journey

Throughout the semester, students kept a reflective journal, which they submitted at the end of the course. The primary aim of this journal was to document their personal learning experiences. The journal provided a window on their challenges, difficulties and successes they encountered, all viewed through the lens of their own perceptions and experiences.

Data analysis

The present research employed a deductive-inductive method for categorical analysis of the dataset. Integration of these deductive and inductive approaches was essential to facilitate investigation of predefined categories that are grounded in extant literature and theoretical frameworks, as well as to permit the discovery of novel categories that surfaced during the analysis process [ 51 ]. Initially, the deductive stage was conducted, focusing on predefined categories derived from existing literature and theoretical frameworks. Following this, the inductive stage allowed for the identification and development of novel categories based on the data analysis. The inclusion of episodes, thoughts, and feelings expressed by the students in this study serves to reinforce the reliability of the identified themes. The analysis of the reflective journals began with in-depth reading to identify initial themes from students’ narratives. Inductive coding facilitated the identification and development of themes by the researcher, rather than merely allowing them to ‘emerge.’ This active interpretation and organization of the data by the researcher led to a compilation of key insights. After ensuring the reliability and validity of these findings through careful review, the researcher then organized the codes into themes and sub-themes, ensuring they accurately reflected the data and provided a clear narrative of the students’ experiences.

The findings

The researcher’s analysis of the reflective journals actively uncovered five main categories: (1) Use of Literacy Skills; (2) User Experiences with ChatGPT; (3) ChatGPT Information Credibility; (4) Challenges and Barriers when Working with ChatGPT; (5) Mastering ChatGPT Prompting Competencies. Table  1 summarizes the identified categories and subcategories. To further clarify each category, the table includes representative quotations from the data for illustrative purposes. Throughout the manuscript, pseudonyms have been used with quotations. This approach ensures confidentiality and anonymity for all participants.

Use of literacy skills

The category comprising the use of literacy skills, the code refers to instances where participants relate literacy skills such as reading comprehension, searching evaluation of Information, etc., in their interactions with ChatGPT.

It includes three subcategories: Search Strategies and Access to Data in ChatGPT Use; Data Analysis Enhancement with ChatGPT ; and Evaluation of Information in ChatGPT Interactions Search Strategies and Access to Data in ChatGPT Use.

In the reflective journals, the students consistently expressed their high regard for the efficiency and ease of searching for and accessing information through ChatGPT. The chat interface significantly improved the process of retrieving information by removing the necessity to navigate through multiple websites or sources, thereby making the material more accessible. Furthermore, the interface’s user-friendly and accessible content format played a crucial role in significantly enhancing students’ understanding of the material. Shir wrote: The chat was super easy and helpful in making the dilemma clearer for me. It put all the info I needed in one spot, and everything was explained in a way that was simple to understand.

The analysis of the student journals underscored the remarkable proficiency of ChatGPT in rapidly and effortlessly providing information for various tasks. This technology alleviated the necessity for students to delve into multiple sources, offering a direct approach for understanding concepts, interpreting implications, and compiling data for complex issues. ChatGPT’s swift and handy information retrieval supported autonomous learning on the topic. As an accessible and user-friendly tool, it saved considerable time. Moreover, its accessibility and constant availability helped in tailoring learning experiences to fit the learner’s schedule, independent of external factors or intermediaries. ChatGPT’s use of simple, everyday language, coupled with its capacity to deconstruct and elucidate complex concepts, rendered it exceedingly approachable and beneficial for information searches and for enhancing the accessibility of educational content. Lihi also acknowledged the efficacy of ChatGPT in facilitating the rapid acquisition and expansion of her conceptual knowledge. She underscored that the ChatGPT tool obviated the need to consult multiple databases and websites for extracting conceptual information: ChatGPT is really fast and easy to use when you need info on lots of different things. It’s great for finding technical stuff, explaining problems, understanding things better, and getting new ideas on the spot. You don’t even have to go looking for more sources – it’s all right there.

Data synthesis and analysis enhancement with ChatGPT

Analysis of the reflective journals indicates that students found the synthesis, editing, and analysis of content facilitated by ChatGPT to be extremely beneficial. The tool significantly reduced the technical complexity of gathering and synthesizing information from different sources, tasks that had previously been their responsibility. As a result, they were spared the need for synthesizing, editing, and analyzing the raw data, with ChatGPT efficiently performing these functions on their behalf. Meir wrote: ChatGPT really helped us out. It gave us a full picture of the whole process, including the good and bad parts, and how to handle them. We didn’t even need to look at any other info sources at that point .

Evaluation of information in ChatGPT Interaction

The streamlined data collection procedures enabled the students to engage in more advanced learning processes, such as distinguishing between facts and assumptions, differentiating critical from non-critical information, and developing arguments as they advanced to more complex stages. The students observed that although ChatGPT presented data objectively, it did not offer explicit arguments, thus requiring them to actively interpret and formulate their own positions regarding the dilemma and identify the foundational principles for their principal arguments. For example, Miri’s reflections highlighted her need to formulate and develop a stance on the dilemma, which compelled her to engage in critical assessment of the situation:

ChatGPT didn’t really point out which arguments were more important or less important. It kind of listed them all the same way, which made me decide for myself what to focus on. I had to pick the arguments I thought were key and then find evidence to back them up.

Furthermore, the students were asked to support their arguments with evidence from the academic literature, necessitating a thorough evaluation and critical analysis of the information. This process led them to make informed decisions and formulate solutions. In their reflective journals, students documented a cautious approach, emphasizing the need not to simply accept information as it is presented. Instead, they highlighted the importance of thoroughly evaluating the information’s accuracy. Amir similarly addressed this issue, noting his necessity to independently navigate the “thinking part” and acquire the skills to construct strong arguments or effectively employ academic resources: The chat didn’t really help me figure out what’s important and what’s not when I write. It also didn’t teach me how to make strong arguments or how to use academic stuff to back up my points.

User experiences with ChatGPT

This category refers to the qualitative data related to participants’ overall experiences, perceptions, and attitudes towards interacting with ChatGPT. The theme of user experiences is divided into three sub-themes: Time Efficiency using ChatGPT; Accessibility and Availability of ChatGPT; and User-Friendly Dynamics . Overall, analysis of the students’ reflective journals reveals broad agreement about ChatGPT’s user-friendliness and ease of use. Many students noted the chatbot’s intuitive interface and straightforward functionality, which made it accessible to those who may not be tech-savvy. This consensus highlights the effectiveness of ChatGPT as a tool that simplifies information acquisition and supports learning without the typical complexities associated with advanced technological tools.

Time efficiency using ChatGPT

In this sub-category, analysis of the student journals revealed the major time-saving benefits of using ChatGPT for various tasks. ChatGPT successfully eliminated the need for students to sift through numerous sources of information. By providing a straightforward way to understand a concept, grasp its implications, and gather information on complex dilemmas, ChatGPT demonstrated its efficiency in saving students’ time. Riad mentioned the significant time efficiency gained from using the tool, highlighting how it saved him considerable time: You can find out a lot about all sorts of things really quickly. The chat gives you detailed breakdowns and explanations, sorting everything into different arguments and topics; it saves you a lot of time.

Ali also referred to this point: I was not very familiar with the details of accreditation, including its benefits and challenges, but within minutes I was able to grasp its essence and understand the importance of the whole process.

The time efficiency extended not only to data retrieval and collection but also encompassed information synthesis, significantly reducing the amount of time usually required for comprehensive and coherent processing and reformulating of acquired data. Mai observed that the time saved was also because she didn’t need to search for data across multiple sources and combine it together:

The amount of time I save is insane. If I had to search for this stuff on the internet instead of using the chat, it would take me way longer to find an answer. And even after finding it, I’d have to summarize what I found and then rephrase it in my own words, which takes so much time.

Accessibility and availability of ChatGPT

A majority of the students noted that the tool’s immediate accessibility and availability significantly facilitated the personalization of learning approaches. This customization seamlessly interfaced with the unique scheduling needs of each learner, offering flexibility that in traditional learning settings is typically constrained by external factors or intermediaries. Hana highlighted ChatGPT’s anytime, anywhere accessibility through a simple interface, enabling quick and comprehensive responses without the wait for expert assistance: ChatGPT is available to use anytime, anywhere using a simple and convenient interface. This would allow you to get a quick and comprehensive response at any time of the day, without having to wait around for people or experts to help you out.

Lina similarly noted: It’s pretty great how available it is (as long as it’s not too busy…). Any question I have, I get an answer. It saved me a lot of Google searches and reading articles and stuff. I get a quick and clear answer to everything I ask and it’s all super fast.

ChatGPT Information credibility

This category involves instances where participants discuss the credibility, reliability, and trustworthiness of the information provided by ChatGPT. Analysis of the reflective journals showed that interaction with ChatGPT facilitated students’ ability to acquire fundamental knowledge, which could then be expanded upon through subsequent inquiries and verification. Nevertheless, as students proceeded in their tasks, particularly those that required articulating arguments and substantiating their stances on complex dilemmas, they acknowledged the limitations of relying solely on ChatGPT. These limitations focused primarily on concerns about the tool’s credibility in providing sufficiently authoritative information. In this regard, Ofri appreciated ChatGPT’s quick access to information but expressed concerns over its credibility and occasional inaccuracies, leading to unexpected disappointment:

I have found that ChatGPT has a lot of good points. It can quickly give you a lot of information on so many topics and you can really use that information. But I have also learned that this tool has its drawbacks. It is not always right, and it certainly doesn’t always give you things that are based on solid academic facts. Sometimes ChatGPT just makes things up. To be honest, realizing this was a bit of a shock to me.

Students also noted that they were often faced with an overwhelming amount of information, some of which was irrelevant or incorrect, requiring them to evaluate the information and determine its quality. Dalia noted that while ChatGPT provided extensive information initially, aiding in learning about the topic, it also required discernment to distinguish between accurate and less relevant information: In the first stage, the chat gave us a lot of information, which was great because it helped us learn more about the topic. But at the same time, we had to decide which information was really important and accurate and which wasn’t.

Students’ understanding of the limitations of relying solely on the information provided to justify arguments and articulate positions in dilemmas motivated them to examine and assess its reliability. They did so by asking specific questions and consulting established academic references. From the students’ point of view, this careful research and critical evaluation process not only provided them with the opportunity to refine their powers of critical thinking and analysis, it also equipped them with the capacity to critically evaluate the credibility of the information presented. Lina wrote:

I attempted to back up the info I found with academic sources, but then I figured out that the chat isn’t always reliable…. I went through each article that I got results from…to check where is it from, and whether the author actually existed or was just made up… After that, I did another check with other databases. This whole process made me super cautious and thorough in checking everything.

The students expressed unanimous agreement that the need to assess the information provided by the chat forced them to be critical and use evaluation skills. Not only was this a skill they needed to be able to put to good use. It also constituted a challenge in using ChatGPT, as Limor stated that, contrary to reducing critical thinking, proper use of ChatGPT can enhance it by prompting users to reconsider and verify information, despite the challenge:

It might seem that using ChatGPT would make you think less because, well, it’s like chatting to a robot. But actually, if you use it properly and really get into it, it adds a lot to your knowledge and makes you think more broadly and deeper. This is because it makes you think about things over and over again, and double-check the information… it wasn’t easy.

Challenges and barriers in Working with ChatGPT

This category encompasses the various obstacles, difficulties, and limitations encountered by participants while using ChatGPT, including technical issues, comprehension challenges, and frustration. The analysis suggests that despite the students’ widespread agreement on the advantages of using ChatGPT, such as its ease of use, constant availability, and user-friendliness, its accompanying challenges should also be considered. Among these challenges are hesitation in adopting new, cutting-edge technology, difficulties in learning how to use the tool, and language barriers. The language issue was particularly significant, as ChatGPT operates mainly in English, which is not the first language of many of the students. Shir faced difficulties with English translation but viewed it as an opportunity to improve language skills, eventually becoming more comfortable with the chat and reducing reliance on outside translation help:

One big problem I had was writing in English and then translating it to express what I wanted to say. But I decided to take it on as a challenge and use it as a chance to improve my reading and writing in English. Since we didn’t have to use English much, at first it felt like it took forever to understand or read stuff. But gradually, we got the hang of the chat and didn’t need as much help with translating from outside sources.

Some students noted that they also faced some technical issues, revealing the downside of depending exclusively on online tools for studying. For many students, this was their first time using AI including applications like ChatGPT that are built on large language models. As they continued to use it, however, they became more accustomed to it. Ali found initially accessing the GPT chat difficult and, despite its ease of use, experienced issues with site access due to high traffic and occasional freezing, hindering continuous use:

When I first tried the GPT chat for my task, it was a bit tough to get onto the site. But after a while, I noticed that even though the chat is easy to use, it’s got its problems. Sometimes, you can’t even get into the chat because too many people are trying to use it at the same time, and other times, it just freezes up, and you can’t keep using it.

Mastering ChatGPT-Prompting competency

This category involves instances where participants demonstrate proficiency in formulating effective prompts and questions to elicit accurate and relevant responses from ChatGPT. Analysis of the reflective journals revealed that this theme posed a notable challenge for the students, primarily due to their unfamiliarity with the tool. Indeed, they needed to learn how to use the chat effectively to elicit the correct responses and achieve their desired outcomes. Additionally, they encountered challenges in ensuring accuracy and setting the right parameters to establish a reliable and precise database. Despite these obstacles, the students recognized that their efforts to achieve accuracy and their practice of asking repetitive questions were instrumental in developing higher-order thinking skills and being able to organize and manage the required information proficiently. Liya related to this challenge by noted that dealing with inaccurate responses from the model involves clarifying questions with more details, considering alternative answers, and emphasizing the importance of verifying the information received:

Sometimes the model may give you wrong information or answers… to cope with getting answers that are not accurate, you should make your question clearer and add more details. Also think about using different choices of answers. And it is really important to always check the answers you’re getting.

Analysis of the reflective journals showed that systematic demonstration of these activities, along with comprehensive detailing of early learning stages and the cumulative nature of the tasks, provided students the chance to assess and revisit each step retrospectively. This reflective review allowed them to seek explanations for any aspects that were unclear, ask more questions and craft more targeted prompts, and gain a deeper understanding of the entire process. Rim, for example, explained: The chat lets us get information in a series, like being able to ask another question to get a better understanding or clear up something from the first questions we asked. This helped us keep track of everything by linking all our questions together.

Nir noted that the need to aim for accuracy by repeatedly refining the questions really helped in dealing with the assigned tasks effectively:

From my experience with ChatGPT, I have learned that if you want good answers, you have to be really clear about what you are asking. You need to know what you want to achieve with the chat. It is best to give specific instructions to obtain the exact info you need. Also, you should think carefully about the answers you get, making sure the facts are right, and using your own thinking to make wise decisions.

This qualitative study examined the process of introducing and using a pedagogical framework that integrates problem-based learning with the use of ChatGPT among undergraduate healthcare management students. The study also provided a qualitative exploration of their experiences using this technology and assessed how the use of ChatGPT can shift the focus from traditional digital literacy skills to advanced AI literacy skills. It demonstrated how the use of the ChatGPT platform can be managed to encourage the development of critical thinking and evaluation skills through active student engagement. These skills are considered critical for learning and working with AI platforms.

The analysis of students’ reflective journals indicated a perception of the platform as user-friendly. Minichiello et al. [ 54 ] expand the definition of “user experience” beyond mere interaction with user interfaces to include design, information presentation, technological features, and factors related to emotion, personal connection, and experience. Students described their experience with the platform positively, citing it as an incentive for ongoing engagement.

The analysis also showed that the platform’s efficiency was significantly influenced by its high availability and accessibility, which were key factors in its attractiveness to users. This attractiveness was further enhanced by its ease of use. A critical aspect of the platform’s effectiveness was its efficiency in providing key materials in a timely manner, drastically reducing the time required to retrieve information. Users particularly appreciated this aspect of the platform as it streamlined their access to information and significantly improved their learning efficiency. The platform’s ability to deliver relevant information quickly and efficiently was instrumental in its positive reception. In an academic environment where efficient time management and quick access to educational materials are essential, the platform’s ability to meet these needs effectively constituted a notable advantage.

However, students noted initial difficulties and obstacles in utilizing ChatGPT, primarily related to data credibility. These challenges, highlighted in the qualitative data, necessitated the application of critical thinking and conducting various checks to verify the information received. This concern over the credibility of information from AI tools aligns with observations by Mohamad-Hani et al. [ 55 ], who reported similar credibility issues with ChatGPT data among healthcare professionals.

Another significant challenge for the students focused on how to retrieve relevant and accurate information. To this end, they had to refine their question formulation to extract the most relevant and accurate data from the tool. Such challenges have increasingly become a focus of academic attention due to the emerging recognition of the importance of developing prompting skills for effective interaction with platforms such as ChatGPT and other AI tools [ 19 , 20 ].

In terms of digital literacy skills, the findings of this study suggest that basic literacy skills such as locating, retrieving, synthesizing, and summarizing information may become less important as AI systems improve. Yet students still must be trained to evaluate and think critically about AI tools and what they can accomplish, especially since AI technologies like ChatGPT are not always completely trustworthy. Therefore, students need to learn how to evaluate the information these tools provide. These findings also offer some support for the notion that while digital literacy is undeniably recognized as crucial for the 21st century, especially in the healthcare arena [ 36 , 45 ], the definition of digital literacy is changing as technological tools develop. For decades, education focused on developing basic skills. Over time, however, there was a shift toward the cultivation of more complex skills involving information evaluation, synthesis, and assessment [ 56 , 57 ]. Yet as AI continues to penetrate everyday life, there has been a noticeable evolution in the forms of literacy required.

This evolution marks a transition from traditional data digital literacy, which emphasizes a basic understanding and processing of information, to AI digital literacy, which goes beyond mere data consumption to include using digital tools skillfully, understanding the nature of digital content, and effectively navigating the complex digital landscape. This shift reflects the changing demands of a technology-driven society, in which digital literacy is becoming increasingly essential for both personal and professional development [ 58 ]. As AI becomes integrated into different dimensions of work and daily life, especially in the healthcare industry, AI digital literacy will continue to evolve to meet the new demands. This will require a different set of skills, including prompting skills that allow users to better interact with AI tools [ 19 , 20 ].

These results highlight the importance of rethinking the educational use of AI tools such as ChatGPT, potentially leading to changes in future learning curricula. Without the ability to use digital tools, students are liable to fall behind when it comes to adapting to new technologies, thus limiting their ability to learn key skills. Therefore, AI tools must be taught and used in a way that supports students’ holistic learning. These findings align with those of other researchers who focus on the use of the AI platform in education [ 40 , 42 , 43 ]. Such an approach will ensure that students are prepared for the evolving challenges and opportunities of our increasingly digital world. This is especially important in the medical education field, as AI is increasingly being used in different ways to improve the accuracy of disease diagnosis, treatment strategies, and prediction of patient outcomes [ 9 , 10 , 25 , 27 ].

Given that AI technology is still developing and is anticipated to advance and become more widely used [ 21 , 22 ], the need to adapt and acquire new literacy skills is growing. As AI evolves, reliance on traditional basic skills may decline over time, underscoring the importance of learning how to effectively utilize and interact with emerging technologies. Learning to engage with AI tools such as ChatGPT from an early stage in their education can greatly enhance students’ learning experiences. This early exposure will not only provide them with a deeper understanding of these tools. It will also boost their motivation to learn how to use them more effectively, thus highlighting the importance of training students to handle such technologies proficiently. Equally important is the need to guide students through these learning processes to ensure they acquire the necessary skills and knowledge to navigate and utilize AI tools successfully in their educational journey [ 11 ].

Limitations and future research directions

This study utilized a pedagogical framework that integrates problem-based learning with the use of ChatGPT. While the researcher focused on the pedagogical aspect, future research is warranted to compare this digitally supported activity to a non-digital equivalent and examine the impact on students’ literacy and skills. Such a comparison would make it possible to assess what the digital instrument contributes to skill development and to identify any challenges encountered.

The use of this tool across different teaching methods could also be explored to determine whether it is particularly effective for certain types of tasks or requirements. The current study focused on health management. Implementation of this teaching approach in other academic areas should be examined to assess its effectiveness in acquiring competencies in different arenas. The findings of this study highlight the need for further research into the use of AI in learning environments that focus on goal-oriented pedagogy. Such research can help in developing educational strategies that promote the skills essential for lifelong learning.

Conclusions and recommendations

In conclusion, revisiting the research questions in the context of our findings highlights the transformative potential of integrating ChatGPT with problem-based learning in healthcare management education. This study underscores how such integration not only shifts the focus from traditional digital literacy to advanced AI literacy skills but also enhances critical thinking and evaluation capabilities among students. These competencies are indispensable as AI continues to reshape the landscape of healthcare and medical education. AI is emerging as a transformative force that will fundamentally change the global landscape. Although we are still in the early stages of integrating and understanding AI capabilities, its potential to shape our future is clear. Adapting to this digital transformation, especially in healthcare, is crucial [ 4 , 6 ].

Integrating AI into healthcare systems poses significant challenges and raises many unanswered questions [ 9 , 10 ]. These issues require careful consideration and strategic planning to maximize benefits while addressing implementation complexities. The extent and impact of these transformations on the health system and its workforce remain uncertain. However, it is crucial to prepare for these changes at both individual and organizational levels. Educational institutions must update their teaching methods to meet digital demands, recognizing the critical role of educators in developing effective support strategies.

To enable healthcare professionals to integrate AI tools effectively, these tools should be introduced early in education, such as during undergraduate studies or initial professional training [ 9 , 32 , 33 ]. Hands-on experience allows learners to build confidence and understand the tools’ limitations. Additionally, AI tools and especially LLMs such as GPT and their applications, including platforms like ChatGPT, can serve as user-friendly and efficient learning aids, as demonstrated in this research. In addition, researchers should strive to develop innovative pedagogical methods for integrating these tools into different curricula, as exemplified here by the effective use of dilemma-based learning enhanced by ChatGPT. These studies should focus on determining which skills will become redundant and on highlighting essential competencies needed for AI literacy, including prompting, evaluation skills, and critical thinking, all of which are essential for effectively integrating AI and LLMs into medical education and daily practice. Participants in such studies have noted that the acquisition of such skills, particularly in the area of effective prompting, significantly improves the quality of AI responses. Similar to learning a new language, learning to use AI requires precise phrasing and an in-depth understanding of context. Not only will AI skills improve student engagement and comprehension, they will also encourage critical thinking, leading to better educational outcomes. Students who formulate well-structured search queries obtain more accurate responses from AI, which are critical to improving healthcare and learning outcomes.

It is therefore imperative that academia and higher education institutions, including medical education institutions, adopt methods for effectively guiding and training students in using AI. This approach is essential to address the evolving global educational landscape and to embrace the shift in roles. Educators should move from being primarily providers of knowledge to being facilitators of cultural understanding and skill development. Such a shift is essential to promote the transformative evolution of the role of educators in the modern educational context.

Availability of data and materials

Data are available upon request from the Corresponding author.

Counte MA, Howard SW, Chang L, Aaronson W. Global advances in value-based payment and their implications for global health management education, development, and practice. Front Public Health. 2019;6:379. https://doi.org/10.3389/fpubh.2018.00379 .

Article   Google Scholar  

WHO. World Health Organisation. Universal health coverage. 2019. Retrieved from https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc) . June 2022.

Naamati Schneider N. Public-private: unequal competition: Israeli public hospitals vs. the private healthcare system following government reforms. Int J Organ Anal. 2021. https://doi.org/10.1108/IJOA-06-2020-2237 .

Deshpande N, Arora VM, Vollbrecht H, Meltzer DO, Press V. eHealth literacy and patient portal use and attitudes: cross-sectional observational study. JMIR Hum Factors. 2023;10:e40105. https://doi.org/10.2196/40105

Naamati Schneider L. Strategic management as an adaptation to changes in the ecosystems of public hospitals in Israel. Isr J Health Policy Res. 2020;9:65. https://doi.org/10.1186/s13584-020-00424-y .

Naamati-Schneider L. The effect of digitalization on service orientation and service perception among Israeli healthcare professionals: a qualitative study. Digit Health. 2023;9. https://doi.org/10.1177/20552076231191892 .

Naamati-Schneider L, Salvatore FP. Sustainability for healthcare organisations and systems: cultivating strategy and governance processes for a better future. In: Vrontis D, Thrassou A, Efthymiou L, Weber Y, Shams SMR, Tsoukatos E, editors. Business for sustainability. 2023; Volume I. pp.227–249. Palgrave studies in cross-disciplinary business research, in association with EuroMed Academy of Business. Cham: Palgrave Macmillan. https://doi.org/10.1007/978-3-031-37361-9_11 .

Naamati-Schneider L, Zaks O. Public hospitals in crisis: managerial and strategic adaptation. In: Vrontis D, Thrassou A, Weber Y, Shams SMR, Tsoukatos E, Efthymiou L, editors. Business under crisis: volume II. Palgrave Macmillan; 2022. p. 43–64. https://doi.org/10.1007/978-3-030-76575-0_3 .

Ali O, Abdelbaki W, Shrestha A, Elbasi E, Alryalat MAA, Dwivedi YK. A systematic literature review of artificial intelligence in the healthcare sector: benefits, challenges, methodologies, and functionalities. J Innov Knowl. 2023;8(1):100333.  https://doi.org/10.1016/j.jik.2023.100333

Manne R, Kantheti SC. Application of artificial intelligence in healthcare: chances and challenges. Curr J Appl Sci Technol. 2021;40(6):78–89. https://doi.org/10.9734/cjast/2021/v40i631320 .

Breeding T, Martinez B, Patel H, et al. The utilization of ChatGPT in reshaping future medical education and learning perspectives: a curse or a blessing? Am Surg. 2024;90(4):560–6. https://doi.org/10.1177/00031348231180950 .

Boscardin CK, Gin B, Golde PB, Hauer KE. ChatGPT and generative artificial intelligence for medical education: potential impact and opportunity. Acad Med. 2024;99(1):22–7. https://doi.org/10.1097/ACM.0000000000005439 .

Tinmaz H, Fanea-Ivanovici M, Baber H. A snapshot of digital literacy. Libr Hi Tech News. 2023;40(1):20–3. https://doi.org/10.1108/LHTN-12-2021-0095 .

Sallam M. ChatGPT utility in healthcare education, research, and practice: systematic review on the promising perspectives and valid concerns. Healthc. 2023;11(6):887. https://doi.org/10.3390/healthcare11060887 .

Buchholz BA, DeHart J, Moorman G. Digital citizenship during a global pandemic: moving beyond digital literacy. J Adolesc Adult Lit. 2020;64(1):11–7. https://doi.org/10.1002/jaal.1076 .

Kuatbekov A, Vershitskaya E, Kosareva I, Ananishnev V. E-learning as a basis for the development of media competences in students. J Inform Sci. 2023;49(4):1111–25.

Morgan A, Sibson R, Jackson D. Digital demand and digital deficit: conceptualising digital literacy and gauging proficiency among higher education students. J High Educ Policy Manag. 2022;44(3):258–75. https://doi.org/10.1080/1360080X.2022.2030275 .

van Laar E, van Deursen AJ, van Dijk JA. Developing policy aimed at 21st-century digital skills for the creative industries: an interview study with founders and managing directors. J Educ Work. 2022;35(2):195–209. https://doi.org/10.1080/13639080.2022.2036710 .

Eager B, Brunton R. Prompting higher education towards AI-augmented teaching and learning practice. J Univ Teach Learn Pract. 2023;20(5):02. https://doi.org/10.53761/1.20.5.02 .

Kasneci E, Seßler K, Küchemann S, Bannert M, Dementieva D, Fischer F, Kasneci G. ChatGPT for good? On opportunities and challenges of large language models for education. Learn Indiv Differ. 2023;103:102274. https://doi.org/10.1016/j.lindif.2023.102274 .

He N, Yan Y, Wu Z, Cheng Y, Liu F, Li X, Zhai S. ChatGPT-4 significantly surpasses GPT-3.5 in drug information queries. J Telemed Telecare. 2023;2023:1–3. https://doi.org/10.1177/1357633X231181922 .

Javaid M, Haleem A, Singh RP. ChatGPT for healthcare services: an emerging stage for an innovative perspective. BenchCouncil Trans Benchmarks Stand Eval. 2023;3(1):100105. https://doi.org/10.1016/j.tbench.2023.100105 .

Haleem A, Javaid M, Singh RP. An era of ChatGPT as a significant futuristic support tool: a study on features, abilities, and challenges. BenchCouncil Trans Benchmarks Stand Eval. 2022;2(4):100089.  https://doi.org/10.1016/j.tbench.2023.100089

Fuchs K. Exploring the opportunities and challenges of NLP models in higher education: is ChatGPT a blessing or a curse? Front Educ. 2023;8:8. https://doi.org/10.3389/feduc.2023.1166682 .

Jiang F, Jiang Y, Zhi H, Dong Y, Li H, Ma S, Wang Y. Artificial intelligence in healthcare: past, present and future. Stroke Vasc Neurol. 2017;2(4):e000101. https://doi.org/10.1136/svn-2017-000101 .

Tekkeşin Aİ. Artificial intelligence in healthcare. Anatol J Cardiol. 2019;22(1):8–9. https://doi.org/10.14744/AnatolJCardiol.2019.28 .

Jimma BL. Artificial intelligence in healthcare: a bibliometric analysis. Telemat Inform Rep. 2023:100041.‏ https://doi.org/10.1016/j.teler.2023.10004 .

Yu KH, Beam AL, Kohane IS. Artificial intelligence in healthcare. Nat Biomed Eng. 2018;2(10):719–31.

Rong G, Mendez A, Assi EB, Zhao B, Sawan M. Artificial intelligence in healthcare: review and prediction case studies. Engineering. 2020;6(3):291–301. https://doi.org/10.1016/j.eng.2019.08.015 .

Sqalli MT, Al-Thani D. AI-supported health coaching model for patients with chronic diseases. In: 2019 16th International Symposium on Wireless Communication Systems (ISWCS). IEEE; 2019. p. 452–456. https://doi.org/10.1109/ISWCS.2019.8877113 .

Matheny ME, Whicher D, Thadaney Israni S. Artificial intelligence in health care: a report from the national academy of medicine. JAMA. 2020;323(6):509–10. https://doi.org/10.1001/jama.2019.21579 .

York TJ, Raj S, Ashdown T, Jones G. Clinician and computer: a study on doctors’ perceptions of artificial intelligence in skeletal radiography. BMC Med Educ. 2023;23(1):1–10. https://doi.org/10.1186/s12909-022-03976-6 .

Eysenbach G. The role of ChatGPT, generative language models, and artificial intelligence in medical education: a conversation with ChatGPT and a call for papers. JMIR Med Educ. 2023;9:e46885. https://doi.org/10.2196/46885

Han Z, Battaglia F, Udaiyar A, Fooks A, Terlecky SR. An explorative assessment of ChatGPT as an aid in medical education: use it with caution. medRxiv. 2023.‏ https://doi.org/10.1101/2023.02.13.23285879 .

Das D, Kumar N, Longjam LA, Sinha R, Roy AD, Mondal H, Gupta P. Assessing the capability of ChatGPT in answering first-and second-order knowledge questions on microbiology as per competency-based medical education curriculum. Cureus. 2023;15(3):e36034. https://doi.org/10.7759/cureus.36034 .

Thurzo A, Strunga M, Urban R, Surovková J, Afrashtehfar KI. Impact of artificial intelligence on dental education: a review and guide for curriculum update. Educ Sci. 2023;13:150. https://doi.org/10.3390/educsci13020150 .

Veikkolainen P, Tuovinen T, Jarva E, Tuomikoski AM, Männistö M, Pääkkönen J, et al. eHealth competence building for future doctors and nurses–attitudes and capabilities. Int J Med Inform. 2023;169:104912. https://doi.org/10.1016/j.ijmedinf.2022.104912 .

Baro EE, Obaro OG, Aduba ED. An assessment of digital literacy skills and knowledge-based competencies among librarians working in university libraries in Africa. Digit Libr Perspect. 2019;35(3/4):172–92. https://doi.org/10.1108/DLP-04-2019-0013 .

Falloon G. From digital literacy to digital competence: the teacher digital competency (TDC) framework. Educ Tech Res Dev. 2020;68:2449–72. https://doi.org/10.1007/s11423-020-09767-4 .

Polizzi G. Digital literacy and the national curriculum for England: learning from how the experts engage with and evaluate online content. Comput Educ. 2020;152:103859.  https://doi.org/10.1016/j.compedu.2020.103859

Tynes BM, Stewart A, Hamilton M, Willis HA. From google searches to russian disinformation: adolescent critical race digital literacy needs and skills. Int J Multicult Educ. 2021;23(1):110–30. https://doi.org/10.18251/ijme.v23i1.2463 .

Ahmed ST, Roche T. Making the connection: examining the relationship between undergraduate students’ digital literacy and academic success in an English medium instruction (EMI) university. Educ Info Technol. 2021;26(4):4601–20. https://doi.org/10.1007/s10639-021-10443-0 .

Musi E, Aloumpi M, Carmi E, Yates S, O'Halloran K. Developing fake news immunity: fallacies as misinformation triggers during the pandemic. Online J Commun Media Technol. 2022;12(3). https://doi.org/10.30935/ojcmt%2F12083 .

Pangrazio L, Sefton-Green J. The social utility of ‘data literacy.’ Learn Media Technol. 2020;45(2):208–20. https://doi.org/10.1080/17439884.2020.1707223 .

Mehoudar O. Health literacy, and eHealth literacy: access to health information as a key to equal opportunity in society. Kidum Briut Isr. 2014;5:25–34 (Hebrew).

Google Scholar  

Alt D, Naamati-Schneider L, Meirovich A. Future problem-solving practiced during COVID-19: implications for health management students’ e-health literacy identity. Front Psychol. 2022;13:829243. https://doi.org/10.3389/fpsyg.2022.829243 .

Kaper MS, Reijneveld SA, van Es FD, de Zeeuw J, Almansa J, Koot J, de Winter AF. Effectiveness of a comprehensive health literacy consultation skills training for undergraduate medical students: a randomized controlled trial. Int J Environ Res Public Health. 2019;17(1):81. https://doi.org/10.3390/ijerph17010081 .

Nguyen HT, Do BN, Pham KM, Kim GB, Dam H, Nguyen TT, Nguyen T, Nguyen YH, Sørensen K, Pleasant A, Duong TV. Fear of COVID-19 scale-associations of its scores with health literacy and health-related behaviors among medical students. Int J Environ Res Public Health. 2020;17(11):4164. https://doi.org/10.3390/ijerph17114164 .

TerKonda SP, Fish EM. Artificial intelligence viewed through the lens of state regulation. Intell Based Med. 2023:100088. https://doi.org/10.1016/j.ibmed.2023.100088 .

Yin RK. Case study research design and methods. 5th ed. California: Sage; 2014.

Creswell JW. Educational research: planning, conducting, and evaluating quantitative and qualitative research. 4th ed. Nebraska-Lincoln: Merrill; 2012.

Tripto J, Ben-Zvi Assaraf O, Snapir Z, Amit M. The ‘What is a system’ reflection interview as a knowledge integration activity for high school students’ understanding of complex systems in human biology. Int J Sci Educ. 2016;38(4):564–95. https://doi.org/10.1080/09500693.2016.1150620 .

Zohar A, Barzilai S. A review of research on metacognition in science education: current and future directions. Stud Sci Educ. 2013;49:121–69. https://doi.org/10.1080/03057267.2013.84726 .

Minichiello A, Hood JR, Harkness DS. Bringing user experience design to bear on STEM education: a narrative literature review. J STEM Educ Res. 2018;1:7–33. https://doi.org/10.1007/s41979-018-0005-3 .

Mohamad-Hani T, Aljamaan F, Malki KH, Alhasan K, Altamimi I, Aljarbou R, Al-Eyadhy A. ChatGPT and the future of digital health: a study on healthcare workers’ perceptions and expectations. Healthcare. 2023;11(13):1812. https://doi.org/10.3390/healthcare11131812 .

Alt D, Raichel N. Enhancing perceived digital literacy skills and creative self-concept through gamified learning environments: insights from a longitudinal study. Int J Educ Res. 2020;101:101561. https://doi.org/10.1016/j.ijer.2020.101561 .

UNESCO. Digital skills critical for job and social inclusion. 2018. Retrieved from https://en.unesco.org/news/digital-skills-critical-jobs-and-social-inclusion .

Kreinsen M, Schulz S. Towards the triad of digital literacy, data literacy, and AI literacy in teacher education: a discussion in light of the accessibility of novel generative AI. A position paper. 2023. https://doi.org/10.1177/0163443710393382 .

Olmos-Vega FM, Stalmeijer RE, Varpio L, Kahlke R. A practical guide to reflexivity in qualitative research: AMEE Guide No. 149. Med Teach. 2023;45(3):241–51.

Download references

Acknowledgements

Conflict of interest.

The author confirms that there are no known conflicts of interest associated with this publication, and there has been no financial support for this work that could have influenced its outcome.

Author information

Authors and affiliations.

Health Systems Management Department, Hadassah Academic College, Jerusalem, Israel

Lior Naamati-Schneider

You can also search for this author in PubMed   Google Scholar

Contributions

L.N.S.: Conceptualization, data curation, methodology, writing- original draft preparation writing- reviewing and editing. The author read and approved the final manuscript.

Corresponding author

Correspondence to Lior Naamati-Schneider .

Ethics declarations

Ethics approval and consent to participate.

Informed consent was obtained from all participants involved in the study. The research was approved by the Hadassah Academic College’s Ethics Committee.

Consent for publication

Competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Naamati-Schneider, L. Enhancing AI competence in health management: students’ experiences with ChatGPT as a learning Tool. BMC Med Educ 24 , 598 (2024). https://doi.org/10.1186/s12909-024-05595-9

Download citation

Received : 23 February 2024

Accepted : 23 May 2024

Published : 30 May 2024

DOI : https://doi.org/10.1186/s12909-024-05595-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• AI digital literacy
• ChatGPT in education
• Healthcare management education

BMC Medical Education

ISSN: 1472-6920

• Submission enquiries: [email protected]
• General enquiries: [email protected]

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Int J Environ Res Public Health

Digital Transformation in Healthcare: Technology Acceptance and Its Applications

Angelos i. stoumpos.

1 Healthcare Management Postgraduate Program, Open University Cyprus, P.O. Box 12794, Nicosia 2252, Cyprus

Fotis Kitsios

2 Department of Applied Informatics, University of Macedonia, 156 Egnatia Street, GR54636 Thessaloniki, Greece

Michael A. Talias

Associated data.

Not applicable.

Technological innovation has become an integral aspect of our daily life, such as wearable and information technology, virtual reality and the Internet of Things which have contributed to transforming healthcare business and operations. Patients will now have a broader range and more mindful healthcare choices and experience a new era of healthcare with a patient-centric culture. Digital transformation determines personal and institutional health care. This paper aims to analyse the changes taking place in the field of healthcare due to digital transformation. For this purpose, a systematic bibliographic review is performed, utilising Scopus, Science Direct and PubMed databases from 2008 to 2021. Our methodology is based on the approach by Wester and Watson, which classify the related articles based on a concept-centric method and an ad hoc classification system which identify the categories used to describe areas of literature. The search was made during August 2022 and identified 5847 papers, of which 321 fulfilled the inclusion criteria for further process. Finally, by removing and adding additional studies, we ended with 287 articles grouped into five themes: information technology in health, the educational impact of e-health, the acceptance of e-health, telemedicine and security issues.

1. Introduction

Digital transformation refers to the digital technology changes used to benefit society and the healthcare industry. Healthcare systems need to use digital technology for innovative solutions to improve healthcare delivery and to achieve improvement in medical problems. The digital transformation of healthcare includes changes related to the internet, digital technologies, and their relation to new therapies and best practices for better health management procedures. The quality control of massive data collected can help improve patients’ well-being and reduce the cost of services. Digital technologies will also impact medical education, and experts will deceive new ways to train people. Now in this way, practitioners will face new opportunities.

Digital transformation is an ongoing process that can create opportunities in the health sector, provided the necessary infrastructure and training are available. Under Regulation (EU) 2021/694 of the European Parliament and of the Council of 29 April 2021, establishing the Digital Europe Program and repealing Decision (EU) 2015/2240, digital transformation is defined as the use of digital technologies for the transformation of businesses and services. Some technologies that contribute to digital transformation are the digital platform of the Internet of Things, cloud computing and artificial intelligence. At the same time, the sectors of society that are almost affected are telecommunications, financial services and healthcare.

Digital health can play a role in innovation in health, as it facilitates the participation of patients in the process of providing health care [ 1 ]. The patient can overcome his poor state of health when they are no longer in a state of well-being. In this case, the patient is given the to participate in the decision-making regarding their health care. Searching for information through the patient’s internet or using digital health applications (e.g., via mobile phone) is essential for the patient to make the right decision about their health.

In the coming years, health change is expected to focus primarily on the patient, who will take on the “health service consumer” role as the patient seeks control over their health management. The healthcare industry will be shaped based on the needs and expectations of this new “consumer of health services”, which will require upgraded experiences with the main characteristics of personalisation, comfort, speed and immediacy in the provision of services. Gjellebaek C. et al. argue that new digital technologies will shift healthcare towards digitalisation, bringing significant benefits to patients and healthcare infrastructure [ 2 ]. Some of the benefits listed by Gjellebaek C. are the increase in employee productivity, the improvement of the efficiency and effectiveness of the operation of the health units, and the reduction of their operating costs.

On the other hand, in terms of health infrastructure, a typical example is the United States, where 75% of hospitals use electronic health record systems, according to Rebekah E. et al. [ 3 ]. However, clinicians often report side effects using digital technologies, which can be attributed to their misuse [ 3 ]. In addition, some health professionals oppose using these systems and develop solutions that jeopardise patient care. In some countries, such as the United States, the government provides incentives for the “effective use” of e-health technologies, but their results remain uncertain [ 3 ].

Rebekah E. et al. focus more specifically on U.S. hospitals, observing that the remaining countries are relatively in the early stages of transformation [ 4 ]. The United Kingdom, for example, has recently pursued troubled e-health initiatives, and Australian hospitals have only recently participated in investments in the digitalisation of their hospital services [ 4 ]. At the European Union level, digital health is a critical key strategic priority, in line with the European Strategic Plan 2019–2024 (European Commission).

Today, digital transformation in health is spreading and consolidating rapidly [ 5 ]. The purpose of this paper is to provide an assessment of the current literature on digital health transformation, as well as to identify potential vulnerabilities that make its implementation impossible. The ultimate goal is to see how digital technologies facilitate patients’ participation in health and their health.

Due to the rapid development of e-health and digitalisation, data from previous studies are becoming potentially irrelevant. Most studies evaluating digitalisation have relied heavily on quantitative research-based methods. Although quantitative evaluations are required, some of their effects could be omitted.

According to Gopal G. et al., healthcare has the lowest level of digital innovation compared to other industries, such as media, finance, insurance and retail, contributing to limited labour productivity growth [ 6 ]. With this article, we seek to reverse this picture and contribute to the emergence of digitalisation as a factor of health innovation while optimising patient outcomes and the cost of services provided. However, to achieve this innovation, systemic changes are needed in healthcare finances, the education of healthcare staff and healthcare infrastructure.

The following section analyses the methodology and its steps, which then contributed to the emergence of our results.

2. Material and Methods

2.1. search strategy and bibliography reviews.

Our research approach is based on the methodology of Webster and Watson, who developed a concept-centric method and an ad hoc classification system in which categories are used to describe areas of literature [ 7 ]. Initially, the existing bibliographic reviews were searched to select the databases based on keywords. A retrospective search was then performed to examine the reports of the selected works. Finally, the references of selected works were investigated to increase the search sample through the future search. After selecting the articles, they were grouped according to their content.

Systematic reviews were conducted to place this paper on existing knowledge of digital health, as well as to review prior knowledge in this area and to discuss recognised research questions based on the results of previous studies. A comprehensive review of the published literature was reported by Marques, I. C., & Ferreira, J. J. [ 8 ]. The authors explored the potential of existing digital solutions to improve healthcare quality and analysed the emerging trend in digital medicine to evaluate the research question of how stakeholders apply and manage digital technologies for business purposes [ 9 ]. The main question is: How and what could be done sustainably and inclusively through innovation to achieve sustainable development goals by taking advantage of Information and Communication Technologies? Recently, researchers have expressed concern about secure communication and user authentication within providing information to patients. In contrast with data storage, information exchange, and system integration, new approaches and uses of patient care processes are envisaged with the prospect of monitoring not only diagnostic statistics but also in-depth analysis of signs and symptoms before and after treatment, essential sources for new research. Table 1 presents the previous bibliographic reviews on which our study was based.

Previous Bibliographic Reviews.

2.2. Network Analysis

Network analysis is considered a branch of graph theory. Our network analysis is based on the similarity of keywords found in identifying the eligible papers. We used visualisation of similarities (VOS) software, version 1.6.18, to construct graphical networks to understand the clustering of the keywords and their degree of dissimilarity. Our network analysis is based on the similarity of keywords found in identifying the eligible papers.

Initial Search

The search was performed on the following databases: Scopus, Science Direct, and PubMed, using the keywords “digital transformation”, “digitalisation”, “Ehealth or e-health”, “mhealth or m-health”, “healthcare” and “health economics”. We selected publications from the search of international journals and conference proceedings. We collected papers from 2008 until 2021. The documents sought belonged to strategy, management, computer science, medicine, and health professions. Finally, the published works were in English only. The total number of articles collected using the keywords as shown in Table 2 was 5847.

Search Strategy.

We systematically checked the total number of papers 5847 by reading their titles, abstracts, and, whenever necessary, the article’s first page to conclude if each document was relevant as a first step as shown in the Figure 1 .

The diagram for the first phase of the selection process.

Then, we looked at the titles of the 378 articles, and after reading their summary, we accepted 321 articles. Further studies were rejected because their full text was not accessible. As a result, there were 255 articles in our last search. Of the selected 255 articles, 32 more were added based on backward and forward research. The investigation was completed by collecting common standards from all databases using different keyword combinations. According to the systematic literature review, we follow the standards of Webster and Watson (2002) to reject an article. Since then, we have collected the critical mass of the relevant publications, as shown in Figure 2 .

The diagram of the article selection process.

3.1. Chronological Development of the Publications

The categorisation of the articles was based on their content and the concepts discussed within them. As a result, we classify articles into the following categories: information technology in health, the educational impact on e-health, the acceptance of e-health, telemedicine, and e-health security.

Although researchers in Information and Communication Technology and digitalisation conducted studies almost two decades ago, most publications have been published in the last eight years. This exciting finding highlights the importance of this field and its continuous development. Figure 3 shows a clear upward trend in recent years. More specifically, the research field of Information and Communication Technology, in combination with digital transformation, appeared in 2008. However, the most significant number of articles was found in 2019, 2020 and 2021. The number of articles decreased to the lowest in 2009–2011 and 2013–2014. Due to the expansion of the field to new technologies, the researchers studied whether the existing technological solutions are sufficient for implementing digital transformation and what problems they may face.

Number of articles and citations per publication by year.

Figure 3 shows a combination of the articles per year and the number of citations per publication per year.

3.2. Document Type

Of the document types, 59.51 per cent of the articles were categorised as “survey”, while a smaller percentage were in: “case study” (32.53%), “literature review” (5.88%) and “report” (2.08%). However, these documents focused on specific concepts: “information technology in health” (45%), “education impact of e-health” (11%), “acceptance of e-health” (19%), “telemedicine” (7%), “security of e-health” (18%).

As we can see from the following Figure 4 , we used network analysis, where the keywords related to digitalisation and digital transformation were identified in the research study. Network analysis, using keywords, came with VOSviewer software to find more breadth and information on healthcare digitalisation and transformation exploration. It was created by analysing the coexistence of keywords author and index. This analysis’s importance lies in the structure of the specific research field is highlighted. In addition, it helped map the intellectual structure of scientific literature. Keywords were obtained from the title and summary of a document. However, there was a limit to the number of individual words. The figure represents a grid focused on reproducing keywords in the literature on the general dimensions of digitalisation. The digitalisation network analysis showed that e-health, telemedicine, telehealth, mobile health, electronic health/medical record, and information systems were the main relevant backgrounds in the literature we perceived. In the healthcare literature, keywords such as “empowerment” and “multicenter study” usually do not lead to a bibliographic search on digitalisation. Figure 4 shows how e-health and telemedicine have gone beyond the essential and most crucial research framework on how they can affect hospitals and the health sector. The potentially small gaps in network analysis can be filled by utilising data in our research study, contributing to future research.

Bibliometric map of the digital transformation and healthcare.

Figure 5 shows the network analysis with the keywords concerning time publication. The yellow colour indicates keywords for most recent years.

Network visualisation of keywords per year.

Figure 6 presents the density visualisation of keywords.

Heat map of keywords.

Figure 7 shows the number of articles per each method (survey, literature review etc.) for each year.

The map of number of articles per method for each year.

It is evident from Figure 7 that the most used method paper is the survey type and that in the year 2021, we have a high number of surveys compared to previous years.

3.3. Summary of the Included Articles

In Figure 2 , we have explained how we collected the critical mass of the 255 relevant publications. We added another 32 articles based on further research with the backward and research methods, which resulted in a total number of 287 articles.

Then, the articles were categorised according to their content. The concepts discussed in the papers are related to information technology in health, the educational impact of e-health, the acceptance of e-health, telemedicine, and e-health security. For this purpose, the following table was created, called the concept matrix table.

4. Concept Matrix

In this section, we provide the Concept matrix table. Academic resources are classified according to if each article belongs or not to any of the five concepts shown in Table 3 .

Concept Matrix Table.

5. Analysis of Concepts

From the articles included in the present study between 2008 and 2021, they were grouped into five categories identified: (i) information technology in health, (ii) acceptance of e-health, (iii) telemedicine, (iv) security of e-health, and (v) education impact of e-health.

5.1. Information Technology in Health

Researchers have studied several factors to maximise the effectiveness and success of adopting new technology to benefit patients. Hospitals can benefit from information technology when designing or modifying new service procedures. Health units can use information and communication technology applications to analyse and identify patients’ needs and preferences, enhancing their service innovation processes. Previous findings conclude that technological capability positively influences patient service and innovation in the service process [ 301 ]. These results have significant management implications as managers seek to increase technology resources’ efficiency to achieve patient-centred care as the cornerstone of medical practice [ 207 ].

Informatics facilitates the exchange of knowledge necessary for creating ideas and the development process. The internet supports health organisations in developing and distributing their services more efficiently [ 206 ]. Also, Information Technology improves the quality of services, reduces costs, and helps increase patient satisfaction. As new technologies have created opportunities for companies developing high-tech services, healthcare units can increase customer value, personalise services and adapt to their patient’s needs [ 209 ]. To this end, the “smart hospitals” should represent the latest investment frontiers impacting healthcare. Their technological characteristics are so advanced that the public authorities need know-how for their conception, construction, and operation [ 228 ].

A new example is reshaping global healthcare services in their infancy, emphasising the transition from sporadic acute healthcare to continuous and comprehensive healthcare. This approach is further refined by “anytime and everywhere access to safe eHealth services.” Recent developments in eHealth, digital transformation and remote data interchange, mobile communication, and medical technology are driving this new paradigm. Follow-up and timely intervention, comprehensive care, self-care, and social support are four added features in providing health care anywhere and anytime [ 289 ]. However, the healthcare sector’s already precarious security and privacy conditions are expected to be exacerbated in this new example due to the much greater monitoring, collection, storage, exchange, and retrieval of patient information and the cooperation required between different users, institutions, and systems.

The use of mobile telephony technologies to support health goals contributes to the transformation of healthcare benefits worldwide. The same goes for small and medium-sized healthcare companies, such as pharmacies. A potent combination of factors between companies and customers is the reason for creating new relationships. In particular, mobile technology applications represent new opportunities for integrating mobile health into existing services, facilitating the continued growth of quality service management. Service-based, service-focused strategies have changed distribution patterns and the relationship between resellers and consumers in the healthcare industry, resulting in mobile health and significant pharmacy opportunities. It has been an important research topic in the last decade because it has influenced and changed traditional communication between professionals and patients [ 211 ]. An example of a mobile healthcare platform is “Thymun”, designed and developed by Salamah et al. aiming to create intelligent health communities to improve the health and well-being of autoimmune people in Indonesia [ 225 ].

5.2. Acceptance of E-Health

In a long-term project and a population study (1999–2002), Hsu et al. evaluated e-health usage patterns [ 302 ]. The authors conclude that access to and use of e-health services are rapidly increasing. These services are more significant in people with more medical needs. Fang (2015) shows that scientific techniques can be an essential tool for revealing patterns in medical research that could not be apparent with traditional methods of reviewing the medical literature [ 303 ]. Teleradiology and telediagnosis, electronic health records, and Computer-Aided Diagnosis (CAD) are examples of digital medical technology. France is an example of a country that invests and leads in electronic health records, based on what is written by Manard S. et al. [ 243 ]. However, the impact of technological innovation is reflected in the availability of equipment and new technical services in different or specialised healthcare sectors.

On the other hand, Mariusz Duplaga (2013) argues that the expansion of e-health solutions is related to the growing demand for flexible, integrated and cost-effective models of chronic care [ 304 ]. The scope of applications that can support patients with chronic diseases is broad. In addition to accessing educational resources, patients with chronic diseases can use various electronic diaries and systems for long-term disease monitoring. Depending on the disease and the symptoms, the devices used to assess the patient’s condition vary. However, the need to report symptoms and measurements remains the same. According to Duplaga, the success of treatments depends on the patient’s involvement in monitoring and managing the disease. The emphasis on the role of the patient is parallel to the general tendency of people and patients to participate in decisions made about their health. Involving patients in monitoring their symptoms leads to improved awareness and ability to manage diseases. Duplaga argues that the widespread use of e-health systems depends on several factors, including the acceptance and ability to use information technology tools, combined with an understanding of disease and treatment.

Sumedha Chauhan & Mahadeo Jaiswal (2017) are on the same wavelength. They claim that e-health applications provide tools, processes and communication systems to support e-health practices [ 305 ]. These applications enable the transmission and management of information related to health care and thus contribute to improving patient’s health and physicians’ performance. The human element plays a critical role in the use of e-health, according to the authors. In addition, researchers have studied the acceptance of e-health applications among patients and the general public, as they use services such as home care and search for information online. The meta-analysis they use combines and analyzes quantitative findings of multiple empirical studies providing essential knowledge. However, the reason for their research was the study of Holden and Karsh (2010) [ 306 ].

To provide a comprehensive view of the literature acceptance of e-health applications, Holden and Karsh reviewed 16 studies based on healthcare technology acceptance models [ 306 ]. Findings show them that the use and acceptance of technological medical solutions bring improvements but can be adopted by those involved in the medical field.

5.3. Telemedicine

On the other hand, telemedicine is considered one of the most important innovations in health services, not only from a technological but also from a cultural and social point of view. It benefits the accessibility of healthcare services and organisational efficiency [ 215 ]. Its role is to meet the challenges posed by the socio-economic change in the 21st century (higher demands for health care, ageing population, increased mobility of citizens, need to manage large volumes of information, global competitiveness, and improved health care provision) in an environment with limited budgets and costs. Nevertheless, there are significant obstacles to its standardisation and complete consolidation and expansion [ 300 ].

At present, there are Telemedicine centres that mediate between the patient and the hospital or doctor. However, many factors make this communication impossible [ 300 ]. Such factors include equipment costs, connectivity problems, the patient’s trust or belief in the system or centre that applies telemedicine, and resistance to new and modern diagnostics, especially in rural and island areas. Therefore, telemedicine would make it easier to provide healthcare systems in remote areas than having a specialist in all the country’s remote regions [ 300 ]. Analysing the concept further, one can easily argue that the pros outweigh the disadvantages. Therefore, telemedicine must be adopted in a concerted effort to resolve all the obstacles we are currently facing. Telemedicine centres and services such as teleradiology, teledermatology, teleneurology, and telemonitoring will soon be included. This means that a few years from now, the patient will not have to go to a central hospital and can benefit remotely from the increased quality of health services. This will save valuable time, make good use of available resources, save patient costs, and adequately develop existing and new infrastructure.

In 2007, the World Health Organisation adopted the following broad description of telemedicine: “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities ” [ 307 ]

According to the Wayback Machine, Canadian Telehealth Forum, other terms similar to telemedicine are telehealth and e-health, which are used as broader concepts of remote medical therapy. It is appropriate to clarify that telemedicine refers to providing clinical services. In contrast, telehealth refers to clinical and non-clinical services, including education, management and research in medical science. On the other hand, the term eHealth, most commonly used in the Americas and Europe, consists of telehealth and other elements of medicine that use information technology, according to the American Telemedicine Association [ 308 ].

The American Telemedicine Association divides telemedicine into three categories: storage-promotion, remote monitoring, and interactive services. The first category includes medical data, such as medical photographs, cardiograms, etc., which are transferred through new technologies to the specialist doctor to assess the patient’s condition and suggest the appropriate medication. Remote monitoring allows remote observation of the patient. This method is used mainly for chronic diseases like heart disease, asthma, diabetes, etc. Its interactive services enable direct communication between the patient and the treating doctor [ 309 ].

Telemedicine is a valuable and efficient tool for people living or working in remote areas. Its usefulness lies in the health access it provides to patients. In addition, it can be used as an educational tool for learning students and medical staff [ 310 ].

Telemedicine is an open and constantly evolving science, as it incorporates new technological developments and responds to and adapts to the necessary health changes within societies.

According to J.J. Moffatt, the most common obstacles to the spread of telemedicine are found in the high cost of equipment, the required technical training of staff and the estimated time of a meeting with the doctor, which can often be longer than the use of a standard doctor [ 311 ]. On the other hand, the World Health Organisation states that telemedicine offers excellent potential for reducing the variability of diagnoses and improving clinical management and the provision of health care services worldwide. The World Health Organisation claims, according to Craig et al. and Heinzelmann PJ, that telemedicine improves access, quality, efficiency and cost-effectiveness [ 312 , 313 ]. In particular, telemedicine can help traditionally under-served communities by overcoming barriers to the distance between healthcare providers and patients [ 314 ]. In addition, Jennett PA et al. highlight significant socio-economic benefits for patients, families, health professionals and the health system, including improved patient-provider communication and educational opportunities [ 315 ].

On the other hand, Wootton R. argues that telemedicine applications have achieved different levels of success. In both industrial and developing countries, telemedicine has yet to be used consistently in the healthcare system, and few pilot projects have been able to be maintained after the end of their initial funding [ 316 ].

However, many challenges are regularly mentioned and responsible for the need for more longevity in many efforts to adopt telemedicine. One such challenge is the complexity of human and cultural factors. Some patients and healthcare workers resist adopting healthcare models that differ from traditional approaches or home practices. In contrast, others need to have the appropriate educational background in Information and Communication Technologies to make effective use of telemedicine approaches [ 314 ]. The need for studies documenting telemedicine applications’ economic benefits and cost-effectiveness is also a challenge. Strong business acumen to persuade policymakers to embrace and invest in telemedicine has contributed to a need for more infrastructure and program funding [ 312 ]. Legal issues are also significant obstacles to the adoption of telemedicine. These include the need for an international legal framework that allows health professionals to provide services in different jurisdictions and countries. Furthermore, the lack of policies governing data confidentiality, authentication and the risk of medical liability for health professionals providing telemedicine services [ 314 ]. In any case, the technological challenges are related to legal issues. In addition, the systems used are complex, and there is a possibility of malfunction, which could cause software or hardware failure. The result is an increase in patient morbidity or mortality as well as the liability of healthcare providers [ 317 ].

According to Stanberry B., to overcome these challenges, telemedicine must be regulated by definitive and comprehensive guidelines, which are ideally and widely applied worldwide [ 318 ]. At the same time, legislation must be enacted governing health confidentiality, data access, and providers’ responsibility [ 314 ].

5.4. Security of eHealth

The possibility of the patients looking at the electronic patient folder in a cloud environment, through mobile devices anytime and anywhere, is significant. On the one hand, the advantages of cloud computing are essential, and on the other hand, a security mechanism is critical to ensure the confidentiality of this environment. Five methods are used to protect data in such environments: (1) users must encrypt the information before storing it; (2) users must transmit information through secure channels; (3) the user ID must be verified before accessing data; (4) the information is divided into small portions for handling and storage, retrieved when necessary; (5) digital signatures are added to verify that a suitable person has created the file to which a user has access. On the other hand, users of these environments will implement self-encryption to protect data and reduce over-reliance on providers [ 210 ].

At the same time, Maliha S. et al. [ 227 ] proposed the blockchain to preserve sensitive medical information. This technology ensures data integrity by maintaining a trace of control over each transaction. At the same time, zero trusts provide that medical data is encrypted and that only certified users and devices interact with the network. In this way, this model solves many vulnerabilities related to data security [ 227 ]. Another alternative approach is the KONFIDO project, which aims at the safe cross-border exchange of health data. A European H2020 project aims to address security issues through a holistic example at the system level. The project combines various cutting-edge technologies in its toolbox (such as blockchain, photonic Physical Unclonable Functions, homomorphic encryption, and trusted execution) [ 234 ]. Finally, Coppolino L. et al. [ 271 ] proposed using a SIEM framework for an e-healthcare portal developed under the Italian National eHealth Net Program. This framework allows real-time monitoring of access to the portal to identify potential threats and anomalies that could cause significant security issues [ 271 ].

5.5. Education Impact of E-Health

But all this would only be feasible with the necessary education of both users and patients [ 11 ]. As the volume and quality of evidence in medical education continue to expand, the need for evidence synthesis will increase [ 295 ]. On the other hand, Brockers C. et al. argued that digitalisation changes jobs and significantly impacts medical work. The quality of medical data provided for support depends on telemedicine’s medical specialisation and knowledge. Adjustments to primary and further education are inevitable because physicians are well trained to support their patients satisfactorily and confidently in the increasingly complex digitalisation of healthcare. The ultimate goal of the educational community is the closest approach of students to the issues of telemedicine and e-health, the creation of a spirit of trust, and the acceptance and transmission of essential knowledge [ 268 ].

Noor also moved in this direction, seeking to discover the gaps in Saudi education for digital transformation in health [ 248 ]. The growing complexity of healthcare systems worldwide and the growing reliance of the medical profession on information technology for precise practices and treatments require specific standardised training in Information Technology (IT) health planning. Accreditation of core Information Technology (IT) is advancing internationally. Noor A. examined the state of Information Technology health programmes in the Kingdom of Saudi Arabia (KSA) to determine (1) how well international standards are met and (2) what further development is required in the light of recent initiatives of the Kingdom of Saudi Arabia on e-health [ 248 ]. Of the 109 institutions that participated in his research, only a few offered programmes specifically in Health Information Technology. As part of Saudi Vision 2030, Saudi digital transformation was deemed an urgent need. This initiative calls for applying internationally accepted Information Technology skills in education programmes and healthcare practices, which can only happen through greater collaboration between medical and technology educators and strategic partnerships with companies, medical centres and government agencies.

Another study by Diviani N. et al. adds to the knowledge of e-health education, demonstrating how online health information affects a person’s overall behaviour and enhances patients’ ability to understand, live and prepare for various health challenges. The increasing digitalisation of communication and healthcare requires further research into the digital divide and patients’ relationships with health professionals. Healthcare professionals must recognise the online information they seek and engage with patients to evaluate online health information and support joint healthcare-making [ 235 ].

6. Discussion

The selected studies comprise a conceptual model based on bibliographic research. Using an open-ended technique, we analyse the selected 287 articles, which are grouped into categories based on their context. This methodology provides readers with a good indication of issues concerning the timeliness of health digitalisation. A limitation of the methodology is that selected criteria of the method might be subjective in terms of the search terms and how the papers are selected. The articles indicate that this field is initial, and further research is needed. Although several articles have created a theoretical basis for corporate sustainability and strategic digital management, only limited studies provided guidelines on the strategic digital transformation process and its health implementation stages. However, studies have also developed sustainable models, software or applications in this area. This is also the reason for creating opportunities for future researchers, who will be closed to investigate this gap and improve the viability of digital health strategies. In addition, any work carried out in case studies provides fruitful results by facilitating researchers through deep penetration into sustainable digitalisation. No generalised frameworks are available to guide the wording and implementation of digital action plans. Thus, the need for quantitative or qualitative research is created, providing conclusions on the impact of internal or external factors in the sustainability process, implementation, adoption, planning, and challenges of digital health solutions in general, as well as the impact of digital transformation. Most existing studies explore the issue of digitalisation in a particular part of a nursing institution or a disease rather than the management strategy perspective. In this way, researchers ignore a debate on obstacles and problems that often face in practice during integration. Such an analysis could lead to more profound knowledge.

7. Conclusions

In conclusion, our research observed a timeless analysis of systematised studies focusing on digital health developments. These studies broaden the researchers’ vision and provide vital information for further investigation. This article focuses on understanding digitalisation in healthcare, including, for the most part, the digitalisation of information and adopting appropriate parameters for further development. To build a more holistic view of digital health transformation, there is a great need for research on the management implications of digitalisation by different stakeholders. Finally, the development of telemedicine, the further enhancement of digital security and the strengthening of technological information systems will contribute to the universal acceptance of the digital health transformation by all involved.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualisation, A.I.S., F.K. and M.A.T.; methodology, F.K. and M.A.T.; software, A.I.S.; validation, A.I.S.; data curation, A.I.S.; writing—original draft preparation, A.I.S. and M.A.T.; writing—review and editing, A.I.S. and M.A.T.; visualisation, A.I.S.; supervision, M.A.T.; project administration, M.A.T. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

The authors declare no conflict of interest.

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Talk to our experts

1800-120-456-456

• Technology Essay

Essay on Technology

The word "technology" and its uses have immensely changed since the 20th century, and with time, it has continued to evolve ever since. We are living in a world driven by technology. The advancement of technology has played an important role in the development of human civilization, along with cultural changes. Technology provides innovative ways of doing work through various smart and innovative means. 

Electronic appliances, gadgets, faster modes of communication, and transport have added to the comfort factor in our lives. It has helped in improving the productivity of individuals and different business enterprises. Technology has brought a revolution in many operational fields. It has undoubtedly made a very important contribution to the progress that mankind has made over the years.

The Advancement of Technology:

Technology has reduced the effort and time and increased the efficiency of the production requirements in every field. It has made our lives easy, comfortable, healthy, and enjoyable. It has brought a revolution in transport and communication. The advancement of technology, along with science, has helped us to become self-reliant in all spheres of life. With the innovation of a particular technology, it becomes part of society and integral to human lives after a point in time.

Technology is Our Part of Life:

Technology has changed our day-to-day lives. Technology has brought the world closer and better connected. Those days have passed when only the rich could afford such luxuries. Because of the rise of globalisation and liberalisation, all luxuries are now within the reach of the average person. Today, an average middle-class family can afford a mobile phone, a television, a washing machine, a refrigerator, a computer, the Internet, etc. At the touch of a switch, a man can witness any event that is happening in far-off places.  

Benefits of Technology in All Fields: 

We cannot escape technology; it has improved the quality of life and brought about revolutions in various fields of modern-day society, be it communication, transportation, education, healthcare, and many more. Let us learn about it.

Technology in Communication:

With the advent of technology in communication, which includes telephones, fax machines, cellular phones, the Internet, multimedia, and email, communication has become much faster and easier. It has transformed and influenced relationships in many ways. We no longer need to rely on sending physical letters and waiting for several days for a response. Technology has made communication so simple that you can connect with anyone from anywhere by calling them via mobile phone or messaging them using different messaging apps that are easy to download.

Innovation in communication technology has had an immense influence on social life. Human socialising has become easier by using social networking sites, dating, and even matrimonial services available on mobile applications and websites.

Today, the Internet is used for shopping, paying utility bills, credit card bills, admission fees, e-commerce, and online banking. In the world of marketing, many companies are marketing and selling their products and creating brands over the internet. 

In the field of travel, cities, towns, states, and countries are using the web to post detailed tourist and event information. Travellers across the globe can easily find information on tourism, sightseeing, places to stay, weather, maps, timings for events, transportation schedules, and buy tickets to various tourist spots and destinations.

Technology in the Office or Workplace:

Technology has increased efficiency and flexibility in the workspace. Technology has made it easy to work remotely, which has increased the productivity of the employees. External and internal communication has become faster through emails and apps. Automation has saved time, and there is also a reduction in redundancy in tasks. Robots are now being used to manufacture products that consistently deliver the same product without defect until the robot itself fails. Artificial Intelligence and Machine Learning technology are innovations that are being deployed across industries to reap benefits.

Technology has wiped out the manual way of storing files. Now files are stored in the cloud, which can be accessed at any time and from anywhere. With technology, companies can make quick decisions, act faster towards solutions, and remain adaptable. Technology has optimised the usage of resources and connected businesses worldwide. For example, if the customer is based in America, he can have the services delivered from India. They can communicate with each other in an instant. Every company uses business technology like virtual meeting tools, corporate social networks, tablets, and smart customer relationship management applications that accelerate the fast movement of data and information.

Technology in Education:

Technology is making the education industry improve over time. With technology, students and parents have a variety of learning tools at their fingertips. Teachers can coordinate with classrooms across the world and share their ideas and resources online. Students can get immediate access to an abundance of good information on the Internet. Teachers and students can access plenty of resources available on the web and utilise them for their project work, research, etc. Online learning has changed our perception of education. 

The COVID-19 pandemic brought a paradigm shift using technology where school-going kids continued their studies from home and schools facilitated imparting education by their teachers online from home. Students have learned and used 21st-century skills and tools, like virtual classrooms, AR (Augmented Reality), robots, etc. All these have increased communication and collaboration significantly. 

Technology in Banking:

Technology and banking are now inseparable. Technology has boosted digital transformation in how the banking industry works and has vastly improved banking services for their customers across the globe.

Technology has made banking operations very sophisticated and has reduced errors to almost nil, which were somewhat prevalent with manual human activities. Banks are adopting Artificial Intelligence (AI) to increase their efficiency and profits. With the emergence of Internet banking, self-service tools have replaced the traditional methods of banking. 

You can now access your money, handle transactions like paying bills, money transfers, and online purchases from merchants, and monitor your bank statements anytime and from anywhere in the world. Technology has made banking more secure and safe. You do not need to carry cash in your pocket or wallet; the payments can be made digitally using e-wallets. Mobile banking, banking apps, and cybersecurity are changing the face of the banking industry.

Manufacturing and Production Industry Automation:

At present, manufacturing industries are using all the latest technologies, ranging from big data analytics to artificial intelligence. Big data, ARVR (Augmented Reality and Virtual Reality), and IoT (Internet of Things) are the biggest manufacturing industry players. Automation has increased the level of productivity in various fields. It has reduced labour costs, increased efficiency, and reduced the cost of production.

For example, 3D printing is used to design and develop prototypes in the automobile industry. Repetitive work is being done easily with the help of robots without any waste of time. This has also reduced the cost of the products. 

Technology in the Healthcare Industry:

Technological advancements in the healthcare industry have not only improved our personal quality of life and longevity; they have also improved the lives of many medical professionals and students who are training to become medical experts. It has allowed much faster access to the medical records of each patient. 

The Internet has drastically transformed patients' and doctors’ relationships. Everyone can stay up to date on the latest medical discoveries, share treatment information, and offer one another support when dealing with medical issues. Modern technology has allowed us to contact doctors from the comfort of our homes. There are many sites and apps through which we can contact doctors and get medical help. 

Breakthrough innovations in surgery, artificial organs, brain implants, and networked sensors are examples of transformative developments in the healthcare industry. Hospitals use different tools and applications to perform their administrative tasks, using digital marketing to promote their services.

Technology in Agriculture:

Today, farmers work very differently than they would have decades ago. Data analytics and robotics have built a productive food system. Digital innovations are being used for plant breeding and harvesting equipment. Software and mobile devices are helping farmers harvest better. With various data and information available to farmers, they can make better-informed decisions, for example, tracking the amount of carbon stored in soil and helping with climate change.

Disadvantages of Technology:

People have become dependent on various gadgets and machines, resulting in a lack of physical activity and tempting people to lead an increasingly sedentary lifestyle. Even though technology has increased the productivity of individuals, organisations, and the nation, it has not increased the efficiency of machines. Machines cannot plan and think beyond the instructions that are fed into their system. Technology alone is not enough for progress and prosperity. Management is required, and management is a human act. Technology is largely dependent on human intervention. 

Computers and smartphones have led to an increase in social isolation. Young children are spending more time surfing the internet, playing games, and ignoring their real lives. Usage of technology is also resulting in job losses and distracting students from learning. Technology has been a reason for the production of weapons of destruction.

Dependency on technology is also increasing privacy concerns and cyber crimes, giving way to hackers.

FAQs on Technology Essay

1. What is technology?

Technology refers to innovative ways of doing work through various smart means. The advancement of technology has played an important role in the development of human civilization. It has helped in improving the productivity of individuals and businesses.

2. How has technology changed the face of banking?

Technology has made banking operations very sophisticated. With the emergence of Internet banking, self-service tools have replaced the traditional methods of banking. You can now access your money, handle transactions, and monitor your bank statements anytime and from anywhere in the world. Technology has made banking more secure and safe.

3. How has technology brought a revolution in the medical field?

Patients and doctors keep each other up to date on the most recent medical discoveries, share treatment information, and offer each other support when dealing with medical issues. It has allowed much faster access to the medical records of each patient. Modern technology has allowed us to contact doctors from the comfort of our homes. There are many websites and mobile apps through which we can contact doctors and get medical help.

4. Are we dependent on technology?

Yes, today, we are becoming increasingly dependent on technology. Computers, smartphones, and modern technology have helped humanity achieve success and progress. However, in hindsight, people need to continuously build a healthy lifestyle, sorting out personal problems that arise due to technological advancements in different aspects of human life.

This paper is in the following e-collection/theme issue:

Published on 31.5.2024 in Vol 26 (2024)

Vulnerability to Cyberattacks and Sociotechnical Solutions for Health Care Systems: Systematic Review

Authors of this article:

• Pius Ewoh, MBA   ; 
• Tero Vartiainen, PhD  

School of Technology and Innovations, Information Systems Science, University of Vaasa, Vaasa, Finland

Corresponding Author:

Pius Ewoh, MBA

School of Technology and Innovations

Information Systems Science

University of Vaasa

Wolffintie 32

Vaasa, 65200

Phone: 358 414888477

Email: [email protected]

Background: Health care organizations worldwide are faced with an increasing number of cyberattacks and threats to their critical infrastructure. These cyberattacks cause significant data breaches in digital health information systems, which threaten patient safety and privacy.

Objective: From a sociotechnical perspective, this paper explores why digital health care systems are vulnerable to cyberattacks and provides sociotechnical solutions through a systematic literature review (SLR).

Methods: An SLR using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted by searching 6 databases (PubMed, Web of Science, ScienceDirect, Scopus, Institute of Electrical and Electronics Engineers, and Springer) and a journal ( Management Information Systems Quarterly ) for articles published between 2012 and 2022 and indexed using the following keywords: “(cybersecurity OR cybercrime OR ransomware) AND (healthcare) OR (cybersecurity in healthcare).” Reports, review articles, and industry white papers that focused on cybersecurity and health care challenges and solutions were included. Only articles published in English were selected for the review.

Results: In total, 5 themes were identified: human error, lack of investment, complex network-connected end-point devices, old legacy systems, and technology advancement (digitalization). We also found that knowledge applications for solving vulnerabilities in health care systems between 2012 to 2022 were inconsistent.

Conclusions: This SLR provides a clear understanding of why health care systems are vulnerable to cyberattacks and proposes interventions from a new sociotechnical perspective. These solutions can serve as a guide for health care organizations in their efforts to prevent breaches and address vulnerabilities. To bridge the gap, we recommend that health care organizations, in partnership with educational institutions, develop and implement a cybersecurity curriculum for health care and intelligence information sharing through collaborations; training; awareness campaigns; and knowledge application areas such as secure design processes, phase-out of legacy systems, and improved investment. Additional studies are needed to create a sociotechnical framework that will support cybersecurity in health care systems and connect technology, people, and processes in an integrated manner.

Introduction

Cybersecurity in health care systems entails the safeguarding of electronic information and assets against unauthorized access, use, and disclosure [ 1 ]. The main objective of cybersecurity in health care systems is to protect the privacy, integrity, and accessibility of health information to provide secure health care services. Despite the digital transformation in health care delivery, health care organizations are facing increasing challenges and crises, which include data breaches of patient health information and vulnerability in their critical infrastructure [ 2 ]. Research has highlighted that health care systems are becoming more vulnerable to cyberattacks as technology advances [ 3 ]. Furthermore, the internet and its diverse nature and connection to the delivery of telehealth and continuous health care services create multiple points of access for cyberattacks [ 4 , 5 ].

In high-income countries such as Finland, the United States, and the United Kingdom, integrated technology is used to monitor and manage health care systems. For instance, at least 10 to 15 medical devices are linked to each patient’s electronic bed in a public hospital [ 6 ]. These complexities increase the susceptibility of health care networks to cyberattacks [ 6 , 7 ]. Studies conducted through the simulation of medical devices have similarly revealed that pacemakers and pulse oximeters can be hacked and compromised without a physician’s knowledge [ 8 , 9 ]. Ransomware is another type of man-made malware that can disrupt health care systems by infecting computer systems, locking people out of their files, and then demanding a ransom payment in exchange for access to those files [ 10 , 11 ]. Cyberattackers can publish the exposed health information to the web or sell it on the dark web [ 12 ]. This type of attack can result in breaches of patient privacy, subjecting health care organizations to fines that are consistent with human health service regulations and European General Data Protection Regulation (GDPR) policies for data breaches. For example, research has shown that, between 2012 and 2022, more than US $128,244,290 million in fines were paid in the United States alone for violations of Health Insurance Portability and Accountability Act laws on data breaches against health care organizations [ 13 ]. Although these fines were derived from no less than 111 health care organizations, many organizations have failed to report breaches.

Cybersecurity education is seriously lacking [ 14 , 15 ]. Moreover, a critical problem with cybersecurity in health care systems is the lack of involvement or recruitment of people with expertise and training in cybersecurity [ 16 ], resulting in considerable neglect of the cybersecurity infrastructure [ 17 ]. A systematic literature review (SLR) revealed that, between 2018 and 2019, more than 24% of the data breaches in all industries happened within the health care context [ 18 , 19 ].

Between 2009 and 2021, the US Department of Health and Human Services office reported 4419 health care data breaches, resulting in >314 million health care records being lost, stolen, or exposed [ 20 ]. In 2015, an estimated 113.27 million records were stolen and exposed, and in 2021 alone, the US Department of Health and Human Services also reported at least 2 health care data leaks daily [ 13 ]. The statistics clearly show an upward trend in health care data breaches over the past 10 years [ 21 ]. When considering this trend on a global scale, the number of health information breaches could potentially reach into the billions of health records. Organizations such as Vaastimo Oy Finland; National Health Service trusts in the United Kingdom; Anthem, Inc; Premera Blue Cross; and Excellus Health Plan have been victims of these threats and breaches of health information. Breaches and vulnerabilities in health care delivery, human safety, and protection of sensitive information are deeply disconcerting. However, it can be argued that research solutions are fragmented and sparse. There is a gap in the knowledge areas of health care cybersecurity in the literature and in practice regarding the vulnerability of health care systems and the reasons for cyberattacks. The argument and motivation are that a holistic approach to security is needed because humans are the weakest link in the cyberattack chain [ 11 , 22 ].

Coventry and Branley [ 6 ] have highlighted the need for resilience and changes in their studies on human behavior, technology, and processes as part of a holistic solution to the problem of health care system vulnerability. The information, technology, processes, objectivity and values, skills and knowledge, management systems and structure, and other resources dimensions by Heeks [ 23 ] also point out that avoiding security design reality gaps requires approaching the security functionality of a health information system as a sociotechnical system and not as a technical system. Security by design, or secure design, is an approach to cybersecurity that enables organizations to automate their data security controls and formalize the design of their infrastructure so that they can build security into their IT management processes [ 24 , 25 ].

In this study, a sociotechnical approach is defined as the interaction between humans and technology with the aim of creating technically efficient organizational information systems and user satisfaction [ 26 ]. Furthermore, conceptualizations of this approach are concerned with 3 primary dimensions: the social environment, technical environment, and organizational environment [ 27 ]. Sociotechnical design is identified as an approach to connect the integration of systems while ensuring that the multifaceted challenges and complexities in smart health care are well managed [ 28 , 29 ]. Smart health care can be defined as care that is equipped with smart IT, such as Internet of Medical Things (IoMT) devices that have the capabilities to anticipate and diagnose patient diseases; respond to treatments; guide, manage, and improve user comfort; and provide security and entertainment via hospital management systems. According to Coiera [ 30 ], “if healthcare is to evolve at a pace that will meet the needs of society, it will need to embrace the science of sociotechnical design.” Therefore, the application of a sociotechnical perspective in health care cybersecurity in this study aimed at better understanding and mitigating the multifaceted challenges and poor uptake and performance of health care system security within health care organizations.

This existing gap in knowledge and practice was a major motivation for this SLR. It is necessary to connect the fragmented research and manage this knowledge gap regarding why health care systems are vulnerable to cyberattacks as the study by Coventry and Branley [ 6 ] did not address this aspect in detail. An SLR was conducted to develop proactive cybersecurity strategies to mitigate threats and vulnerabilities that result in health care data breaches by proposing sociotechnical solutions and recommendations. Furthermore, to link human behavior, technology, and processes as highlighted by Coventry and Branley [ 6 ] and supported by the narrative review by Mohan et al [ 31 ] for further research, these 3 core areas can be interpreted as a sociotechnical framework [ 27 ]. It is essential to mitigate the increase in breaches of health information and protect health care from cybercrime and cyberattacks on critical health care infrastructure. However, none of these studies have examined why health care systems are vulnerable to attack through a sociotechnical lens. On the basis of this knowledge gap identified in the literature, the following research questions (RQs) were raised: (1) Why are health care systems vulnerable to cyberattacks? (RQ 1) (2) How can health care systems be protected? (RQ 2).

The objective of this review was to explore from a sociotechnical approach why digital health care systems are vulnerable to cyberattacks, provide sociotechnical solutions, and identify the areas of health care systems that need further improvement.

Previous Literature Review

Regarding the existing literature on health care cybersecurity, our previous SLR identified the following review themes: (1) cybersecurity threats and trends: studies that provide solutions and insights into threats and trends have been conducted to address cybersecurity threats and trends in health care systems [ 2 , 6 , 11 , 17 , 32 , 33 ]; (2) cybersecurity vulnerability: some studies have also investigated the cybersecurity vulnerability of health care systems to provide solutions and future directions for health care services [ 22 , 34 - 36 ]; and (3) cybersecurity interceptions in health care: studies have also investigated cybersecurity interceptions with health care systems to protect the security posture of these systems [ 12 , 19 , 37 ]—Coventry and Branley [ 6 ] have highlighted the need for further studies on human behavior, technology, and processes to further investigate why health care systems are vulnerable and provide a holistic solution to this problem.

Therefore, there is a need for further studies to identify the reasons behind the increase in health information breaches in health care systems. This area of study through a sociotechnical lens is lacking. Accordingly, our SLR critically investigated why health care systems are vulnerable to cyberattacks and expanded this area of study from a sociotechnical point of view. This review is significant given the lack of SLRs on the areas linking human behavior, technology, and processes using a holistic approach from a sociotechnical viewpoint in this context and as the studies by Coventry and Branley [ 6 ] and Mohan et al [ 31 ] were based on narrative reviews.

Protocol and Registration

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct our SLR using the checklist guide [ 38 ] ( Multimedia Appendix 1 ). The aim of this review was to identify the reasons why health care systems are vulnerable to cyberattacks and provide sociotechnical solutions. In the planning stage of this review, a protocol for the sources of information, search strategies, study selection, criteria for eligibility, and data collection processes was created, and this review was not registered.

Eligibility Criteria

A paper was selected for inclusion if it was published in English and comprised a full-text version of the manuscript, review paper, conference proceeding paper, report, news article or website, or white paper published between 2012 and 2022. The introduction, abstract, results, and discussion sections of the paper were checked by the authors for conformity with the study objectives and critical appraisal using the checklist guidelines before inclusion. Research papers were excluded if they were not relevant to the research areas—cybersecurity, cybercrime, ransomware, and health care. These criteria are presented in Textbox 1 .

Inclusion criteria

• Study types: published peer-reviewed and original research papers (empirical and conceptual papers)
• Bibliometric study types: white papers and cybersecurity news reports in line with health care and cybersecurity
• Period: papers published between 2012 and 2022
• Language: English
• Subjects and domain: computer sciences, health care, and cybersecurity
• Requirements for paper inclusion: full-text papers.

Exclusion criteria

• Study types: unpublished work, editorial letters, textbooks, and research in progress
• Language: any other languages
• Subjects: studies outside the domain of cybersecurity and health care

Information Sources

To identify original research papers and review papers on cybersecurity in health care systems published between 2012 and 2022, a total of 6 databases (Web of Science, ScienceDirect, Scopus, PubMed, Springer, and the Institute of Electrical and Electronics Engineers) and a journal ( Management Information Systems Quarterly ) were searched. Furthermore, bibliometric records such as website reports, white paper reports, and magazine reports that supported cybersecurity in health care were also collected for the review. As a means of verifying the papers identified in our search, we searched Google Scholar using a search string.

Search Strategy

The following search string and keywords were used: (“cybersecurity” OR “cybercrime OR ransomware”) AND (“health care”) OR (“cybersecurity in healthcare”). Multimedia Appendix 2 provides more information.

Data Extraction

A total of 70 papers were extracted and recorded in a Microsoft Excel (Microsoft Corp) spreadsheet. The extracted data included information such as author or authors, year of publication, method, problem, and solution. The first author independently charted the data and updated the table to ensure the quality of the key findings drawn from the papers based on the recommendations of the second author. Critical appraisal was conducted to ensure the quality of evidence and the relevance of the articles. The data retrieved from the selected articles were analyzed.

Data Synthesis

The data from the literature were analyzed and synthesized using qualitative themes, which are presented in the following sections. The data were analyzed to identify the causes of vulnerabilities; solutions provided in the literature; and areas of classification based on sociotechnical, technical, and social perspectives in health care systems.

Selection of Sources of Evidence

A total of 1257 papers were retrieved for the screening exercises. To determine whether the papers met our inclusion criteria regarding the topic domain, we began by scanning the abstracts and titles. The papers were reviewed by reading the full texts and determining their eligibility. Duplicated papers as well as those nonrelevant to cybersecurity, cybercrime, ransomware, and health care research were excluded. Furthermore, some papers were excluded after reading them in full and discovering that they were papers on research in progress. Finally, 70 papers were included in the analysis based on the eligibility criteria. Figure 1 illustrates the selection process.

The results of the SLR show the reasons why health care systems are vulnerable to cyberattacks and health care breaches. These reasons are the 5 vulnerability themes ( Figure 2 and Table 1 ). Furthermore, the 5 vulnerability themes were classified into social, technical, and sociotechnical approaches.

a ECRI: Emergency Care Research Institute.

b PECB: Professional Evaluation and Certification Board.

The results also revealed that >24% of the data breaches from all industry clusters originated in the health care sector alone ( Table 1 ) [ 19 , 21 , 84 ]. Other studies highlighted that organizations tend to spend more money on procuring new technology while committing only ≤5% of their budgets to the security of their critical health care systems [ 17 , 35 ]. Cybercriminals exploit health care systems due to the lack of investment, technology advancement as a result of digitalization, human error due to a lack of awareness and training, and old legacy systems, which enable cybercriminals to access valuable health information and sell it on the dark web for money and other gains [ 12 ]. The results reported a significant increase in data breaches and cyberattacks, with complex systems, IoMT devices, technology advancement, and network-connected end-point devices in complex connected heterogeneous health care systems identified as the major contributing factors.

The studies also identified a shortage of cybersecurity skills to contain cyberattacks or threats to health care organizations and systems [ 16 ]. The studies revealed that approximately 60% to 70% of health care organizations have witnessed breaches of health information without disclosure [ 85 ].

Human Error

Human error is a significant factor in the event of a cyberattack [ 11 , 22 ]. This shortcoming is one of the most crucial issues in health care systems as most cybercriminals use methods such as phishing to execute attacks with just a deceitful email. This is a social problem that can be addressed from a social approach. For example, human error posed a risk to the Geneva University Hospitals [ 86 ]. Table 1 shows that 11% (8/70) of the studies acknowledged human error as the primary social reason for health care system vulnerability. Human error is attributed to a lack of skills and is a major trend in this ever-changing technological landscape, playing a role in several cybersecurity breaches [ 56 ]. From a technological point of view, a lack of expertise from humans and threats from human-related events are responsible for >70% of data fraud and breaches in business organizations (McCue, A, unpublished data, May 2008) [ 80 ] because of the value of health information on the dark web [ 6 ] and breaches in business organizations (McCue, A, unpublished data, May 2008) [ 80 ]. Furthermore, human-related threats have recently emerged as a growing concern.

Old Legacy Systems

Old legacy systems have been the basis of system development from the dawn of the medical device, operating system, and embedded mobile device era. Legacy operating systems such as Windows ME, Windows 2000, MS-DOS, UNIX, and firmware provide the foundation for system development. However, these systems pose a significant threat to health care sectors and organizations in our current era. Table 1 shows that 16% (11/70) of the studies acknowledged the vulnerability of health care systems to attacks due to old legacy systems. Such attacks occur from a sociotechnical approach, with cybercriminals exploiting humans and technology. Many data breaches, system incompatibilities, and security risks in health care systems and sectors are associated with legacy systems. Similarly, our SLR found that 85% of medical organizations use outdated operating systems or infrastructure [ 12 , 16 ]. Furthermore, Fu and Blum [ 50 ] raised concerns about organizations relying on unsupported software, alluding to medical devices that run on Windows XP operating systems with service packs but lack security updates. In addition, the case of the National Health Service 2017 WannaCry malware, which interrupted health care operations and shut down numerous hospitals by infecting thousands of computers, was caused by Windows XP software [ 87 ]. The authorities had been informed about the bugs but failed to act due to negligence. When a medical device is compromised, cybercriminals use it as a gateway to abuse hospitals, health care system networks, and health information or data. Perriello [ 88 ] and Meggitt [ 89 ] highlighted another issue, Medijack , referring to hackers hijacking medical devices to construct a back entrance into a hospital network. As a result, the use of a network of old legacy medical devices for administrative processes and care delivery increases the opportunities for an attacker or cybercriminal to easily intrude into hospital or health care organization networks and exploit and compromise the network of medical devices and health information. In this era of rapid medical technological advancement, health care systems also lack built-in security safeguards. Legacy systems do not support new technologies, and so the network of medical equipment in intensive care units, recovery rooms, operating rooms, and electronic health records (EHRs) will lack proper and secure communication and interoperability. Outdated legacy systems and unsupported operating systems are vulnerable to high-speed attacks. Furthermore, these problems are attributable to the lack of important updates to health care infrastructure. To support our point, health and human services should provide more guidance on applying the National Institute of Standards and Technology framework to the health care industry and consider appropriate incentives that would allow health care organizations to phase out old vulnerable legacy systems [ 16 ].

Lack of Investment

Investment in the health sector will yield better outcomes and quality health care delivery. According to our analysis and results, the health care sector suffers from underinvestment, and crucial infrastructure and training for health care cybersecurity are disregarded [ 6 ], which is one of the primary causes of the increase in sensitive health information breaches. Investment can be seen in social (human) and technical (technology) aspects. As shown in the analysis in Table 1 , a total of 21% (15/70) of the studies acknowledged the lack of investment and advised both directly and indirectly regarding the necessity of cybersecurity investment in the health care industry [ 55 , 56 ]. The analysis acknowledged and revealed that the health care sector lagged more than other sectors in terms of health information protection and breaches. Furthermore, the findings of our SLR revealed that 80% to 85% of worldwide breaches occur in the health sector [ 4 ], whereas 45% to 90% of health care organizations have witnessed one or more threats or breaches [ 18 , 57 ]. Investment in critical infrastructure for health care and best practices in cyber hygiene will aid in the protection of health care systems from potential vulnerabilities. Proper investment will ensure the safeguarding of personal information and render health care systems more resilient to cyberattacks.

Complex Network-Connected End-Point Devices

Medical end-point devices have long served as a hospital’s backbone for treatment, diagnosis, and precision-based technological applications to complement health care service operations and management. To fully exploit their potential, the medical device development pattern has shifted from traditional-based medical device system development to a network of wireless, connected end-point technological devices with built-in communications and remote connectivity. Complex network-connected end-point devices have increased the cyberattack surfaces in conjunction with their complexity and technological systems as heterogeneity in nature of medical technology has evolved. Complex network devices are classified as a technical challenge from the perspective of technical security system design. The analysis in Table 1 shows that 51% (36/70) of the studies acknowledged network-connected end-point medical devices as the most significant technical reason for health care systems’ vulnerability to cyberattacks. The operational modes continue to evolve with more interconnections between new applications and devices such as cloud-based applications, third-party software, IoMT devices, and system networks in health care environments. Lechner [ 68 ] revealed that original equipment manufacturers are now creating interconnected medical devices without incorporating proper cybersecurity features into the development life cycle of medical and end-point device systems. The vulnerability of the end point requires urgent attention; otherwise, cybercriminals will continue to use the weakness of connected devices to access personal health information. According to research and cybersecurity stakeholders, wearables, implanted devices, and sensors may become the new targets of future exploits [ 6 , 8 ]. As shown in Table 1 , complex network-connected end-point medical devices also require medical technology security by design [ 72 , 90 ] as a solution strategy to protect critical health care infrastructure from breaches. In the past, medical device system development has primarily focused on critical performance and safety. Furthermore, the security aspects of these medical devices are not a factor during the planning and development process. The process indicates that developing traditional or stand-alone systems of noninterconnected devices was a suitable method for designing the traditional approach. These are the current legacy systems that lack interoperability, updates, security design, or compatibility. Furthermore, connected medical devices such as sensor-controlled drug infusion pumps, cardiac pacemakers, pulse oximeters, and network-connected x-ray machine components such as picture archiving and communication systems are vulnerable to cybersecurity threats and attacks [ 5 ]. To continue solving cybersecurity issues in medical devices, developers and actors must recognize the importance of the health care environment’s complex operations. In addition, there should be incident reports, an audit trail in the device system database, and paper-based documentation of technical vulnerabilities [ 34 ]. Medical device manufacturers such as security experts or systems integrators must address this issue because, with a single cyber vulnerability, cybercriminals or hackers can exploit medical technology connected to the internet, compromising data integrity, wearable sensor readings, protected health information, patient safety, and care outcomes [ 2 , 50 ]. When cyberattackers manipulate systems or deposit a virus, this could cause medical device software or systems to malfunction, resulting in abnormal effects or different readings from the systems, such as implantable medical devices that take and display incorrect readings [ 5 , 8 ].

Technology Advancement (Digitalization)

Technology advancement has enabled unique access and benefits to revolutionize health care systems in terms of precision. Modern medical care now relies on health care delivery organizations, including hospitals and clinics, built on a backbone of connected computer-based infrastructure. Over the past 30 years, the expansive integration of new health care technology has changed the face of medicine [ 53 ]. However, the rapid digitalization in health care delivery, where medical devices are intertwined in a digital network setting and system to ensure the precision of health care delivery with the use of IoMT and digital devices, has created gateway access for cyberattacks, risks, and vulnerabilities [ 37 , 81 ]. Table 1 shows that 14% (10/70) of the studies acknowledged technology advancement due to digital transformation as the reason why health care systems are vulnerable to cyberattacks. This type of attack and vulnerability usually occur from the technical areas of cyberattacks, for example, a technology error such as glitches and design errors. One example of vulnerability is St. Joseph Hospital in California, where the health information of 31,800 patients was made public through a basic internet search engine for >1 year without anyone noticing. The underlying issue was that security settings on the medical devices were not correctly configured [ 91 ]. As technology continues to evolve, IoMT will become more inseparable in health care service delivery, which will create more vulnerabilities if health care organizations continue to disregard cybersecurity threats without proactive readiness to address them in this era of Industry 4.0. These vulnerabilities pose threats to the security and privacy of human and health information.

Studies have shown the health care sector to be unequipped and lacking in investment [ 11 , 92 ]. For example, the use of electronic health technology, motivated by acts such as the Meaningful Use program introduced by the US government, has compelled many health care organizations to increase the use of digital technology in health care, such as EHRs and electronic data exchange, and comply with enhanced health care delivery management. Organizations began to focus on adopting new technology and spending less on security, creating part of the problem [ 32 ]. Technological advancements and a federal policy mandate ultimatum are 2 of the causes noted in this SLR that have increased health care industry exposure to cyberattacks and breaches of health information [ 17 ]. Therefore, an organization should have proper planning; be proactive instead of reactive; and ensure the protection of health technology, information, patient privacy, and security when implementing or adopting advanced technology [ 17 , 80 ]. One such process is to ensure that a medical technology statement of disclosure and liability is included during the procurement, integration, and adoption of a technology. Support services and maintenance during and after procurement and installation should be part of the procurement process. Furthermore, the device manufacturer should also consider security in product development planning. Digital technology should also have the capability to monitor and collate threats and patterns and log these in a risk assessment register for analysis and improvement or threat containment.

Causes of Vulnerabilities in Health Care Systems

Figure 3 shows the causes of vulnerabilities in health care systems, which complement the findings regarding health care vulnerability, and categorizes them accordingly. The following sections address these vulnerabilities.

How Can Health Care Systems Be Protected?

This study summarizes how health care systems can be protected from cyber threats and cyberattacks and presented in Table 2 .

a Not applicable.

b IoMT: Internet of Medical Things.

c IoT: Internet of Things.

Human-Related Case Type and Challenges

The protection of health care systems from cyberattack-related vulnerabilities caused by human error, such as identity theft and health information breaches, requires by law that health care organizations inform the human health office, regulatory bodies, and data owners [ 93 ] to ensure compliance with ethical and privacy standard regulations [ 94 , 95 ]. A security compliance officer should also be employed to guide and ensure that proper cyber hygiene measures are in place to avoid such occurrences. It is important to ensure that health information is encrypted to assure that data are unusable and back up data offline and on the web. Furthermore, in cases in which a health care organization is saddled with challenges due to insecure human behavior, such as employee negligence, a lack of skills, and cyber warfare, the organization must ensure proper training of all staff [ 62 ] and implement awareness programs using a comprehensive guide to avert cyber threats [ 36 , 41 ]. This proposed solution requires a social approach in designing guidelines and training programs.

Old Legacy Systems Case Type and Challenges

Interoperability and compatibility challenges in medical devices stem from human-related activities within health care systems, potentially impacting the persistence of outdated legacy systems [ 50 ]. Therefore, to holistically protect health care systems, proposed solutions involve sociotechnical measures due to the old legacy in human work processes, organizational structures, and technology tasks, as mentioned by Offner et al [ 2 ]. Organizations should adhere to policies and standards linked to the old legacy, ensure proper updates and upgrades, and implement patches. Modern equipment that supports security and carries out updates must be procured to avert crises and phase out legacy systems [ 16 ].

Lack of Investment Case Type and Challenges

Investment in critical health care infrastructure is very important to ensure a health care ecosystem that is secure from cyberattacks and vulnerabilities. The susceptibility of health care to cyberattacks is a result of the underinvestment in and neglect of cybersecurity infrastructures. Kruse et al [ 17 ] also highlighted that a health organization invests ≤5% in cybersecurity but tends to focus on integrating and delivering care. It is important for a health care organization to invest in technology, human behavior, and processes [ 96 ] to protect sensitive and valuable health information from breaches and attacks.

Complex Network-Connected End-Point Devices Case Type and Challenges

The increase in health information breaches in hospitals is attributed to complex network-connected end-point devices, which are vulnerable to cyberattacks because sensor-based medical devices and system networks are interlinked and connected to the internet [ 8 ]. Internet of Things devices are vulnerable because they can be controlled through a media access control address and network. A proposed solution identified in this SLR highlighted that health care can be protected though proper encryption of data and installation of network defenders [ 3 ]. It is important that medical device simulation and assessment be performed through vulnerability analysis to ensure that devices are not tampered with or compromised [ 8 ].

Technology Advancement (Digitalization) Case Type and Challenges

Technology advancement has revolutionized the health care delivery process using digital technological processes. Manufactured medical devices enable patients to be diagnosed remotely, and physicians can administer care using telemedicine. However, technological advancements still lack security in the design of these devices because security is an afterthought during development, which makes them vulnerable to cyberattacks [ 5 ]. A proposed solution is that health care organizations must ensure that medical device security starts from the planning stage [ 68 ] and that device manufacturers maintain and manage security in the pre- and postmarket phases. This solution paradigm must be catalogued as a technical measure. Hospitals with modern-day smart care should leverage comprehensive guidelines and compliance with standards such as those of the International Organization for Standardization or International Electrotechnical Commission 27001 or 27002, as well as cyber hygiene to enable effective and efficient care delivery processes [ 4 , 11 ]. Therefore, the implementation of solutions should always adopt a sociotechnical approach [ 96 ].

Intervention Application Areas and Domain Counts for 2012 to 2022

The selected studies from this SLR that discussed and presented knowledge interventions and solutions applied in some health care sectors between 2012 and 2022 are categorized and presented in Table 3 .

a PECB: Professional Evaluation and Certification Board.

b HIPAA: Health Insurance Portability and Accountability Act.

c ECRI: Emergency Care Research Institute.

Knowledge Application Domains and Vulnerabilities

The vulnerabilities listed in Table 3 reveal that human error was associated with interventions linked to one of the knowledge application domains of training, awareness, education, and intelligence information sharing.

Employee training is important to avoid human factors or error challenges in health care. Table 3 shows the proposed solutions and interventions for training from 17% (12/70) of the studies. Figure 4 shows that training emerged in 2018 at 1% and increased to its peak between 2019 and 2021. However, this finding suggests the need for cybersecurity training in health care to manage human vulnerability challenges. This need is supported by the literature highlighting the importance of cybersecurity skills and education for health care professionals [ 16 ] and the need for investment in this area [ 17 ].

The solutions presented regarding educational intervention were derived from 3% (2/70) of the studies ( Table 3 ). Figure 4 shows that educational solutions emerged in 2017 and declined until 2020, when studies on educational intervention emerged. This finding is supported by research that shows a lack of educational skills [ 16 ]. Organizations must invest in educational training and skills to curb social and technical cybersecurity vulnerability in health care.

A total of 6% (4/70) of the studies in Table 3 presented solutions on awareness to address the vulnerability of human errors. This small number of studies has shown a decline and a lack of cybersecurity awareness program in health care systems. Figure 4 similarly shows that cybersecurity awareness emerged in 2016 and reached its peak at 2 studies. This has been validated by previous studies that indicate a lack of awareness programs and training [ 45 , 62 ].

Intelligence Information Sharing

Table 3 also shows that intelligence information sharing was a solution investigated in 7% (5/70) of the studies. It can be seen that information sharing emerged in 2014 and declined in 2015 before re-emerging in 2017 and 2018 at the rate of 1 study each year. This finding also shows that health care organizations should collaborate in training and intelligence information sharing to address cybersecurity challenges in health care.

The vulnerabilities listed in Table 3 reveal that old legacy systems were associated with interventions linked to the knowledge application domain of health policy and standards.

Health Policy and Standards

The knowledge intervention analysis indicates that 36% (25/70) of the studies acknowledged and were linked to health policy and standards ( Table 3 ). The analysis shows that governments and health care organizations have proposed more interventions or solutions regarding health policy and standards to regulate health care organizations. The policy studies shown in Figure 4 emerged in 2014 and continued to increase to their peak in 2018. Policies such as the Health Insurance Portability and Accountability Act, the GDPR, and the Health Information Technology for Economic and Clinical Health Act to engineer has helped to mitigate data breaches and vulnerabilities in health care organizations in addressing old legacy systems to avoid sanctions and fines in case of breaches. However, full implementation or enforcement of day-to-day monitoring in hospitals or health care organizations remains challenging.

The vulnerabilities listed in Table 1 reveal that a lack of investment was associated with interventions linked to the knowledge application domain of partnership.

Partnership

Partnership is key to sustaining and protecting health care systems from cybersecurity vulnerability [ 72 ]. When organizations fail to invest in critical cyber infrastructure, skills, and partnerships with governments and expert security organizations, it is likely that they will be vulnerable to cyberattacks and breaches of health information and lack the capability to protect health care systems from the vulnerability of underinvestment. Table 3 shows that partnership solutions were provided in 4% (3/70) of the studies, whereas Figure 4 shows that partnership emerged in 2018 and declined in 2021. There is a need for health care organizations to partner for better capability and structure to protect health care systems [ 64 ].

The vulnerabilities listed in Table 1 reveal that complex network-connected end-point devices were associated with interventions linked to the knowledge application domains of participatory design, network security, and encryption.

Participatory Design

Health care organizations and medical device manufacturers must jointly participate in designing processes and systems to avoid a sociotechnical design gap. This collaboration will help protect health care systems and increase the acceptability of organizational systems and productivity. Table 3 shows only 1 pertinent study in 2014. This infer that participatory design is one of the reasons for the vulnerabilities in complex network-connected end-point devices in health care systems. Health care systems comprise a complex environment that requires a sociotechnical and collaborative approach to addressing challenges [ 2 ].

Network Security

Network security solutions were covered in 23% (16/70) of the studies ( Table 3 ). A number of intervention solution studies were conducted in this domain. As shown in Figure 4 , the first increase was observed in 2014 with 4 studies, a decline to 2 studies was observed in 2017, and then the number of studies increased to 3 before a final decline to 2 studies in 2021. These studies still attest to the vulnerability of complex network-connected end-point devices, which require increased interventions to solve health care vulnerability challenges.

The encryption technological solution in this review was mentioned in 6% (4/70) of the studies. There was a limited number of solutions regarding encryption intervention in this review ( Figure 4 ). Encryption only emerged in 2014 with 2 studies, and there was a gap in studies until 2017 and 2018. This finding shows that health care organizations need to implement encryption technology to protect valuable health information from breaches and attacks [ 77 ].

The vulnerabilities listed in Table 1 reveal that technology advancement (digitalization) was associated with interventions linked to the knowledge application domains of machine learning, blockchain, and security design.

Machine Learning

Machine learning is a new area in which cybersecurity in health care systems is evolving. However, solutions were provided in only 11% (8/70) of the studies ( Table 3 ). This technology surfaced in 2014 according to Figure 4 . There was only 1 study in 2014 and 2015. No solutions were provided until 2018, and the number of interventions categorized under technology advancement increased from 2019 to 2021.

Blockchain technology is new and still lacking solutions according to this SLR, where only 1% (1/70) of the studies showed an effective intervention. Blockchain surfaced in 2019, as shown in Figure 4 . Additional solutions and interventions are needed as this area is promising and can be categorized under technology advancement (digitalization) as the key to protecting smart health care systems.

Security by Design

Security by design is a strategy that demands that health care organizations implement auto-based technology to protect digital health care systems. Table 3 shows that 9% (6/70) of the studies acknowledged security by design as a solution for technology advancement to prevent vulnerability in digital systems. Figure 4 shows studies on secure design in 2013 to 2014. There were no studies in 2015, whereas in 2016 to 2019, some studies provided interventions. There is a need for more solutions in this area to protect technological advancement or digital health care systems from vulnerability [ 68 ].

Summary of the Knowledge Application Domains and Vulnerabilities

In summary, the findings of this SLR indicate that interventions provided for the containment of health care cybersecurity vulnerabilities were limited over the past 11 years. This SLR also revealed that interventions regarding the rate of technological advancements in addressing health care cybersecurity challenges were inconsistent and lagging between 2012 and 2022. Findings also indicates that interventions in some of the mapped variables were scarce between 2012 and 2022 ( Table 3 ). Few or no solutions are provided to address the challenges in many domains regarding health care vulnerabilities.

Brief Summary of Findings

This SLR provided a synthesis of literature on cybersecurity in health care and identified the reasons why health care systems are vulnerable to cyberattacks. This review analyzed 70 published studies and identified 5 vulnerability themes of cybersecurity in health care systems and also proposed sociotechnical solutions for health care organizations.

The findings indicate that the extensive vulnerability of health care systems is due to internet-connected devices and software applications. Health care organizations face significant challenges, such as medical end-point device complexities and saturated wireless medical technology resulting in its difficulty in securing an interconnected technological landscape.

Importantly, many cyberattacks occur within this interconnected network without the health care organization’s awareness, contributing to health information breaches.

Our findings also underscore that the crucial role of investment in health care organizations is a key panacea for addressing cyberattacks and threats. Thus, lack of investment leverages the other vulnerabilities.

In addition, this study found that lack of adequate preparation for the potential threats or vulnerability in shifting to the digitalization of health care is also a contributing factor to most successful cyberattacks on health care organizations.

We found that human activity also played a major role in subjecting health care systems to cybercrimes. The decision of humans to develop medical devices, health software applications, management systems, and processes in an effective and secured manner is vital in safeguarding health information. However, there is a bit of disconnect in the human-centric design in health care system development, most importantly during the planning of procurement of medical technology and systems and the integration between health care organizations and stakeholders such as medical device developers, health care professionals, cybersecurity compliance officers, and system integration experts. Generally, the findings revealed that health care organizations lack adequate cybersecurity preparations during transitions to digitalization.

The findings also revealed that the health care cybersecurity knowledge application domain areas in Figure 4 depict that more intervention studies over the past 11 years were focused on health policy and standards.

In Table 4 , solutions are proposed from a sociotechnical perspective to counteract cybersecurity vulnerabilities in health care organizations.

Further findings on the vulnerabilities and implications for future research are discussed in the following sections.

Table 4 is an integrated table that is presented in a stand-alone view for health care system solutions from a sociotechnical viewpoint.

To protect health care systems from attacks and vulnerabilities, as shown in Table 4 , through the intervention of effective and noneffective studies, it can be seen that sociotechnical intervention studies classified invention most often and were the most effective. There are patterns and convergences between technical solutions and sociotechnical solutions in their domain of applications and solutions, such as a lack of investment, complex network-connected end-point devices, old legacy systems, and technology advancement, which lean toward interventions.

While we can consider human errors in human-computer interactions and technology usability from a human perspective, design and management can be approached through a sociotechnical perspective [ 96 ]. This approach also considers the final users of digital health care systems. Organizations would benefit from leveraging the sociotechnical solutions and guide in Table 4 in the case of cyberattacks attributed to human error by training all staff to respond using a comprehensive guide to avert cyber threats [ 62 ]. Challenges of technology, such as network-connected end-point devices and technology advancement for digitalization, should be addressed through network and security solutions and encryptions [ 6 , 67 ].

Hospitals with modern-day smart care should leverage their comprehensive guidelines and standard International Organization for Standardization or International Electrotechnical Commission 27001 and 27002 compliances.

Health care organizations should ensure and implement proper cyber hygiene to enable effective and efficient health care delivery processes [ 4 , 11 ]. They should increase their budget for critical cyber systems to address the lack of investment [ 17 ] and phase out old legacy systems by increasing investment. These actions will enable resilience and preparedness for future response plans and mitigations.

a AIDE: Assess, Identify, Develop, and Evaluate.

b Not applicable.

c ISA: information security awareness.

d ANT: actor-network theory.

e CERT RMM: Computer Emergency Response Team Resilience Management Model.

f IoMT: Internet of Medical Things.

g HIPAA: Health Insurance Portability and Accountability Act.

h GDPR: General Data Protection Regulation.

i HITECH: Health Information Technology for Economic and Clinical Health.

j FDA: Food and Drug Administration.

k NIST-CSF: National Institute of Standards and Technology Cybersecurity Framework.

l HICP: Health Industry Cybersecurity Practices.

m ITPOSOM: information, technology, processes, objectivity and values, skills and knowledge, management systems and structure, and other resources.

n EHR: electronic health record.

o e-PSG: electronic health record–specific patient safety goals.

p IoT: Internet of Things.

q FHSS: frequency-hopping spread spectrum.

r RSSI: received signal strength indicator.

s BYOD: bring your own device.

t PHR: personal health record.

u OCSVM: one-class support vector machine.

Implications for Future Research

Health care sectors have improved with policies and measures developed to control health information breaches and vulnerabilities. However, further research is needed in social and technical interception design, namely, the human factor. Managing complex end-point devices and investment on addressing health care vulnerability and breaches should be considered from a sociotechnical design and sustainability perspective.

Protecting Complex Network-Connected End-Point Devices

The protection of complex network-connected end-point devices for health care organizations involves several key measures. The network of interconnected medical end-point devices and the software systems that connect to the internet are becoming vulnerable to attacks and breaches. This is a growing issue; health care organizations tend to procure medical device technology without proper equipment planning and guidelines in place. This implies that security is overlooked and is not a major focus area. Examples include hospital beds connected to >10 medical devices, such as pulse oximeters, syringe pumps, and patient care monitors, which are connected devices and vulnerable to attacks [ 2 , 6 ].

To address this technical challenge, organizations can concentrate on developing advanced threat detection and mitigation techniques, such as network defenders tailored to intricate network-connected end-point devices in health care and the integration of artificial intelligence using machine learning algorithms to effectively identify and respond to emerging threats. Furthermore, the health care industry must take a sociotechnical approach [ 96 ] toward implementing standard guidelines and technical solutions via the protection of health care networks through planning and integrating network security protection and segmentation. In addition, health information exchange over the network should undergo steganography and encryption as a solution using blockchain technology. Therefore, the integration of a complex end-point medical device should use built-in security with alert response and communication in processes to monitor health care cybersecurity ecosystems for a healthy security posture.

Health care organizations should collaborate with security experts and health care professionals and implement user education and incidence response to catalog cyber vulnerability incidences for further analysis. The implication is that, if networks and end-point medical devices are not properly secured, this will lead to breaches of health information through the network, which will cause patient information to be hijacked by cybercriminals for political gains. Sponsored state actors may use this weakness to seize networks and systems of care delivery, demanding money from an organization before the latter can regain access. This approach will expose the health information of patients while they are receiving treatment and accessing health care services. This is an evolving challenge of the digital consequences of connected care. Building security through a design solution should be achieved from a sociotechnical approach as the human is the final user of systems of care.

Future research should focus on security by design before integrations of complex technology and design a simpler flow process with the disaggregation of complex network connections.

Increasing Investment in Cybersecurity

Investment in health care systems is critical to ensure the proper safeguarding of health care ecosystems from cyberattacks and vulnerabilities. To ensure efficient and secure health care, organizations should invest in human capital and technology to function effectively. An evaluation through research reveals that health care is lagging behind other sectors in terms of investment. This finding was confirmed by Kruse et al [ 17 ], who found that only 5% of health care investment is earmarked to protect health care, whereas a large percentage is allocated for health care delivery.

Insufficient investment in cybersecurity experts, awareness, and investment partnership plans will continue to subject health care employees to insecure behavior and result in a health care organization that is unprepared to mitigate cyber threats and other tactics used by attackers to disrupt evolving health care trends and patterns, particularly ransomware attacks.

Similarly, old legacy systems pose another security risk. Malicious actors can continue to exploit these systems to expose personal health information due to their limited capabilities and outdated organizational structure. Such vulnerability is worsened by a lack of investment in new cybersecurity infrastructure and computer devices to protect or process health information in a secure manner.

Health care organizations can engage in partnership with medical technology providers, application developers, and network solution integrators to develop strong systems and structures with seamless integration. Health care organizations should also develop and implement a framework for prioritizing cybersecurity investment based on risk assessments and threat intelligence. This approach can help identify the most critical areas of vulnerability within different departments, aiding organizations and policy makers in directing investments where they are most needed. Health care organizations should invest in humans and technology through training to ensure the development of necessary skills and investment in critical cyber infrastructure.

Awareness campaigns for patients and staff will help organizations recover from errors and breaches, whereas investment in technological security systems for health care will prepare health care organizations with the appropriate structure and system for resilience.

The findings presented in this paper are also highlighted in Table 4 . Investment challenges in health care cybersecurity should focus on a sociotechnical approach that involves human behavior, technology, and organizational processes and should not be segregated as a separate technical or social problem. Future research should focus on security and investment in smart health care for attaining sustainability and resilience.

Managing Technological Advancement

Health care industries and organizations have improved over the years and are continuing to forge the development of new capabilities, technological advances, and processes to manage the multifaceted challenges of health care cybersecurity. Complexity in technology advancement and networks of digital systems increase the number of attack surfaces, where cybercriminals take advantage of the digital gateway access and execute malicious software programmed with code, such as malware to compromise digital technology and health care system networks. However, technological development necessitates a proactive approach to cybersecurity, particularly when considering security-by-design principles.

Future research projects must concentrate on important areas to protect networks, systems, and applications against vulnerabilities. Health care organizations should collaborate with medical device manufacturers as part of the planning phase of procurement requirements to ensure specifications needs before the development of medical devices technology for seamless integration. Implanted devices, for instance, should be built with security by design and continuously updated when necessary. A 2-factor authentication security for critical medical technology is also necessary. In addition, it is important that health care organizations quantify the risk, ensure that proper National Institute of Standards and Technology and GDPR standard guidelines are followed, and conduct threat modeling and simulation to evaluate the protectability of health care systems as a guideline in managing cybersecurity vulnerability.

Collaborative (sociotechnical) efforts among academia, industry, and policy makers are essential to drive this research agenda forward and create a safer digital landscape for the future.

The technology procurement requirement and collaboration should consider the integration of social and technical processes during digital technology development with health care delivery processes.

Health care organizations can adopt a blockchain technology solution for the protection of health information and other applications such as EHR systems from malicious use and insider threats.

Future research should examine the use of blockchain for health care big data protection and processes to manage cybersecurity vulnerability.

Containing Human Error in Cybersecurity

Humans are at the receiving end of the cyberattack chain. An example is the case of the WannaCry attack that affected 150,000 computers. It was attributed to human error because humans were warned of the attack on Windows server legacy systems but they ignored the warning by clicking on malicious email links [ 38 , 43 ]. When an organization fails to train humans, cybercriminals take advantage of human weakness to exploit health care systems. Today, medical device manufacturers are building devices without considering humans as the final users or a participatory (sociotechnical) design approach. This is one factor of the clinical process and security dimension to protect critical infrastructure. Another factor is that, if a system is developed and does not start with security and support human usability, it becomes stressful for a human user to navigate the systems, which could cause them techno-stress, with the likelihood of mistakes. The health sector should use the Assess, Identify, Develop, and Evaluate technique to identify areas of human weakness, develop a new training method through simulations, and offer gamification training on issues such as phishing email deception and ransomware attacks. The implication is that, if humans are not trained, they will lead organizations to disaster because cybercriminals will continue to exploit the weakness of humans to cause more damage to health care systems. The consequences will include legal issues, fines, and possibly bankruptcy for health care organizations. Proper training and awareness campaigns should be implemented. Future research should focus on developing futuristic health care cybersecurity curriculums and training.

Practical Implications

Inadequate systems will cause health care systems and organizations to face increasing cyberattacks and setbacks in health information and patient safety. Moreover, a new trend reveals that, if implanted medical devices and technology are not protected, humans will be targeted by hackers seeking to make money or gain political power for ransom. However, implementation and adoption of the medical device security life cycle model [ 68 ] will protect medical devices, health information, patients, and organizations from harm and against future emerging threats. Thus, there is a need for the design of a cybersecurity sociotechnical framework toward sustaining smart health care systems.

Comparison With Prior Work

Previous narrative literature reviews by Coventry and Branley [ 6 ] and Mohan et al [ 31 ] highlight the need for an integrated approach in health care systems to address cybersecurity vulnerabilities. They emphasize the need for a comprehensive approach that connects human behavior, technology, and processes in a holistic way as a best strategy to tackle vulnerabilities, although the authors did not classify human behavior, technology, and processes from a sociotechnical lens. This systematic review supports their view by building and extending the literature on cybersecurity case challenge descriptions in all the tables in this paper to integrate human behavior, technology, and processes as a sociotechnical approach [ 2 , 23 , 26 - 28 ]. For example, an SLR conducted by Offner et al [ 2 ] reported that health care system vulnerability is a complex sociotechnical problem. Furthermore, for a health care organization to build resilience against cyberattacks and threats to avoid cybersecurity design gaps and vulnerabilities in the health care system, a strategic approach that integrates people, technology, and processes must be adopted [ 23 , 27 , 31 ]. The aforementioned aligns with the approach adopted in this study.

Different schools of thought have highlighted the key importance of investment in technology and humans to protect health care systems from cyberattacks and threats [ 6 , 8 , 11 , 19 , 36 , 56 ]. This corroborates our findings that cybersecurity investment plays a main role in health care systems.

This study also revealed that complex network-connected end-point devices were mentioned several times by different schools of thought. Moreover, existing literature has opined that complex network-connected end-point devices were the most mentioned vulnerability [ 5 , 17 , 18 , 35 , 53 ].

Furthermore, technology advancement through a digital transformation evolution has created precision, and managed health care delivery [ 32 , 94 ]. However, more effort is still required in designing security features in health care technology. This study highlighted that security by design is required for medical device technology in health care systems [ 9 , 34 , 68 ].

Health care organizations must ensure that the design of technology evolves with a secure design approach from conception to avoid breaches of health information by external and internal attackers [ 24 , 32 , 68 ].

The sociotechnical solutions in Table 4 will aid health care organizations in being resilient in dealing with vulnerabilities and cybersecurity breaches in health care systems through a comprehensive and holistic approach. The sociotechnical perspective defines the meaning and constructs of technology, humans and processes [ 6 , 19 , 31 , 36 , 37 ]. This approach is promising and effective in dealing with health care system and cybersecurity vulnerabilities.

Limitations

For this study, non–English-language articles on cybersecurity and health care were not included. Closed-access articles directly related to cybersecurity and health care were also not included. Textbooks linked to cybersecurity and health care were excluded. In addition, as cybersecurity is a broad topic, more time was needed for data analysis.

Conclusions

This study conducted an SLR (PRISMA guidelines) to investigate the body of literature on cybersecurity in health care systems because of the exponential increase in health information breaches and vulnerability issues surrounding medical device technology and networks. This study also examined why health care systems are vulnerable to cyberattacks and threats.

In this review, sociotechnical solutions and mitigation strategies were proposed to protect patient health information, medical devices, and the critical cyber infrastructure of health care organizations from attacks and threats. We identified human error, lack of investment, complex network-connected end-point devices, old legacy systems, and technological advancement due to rapid digitalization as the causes of data breaches and the vulnerability of digital health care systems to attacks and threats. This study also revealed that research in the areas of education, awareness, training, collaborative partnerships, blockchain, and machine learning for health care cybersecurity is underrepresented. In addition, there was inconsistency in the publication of intervention studies. There is a gap in intervention studies published between 2012 and 2013, as shown in this SLR, as well as breaks in research publications between 2012 and 2022, as illustrated in Table 3 and Figure 4 .

As shown in Table 1 , of the 70 papers published between 2012 and 2022 and reviewed in this study, only 8 (11%) carried out research in the areas of human error–related perspectives where health care systems are vulnerable to attacks. This finding clearly shows that considerably more studies are required on human factors. We also identified from this review that network-connected end-point devices are the most vulnerable challenge that causes health information breaches. However, stakeholders have rolled out interventions in the areas of health policy, health care system support (network security), and training. The support and training target operational activities and health care delivery while investment in cybersecurity critical infrastructure is disregarded. Rapid technology advancement has resulted to an increasing risk of cyberattacks and threats because most manufactured connected medical devices were not built with security in mind. With the possible sociotechnical solutions in Table 4 , we form conclusions about how to protect health care systems as a sociotechnical solution in relation to the gap in research on technology, human behavior, and processes.

Health care organizations must concede that efficient and effective cybersecurity cannot be addressed with a technological process only but must also evolve beyond technological operation to a sociotechnical process that calls for a comprehensive knowledge of the human elements.

The profound implication of our findings steps further from just the concept of security. It deems it necessary for a major change in the approach to health care security by shifting from a reactive measure of patching and mitigation toward an approach of proactiveness and integration of detailed mechanisms that depend on complex sociotechnical dynamics at play in the design and development processes across the health care systems.

Our review emphasized the importance of a mandatory collaboration and cross-disciplinary engagement among stakeholders in health care, technology policy, and academia. The inclusion of a team-based effort from stakeholders will foster an integrated solution that responds to the challenges of cybersecurity vulnerabilities in health care systems.

In addition, our findings also give prominence to the great significance of investment in health care systems, such as in cybersecurity technology, medical devices, networks, health care professionals, and cybersecurity professionals, in advancing health care organizations. Furthermore, investment is imperative in cybersecurity education and training programs that will provide health care professionals and organizations with the updated knowledge and skills to navigate the complexities of cybersecurity vulnerabilities constructively. Governments should provide additional financial incentives for health care organizations to facilitate cybersecurity sustainability in health care systems. Future research should explore the application of blockchain technology for safeguarding health care system data. Blockchain offers a secure decentralized architecture. Therefore, system developers should consider a human-centric design approach when integrating blockchain technology into health care systems.

By strengthening awareness culture, intelligence information sharing, and accountability in health care systems, health care organizations can equip their operations and workforce to become active front-runners in safeguarding patient data and health care critical infrastructure and assuring the confidentiality, availability, and integrity of health care systems. Consequently, our SLR implores for an exhaustive procedure regarding cybersecurity in health care that affirms and entwines the sociotechnical nature of the vulnerabilities and challenges. By merging a technical approach with human-centric strategies, health care organizations can protect health care systems from vulnerabilities and cyber threats and advance a culture of resilience, trust, and innovation in health care service delivery. The implications of this review present a sociotechnical solution for establishing more secure and resilient health care ecosystems. This paper provides health care organizations with a better understanding of and resilience to cyberattacks, threats, and vulnerabilities.

Acknowledgments

The author is grateful to the Finnish Cultural Foundation and University of Vaasa in Finland for their support in funding this research.

Conflicts of Interest

None declared.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist guide.

Search strategy.

• Cybersecurity in healthcare. Health Insurance Portability and Accountability Act. URL: https://www.himss.org/resources/cybersecurity-healthcare [accessed 2024-05-05]
• Offner KL, Sitnikova E, Joiner K, MacIntyre CR. Towards understanding cybersecurity capability in Australian healthcare organisations: a systematic review of recent trends, threats and mitigation. Intell National Secur. Apr 22, 2020;35(4):556-585. [ FREE Full text ] [ CrossRef ]
• Frost. Medical Device and Network Security Coming to terms with the Internet of Medical Things (IoMT). -. 2024:2019. [ FREE Full text ]
• Karambelas C. Healthcare care technology: ransomware risk and protection. Am Bankruptcy Inst J. May 2020;39(5):30.
• Giansanti D. Cybersecurity and the digital-health: the challenge of this millennium. Healthcare (Basel). Jan 11, 2021;9(1):62. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Coventry L, Branley D. Cybersecurity in healthcare: a narrative review of trends, threats and ways forward. Maturitas. Jul 2018;113:48-52. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Walker T. Interoperability a must for hospitals, but it comes with risks. Managed Healthcare Executive. Dec 10, 2017. URL: https://www.managedhealthcareexecutive.com/view/interoperability-must-hospitals-it-comes-risks [accessed 2024-05-06]
• Dameff CJ, Selzer JA, Fisher J, Killeen JP, Tully JL. Clinical cybersecurity training through novel high-fidelity simulations. J Emerg Med. Feb 2019;56(2):233-238. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Klonoff DC. Cybersecurity for connected diabetes devices. J Diabetes Sci Technol. Apr 16, 2015;9(5):1143-1147. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Reshmi TR. Information security breaches due to ransomware attacks - a systematic literature review. Int J Inf Manag Data Insights. Nov 2021;1(2):100013. [ FREE Full text ] [ CrossRef ]
• Argaw ST, Bempong NE, Eshaya-Chauvin B, Flahault A. The state of research on cyberattacks against hospitals and available best practice recommendations: a scoping review. BMC Med Inform Decis Mak. Jan 11, 2019;19(1):10. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Zarour M, Alenezi M, Ansari MT, Pandey AK, Ahmad M, Agrawal A, et al. Ensuring data integrity of healthcare information in the era of digital health. Healthc Technol Lett. Jun 2021;8(3):66-77. [ FREE Full text ] [ CrossRef ] [ Medline ]
• What are the penalties for HIPAA violations? The HIPAA Journal. URL: https://www.hipaajournal.com/what-are-the-penalties-for-hipaa-violations-7096/ [accessed 2024-05-06]
• Mcnulty M, Kettani H. On cybersecurity education for non-technical learners. In: Proceedings of the 3rd International Conference on Information and Computer Technologies (ICICT). 2020. Presented at: ICICT 2020; March 9-12, 2020; San Jose, CA. URL: https://doi.org/10.1109/ICICT50521.2020.00072 [ CrossRef ]
• Ricci J, Breitinger F, Baggili I. Survey results on adults and cybersecurity education. Educ Inf Technol. Jul 11, 2018;24(1):231-249. [ FREE Full text ] [ CrossRef ]
• Sweeney E. Healthcare data breaches haven’t slowed down in 2017, and insiders are mostly to blame. Fierce Healthcare. Aug 3, 2017. URL: https://tinyurl.com/yn2m49y8 [accessed 2024-05-06]
• Kruse CS, Frederick B, Jacobson T, Monticone DK. Cybersecurity in healthcare: a systematic review of modern threats and trends. Technol Health Care. Feb 21, 2017;25(1):1-10. [ FREE Full text ] [ CrossRef ]
• Wasserman L, Wasserman Y. Hospital cybersecurity risks and gaps: review (for the non-cyber professional). Front Digit Health. 2022;4:862221. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Jalali MS, Razak S, Gordon W, Perakslis E, Madnick S. Health care and cybersecurity: bibliometric analysis of the literature. J Med Internet Res. Feb 15, 2019;21(2):e12644. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Healthcare data breach statistics. The HIPAA Journal. URL: https:/​/www.​hipaajournal.com/​healthcare-data-breach-statistics/​#:~:text=2021%20was%20a%20bad%20year,stolen%2C%20or%20otherwise%20impermissibly%20disclosed [accessed 2024-05-06]
• IBM report: cost of a data breach hits record high during pandemic. IBM. Jul 28, 2021. URL: https://tinyurl.com/euc26j9y [accessed 2024-05-06]
• Nifakos S, Chandramouli K, Nikolaou CK, Papachristou P, Koch S, Panaousis E, et al. Influence of human factors on cyber security within healthcare organisations: a systematic review. Sensors (Basel). Jul 28, 2021;21(15):5119. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Heeks R. Health information systems: failure, success and improvisation. Int J Med Inform. Feb 2006;75(2):125-137. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Casola V, De Benedictis A, Rak M, Villano U. Security-by-design in multi-cloud applications: an optimization approach. Inf Sci. Jul 2018;454-455:344-362. [ FREE Full text ] [ CrossRef ]
• Secure-by-design: shifting the balance of cybersecurity risk: principles and approaches for secure by design software. Cybersecurity and Infrastructure Security Agency. Oct 25, 2023. URL: https://www.cisa.gov/resources-tools/resources/secure-by-design [accessed 2024-05-06]
• Mumford E. The story of socio‐technical design: reflections on its successes, failures and potential. Inf Syst J. Sep 04, 2006;16(4):317-342. [ FREE Full text ] [ CrossRef ]
• Palvia SC, Sharma RS, Conrath DW. A socio-technical framework for quality assessment of computer information systems. Ind Manag Data Syst. 2001;101(5):237-251. [ FREE Full text ] [ CrossRef ]
• Atkinson C, Eldabi T, Paul RJ, Pouloudi A. Investigating integrated socio-technical approaches to health informatics. In: Proceedings of the 34th Annual Hawaii International Conference on System Sciences. 2001. Presented at: HICSS 2001; January 6, 2001; Maui, HI. URL: https://doi.org/10.1109/HICSS.2001.926578 [ CrossRef ]
• Altman R. Informatics in the care of patients: ten notable challenges. West J Med. Feb 1997;166(2):118-122. [ FREE Full text ] [ Medline ]
• Coiera E. Four rules for the reinvention of health care. BMJ. May 15, 2004;328(7449):1197-1199. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Mohan DN, Gowda SS, Vikyath IS. Cyber security in health care. Int J Res Eng Sci Manag. 2020;3(1):551-553. [ CrossRef ]
• Luna R, Rhine E, Myhra M, Sullivan R, Kruse CS. Cyber threats to health information systems: a systematic review. Technol Health Care. Jan 27, 2016;24(1):1-9. [ FREE Full text ] [ CrossRef ]
• Jalali MS, Russell B, Razak S, Gordon WJ. EARS to cyber incidents in health care. J Am Med Inform Assoc. Jan 01, 2019;26(1):81-90. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Williams P, Woodward A. Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem. Med Devices Evid Res. Jul 2015;8:305-316. [ FREE Full text ] [ CrossRef ]
• Safavi S, Meer AM, Melanie EK, Shukur Z. Cyber vulnerabilities on smart healthcare, review and solutions. In: Proceedings of the Cyber Resilience Conference (CRC). 2018. Presented at: CR 2018; November 13-15, 2018; Putrajaya, Malaysia. URL: https://doi.org/10.1109/CR.2018.8626826 [ CrossRef ]
• He Y, Aliyu A, Evans M, Luo C. Health care cybersecurity challenges and solutions under the climate of COVID-19: scoping review. J Med Internet Res. Apr 20, 2021;23(4):e21747. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Jalali MS, Kaiser JP. Cybersecurity in hospitals: a systematic, organizational perspective. J Med Internet Res. May 28, 2018;20(5):e10059. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. Mar 29, 2021;372:n71. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Arndt RZ. For epic, interoperability comes from within. Modern Healthcare. Jan 29, 2018. URL: https:/​/www.​modernhealthcare.com/​article/​20180130/​NEWS/​180139993/​for-epic-interoperability-comes-from-within [accessed 2024-05-06]
• Incident detection, email attacks continue to cause headaches for companies. Twitter. URL: https://twitter.com/SandraProske/status/967893399599796224 [accessed 2024-05-06]
• Mukherjee SY. Anthem’s historic 2015 health records breach was likely ordered by a foreign government. Fortune. Jan 10, 2017. URL: https://fortune.com/2017/01/09/anthem-cyber-attack-foreign-government/ [accessed 2024-05-06]
• 2017 cost of data breach study: United States. Ponemon Institute. Jun 13, 2017. URL: https://www.ponemon.org/news-updates/blog/security/2017-cost-of-data-breach-study-united-states.html [accessed 2024-05-06]
• Cost of a data breach report 2021. IBM Security. URL: https://info.techdata.com/rs/946-OMQ-360/images/Cost_of_a_Data_Breach_Report_2021.PDF [accessed 2024-05-06]
• Scott M, Wingfield N. Hacking attack has security experts scrambling to contain fallout. New York Times. May 13, 2017. URL: https://tinyurl.com/4weatd6e [accessed 2024-05-06]
• Gordon WJ, Wright A, Glynn RJ, Kadakia J, Mazzone C, Leinbach E, et al. Evaluation of a mandatory phishing training program for high-risk employees at a US healthcare system. J Am Med Inform Assoc. Jun 01, 2019;26(6):547-552. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Bouveret A. Cyber risk for the financial sector: a framework for quantitative assessment. SSRN. Preprint posted online July 16, 2018. [ FREE Full text ] [ CrossRef ]
• Top 10 health technology hazards for 2016. ECRI Institute. Nov 2015. URL: https://www.ecri.org/Resources/Whitepapers_and_reports/2016_Top_10_Hazards_Executive_Brief.pdf [accessed 2024-05-06]
• Faruki P, Bharmal A, Laxmi V, Ganmoor V, Singh Gaur M, Conti M, et al. Android security: a survey of issues, malware penetration, and defenses. IEEE Commun Surv Tutorials. 2015;17(2):998-1022. [ FREE Full text ] [ CrossRef ]
• Filkins B. Health care cyberthreat report: widespread compromises detected, compliance nightmare on horizon. SANS Institute. 2014. URL: https:/​/asprtracie.​hhs.gov/​technical-resources/​resource/​3381/​health-care-cyberthreat-report-widespread-compromises-detected-compliance-nightmare-on-horizon [accessed 2024-05-06]
• Fu K, Blum J. Controlling for cybersecurity risks of medical device software. Commun ACM. Oct 2013;56(10):35-37. [ FREE Full text ] [ CrossRef ]
• McHugh M. Medical device software and technology: the past, present and future. BEAI Spectrum, Biological and Clinical Engineers Association of Ireland. 2015. URL: https://arrow.tudublin.ie/scschcomart/38/ [accessed 2024-05-06]
• Newman LH. Medical devices are the next security nightmare. WIRED. Mar 2, 2017. URL: https://www.wired.com/2017/03/medical-devices-next-security-nightmare/ [accessed 2024-05-06]
• Tully J, Selzer J, Phillips JP, O'Connor P, Dameff C. Healthcare challenges in the era of cybersecurity. Health Secur. 2020;18(3):228-231. [ FREE Full text ] [ CrossRef ] [ Medline ]
• The state of ransomware in the US: report and statistics 2019. Emsisoft Malware Lab. Dec 12, 2019. URL: https://tinyurl.com/ykx5zjce [accessed 2024-05-06]
• The state of ransomware in the US: report and statistics 2020. Emsisoft Malware Lab. Jan 18, 2021. URL: https://www.emsisoft.com/en/blog/37314/the-state-of-ransomware-in-the-us-report-and-statistics-2020/ [accessed 2024-05-06]
• Branley-Bell D, Coventry L, Sillence E, Magalini S, Mari P, Magkanaraki A, et al. Your hospital needs you: eliciting positive cybersecurity behaviours from healthcare staff. Ann Disaster Risk Sci. 2020;3(1). [ FREE Full text ] [ CrossRef ]
• Information Commissioner's Office, National Cyber Security Centre, James M. New figures show large numbers of businesses and charities suffer at least one cyber attack in the past year. United Kingdom Government. Apr 25, 2018. URL: https:/​/www.​gov.uk/​government/​news/​new-figures-show-large-numbers-of-businesses-and-charities-suffer-at-least-one-cyber-attack-in-the-past-year [accessed 2024-05-06]
• IT security in the era when everything can be hacked. Kaspersky Lab. URL: https://www.unodc.org/documents/organized-crime/cybercrime/cybercrime-april-2018/RUSSIAN_FED.pdf [accessed 2024-05-06]
• GDPR: getting ready for the new EU data protection regulation. PECB Insights. Apr 27, 2018. URL: https://insights.pecb.com/gdpr-compliance-getting-ready/ [accessed 2024-05-06]
• Rahman NA, Sairi IH, Zizi NA, Khalid F. The importance of cybersecurity education in school. Int J Inf Educ Technol. 2020;10(5):378-382. [ FREE Full text ] [ CrossRef ]
• Chowdhury N, Gkioulos V. Cyber security training for critical infrastructure protection: a literature review. Comput Sci Rev. May 2021;40:100361. [ FREE Full text ] [ CrossRef ]
• Coventry L, Branley-Bell D, Sillence E, Magalini S, Mari P, Magkanaraki A, et al. Cyber-risk in healthcare: exploring facilitators and barriers to secure behaviour. In: Proceedings of the HCI for Cybersecurity, Privacy and Trust 2020. 2020. Presented at: HCI-CPT 2020; July 19-24, 2020; Copenhagen, Denmark. URL: https://tinyurl.com/v2dbyrsx [ CrossRef ]
• Burns AJ, Johnson ME, Honeyman P. A brief chronology of medical device security. Commun ACM. Sep 22, 2016;59(10):66-72. [ FREE Full text ] [ CrossRef ]
• Chua JA. Cybersecurity in the healthcare industry - A collaborative approach. American Association for Physician Leadership. Jan 8, 2021. URL: https://www.physicianleaders.org/articles/cybersecurity-healthcare-industry-collaborative-approach [accessed 2024-05-06]
• Djenna A, Harous S, Saidouni DE. Internet of things meet internet of threats: new concern cyber security issues of critical cyber infrastructure. Appl Sci. May 17, 2021;11(10):4580. [ FREE Full text ] [ CrossRef ]
• Francis R. Medical devices that could put you at security risk. IDG Communications. Apr 27, 2017. URL: https://www.csoonline.com/article/561347/medical-devices-that-could-put-you-at-security-risk.html [accessed 2024-05-06]
• Handa A, Sharma A, Shukla SK. Machine learning in cybersecurity: a review. WIREs Data Min Knowl. Feb 17, 2019;9(4):e1306. [ FREE Full text ] [ CrossRef ]
• Lechner NH. Developing a compliant cybersecurity process for medical devices. In: Proceedings of the Central European Conference on Information and Intelligent Systems. 2018. Presented at: CECIIS 2018; September 19-21, 2018; Varaždin, Croatia. URL: https:/​/www.​proquest.com/​openview/​8a2a254a80f34ef64b55c71d5bac01d6/​1?pq-origsite=gscholar&cbl=1986354
• Lewis CJ. Cybersecurity in healthcare.  Utica College. 2014. URL: https://tinyurl.com/3usz5jat [accessed 2024-05-16]
• Lyon D. Making trade-offs for safe, effective, and secure patient care. J Diabetes Sci Technol. Mar 2017;11(2):213-215. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Mohan A. Cyber security for personal medical devices internet of things. In: Proceedings of the IEEE International Conference on Distributed Computing in Sensor Systems. 2014. Presented at: DCOSS 2014; May 26-28, 2014; Marina Del Rey, CA. URL: https://doi.org/10.1109/DCOSS.2014.49 [ CrossRef ]
• Baranchuk A, Refaat MM, Patton KK, Chung MK, Krishnan K, Kutyifa V, et al. Cybersecurity for cardiac implantable electronic devices: what should you know? J Am Coll Cardiol. Mar 20, 2018;71(11):1284-1288. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Perakslis E. Cybersecurity in health care. N Engl J Med. Jul 31, 2014;371(5):395-397. [ FREE Full text ] [ CrossRef ]
• Peterson A. Yes, terrorists could have hacked Dick Cheney’s heart. The Washington Post. Oct 21, 2013. URL: https:/​/www.​washingtonpost.com/​news/​the-switch/​wp/​2013/​10/​21/​yes-terrorists-could-have-hacked-dick-cheneys-heart/​ [accessed 2024-05-06]
• Sajedi H, Rahbar Yaghobi S. Information hiding methods for E-Healthcare. Smart Health. Mar 2020;15:100104. [ FREE Full text ] [ CrossRef ]
• Omotosho A, Adegbola O, Mikail OO, Emuoyibofarhe J. A secure electronic prescription system using steganography with encryption key implementation. Int J Comput Inform Technol. Sep 2014;03(5):980-986. [ CrossRef ]
• Singh Rayat A, Singh I, Singh K. Review on security challenges of data communication in IoT devices. Int J Electron Eng. 2019;11(2):406-415. [ FREE Full text ]
• Sittig DF, Singh H. Electronic health records and national patient-safety goals. N Engl J Med. Nov 08, 2012;367(19):1854-1860. [ FREE Full text ] [ CrossRef ]
• Snell E. Healthcare data breach costs highest for 7th straight year. Health IT Security. 2017. URL: https://healthitsecurity.com/news/healthcare-data-breach-costs-highestfor-7th-straight-year [accessed 2024-05-06]
• Bhuyan SS, Kabir UY, Escareno JM, Ector K, Palakodeti S, Wyant D, et al. Transforming healthcare cybersecurity from reactive to proactive: current status and future recommendations. J Med Syst. Apr 02, 2020;44(5):98. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Raina MacIntyre C, Engells TE, Scotch M, Heslop DJ, Gumel AB, Poste G, et al. Converging and emerging threats to health security. Environ Syst Decis. 2018;38(2):198-207. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Filkins BL, Kim JY, Roberts B, Armstrong W, Miller MA, Hultner ML, et al. Privacy and security in the era of digital health: what should translational researchers know and do about it? Am J Transl Res. 2016;8(3):1560-1580. [ FREE Full text ] [ Medline ]
• Rodrigues JJ, de la Torre I, Fernández G, López-Coronado M. Analysis of the security and privacy requirements of cloud-based electronic health records systems. J Med Internet Res. Aug 21, 2013;15(8):e186. [ FREE Full text ] [ CrossRef ] [ Medline ]
• -. Verizon: 2019 data breach investigations report. Comput Fraud Secur. Jan 2019;2019(6). [ CrossRef ]
• 2022 cost of insider threats global report. Ponemon Institute. 2022. URL: https:/​/protectera.​com.au/​wp-content/​uploads/​2022/​03/​The-Cost-of-Insider-Threats-2022-Global-Report.​pdf [accessed 2024-05-06]
• Wagner S. The medical data of hundreds of HUG patients accessible on the internet. Ictjournal. 2019. URL: https:/​/www.​ictjournal.ch/​news/​2019-10-04/​les-donnees-medicales-dune-centaines-de-patients-des-hug-accessibles-sur-internet [accessed 2019-10-04]
• Arapi K. The healthcare industry: evolving cyber threats and risks. Utica College. May 2018. URL: https://www.proquest.com/openview/6fb8d8f9984e83b682b5499fb1d36194/1?pq-origsite=gscholar&cbl=18750 [accessed 2024-05-06]
• Perriello B. ‘Medjack:’ hackers threaten hospitals using medical devices as back doors. MassDevice. Jun 5, 2015. URL: https://www.massdevice.com/medjack-hackers-threaten-hospitals-using-medical-devices-as-back-doors/ [accessed 2024-05-06]
• Meggitt S. MEDJACK attacks: the scariest part of the hospital. Tufts University. Dec 18, 2018. URL: https://www.cs.tufts.edu/comp/116/archive/fall2018/smeggitt.pdf [accessed 2024-05-06]
• Rajamäki J, Pirinen R. Towards the cyber security paradigm of ehealth: resilience and design aspects. AIP Conf Proc. Jun 5, 2017;1836(1). [ FREE Full text ] [ CrossRef ]
• Murphy S. Is cybersecurity possible in healthcare? National Cybersecur Institute J. 2015;1(3):49. [ FREE Full text ]
• Kioskli K, Fotis T, Mouratidis H. The landscape of cybersecurity vulnerabilities and challenges in healthcare: security standards and paradigm shift recommendations. In: Proceedings of the 16th International Conference on Availability, Reliability and Security. 2021. Presented at: ARES '21; August 17-20, 2021; Vienna, Austria. URL: https://doi.org/10.1145/3465481.3470033 [ CrossRef ]
• Tuttle I. Cyberdisaster: how the government compromised our security. National Review. Sep 9, 2016. URL: https://www.nationalreview.com/2016/09/opm-hack-house-oversight-committee-report/ [accessed 2024-05-08]
• Loi M, Christen M, Kleine N, Weber K. Cybersecurity in health – disentangling value tensions. J Inform Commun Ethics Soc. May 13, 2019;17(2):229-245. [ FREE Full text ] [ CrossRef ]
• Christen M, Gordijn B, Loi M. The ethics of cybersecurity. CrimRxiv. 2020. URL: https://www.crimrxiv.com/pub/s79bo1xu/release/1 [accessed 2024-05-06]
• Coles-Kemp L, Williams PA. Changing places: the need to alter the start point for information security design. Electron J Health Inform. 2014;8(2). [ FREE Full text ]
• Khaloufi H, Abouelmehdi K, Beni-hssane A, Saadi M. Security model for big healthcare data lifecycle. Procedia Comput Sci. 2018;141:294-301. [ FREE Full text ] [ CrossRef ]
• Holst C, Sukums F, Radovanovic D, Ngowi B, Noll J, Winkler AS. Sub-Saharan Africa—the new breeding ground for global digital health. Lancet Digit Health. Apr 2020;2(4):e160-e162. [ FREE Full text ] [ CrossRef ]
• Khando K, Gao S, Islam SM, Salman A. Enhancing employees information security awareness in private and public organisations: a systematic literature review. Comput Secur. Jul 2021;106:102267. [ FREE Full text ] [ CrossRef ]
• Winton R. Hollywood hospital pays $17,000 in bitcoin to hackers; FBI investigating. Los Angeles Times. Feb 18, 2016. URL: https://tinyurl.com/5yae788s [accessed 2024-05-06]
• Dobuzinskis A, Finkle J. California hospital makes rare admission of hack, ransom payment. Reuters. Feb 20, 2016. URL: https://www.reuters.com/article/idUSKCN0VS05M/ [accessed 2024-05-06]
• Bickers S, Dunlevy S, Minear T. Hackers are offering to sell the medicare details of Australians on the dark web, government confirms. News Corp Australia Network. Jul 4, 2017. URL: https://tinyurl.com/4ryf66v8 [accessed 2024-05-06]
• Zorabedian J. How malware works: anatomy of drive-by download web attack. Sophos News. Mar 26, 2014. URL: https:/​/news.​sophos.com/​en-us/​2014/​03/​26/​how-malware-works-anatomy-of-a-drive-by-download-web-attack-infographic/​ [accessed 2024-05-06]
• Omotosho A, Asanga U, Fakorede A. Electronic prescription system for pediatricians. Eur Sci J. 2017;13(18):426. [ FREE Full text ] [ CrossRef ]
• Chen B, Ren Z, Yu C, Hussain I, Liu J. Adversarial examples for CNN-based malware detectors. IEEE Access. 2019;7:54360-54371. [ FREE Full text ] [ CrossRef ]

Abbreviations

Edited by A Mavragani; submitted 03.03.23; peer-reviewed by R Marshall, V Perez Jover; comments to author 27.07.23; revised version received 17.10.23; accepted 08.03.24; published 31.05.24.

©Pius Ewoh, Tero Vartiainen. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 31.05.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

The Remarkable Contributions of Mae Jemison at Every Age

This essay is about the remarkable life and contributions of Mae Jemison, the first African American woman to travel in space. It highlights her early interest in science, her education at Stanford and Cornell, and her work with the Peace Corps. The essay details her historic space mission in 1992 and her subsequent efforts to promote science education and literacy through the Jemison Group and the Dorothy Jemison Foundation for Excellence. It underscores her ongoing influence as an advocate for diversity and inclusion in STEM fields and her continued impact on science, education, and technology. Jemison’s legacy is presented as a testament to perseverance, dedication, and the pursuit of excellence.

How it works

Mae Jemison’s story is profoundly exceptional. Born on October 17, 1956, she has emerged as an emblem of excellence and persistence across various domains, spanning from celestial voyages to medical and educational realms. Being the inaugural African American female voyager into the cosmos, she not only breached barriers but also ignited inspiration among innumerable individuals worldwide. However, her accomplishments transcend the mere epoch-making event, delineating a life teeming with pioneering contributions at every phase.

Raised in the milieu of Chicago, Jemison manifested an inquisitive and astute disposition, exhibiting an inherent proclivity towards both scientific inquiry and artistic expression since her formative years.

Charlie and Dorothy Jemison, her progenitors, nurtured her intellectual inclinations, fostering an ambiance where inquisitiveness found solace and nourishment. It was this nurturing environment that laid the groundwork for her subsequent triumphs. By the age of 16, Jemison harbored lofty aspirations, envisioning a trajectory steeped in scientific pursuits. This ambitious resolve led her to Stanford University, where she attained a Bachelor of Science degree in Chemical Engineering while concurrently fulfilling the requisites for a Bachelor of Arts in African and Afro-American Studies. The dual trajectory of her scholastic endeavors epitomized a broader vision—one that amalgamated technical prowess with a profound comprehension of cultural and societal dynamics.

Post her graduation from Stanford, Jemison embarked on a trajectory towards a medical vocation at Cornell University Medical College, culminating in the attainment of her M.D. in 1981. Her medical odyssey commenced earnestly within a general practice milieu, yet her impetus to effectuate a substantial difference soon steered her towards the Peace Corps. From 1983 to 1985, Jemison discharged her duties as a medical officer in Liberia and Sierra Leone. This experiential juncture was transformative, broadening her vista on healthcare and cementing her dedication towards global health and humanitarian endeavors. The adversities encountered and lives touched during this phase served to fortify her resolve to harness her skills for the collective welfare.

In 1987, a historic juncture transpired in Jemison’s career when NASA designated her as an astronaut candidate, heralding the commencement of a demanding training regimen that scrutinized her endurance and intellect. On September 12, 1992, Jemison embarked on her celestial sojourn aboard the Space Shuttle Endeavour as part of mission STS-47. This expedition etched her name in history as the pioneer African American woman to voyage into space—a milestone reverberating globally. Over the course of the eight-day mission, Jemison conducted experiments encompassing life sciences and materials processing, thereby furnishing invaluable data to NASA’s research endeavors. Her tenure in space not only underscored her scientific acumen but also underscored her capacity to thrive in one of the most arduous environments conceivable.

Post her triumphant mission, Jemison bid adieu to NASA in 1993 to embark on fresh challenges and prospects. She spearheaded the Jemison Group, a technology consultancy entity aimed at integrating cutting-edge technology into quotidian existence. This venture constituted merely one facet of her overarching commitment to fomenting innovation and ameliorating lives through scientific and technological avenues. In a similar vein, she established the Dorothy Jemison Foundation for Excellence, christened after her mother. The foundation’s mandate revolves around promoting science education and literacy, particularly among youth hailing from marginalized communities. Through initiatives like The Earth We Share (TEWS), an international science camp, Jemison has both inspired and enlightened the succeeding generation of scientists, engineers, and innovators.

Jemison’s impact as an educator and proponent of STEM (Science, Technology, Engineering, and Mathematics) disciplines is profound. She has delivered myriad speeches and lectures, accentuating the significance of diversity and inclusivity within these domains. Her endeavors have galvanized youngsters from all strata of society to pursue vocations in science and technology, thereby challenging the preconceived notions and barriers that have traditionally impeded participation in these spheres. Her message resonates unequivocally: scientific progress and innovation flourish upon diverse perspectives and inclusive practices.

As the sands of time have trickled, Jemison’s contributions have only deepened and expanded. She assumes diverse roles on various boards and advisory panels, incessantly advocating for progressions in science, education, and technology. Her entrenchment in these domains underscores her sustained dedication towards effectuating a meaningful difference, thereby underscoring the truism that age constitutes no impediment to impactful endeavors. Jemison’s life narrative stands as a potent testimony to the enduring value of curiosity, perseverance, and an unyielding pursuit of one’s objectives.

Mae Jemison’s odyssey serves as a poignant exemplification of shattering barriers and confronting conventions. From her nascent fascination with celestial bodies to her trailblazing exploits in space and her relentless endeavors to propel education and technology forward, she has epitomized that determination and diligence can surmount even the most daunting hurdles. Her legacy transcends her personal triumphs, serving as a guiding light for myriad individuals who aspire to effectuate positive change on a global scale.

Jemison’s influence extends beyond the precincts of space exploration, permeating into the broader vista of societal advancement. Her narrative underscores the quintessence of representation and the transformative potency of education and mentorship. By championing scientific literacy and inclusivity, she has laid a bedrock for a more equitable and innovative future. Her endeavors serve as a poignant reminder that advancements in any realm necessitate not just technical prowess but also a commitment to societal equity and communal engagement.

In the latter phase of her life, Jemison persists as a dynamic force, championing causes of import and channeling her expertise into various initiatives. Whether through her foundation, her oratory engagements, or her involvement in advisory capacities, she endures as a pivotal figure in the ongoing discourse concerning the role of science and technology in societal fabric. Her life’s work epitomizes the interconnectedness of erudition, empathy, and action.

Mae Jemison’s achievements stand as a testament to the boundless possibilities that unfurl with ardor, persistence, and a dedication to excellence. From her epochal voyage into the cosmos to her seminal endeavors in education and technology, she exemplifies that one individual’s ardor can ignite transformative change on a global panorama. As she persists in contributing across myriad domains, Jemison’s saga serves as a poignant reminder that the quest for knowledge and the impetus to ameliorate our world are endeavors unbound by temporal constraints.

Her odyssey is far from its denouement, and her contributions persist in shaping the vista of tomorrow. Mae Jemison transcends the realm of an astronaut; she embodies the quintessence of a scientist, a medic, an educator, and an advocate. Her life’s saga bridges the chasm between aspiration and fruition, underscoring that with the requisite support and determination, extraordinary feats become attainable. Her legacy is one of hope, progression, and an unwavering conviction that each of us can aspire to reach for the stars.

Cite this page

The Remarkable Contributions of Mae Jemison at Every Age. (2024, Jun 01). Retrieved from https://papersowl.com/examples/the-remarkable-contributions-of-mae-jemison-at-every-age/

"The Remarkable Contributions of Mae Jemison at Every Age." PapersOwl.com , 1 Jun 2024, https://papersowl.com/examples/the-remarkable-contributions-of-mae-jemison-at-every-age/

PapersOwl.com. (2024). The Remarkable Contributions of Mae Jemison at Every Age . [Online]. Available at: https://papersowl.com/examples/the-remarkable-contributions-of-mae-jemison-at-every-age/ [Accessed: 2 Jun. 2024]

"The Remarkable Contributions of Mae Jemison at Every Age." PapersOwl.com, Jun 01, 2024. Accessed June 2, 2024. https://papersowl.com/examples/the-remarkable-contributions-of-mae-jemison-at-every-age/

"The Remarkable Contributions of Mae Jemison at Every Age," PapersOwl.com , 01-Jun-2024. [Online]. Available: https://papersowl.com/examples/the-remarkable-contributions-of-mae-jemison-at-every-age/. [Accessed: 2-Jun-2024]

PapersOwl.com. (2024). The Remarkable Contributions of Mae Jemison at Every Age . [Online]. Available at: https://papersowl.com/examples/the-remarkable-contributions-of-mae-jemison-at-every-age/ [Accessed: 2-Jun-2024]

Don't let plagiarism ruin your grade

Hire a writer to get a unique paper crafted to your needs.

Our writers will help you fix any mistakes and get an A+!

Please check your inbox.

You can order an original essay written according to your instructions.

Trusted by over 1 million students worldwide

1. Tell Us Your Requirements

2. Pick your perfect writer

3. Get Your Paper and Pay

Hi! I'm Amy, your personal assistant!

Don't know where to start? Give me your paper requirements and I connect you to an academic expert.

short deadlines

100% Plagiarism-Free

Certified writers

• Alzheimer's disease & dementia
• Arthritis & Rheumatism
• Attention deficit disorders
• Autism spectrum disorders
• Biomedical technology
• Diseases, Conditions, Syndromes
• Endocrinology & Metabolism
• Gastroenterology
• Gerontology & Geriatrics
• Health informatics
• Inflammatory disorders
• Medical economics
• Medical research
• Medications
• Neuroscience
• Obstetrics & gynaecology
• Oncology & Cancer
• Ophthalmology
• Overweight & Obesity
• Parkinson's & Movement disorders
• Psychology & Psychiatry
• Radiology & Imaging
• Sleep disorders
• Sports medicine & Kinesiology
• Vaccination
• Breast cancer
• Cardiovascular disease
• Chronic obstructive pulmonary disease
• Colon cancer
• Coronary artery disease
• Heart attack
• Heart disease
• High blood pressure
• Kidney disease
• Lung cancer
• Multiple sclerosis
• Myocardial infarction
• Ovarian cancer
• Post traumatic stress disorder
• Rheumatoid arthritis
• Schizophrenia
• Skin cancer
• Type 2 diabetes
• Full List »

share this!

May 31, 2024

This article has been reviewed according to Science X's editorial process and policies . Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

trusted source

Hong Kong team pioneers robot-assisted spinal surgery

by The University of Hong Kong

In a groundbreaking development, a research team from the Department of Orthopedics and Traumatology of the School of Clinical Medicine in the LKS Faculty of Medicine of the University of Hong Kong (HKUMed) have introduced robot-assisted technology in spine surgery. This is the first time this advanced approach has been used in the city to assist with guidance for instrumentation during spinal surgery.

The team has successfully performed robot-guided spinal procedures for 20 patients since October 2023. The joint-team surgeries were carried out by the Division of Spine Surgery, Department of Orthopedics and Traumatology, School of Clinical Medicine, HKUMed, Queen Mary Hospital and Duchess of Kent Children's Hospital. The use of robotic technology in spine surgery allows for unprecedented precision, safety and minimally invasive approaches, benefiting patients with enhanced surgical outcomes, reduced risk of complications and better revision rates.

Spinal fusion surgery often requires the use of spinal instrumentation, which is particularly important in the treatment of scoliosis, a spine deformity condition that is common among children.

In adult patients , instrumentation is commonly used to address issues like back pain, an unstable and/or deformed spine, or a fractured spinal column. Surgeons typically need to place screws into the deformed spine to facilitate correction and fusion of the spine.

The traditional method of screw insertion into the spine uses the freehand technique, which relies on the surgeon's anatomical knowledge, surgical experience and intraoperative X-ray checks to guide the placement. While skilled surgeons can achieve great precision with their expertise, the accuracy of screw placement has not reached 100%.

Cutting-edge robotic technology in local spine surgery

Since October 2023, 20 robotic spine surgeries have been performed with patients ranging from the teens to the 70s. One patient of note was a 72-year-old woman with degenerative kyphoscoliosis, presenting with back pain and difficulties in walking more than 10 minutes at a time. Traditionally, the surgery would be performed with freehand screw insertion, which is dependent on the surgeon's experience.

This novel technology allowed the team to utilize preoperative surgical planning software to determine the best implant strategy for optimal surgical correction. Intraoperatively, the surgery was executed according to the preoperative plan and with the assistance of the surgical robot, and the implants were inserted without stress or difficulty. Despite a lengthy surgery, it was completed smoothly and successfully.

Delivering greater precision and safer outcomes

The spine robotic system allows for preoperative planning incorporating CT images of the patient's spine as part of the system. The surgeon plans the ideal entry point, screw size and trajectory tailored to each patient's unique anatomy and the predicted screw alignment in the spine. During surgery, the spine robotic arm is precisely guided to the pre-planned position.

The robotic guidance system also provides surgeons with real-time images of the patient's spine, helping them achieve an unparalleled level of accuracy and precision when implanting the screw. This is a significant improvement over the traditional 'freehand' technique, which relies heavily on the surgeon's experience and estimates.

"This innovative technology was introduced to public hospitals in Hong Kong in October 2023, offering local patients access to cutting-edge treatment options. The technology empowers surgeons to deliver the best possible outcomes for their patients when performing complex spinal procedures," said Dr. Kenny Kwan Yat-hong, Clinical Associate Professor and Chief of Division of Spine Surgery, Department of Orthopaedics and Traumatology, School of Clinical Medicine, HKUMed.

"We believe this revolutionary approach is a game-changer for local patients with scoliosis or other spinal problems, improving the accuracy and safety of instrumentation during spinal surgery, reducing the rate of revision surgery, increasing operating efficiency, reducing post-operative complications, and decreasing the length of hospital stays. We believe that there will be further applications of robotic systems in spinal surgery in the near future, resulting in shorter operation times and reduced waiting lists for spinal surgery," added Dr. Kwan.

Professor Jason Cheung Pui-yin, Chairperson of the Department of Orthopedics and Traumatology, School of Clinical Medicine, HKUMed, stated that the launch of this novel technology in public hospitals in Hong Kong represents a major milestone in advancing the field of spinal surgery in the city.

He explained, "The enhanced precision and predictability of robot-assisted spine surgery mean that we can provide our patients with safer, more effective treatments, leading to faster recovery and better long-term outcomes. We are truly excited about the transformative potential of this advanced spine robotic system and the doors it opens for our team to push the boundaries of what is possible in the world-class treatment of spinal disorders."

The novel robot-assisted spine surgeries were carried out by a team of surgeons from the School of Clinical Medicine at HKUMed, led by Dr. Kenny Kwan Yat-hong, Clinical Associate Professor and Chief of Division of Spine Surgery; and Professor Jason Cheung Pui-yin, Clinical Professor and Chairperson, Department of Orthopedics and Traumatology.

Explore further

Feedback to editors

Almost 1 in 3 Americans know someone who's died from a drug overdose

9 hours ago

Antibody discovery promises new hope in influenza B battle, paves way for universal vaccine

13 hours ago

Eye-tracking techniques could help primary care providers diagnose autism sooner, more accurately

This self-powered sensor could make MRIs more efficient

Not eating can hinder weight loss, study in fruit flies suggests

Neuroscience research suggests ketones can enhance cognitive function and protect brain networks

New research finds antidepressants may help deliver other drugs into the brain

Mediterranean diet tied to one-fifth lower risk of death in women

Scientists find new method to enhance efficacy of bispecific antibodies for solid tumors

Cardiomyocytes study discovers new way to regenerate damaged heart cells

Related stories.

Study evaluates robotic- and navigation-assisted pedicle screw placement in adult degenerative spinal surgery

Sep 2, 2021

How awake spinal surgery benefits patients

Jun 7, 2023

When spine surgery is the answer

Sep 21, 2021

Researchers suggest changing gold standard of spine surgery from operative microscope to 3D exoscope

Jan 24, 2024

Study: Intraoperative 3D imaging can improve accuracy of pedicle screw placement in spine surgery

Mar 7, 2023

New spine robot to serve as backbone for orthopedic innovations

May 16, 2022

Recommended for you

Tackling the hurdle of tumor formation in stem cell therapies

Scientists develop visual tool to help people group foods based on their levels of processing

Microfluidic organ chip models human cervix to fill key women's health gap

May 30, 2024

Rewritable, recyclable 'smart skin' monitors biological signals on demand

A multimodal approach to better predict recovery in patients with disorders of consciousness

Let us know if there is a problem with our content.

Use this form if you have come across a typo, inaccuracy or would like to send an edit request for the content on this page. For general inquiries, please use our contact form . For general feedback, use the public comments section below (please adhere to guidelines ).

Please select the most appropriate category to facilitate processing of your request

Thank you for taking time to provide your feedback to the editors.

Your feedback is important to us. However, we do not guarantee individual replies due to the high volume of messages.

E-mail the story

Your email address is used only to let the recipient know who sent the email. Neither your address nor the recipient's address will be used for any other purpose. The information you enter will appear in your e-mail message and is not retained by Medical Xpress in any form.

Newsletter sign up

Get weekly and/or daily updates delivered to your inbox. You can unsubscribe at any time and we'll never share your details to third parties.

More information Privacy policy

Donate and enjoy an ad-free experience

We keep our content available to everyone. Consider supporting Science X's mission by getting a premium account.

E-mail newsletter