The Digital Health Competencies in Medical Education Framework

IMPORTANCE Rapid digitalization of health care and a dearth of digital health education for medical
students and junior physicians worldwide means there is an imperative for more training in this
dynamic and evolving field.
OBJECTIVE To develop an evidence-informed, consensus-guided, adaptable digital health
competencies framework for the design and development of digital health curricula in medical
institutions globally.
EVIDENCE REVIEW A core group was assembled to oversee the development of the Digital Health
Competencies in Medical Education (DECODE) framework. First, an initial list was created based on
findings from a scoping review and expert consultations. A multidisciplinary and geographically
diverse panel of 211 experts from 79 countries and territories was convened for a 2-round, modified
Delphi survey conducted between December 2022 and July 2023, with an a priori consensus level of
70%. The framework structure, wordings, and learning outcomes with marginal percentage of
agreement were discussed and determined in a consensus meeting organized on September 8,
2023, and subsequent postmeeting qualitative feedback. In total, 211 experts participated in round 1,
149 participated in round 2, 12 participated in the consensus meeting, and 58 participated in
postmeeting feedback.
FINDINGS The DECODE framework uses 3 main terminologies: domain, competency, and learning
outcome. Competencies were grouped into 4 domains: professionalism in digital health, patient and
population digital health, health information systems, and health data science. Each competency is
accompanied by a set of learning outcomes that are either mandatory or discretionary. The final
framework comprises 4 domains, 19 competencies, and 33 mandatory and 145 discretionary learning
outcomes, with descriptions for each domain and competency. Six highlighted areas of
considerations for medical educators are the variations in nomenclature, the distinctiveness of digital
health, the concept of digital health literacy, curriculum space and implementation, the inclusion of
discretionary learning outcomes, and socioeconomic inequities in digital health education.
CONCLUSIONS AND RELEVANCE This evidence-informed and consensus-guided framework will
play an important role in enabling medical institutions to better prepare future physicians for the
ongoing digital transformation in health care. Medical schools are encouraged to adopt and adapt this
framework to align with their needs, resources, and circumstances.