Computer literacy among first year medical students in a developing country: A cross sectional study
© Ranasinghe et al.; licensee BioMed Central Ltd. 2012
Received: 21 February 2012
Accepted: 13 September 2012
Published: 14 September 2012
The use of computer assisted learning (CAL) has enhanced undergraduate medical education. CAL improves performance at examinations, develops problem solving skills and increases student satisfaction. The study evaluates computer literacy among first year medical students in Sri Lanka.
The study was conducted at Faculty of Medicine, University of Colombo, Sri Lanka between August-September 2008. First year medical students (n = 190) were invited for the study. Data on computer literacy and associated factors were collected by an expert-validated pre-tested self-administered questionnaire. Computer literacy was evaluated by testing knowledge on 6 domains; common software packages, operating systems, database management and the usage of internet and E-mail. A linear regression was conducted using total score for computer literacy as the continuous dependant variable and other independent covariates.
Sample size-181 (Response rate-95.3%), 49.7% were Males. Majority of the students (77.3%) owned a computer (Males-74.4%, Females-80.2%). Students have gained their present computer knowledge by; a formal training programme (64.1%), self learning (63.0%) or by peer learning (49.2%). The students used computers for predominately; word processing (95.6%), entertainment (95.0%), web browsing (80.1%) and preparing presentations (76.8%). Majority of the students (75.7%) expressed their willingness for a formal computer training programme at the faculty.
Mean score for the computer literacy questionnaire was 48.4 ± 20.3, with no significant gender difference (Males-47.8 ± 21.1, Females-48.9 ± 19.6). There were 47.9% students that had a score less than 50% for the computer literacy questionnaire. Students from Colombo district, Western Province and Student owning a computer had a significantly higher mean score in comparison to other students (p < 0.001). In the linear regression analysis, formal computer training was the strongest predictor of computer literacy (β = 13.034), followed by using internet facility, being from Western province, using computers for Web browsing and computer programming, computer ownership and doing IT (Information Technology) as a subject in GCE (A/L) examination.
Sri Lankan medical undergraduates had a low-intermediate level of computer literacy. There is a need to improve computer literacy, by increasing computer training in schools, or by introducing computer training in the initial stages of the undergraduate programme. These two options require improvement in infrastructure and other resources.
KeywordsComputer literacy Medical undergraduates Sri Lanka Developing country
Computers are being increasingly utilized as an aid in undergraduate medical education. The use of computer assisted learning has enhanced undergraduate medical education in numerous ways. Computers are used for a wide range of functions in medical education, which ranges from simple drill and practice applications and computer based lectures to more advanced simulations and intelligent tutoring systems. Studies have consistently shown that computer assisted learning improves performance at Multiple Choice Questions (MCQ), Objective Structured Clinical Examination (OSCE) and written assessments[2, 3], develops problem solving skills and knowledge, and increases student satisfaction. In addition computers are also now being regularly used in student assessments. Furthermore computers are also being increasingly utilized in postgraduate teaching programmes and also plays an essential role in Continuing Medical Education (CME) activities. Hence it is evident that computer literacy has become a vital competency for the present day medical undergraduate.
Computer literacy amongst medical undergraduates in developed countries is at a relatively higher level in comparison to students of developing resource poor countries. Studies have shown that students at resource poor settings lack the necessary skills to use computer-based learning platforms effectively and are therefore at a disadvantage. In addition, a study from Southern India has shown that Indian medical undergraduates use computers frequently for simple tasks, which may not contribute to the development of knowledge acquisition skills. Lack of resources, time and structured training programmes are amongst the reasons for the low computer literacy of medical undergraduates in developing countries. As computers are being widely used, learning to use them to manage knowledge effectively is a core competency in modern medicine. It has been shown that the acquisition of computer skills should commence during the initial stages of the undergraduate curriculum. Studies have shown that medical students who have not acquired basic computer information technology skills by the third year of undergraduate training are unlikely to do so in the final hospital-based years.
Sri Lanka is a developing middle-income country in the South Asian region with a population of nearly 20 million. Computers are being used widely by both state and private sector organizations in Sri Lanka including health care services in order to improve productivity. According to recent surveys computer literacy of the Sri Lankan population has increased dramatically over the last few years. Medical education in Sri Lanka is solely conducted at government universities and each year nearly seven hundred students graduate from the seven medical faculties at government universities. Established in 1870 as the Colombo Medical School, the Faculty of Medicine of the University of Colombo, Sri Lanka, is the second oldest medical school in South Asia. The medical undergraduate curriculum at the faculty spans five year, the initial one and a half to two years of pre-clinical training is followed by three years of clinical training.
At present there are no studies evaluating computer literacy of Sri Lankan medical undergraduates. At Faculty of Medicine, Colombo computer assisted learning facilities such as Learning Management Systems (LMS) is freely available to students; however, presently there is no structured computer training programme. Due to diverse backgrounds and different levels of exposure, an initiative to introduce Computer Assisted Learning at Faculty of Medicine, Colombo would require a prior assessment of computer-related capabilities and attitudes toward computer-based learning. The present study aims to evaluate the computer literacy among first year medical students at Faculty of Medicine, University of Colombo, Sri Lanka.
Study participants and sampling
The study was conducted at Faculty of Medicine, University of Colombo, Sri Lanka between August and September 2008. One hundred and ninety first year medical students entering the faculty in year 2008 were invited for the study. Informed consent was obtained from each study participant. Ethical approval for the study was obtained from Ethics Review Committee, Faculty of Medicine, University of Colombo, Sri Lanka.
Data on computer literacy and its potential associated factors were collected by means of an expert-validated pre-tested self-administered questionnaire [see Additional file1]. The questionnaire evaluated socio-demographic characteristics, computer ownership, computer literacy, attitudes towards computer usage, level of exposure to computers as assessed by prior computer training, preferences for a structured computer training programme at the faculty and tasks for which computers are frequently used.
Computer literacy was evaluated by testing knowledge on 6 different domains; common software packages (MS Word, MS Powerpoint and MS Excel), operating systems (Windows), database management and the usage of internet and E-mail. The questionnaire was designed by two experts in the field of medicine and information technology, and was independently validated by two different experts in the same field. The questionnaire evaluated areas of computer skills that are required by students to acquire new knowledge and perform using computers during the undergraduate curriculum, such as when preparing reports, presentations and conducting research data analysis. The computer literacy section of the questionnaire consisted of 30 different questions. Marks for the individual questions were given taking in to consideration the relative difficulty levels as assessed by two independent experts in the field of computer training and education. The total score for the computer literacy section was sixty-five and the score and number of questions (n) of the different domains were as follows; MS Word – 13 (n = 6), MS Powerpoint – 13 (n = 6), MS Excel – 13 (n = 5), database management – 6 (n = 4), Internet and email – 15 (n = 7) and MS Windows – 5 (n = 2). The final score on computer literacy for each student was calculated as the percentage of the individual score for the six domains out of the total mark of sixty five. Students were categorized in to four categories based on the total marks obtained for the computer literacy questionnaire; low-literacy (<35%), intermediate-literacy (35-49%), high-literacy (50-69%) and very high-literacy (> = 70%).
Sri Lanka is a country with nine provinces and twenty five districts. Colombo is the commercial district of Sri Lanka and it is one of the three districts in the Western province. Colombo has the highest computer literacy rate amongst the general population in Sri Lanka. The Faculty of Medicine at the University of Colombo is situated in the ‘Colombo’ district in the ‘Western’ province of Sri Lanka. Thus for analytical purposes the hometown districts and provinces of the students were divided in to two groups ‘Colombo district’ or ‘Other districts’ and ‘Western province’ or ‘Other provinces’. A linear regression was conducted using total score for computer literacy as the continuous dependant variable and the following binary independent variables (unless otherwise stated 0 – No, 1 – Yes); gender (0 – female, 1 – male), province (0 – not Western, 1 – Western), district (0 – not Colombo, 1 – Colombo), Gained knowledge from formal training course, Self learning or Peer learning, doing IT as a subject for GCE (A/L), computer ownership, Usage of computers for word processing, entertainment, presentation, statistics, web browsing, computer programming or computer assisted learning and using internet facility. The ‘explained variance’ of the logistic regression model was calculated by means of Nagelkerke’s R2 and the goodness of fit by means of the Hosmer and Lemeshow goodness-of fit test. All data were double entered and cross checked for consistency. Data were analyzed using SPSS version 14 (SPSS Inc., Chicago, IL, USA) statistical software package. A p-value ≤ 0.05 was considered statistically significant.
Computer ownership, knowledge and exposure to training of students
All(n = 181)
Males (n = 90)
Females (n = 91)
Ownership of a computer
Desktop computer only
Laptop computer only
Computer knowledge gained by,
Formal training programme
Formal training on,
Web designing and graphics
IT education at School level,
Subject in GCE (O/L)
Subject in GCE (A/L)
The students used computers for predominately; word processing (n = 173, 95.6%), entertainment (n = 172, 95.0%), web browsing (n = 145, 80.1%) and preparing presentations (n = 139, 76.8%). Only a few students have used computers more advanced functions such as computer assisted learning (n = 40, 22.1%), computer programming (n = 45, 24.9%) and database management (n = 73, 40.3%). Most of the students were using internet facilities (n = 127, 70.7%), which was mainly accessed from their own residences (n = 83, 45.9%). Only 5 students (2.8%) used internet facilities that were freely available at the faculty. The frequency of internet access varied between students; most accessed 2–3 hours per week (n = 51, 40.2%), followed by rarely (n = 34, 26.8%), 2–3 h per month (n = 25, 19.7%) and 2–3 h per day (n = 17, 13.4%). One hundred and fifteen students had their own e-mail address (63.5%), of which 57.6% (n = 68) checked emails at least once a week.
The needs of students that preferred a formal IT training programme at faculty
All (n = 137)
Males (n = 67)
Females (n = 70)
Prefer learning from,
Faculty academic staff
Formal training on,
Timing of training programme,
Before commencement of faculty teaching
During 1st or 2nd term
Just prior to whenever IT skills are required
Results of the linear regression analysis
ß – coefficient
95% Confidence interval
−6.074 to 2.911
District of residence
−0.550 to 9.640
Province of residence
4.206 to 19.283
Gained knowledge from,
Formal training course*
7.518 to 18.552
−4.274 to 6.387
4.521 to 5.398
IT as a subject for GCE (A/L)*
0.201 to 8.722
2.233 to 6.451
Usage of computers for,
−3.287 to 19.588
−3.064 to 16.940
−2.549 to 10.468
−6.459 to 4.329
6.773 to 10.857
2.843 to 14.342
Computer Assisted Learning*
−2.411 to 8.579
Using internet facility*
6.067 to 19.901
The recent technological advances in the fields of medicine and medical education have made computer literacy a vital competency for the present day medical undergraduate. In this first comprehensive survey of computer literacy and its associates amongst Sri Lankan medical undergraduates we demonstrate that the level of computer literacy in Sri Lanka remains at an intermediary stage with nearly half the students obtaining a computer literacy score less than or equal to 50%. In addition, only about 15% of students had very high-computer literacy levels comparable to students of developed countries[8, 16]. Hence similar to other developing countries Sri Lankan medical undergraduates could be at a disadvantage in comparison to their counterparts from developed resourceful countries.
A majority of Sri Lankan medical undergraduates (nearly 80%) had their own computers, a figure which is much higher than the recently reported value of 11.4% for the general population of Sri Lanka. This is comparable to computer ownership data of medical undergraduates from developed countries. Computer ownership is an important prerequisite for improving computer literacy; our data demonstrates that computer ownership was a significant predictor of computer literacy amongst the students. The important relationship between computer ownership and computer literacy is also evident by the fact that several medical faculties in developed countries have adopted a mandatory computer ownership criteria for admission. The adoption of a requirement for student ownership of computers at these institutions has successfully facilitated development of students computer skills. Hence, instituting methods such as provision of low-interest loans to increase the ownership of computers amongst Sri Lankan students might help further increase computer literacy.
Formal training of students was also significant predictor of computer literacy. Although our results show that over 60% of students have undergone formal training programmes, only 38% have studies IT as a subject in school. Hence there is a need to increase computer training of students during their school years, in order to bridge the computer skills requirement gap between school and university levels. Another plausible alternative is the implementation of a formal computer training programme during faculty years. Such programmes could also be attractive to students as demonstrated by the high student preference for a formal computer training programme in the present study, this is similar to findings from other resource poor settings. Implementing a formal computer literacy course with stated objectives and measurable outcomes for first-year medical students is one way to instil a minimal level of competence and to target those students who are in need of further instruction. However, such implementation would necessitate the overcoming of barriers such as the finding of adequate time allocations from the busy undergraduate medical curriculum and the lack of adequate resources at medical faculties for computer training. Rapidly evolving use of technology in medical education will require students to acquire a host of new technological skills to meet with future demands, which is in addition to the minimal skills evaluated in the present study. Examples of such skills include the ability to search bibliographic databases to obtain current practice guidelines and research information and participation in web conferences and online teaching programmes. It is the duty of the institution to provide the necessary equipment and facilities required such as webcams, web conferencing tools and software, high speed internet connections and access to the major bibliographic databases. However this could be economically demanding in a developing country such as Sri Lanka.
Our results also show that Sri Lankan medical undergraduates mostly use computers for relatively simple tasks like word processing, web browsing and making presentations. While the general usage of computers would help to increase computer literacy, it is doubtful whether these simple tasks would cater to improving the sometimes complex computer skills that are required for computer assisted learning. Studies have shown that the lack of experience with synchronous and asynchronous online communication, may cause problems when using the collaboration tools included in an LMS. It is important to note that presently the students do not have access to most major bibliographic databases due to the high costs involved. In contrast to some published studies we did not observe a significant difference between males and females in computer literacy and its associated factors[9, 16]. This could be due to the high literacy and educational levels of Sri Lankan females. Sri Lanka has the highest female literacy level in the South Asian regions.
At present although computer knowledge and competence are not essential requirement for medical undergraduates in Sri Lanka, they are becoming increasingly important due to the reasons such as; Limitation of access to current books and journals and difficulty in obtaining up to date information, which may affect performance at examinations and practice after graduation. Poor computer knowledge can adversely affect the collation and analysis of data as well as the final quality of the research work and after graduation it may have an adverse impact on postgraduate training. The present study contributes to the existing scarce knowledge on computer literacy among medical undergraduates in the South Asian region. This together with other similar regional studies will provide guidance for regional research on interventional training programmes aimed at improving knowledge, based on the identified success predictors.
The present study has several limitations; we did not study the effects of several other factors that could be associated with computer literacy such as the specifics of schooling, language of schooling, and computer literacy and use of computers among parents and siblings, similarly whether it was economic constraint or lack of interest that precluded computer ownership and learning. However, we had to curtail the length of the survey instrument taking in to consideration time constraints of medical students. Hence, a lengthy questionnaire could have compromised the accuracy of essential data. The relatively high response rate of over 95% is a major strength of the present study. In addition, this study is the first comprehensive survey from the Sri Lankan setting. The factors identified during the present study could be used to improve computer literacy amongst medical undergraduates in Sri Lanka and other developing countries with similar student populations. In addition, technology is advancing very rapidly and it is possible that some of these students are using devices and resources that are not being captured in the current survey.
Sri Lankan medical undergraduates had a low-intermediate level of computer literacy. There is a need to improve computer literacy in students with poor knowledge. This could be done by increasing computer training in the schools, or by introducing a computer training and support programme for these students in the initial stages of the undergraduate programme. These two options require improvement in infrastructure and other resources. As there are students who have very good computer skills an ideal form of teaching/learning model to cater to our requirements will be a peer to peer teaching/learning model.
Ranasinghe P: Is a MBBS graduate at the Faculty of Medicine, University of Colombo. He is a Lecturer at the Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka. His research interests include Medical Education and Non-communicable diseases.
Wickramasinghe SA: Is a MBBS graduate at the Faculty of Medicine, University of Colombo. She has served as a Research Assistant at the Medical Education Development and Research Centre (MEDARC), Faculty of Medicine, Colombo, Sri Lanka.
Pieris WAR: Is a MBBS graduate at the Faculty of Medicine, University of Colombo. She has served as a Research Assistant at the Medical Education Development and Research Centre (MEDARC), Faculty of Medicine, Colombo, Sri Lanka. Her research interests include Medical Education.
Karunathilaka I: Is the Director of the Medical Education Development and Research Centre (MEDARC), Faculty of Medicine, Colombo, Sri Lanka. He received training in Medical Education at the Centre for Medical Education, University of Dundee. He has authored many publications in medical education and has been a resource person at national and international forums.
Constantine GR: Is a Senior Lecturer at the Department of Clinical Medicine, Faculty of Medicine, University of Colombo. He is a consultant cardiologist and his research interest includes Medical Education and Non-communicable diseases.
Computer Assisted Learning
Continuing Medical Education
General Certificate of Education
Learning Management Systems
Multiple Choice Questions
Ob jective Structured Clinical Examination.
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