Development of a virtual patient as a chatbot to promote physicians' digital literacy in the context of digital health applications

Digitalisation in the healthcare system is supposed to promote the quality of care and the autonomy of patients but is proceeding rather slowly in Germany (Bratan et al., 2022). Reasons for this include scepticism among service providers and deficits in training medical staff in new technologies (ibid.). Digital health applications (german: Digitale Gesundheitsanwendung – short: DiGA), which the medical profession and psychotherapists can prescribe to people with health insurance in Germany since 2019, also meet a certain degree of scepticism among the medical profession (Bundesanzeiger Verlag, 2019; Bitkom, 2020). Current research suggests that most medical professionals do not want to prescribe DiGAs or that there is still uncertainty (Bitkom, 2020; Dahlhausen et al., 2021). Information deficits and technological uncertainties were primarily mentioned as obstacles (Dahlhausen et al., 2021). Accordingly, the need for good education and improvement of digital competencies in the health professions is a basis for dealing with digital applications in everyday medical life and increasing acceptance (Bratan et al., 2022; Kirsten et al., 2022; Dahlhausen et al., 2022). In addition, further research is needed on the factors influencing the prescription of digital health apps (Dahlhausen et al., 2022; Techniker Krankenkasse, 2022). Education on digital health apps and digital literacy promotion could be achieved by integrating suitable teaching content into the medical curriculum. So far, such learning content has hardly been included in medical training (Bratan et al., 2022; Neumann et al., 2021). A technological-methodological approach to this can be virtual patients. These learning technologies provide a multimedia opportunity to practice clinical, problem-solving and decision-making skills in real-world situations (Sahu et al., 2019). Although current research points to the potential of chatbots as a flexible and accessible way to improve medical students' skills, there is little research on implementing such chatbots (Kaur et al., 2021; Frangoudes et al., 2021).

The cumulative dissertation project aims at the prototypical development of a virtual patient as a chatbot to promote physicians' digital literacy on digital health applications in medical education. According to Design-Search-Research (DSR), with a mixed-methods approach, a design- and problem-oriented approach is planned (Hevner et al., 2004; Peffers et al., 2007). The project aims to address three research questions:

Q1: What are the requirements for an artificially-intelligent patient as a chatbot for prescription research and training on digital health applications?

Q1 aims to develop a concept that includes design options for a virtual patient chatbot for research on physicians’ intention to prescribe health apps and to train prescriptions on digital health apps with physicians, and a (first) prototype for the patient chatbot.

Q2: What factors influence physicians' prescribing intention for digital health apps?

F2 aims to develop a model on the influencing factors of physicians' prescribing intention for digital health apps identified in an online experiment with the chatbot.

Q3: What implications for promoting physicians' digital literacy in digital health apps can be derived for medical education?

Q3 aims to develop implications in the form of a (training) concept and the virtual artificially intelligent patient chatbot to promote digital literacy in medical education in the context of digital health applications.