Background Digital health technologies hold promise to enhance patient-related outcomes, to support health care staff by reducing their workload, and to improve the coordination of care. As key users of digital health technologies, health care workers are crucial to enable a meaningful digital transformation of health care. Digital health literacy and digital skills should become prerequisite competencies for health professionals to facilitate the implementation and leverage the potential of digital technologies to improve health. Objective We aimed to assess European medical students’ perceived knowledge and opinions toward digital health, the status of digital health implementation in medical education, and the students’ most pressing needs. Methods The explanatory design of our mixed methods study was based on an online, anonymous, self-administered survey targeted toward European medical students. A linear regression analysis was used to identify the influence of the year of medical studies on the responses. Additional analysis was performed by grouping the responses by the self-evaluated frequency of eHealth technology use. Written responses to four qualitative questions in the survey were analyzed using an inductive approach. Results The survey received a total of 451 responses from 39 European countries, and there were respondents for every year of medical studies. The majority of respondents saw advantages in the use of digital health. While 40.6% (183/451) felt prepared to work in a digitized health care system, more than half (240/451, 53.2%) evaluated their eHealth skills as poor or very poor. Medical students considered lack of education to be the reason for this, with 84.9% (383/451) agreeing or strongly agreeing that more digital health education should be implemented in the medical curriculum. Students demanded introductory and specific eHealth courses covering data management, ethical aspects, legal frameworks, research and entrepreneurial opportunities, role in public health and health systems, communication skills, and practical training. The emphasis lay on tailoring learning to future job requirements and interprofessional education. Conclusions This study shows a lack of digital health-related formats in medical education and a perceived lack of digital health literacy among European medical students. Our findings indicate a gap between the willingness of medical students to take an active role by becoming key players in the digital transformation of health care and the education that they receive through their faculties.

The human body contains 3-4 grams of iron. The majority is utilized in erythrocytes to bind and shuttle oxygen throughout the body. Macrophages in the spleen, bone marrow, and liver recycle iron by taking up senescent erythrocytes and breaking them down to provide iron for processes such as erythropoiesis [5]. The remaining iron is stored in hepatocytes, which serve as a regulatory unit to control the systemic iron level. An alternative regulatory measure to control body iron is adjusting its absorption realized by enterocytes in the duodenum. In enterocytes, iron is either stored to minimize the amount of circulating iron as ferritin or transported to the basal side and released into the bloodstream by Fpn, the only known iron exporter on a cellular level [6,7]. After the release, iron is loaded onto transferrin and distributed safely throughout the body [8]. Transferrin-bound iron is recognized by transferrin receptor (TfR), a membrane-bound protein Trends Trends in in Pharmacological Pharmacological Sciences Sciences Figure 1. Key players in iron metabolism. Iron is absorbed by enterocytes in the duodenum. Non-heme iron in ferric form is reduced by the duodenal cytochrome b (DCYTB) to ferrous iron, which can be transported into cells by divalent metal-ion transporter-1 (DMT1). Ferrous iron is released from enterocytes by ferroportin (Fpn) and oxidized by either membrane-bound hephaestin, ferroxidase, or ceruloplasmin (Cp). In its ferric state, iron can be loaded onto transferrin, which allows for its transportation throughout the body to sites of high iron demand, such as the bone marrow, where the production of erythrocytes takes place. Senescent erythrocytes are recognized and phagocytosed by macrophages and degraded intracellularly. The iron obtained as part of this process is either secreted, stored inside ferritin, or used as part of the labile iron pool. Hepcidin, the master regulator of iron metabolism, is produced and secreted by hepatocytes, where its production is regulated by iron stores and plasma iron levels. Hepcidin binds to Fpn and thereby initiates its internalization and degradation by enterocytes, macrophages, and hepatocytes, resulting in reduced plasma iron levels.

BACKGROUND Digital health technologies promise to enhance patient-related outcomes, to support the healthcare staff by reducing their workload and improve the coordination of care. As key users of digital health technologies, healthcare workers are crucial to enable a meaningful digital transformation of healthcare. Digital health literacy and digital skills are to become prerequisite competencies for health professionals to facilitate the implementation and leverage the potential of digital technologies to improve health. OBJECTIVE We aimed to assess European medical students’ perceived knowledge and opinions towards digital health, the status of digital health implementation in medical education, and the students’ most pressing needs. METHODS The explanatory design of our mixed-methods study was based on an online, anonymous, self-administered survey targeted towards European medical students. The quantitative analysis was performed using R statistical language; qualitative data was analyzed applying an inductive categorization approach using MaxQDA 2020 software. RESULTS The survey received a total of 451 responses from 39 European countries and all years of medical studies. The majority of respondents saw advantages in the use of digital health. More than half (53%) evaluated their eHealth skills as poor or very poor and 40% felt prepared to work in a digitized healthcare system. Medical students considered the reason for this a lack of education, with 85 % agreeing or strongly agreeing that digital health education should be more implemented in the medical curriculum. Students demanded introductory and specific eHealth courses covering data management, ethical aspects, legal frameworks, research and entrepreneurial opportunities,, its role in public health and health systems, communication skills, and practical training with eHealth technologies. The emphasis lay on tailoring learning to future job requirements and interprofessional education. CONCLUSIONS This study shows a lack of digital health-related formats in medical education and a perceived lack of digital (health) literacy among European medical students. Our findings indicate a gap between the willingness of medical students to take an active role by becoming key players in the digital transformation of healthcare, and the education they receive through their faculties. CLINICALTRIAL