gms | German Medical Science

GMS Journal for Medical Education

Gesellschaft für Medizinische Ausbildung (GMA)

ISSN 2366-5017

Digital Health meets Hamburg integrated medical degree program iMED: concept and introduction of the new interdisciplinary 2nd track Digital Health

article Digital Skills

  • corresponding author René Werner - University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Biomedical Artificial Intelligence (bAIome), Hamburg, Germany
  • author Maike Henningsen - University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Hamburg, Germany
  • author Rüdiger Schmitz - University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Biomedical Artificial Intelligence (bAIome), Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Department for Interdisciplinary Endoscopy, Hamburg, Germany
  • author Andreas H. Guse - University Medical Center Hamburg-Eppendorf, Faculty of Medicine, Deanery, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Department of Biochemistry and Molecular Cell Biology, Hamburg, Germany
  • author Matthias Augustin - University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Hamburg, Germany
  • author Tobias Gauer - University Medical Center Hamburg-Eppendorf, Department of Radiotherapy and Radiation Oncology, Hamburg, Germany

GMS J Med Educ 2020;37(6):Doc61

doi: 10.3205/zma001354, urn:nbn:de:0183-zma0013546

This is the English version of the article.
The German version can be found at:

Received: November 22, 2019
Revised: March 27, 2020
Accepted: May 11, 2020
Published: November 16, 2020

© 2020 Werner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at


Digitalization in medicine is transforming the everyday work and the environment of current and future physicians – and thereby brings new competencies required by the medical profession. The necessity for a curricular integration of related digital medicine and, in more general, digital health topics is mostly undisputed; however, few specific concepts and experience reports are available. Therefore, the present article reports on the aims, the implementation, and the initial experiences of the integration of the topic Digital Health as a longitudinal elective course (2nd track) into the integrated medical degree program iMED in Hamburg.

Keywords: medical degree, digitalization, digital medicine, model degree program

1. Introduction

Health apps are already extensively being used [1], [2], [3] and the prerequisites and processes for their prescription have become a topic of current legislative debates [4]. But how can the benefits and quality of health apps be objectively recorded and assessed? Artificial intelligence (AI) and big data are widely anticipated to change, if not revolutionize, current medical practice [5]. AI systems have demonstrated to be on par with or even surpass human experts in specific tasks [6], [7]. But how do these systems function technically? What are their inner workings? How can, and should, they be integrated into daily clinical practice? What implications will this pose on data privacy and liability? These selected examples already illustrate that the digital transformation of the health care system, which goes far beyond mere digitization, will change the way in which current and future clinicians carry out their daily work. Accordingly, the questions arise as to which competencies clinicians will need in order to work effectively in these changing environments – and to actively shape the process themselves. And how should these competencies be integrated practically into the medical curricula [8]? As a first response, the Faculty of Medicine of the University of Hamburg developed a new interdisciplinary elective course Digital Health, which it introduced into the Hamburg integrated medical degree program (iMED) as of the winter semester 2018/2019. This report describes the underlying objectives, the specific implementation and structure of this course as well as the initial experiences.

iMED elective courses: thematically structured longitudinal 2nd tracks

The integrated medical degree program iMED consists of a modularly structured core curriculum and elective courses (the so-called 2nd tracks). As shown in figure 1 [Fig. 1], the first nine iMED semesters are organized in a 6-2-6-week rhythm: two six-week compulsory modules with a two-week elective course module in between. The elective courses are longitudinally arranged. In the 1st semester, all students attend a module on principles of scientific methods. Semesters 2-4 form an orientation phase: Each semester, students attend an orientation module for one of the different thematically structured 2nd tracks (see [9] for further details). After the 4th semester and based on their experience in the orientation modules, the students select one of the 2nd tracks as a specialization area for the semesters 5-9. The 10th semester is dedicated to a compulsory student research project, which the students prepare as an independent academic achievement. Thus, the subject-specific content to be offered by each 2nd track comprises of a two-week orientation module (for students in semesters 2-4) and five two-week advanced modules (semesters 5-9).

2. Requirements and planning of the new 2nd track Digital Health

The iMED 2nd tracks are oriented toward the main research areas and interests of the University Medical Center Hamburg-Eppendorf (UKE) as well as the interests of the students; the necessity of a demand-driven extension and adaptation is evaluated regularly. The development of the 2nd track Digital Health was initiated during the annual iMED faculty retreat in summer 2018 (focus topic: digitalization in medicine). To address the inherent interdisciplinarity and complexity of the topics digital medicine and digital health, the 2nd track contents and goals were coordinated in open meetings and definition workshops for members of the Faculty of Medicine. In addition, active discussions and collaborations with the MIN faculty (Departments of Informatics and Physics) and the Faculty of Law of the University of Hamburg were sought. Furthermore, the medical students were offered to actively participate in the design and development of this new curriculum.

2.1. Development of key 2nd track areas, comprehensive key questions, and a 2nd track matrix

As the starting point for the 2nd track development, the following overarching objectives were defined:

  • The students will be introduced to the digital transformation process of the medical profession and its environment as well as the related opportunities and challenges of digitalization.
  • The students will be enabled to critically discuss social and ethical questions and potential areas of conflict arising from the digitalization process.
  • The students will ascribe to the interdisciplinary collaboration that these objectives require.

To select appropriate thematic foci to bring these generic objectives to life, the „Curriculum 4.0 – Medizin im digitalen Zeitalter“ (Curriculum 4.0 – Medicine in the digital age) introduced in Mainz in 2017 [8] served as a template. However, in contrast to the one-week elective course in Mainz, the structure of the iMED elective study program (see figure 1 [Fig. 1]) allows for the topics of digital medicine and digital health to be presented more broadly and in more depth. After intensive discussions, the following thematic foci were selected as the topics for the 2nd track advanced modules:

  • Advanced module A1 (5th semester students): telemedicine
  • Advanced module A2 (6th semester): robotics, automation and virtual/augmented reality in medicine
  • Advanced module A3 (7th semester): artificial intelligence
  • Advanced module A4 (8th semester): big data: omics and biomarkers for personalized medicine
  • Advanced module A5 (9th semester): smart medical devices & health apps

The orientation modules (for students in semesters 2-4) were designed as an overview of the topics and contents of the 2nd track.

The concept design and implementation of the advanced modules of the 2nd track was guided by five overarching questions:

  • What are the main aspects and elements of digitalization in relation to the topics and applications covered by the respective module?
  • What has been changed/improved by digitalization with regard to the module topics and patient treatment?
  • What has been changed by digitalization with regard to the module topics for the medical profession and the required skills of the physicians?
  • Which quality criteria were/are used to measure the benefit/value of digitalization with respect to the module topics?
  • What open medical, technical, legal and ethical questions exist with regard to the module topics?

The elaboration of the five key questions for the five advanced modules and module-specific topics define the so-called 5x5 2nd track matrix. This matrix serves as the thematic foundation of the 2nd track that will be continuously adapted to developments in the health care sector.

2.2. From theory to praxis: interdisciplinary and competency-driven distributed 2nd track organization

The organizational effort for the development and implementation of a 2nd track is immense. With up to four of the two-week modules of the 2nd track, each with 30-40 teaching hours, being offered simultaneously, successful implementation requires collaboration and interdisciplinarity. To efficiently utilize the personnel resources of the UKE departments and institutes, the individual modules of the 2nd track Digital Health are primarily organized independently and in a competence-driven manner. Thus, the A1 module is organized by the Department of Diagnostic and Interventional Radiology and Nuclear Medicine (contributing expertise in teleradiology) and the Institute for Health Services Research in Dermatology and Nursing (IVDP; e.g. teledermatology). The A2 module is coordinated by the Department of Radiotherapy and Radiation Oncology, the Department of Neurosurgery, and the Department of Urology (Martini Clinic). The A3 module is jointly organized by theoretically and practically oriented working groups (Department Institute of Computational Neuroscience, Department of Medical Systems Biology, the UKE Center for Biomedical Artificial Intelligence, and Department of Dermatology and Venereology). The Department of Cardiology and the Department of Pathology are responsible for the implementation of the A4 module, and the A5 module is coordinated by the IVDP. Course implementation and lecturing is further supported by the MIN faculty of the University of Hamburg and a student advisory board. The independent organization of the individual modules also incorporates the selection of the teaching formats. To further promote scientific application and principles, cross-module events (e.g. student research project fairs) are offered. Lastly, each module is to be concluded with a module examination. The appropriate form of examination in a 2nd track Digital Health course is currently under discussion, but will be consistent for all advanced modules. For the orientation modules, the form of a multiple-choice exam was initially chosen; in the future – in line with the topic of the 2nd track – electronic forms of examination will be introduced.

3. Initial experiences and evaluation

The first orientation module was held in May 2019 with 13 students. The advanced modules will be introduced gradually, starting with the A1 module from the winter semester 2020/2021. Building on general iMED guiding principles and goals, special attention was given to the following aspects during the implementation of the orientation module:

  • Integration of theory and practice: A key feature of iMED is the close integration of theoretical knowledge with practical skills, which is also reflected by the 2nd track Digital Health. For example, the foundations and functional principles of virtual and augmented reality (VR, AR) are first introduced in a conventional seminar form and then directly concretized as part of a VR-based training course in anesthesia and emergency medicine offered at the UKE.
  • Critical attitude and problem awareness: The digital transformation in medicine not only affects the medical environment and the doctor-patient relationship, but also the healthcare system as a whole. To illustrate this, an industry panel with three distinguished speakers both from academia and industry in the biomedical field was organized together with the research group Ethics in Information Technology at the Department of Informatics of the University of Hamburg. The invited panelists were encouraged to put on rose-tinted glasses and to present only the opportunities offered by the digitalization in their business sector, while the students were asked to identify the associated risks and potential ethical problems.
  • Development of communicative competencies: In preparation for the industry panel, the student advisory board organized a so-called One Million Euro Challenge. The goal of the challenge was to directly apply the newly acquired knowledge of methods and applications (e.g. artificial intelligence) in small groups and to develop business models in the context of the digital transformation, i.e. to take the perspective of a digital health entrepreneur. In order to mimic a realistic “pitching scenario”, the developed business models were presented before and defended to the student advisory board that awarded the best idea and presentation. Each student group was supported by an experienced tutor. To structure and present the business models, concepts like SWOT analysis, the CO-STAR methodology [10] and the elevator pitch were tested together with the tutor.

“Exciting and practical perspectives!”, “Discussions were always very stimulating.” The students’ assessment in the final feedback round of our first run of the orientation module was consistently very positive. Furthermore, the official and student-questionnaire based evaluation of all 2nd tracks, as conducted by the Faculty of Medicine, supported this feedback: The Digital Health orientation module received the highest scores in overall satisfaction (n=13 students, M=6.0, SD=0.0; 6=highest overall satisfaction, 0=lowest satisfaction) of all 16 2nd track orientation modules offered in the semester. These initial experiences suggest that the presented concept is, in general, attractive. On the other hand, it should be noted that the orientation module offered 20 places for students but only the aforementioned 13 places were occupied. When asked, the students reported that many had suspected that this 2nd track would contain “too much computer science stuff” – a fear that had been refuted. In addition, the 2nd semester medical students considered the term “digital health” not clearly defined and sufficiently relevant when compared to classical medical elective course titles. This may seem surprising at first glance, but it confirms the observations that consumer level usage and familiarity of digital media does not necessarily lead to the acquisition of job-specific digital competencies [11] or a pronounced interest in them.

4. Conclusions

The presented concept of integrating digital health as a longitudinal interdisciplinary 2nd track into the Hamburg integrated medical degree program iMED enables related topics to be taught in greater breadth and depths than currently realized or intended in many other places. The concept thereby defines a model that can be transferred to and adopted by other university medical centers and medical faculties. In our view, there is, however, no alternative but to partner with external collaboration partners and to think beyond traditional faculty and university borders (see, e.g., the industry panel) to adequately address the complexity and dynamics of the field. The positive initial student feedback supports our ideas and concept, but represents only a first snapshot. The continued monitoring within the iMED quality assurance framework will show the extent to which digital health can be established permanently as a successful longitudinal elective course in iMED.


The authors thank all colleagues and students that participated in the development, conception and realization of the 2nd track (also and in particular those persons and UKE departments and clinics not mentioned in this article). We thank Dr. Leigh-Anne Dell-Brown for support with the English translation of this report.

Competing interests

The authors declare that they have no competing interests.


Debong F, Mayer H, Kober J. Real-World Assessments of mySugr Mobile Health App. Diabetes Technol Ther. 2019;21(S2):S235-S240. DOI: 10.1089/dia.2019.0019 External link
Meyer B, Berger T, Caspar F, Beevers CG, Andersson G, Weiss M. Effectiveness of a novel integrative online treatment for depression (Deprexis): randomized controlled trial. J Med Internet Res. 2009;11(2):e15. DOI: 10.2196/jmir.1151 External link
Xu W, Liu Y. mHealthApps: a repository and database of mobile health apps. JMIR Mhealth Uhealth. 2015;3(1):e28. DOI: 10.2196/mhealth.4026 External link
Bundesministerium für Gesundheit. Ärzte sollen Apps verschreiben können. Gesetz für eine bessere Versorgung durch Digitalisierung und Innovation (Digitale-Versorgung-Gesetzt - DVG). Berlin: Bundesministerium für Gesundheit; 2020. Zugänglich unter/available from: External link
The Lancet. Artificial intelligence in health care: within touching distance. Lancet. 2017;390(10114):2739. DOI: 10.1016/S0140-6736(17)31540-4 External link
Esteva A, Kuprel V, Novoa RA, Ko J, Swetter SM, Blau HM, Thrun S. Dermatologist-level classification of skin cancer with deep neural networks. Nature. 2017;542(7639):115-118. DOI: 10.1038/nature21056 External link
Schmitz R, Werner R, Rösch T. Künstliche Intelligenz in der Endoskopie: Neuronale Netze und maschinelles Sehen - Techniken und Perspektiven. Z Gastroenterol. 2019;57(06):767-780. DOI: 10.1055/a-0891-4032 External link
Kuhn S. Transformation durch Bildung. Dtsch Arztebl. 2018;115(14):A-633/B-552/C-552.
Rheingans A, Soulos A, Mohr S, Meyer J, Guse AH. The Hamburg integrated medical degree program iMED. GMS J Med Educ. 2019;36(5):Doc52. DOI: 10.3205/zma001260 External link
Gyorffy L, Friedman L. Creating value with CO-STAR: an innovative tool for perfecting and pitching brillant ideas. Palo Alto, CA: Enterprise Development Group, Inc.; 2012.
Kuhn S, Jungmann F. Medizin im digitalen Zeitalter. Radiologe. 2018;58(3):236-240. DOI: 10.1007/s00117-017-0351-7 External link
Guse AH, Kuhlmey A. Modellstudiengänge in der Medizin. Lehrinnovationen am Beispiel der Studiengänge in Hamburg und Berlin. Bundesgesundheitsbl. 2018;61(2):132-140. DOI: 10.1007/s00103-017-2678-7 External link