Computer literacy amongst medical undergraduates in developed countries is at a relatively higher level in comparison to students of developing resource poor countries [8]. 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 [9]. 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 [10]. Lack of resources, time and structured training programmes are amongst the reasons for the low computer literacy of medical undergraduates in developing countries [9]. 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 [11].

Sri Lanka is a developing middle-income country in the South Asian region with a population of nearly 20 million [12]. 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 [13]. 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 [14]. 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 [15].

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.

Majority of the students (n = 137, 75.7%) expressed their willingness for a formal computer training programme at the faculty (Males – 74.4%, Females – 76.9%). The students mostly preferred to be trained by either a computer trainer (n = 68, 49.6%) or peers (n = 40, 29.2%) (Table ​(Table2).2). There was no significant gender difference in this preference. They preferred to be trained on using the internet (n = 114, 83.2%), computer statistics (n = 100, (73.0%), making presentations (n = 73, 53.3%) and word processing (n = 48, 35.0%). A significant majority of females (90.0%) expressed willingness for training in using internet than males (76.1%) (Table ​(Table2).2). Eighty three students (60.6%) wanted the formal training programmed to be scheduled prior to the commencement of faculty teaching activities (Table ​(Table22).

The mean score of students out of hundred for the computer literacy section of the questionnaire was 48.4 ± 20.3. There was no significant gender difference in the mean scores (Males – 47.8 ± 21.1, Females – 48.9 ± 19.6). Most student (37.6%) were in the category of high (score 50-69%) computer literacy (Figure ​(Figure1).1). However, 47.9% of students had a score less than 50% for the computer literacy questionnaire. There were 14.4% students having a very-high computer literacy (score > =70%). There was no significant gender difference observed in the categories of computer literacy (Figure ​(Figure1).1). Students from Colombo district (54.2 ± 19.8) had a significantly higher mean score in comparison to students from other districts (44.2 ± 19.8) (p < 0.001). However, this difference was not observed between males from Colombo district (49.9 ± 22.7) and other districts (46.8 ± 20.4) (p-NS). Students residing in Western province (54.9 ± 18.5) had a higher mean score than those residing in other provinces (41.1 ± 19.8) (p < 0.001). In both genders the difference in mean score between the provinces was significant. Students owning a computer had a higher mean score (50.9 ± 18.9) compared to others (39.5 ± 22.4) (p < 0.001). In addition, students who have gained their present computer knowledge from a formal training course (56.7 ± 16.7) also had a significantly higher mean score than other (33.6 ± 17.7) (p < 0.001). However there was no statistically significant difference observed between score of those who have said that they have gained their knowledge from self-learning or by peer-learning.

The linear regression model explained 55.6% of the variance in score for computer literacy (R² = 0.556). The analysis of variance revealed that the final model was significant (F_{17, 2431} = 12.002, p < 0.001). In all students, undergoing a formal computer training course was the strongest predictor of computer literacy score (β = 13.034, p <0.001), followed by Using internet facility (β = 12.984, p < 0.001), being from Western province (β = 11.744, p < 0.001), using computers for Web browsing (β = 8.041, p < 0.01) and computer programming (β = 8.592, p < 0.001), ownership of a computer (β = 4.609, p < 0.01) and doing IT as a subject in GCE (A/L) examination (β = 4.261, p < 0.05) (Table ​(Table3).3). Being from Colombo district and gender were not significant predictors of computer literacy score (Table ​(Table33).

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 [13]. This is comparable to computer ownership data of medical undergraduates from developed countries [17]. 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 [18]. The adoption of a requirement for student ownership of computers at these institutions has successfully facilitated development of students computer skills [18]. 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 [19]. 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 [20]. 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 [21]. 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 [22].

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.

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.