Introduction

Society has undergone several cultural, social and economic changes in the last few years. Therefore, people have had to strengthen their training in order to face a new reality. Sánchez-Caballé et al. (2020, p. 64) state that "Information and communication technology (ICT) has impacted all areas of human activity" ¹. As the UNESCO stated in 2005 (p. 27), "The new information and communication technologies have created new conditions for the emergence of knowledge societies" ²; based on the foregoing, for some years, several countries have gradually added these technologies, thereby passing from the industrial age to the information age. Hence, as Zao et al. (2021, p. 1) state, "the acquisition, production, processing and utilization of knowledge all play increasingly important roles in boosting a country’s economic growth and has gradually become essential" ³. People are currently surrounded by internet and many digital technologies; the development of social structure and trends in using technologies have produced changes in lifestyle and, definitely, in the way knowledge is gained ⁴.

The development of activities that allow acquiring digital skills keeps becoming more popular. The 21st century university students belong to a generation that grew up amidst an unprecedented boom of networks, which they experience through online media: internet, virtual reality and artificial intelligence. Moreover, in the last few years, the pandemic has increased the social attention towards the need to have digital skills ⁵.

The teaching process in higher education also undergoes constant social and cultural transformations. A new model frequently appears to face problems in this area, and it is received and included, and thereby added to students’ and teachers’ activities. Our time is characterized by rapid scientific, technological and societal advancements which demand high standards of knowledge and skills that must be acquired and shown in the performance of any profession ⁶.

It has been demonstrated worldwide that developing digital skills is valuable and useful for students and also very useful to solve problems. Nowadays, it is essential to teach or train students who manage knowledge, are competent, skilled, creative and critical as well as able to use their abilities and solve problems by using digital media, ITCs and digital literacy, without neglecting the ethical commitment that it involves ^7-9.

However, as Cabezas et al. concluded, despite being members of a generation referred to as digital natives, "they are not highly digitally competent at all," which is confirmed by different research studies stating that students do not have the digital skills needed for higher education but, in contrast, have a low level of digital skills ¹⁰. In this regard, Gabarda et al. stated that despite studies showing "an extended use of ICTs, but this does not necessarily imply digital skills which support that they are used properly" ¹¹. The foregoing is seen when examining abilities, many of which are technical, a fact that evidences the need to improve information and multimedia skills (^11,12). Furthermore, it is stated that most of the students have limitations in the use of specific software while they are trained: they frequently use multimedia applications but have a low knowledge regarding the related technology or theories ¹³.

It should be noted that it is important to include digital technologies in the educational process. These benefit the teaching-learning process since the basic training in digital skills is key for personal development in current society and may contribute to reduce the digital divide ^14,15. In this regard, Ferrari defines digital competence as

"[…] the set of knowledge, skills, attitudes (thus including abilities, strategies, values and awareness) that are required when using ICT and digital media to perform tasks; solve problems; communicate; manage information; collaborate; create and share content; and build knowledge effectively, efficiently, appropriately, critically, creatively, autonomously, flexibly, ethically, reflectively for work, leisure, participation, learning, socialising, consuming, and empowerment" ¹⁶.

For some years now, training in palliative care and pain management have been included in the master’s programs because they have become a continually growing area that requires attention, particularly in oncology and other chronic diseases. It should be noted that training in palliative care and pain management have become very necessary for all the physicians who treat patients suffering from an oncologic disease or from severe degenerative diseases.

According to the new needs, the prevalence of an approach oriented to the development of complex skills in a modern society is evident; therefore, young university students should be trained so that they may be competent in the development and application of thought by means of critical reasoning and the solution of health problems by using digital media and ICTs. In this setting, universities should restructure their pedagogical processes to respond to the impact of globalization and to determine the impact of their implementation and how it contributes to train students committed to their professional activity and also to train competent individual. In this context, the study sets the objective of determining digital skills among students of the master’s program in Palliative Care and Pain Management at a Peruvian public university in 2022.

Materials and methods

Results

According to the records, 32 students were excluded; thus, this sample was made up of 59 students. The average age was 38.03 ± SD 6.02 years; 76.3 % were women, 47.5 % of which were studying the second semester of the program. All the students had a personal computer and internet access at home. A total of 59.3 % used the computer up to 20 hours per week; 39 % stated that they had basic computer skills, and 44.1 % used computer programs. The average number of years using the computer was 18.92. Out of them, 69.5 % totally agreed with the clam that using a computer helps to improve the quality of professionals. Concerning the training or experience in using ICTs, 33.9 % rated it as fair, and 30.5 % each learned to use a computer at school or an institute. Furthermore, 33.9 % stated they had an optimal training in the use of ICTs at the university; in addition, 39 %, followed training programs.

As to the results for factor 1 "digital literacy," 15.3 % of the students considered that it was of low importance to have a good command of applications to process audio, image and digital video using programs such as Photoshop, Audacity, Movie Maker or others; 47.5 % stated that it was very important to hold online conversations by means of synchronous communication tools via web (chat, instant messaging services, Skype, videoconference tools, etc.); and 13.6 % considered of low importance to use e-learning or b-learning platforms for online training and collaboration (Dokeos, Moodle, ILias, etc.). According to the result weighting for the "digital literacy" factor, 44.1 % described it as very important and 39 % as important (Figure 1).

Figure 1 Results of factor 1: digital literacy among graduate students 

Concerning the response about factor 2 "access and use of information," 54.2 % considered that the use of applications and technological services was important since information could be retrieved, organized and managed; 44.1 % considered that those activities to collect, organize and use selected information properly and thus, to build and grasp new knowledge, were very important. According to the result weighting for the "access and use of information" factor, 45.8 %, 42.4 % and 10.2 % considered it was very important, important and moderately important, respectively (Figure 2).

Figure 2 Results of factor 2: Access and use of information among graduate students 

Concerning the results of factor 3 "communication and collaboration", 49.2 % considered it was important to interact with experts or other people on social media and ITC-based communication channels. Moreover, that interaction allowed developing cultural understanding and global awareness by means of relationships with professionals from other cultures. A total of 52.5 % considered it was important to share experiences on social media. According to the result weighting for the "communication and collaboration" factor, 47.5 % considered it was very important, 42.4 % important and 6.8 % moderately important (Figure 3).

Figure 3 Results of factor 3: communication and collaboration among graduate students 

As to the results for factor 4 "digital citizenship," 54.2 % considered that it was very important to have an ethical conduct when using digital information and that from ITCs in order to respect copyrights, intellectual property and appropriate source documentation. A total of 52.5 % stated that it was important to demonstrate personal responsibility for lifelong learning in the use of ITCs as well as developing cultural understanding and global awareness through relationships with professionals from other cultures by using communication and collaboration tools from the digital age. According to the result weighting for the "digital citizenship factor," 49.2 %, 44.1% and 6.8 % considered it was very important, important and moderately important, respectively (Figure 4).

Figure 4 Results of factor 4: digital citizenship among graduate students 

As to factor 5 "creativity and innovation," 52.2 % of the students stated that it was very important to adapt to new situations and technological settings. Likewise, they considered it was important to use prior knowledge to create new ideas, products or processes by means of ICTs. It was also important to understand professional effectiveness and self-renovation by including ICTs in their work setting and to create original works as personal or group means of expression by using ITCs as a part of their lifelong and reflective learning. According to the result weighting for the "creativity and innovation" factor, 45.8 % considered it was very important and important and 6.8 % moderately important (Figure 5).

Figure 5 Results of factor 5: creativity and innovation among graduate students 

The results of the global analysis of digital skills are detailed as follows: 49.2 % considered they were very important, 42.4 % important, 6.8 % moderately important and 1.7 % of low importance. There were no results for not at all important.

Discussion

The educational paradigm shift and the emergence of new teaching models due to the acceleration of digitalization process and the impact of COVID-19 pandemic, as well as the objectives of sustainable development, evidence that digital skills are essential for students who seek higher academic performance and improve their professional training. Therefore, they should be required to gain and develop such skills and also to meet the community demands and to face new challenges ^18-20.

Different research studies conducted in the educational environment show that graduate students are digital natives who use digital devices and tools daily. Nowadays, it is possible because internet access is more feasible and portable computing devices are more available. However, the foregoing does not mean that they have a high level of digital skills ²¹. In addition, it should be specified that there are other factors representing an obstacle to implement digitalization in higher education. In this regard, PaloméVega et al., in a research study carried out with nursing students at Universidad Autónoma de Querétaro, state that "only 9 % […] use a computer and internet for academic purposes. On the other hand, only 20 % know how to use applications" ²². These data are lower than our results due to the lack of digital skills in the educational environment. Furthermore, the findings of Paredes-Parada and Posey stated that 81 % had internet connection and 67 % had a portable device ^23,24.

Concerning the training degree in ICTs and digital skills, less than 50 % of the students got them before entering university or by means of computer courses ²⁵. Also, training in digital skills and the use of ITCs have not been fully addressed during secondary education. On the other hand, its development in university study plans has not been implemented in all the professional careers ^26,27. However, it has been demonstrated that the acquisition of skills and knowledge in the use of technologies has a favorable influence on the level of self-perception concerning digital skills.

According to Sánchez-Caballé et al., digital literacy achieved an optimal result, which is quite logical since it includes data processing, hardware and software management and is influenced by the student’s profile ¹. Nevertheless, it is stated that—when creating digital contents—students need to improve their level of skills well as their ability to solve technical problems and to understand technological trends. The results were similar in the research studies by Llorent-Vaquero et al. and Martzoukou et al. ^28,29. Furthermore, the students gave an optimal or favorable rating to the "access and use of information" factor during their graduate studies. However, there are reports stating that university students do not have a good command of data retrieval, organization and management due to their lack of knowledge in the use of these tools. This fact sets forth the need to manage the use of digital resources to create contents, material access, sound and image editing as a pedagogical strategy that allows supporting students’ learning and demanding teachers to take on their role of mediators ^30,31.

Different studies, as DigCom adaptation carried out by REBIUM (2016), state that "communication and collaboration by means of digital environments, as sharing resources through online tools such as connecting and collaborating with others through digital tools, interacting and participating in communities" ³² allow developing intercultural awareness. It should be pointed out that it is important to analyze collaboration and communication where findings are considered optimal as there are conflicting reports that show unfavorable levels in their development ^33-35. Approximately 50 % of the students showed favorable results in the "digital citizenship" factor because they are respectful and safe users, but the effort to improve digital education from a self-conception still persists because the results are confusing and continually evolving. At present, establishing the educational effort without developing an ethical component in the use of this technology has low acceptance because it is not enough to be technically efficient users but also to know how to act when technological power seeks to prevail ^36,37.

It is important to point out that students assess indicators for the "creativity and innovation" factor in a positive way because they have professional training and are used to learning with ICTs and adapting to certain negative conditions. These results seem to have an explanation since the onset of the pandemic favored the use and application of multimedia technology in the educational sector ³⁶. Therefore, Ferrari et al. state that "digital competence is one of the eight key competences for lifelong learning" ³⁸. Moreover, Simovic et al. stated the following:

"Skills necessary to be digitally competent are related to the ability to manage information; the ability to distinguish the virtual and the real world; the ability to use Internetbased services and to use technologies to support critical thinking, creativity and innovation as well as the interest to participate in communities and online networks" ³⁹.

The "digital literacy" factor showed lower rating compared to the other factors in spite of having a favorable orientation; however, "access and use of information," "communication and collaboration", "digital citizenship" and "creativity and innovation" factors had better ratings, which were similar to those described in a research study conducted among Education students belonging to a high-performance group ³⁶ and in other experiences using b-learning ^40-42. Therefore, it should be noted that it is important to develop these skills and achieve digital literacy, which requires a set of skills and attitudes of students in the educational process.

The research study is not exempted from limitations, e.g., the sample size, which was determined by the students of the same master´s program at a university. Also, it used a self-perception instrument and not an objective assessment of digital skills. Therefore, the results may not reflect the real level of digital skills among students.

In conclusion, this study focused particularly on the actual condition of digital skills among students of the master’s program in Palliative Care and Pain Management. All the students had a personal computer and Internet access; also, the increasing interest for including the aspects related to digital in university education was confirmed. The "digital literacy" factor had the lowest rating, while the "digital citizenship" factor had the highest rating. It showed that 91.6 % of the students rated digital skills as very important and important, which could be considered as very favorable.