Abstract
Purpose
Information literacy education can produce positive learning experiences for medical students, enabling them to understand research and prepare for future professions. The objectives of this study were to identify the information literacy skills of medical students in North Sumatra; explore the learning methods for information retrieval and management conducted by the medical schools; and explore student challenges in accessing and reviewing information.
Methods
This was mixed-method research in which quantitative and qualitative analyses were performed simultaneously. The number of subjects in this study was 318 students, who were randomly selected from four medical schools. Data from those subjects were collected using the Information Literacy Self-Efficacy Scale for Medicine questionnaire and open-ended questions.
Results
Study period was a significant predictor among other sociodemographic factors influencing information literacy skills. More than 60% of the students demonstrated proficiency in various information literacy components, particularly in evaluating information sources, with varied learning methods fostering these skills from lectures, tutorials, practicums, and activities beyond the campus. Otherwise, using a library and bibliography was the component that students were poorly competent in, and six themes of barriers to information literacy that might influence this competency were determined.
Conclusion
Despite students' challenges in enhancing information literacy, their skills were adequate. A comprehensive information literacy in the curriculum should be implemented through meaningful methods and integrated with English proficiency and digital support.
Keywords: Information literacy, Experiences, Challenges
Introduction
The World Health Organization attributes specific qualities to five-star doctors, defining them as care providers, decision-makers, communicators, community leaders, and managers [1]. Doctors must carry out evidence-based practice. Outcomes or competency-based medical education must be explicitly demonstrated in the curriculum through evidence-based learning methods [2]. The Indonesian Medical Council has formulated competency standards for Indonesian doctors since 2012 so that the implemented curriculum follows a competency-based approach. Two areas of physician competence closely related to information literacy skills are information management and self-development introspection [3]. Current technological advances allow everyone to have access to information. For example, patients can search for information about their symptoms online before visiting the doctor. Information literacy is a challenge and a competency that doctors must possess to update their knowledge continuously. Information literacy education can produce positive learning experiences for medical students, enabling them to understand research and prepare for future professions [4]. Information literacy is knowing when and why someone needs information, how to get it, evaluate it, and use it ethically. According to the lecturer, the most common weakness of students in information literacy is their ability to evaluate literature. Students often choose inappropriate sources, cannot distinguish between primary and secondary sources, struggle with time management, lack perseverance, have inadequate critical thinking skills, and lack experience. The inability of students to evaluate sources effectively is a problem that needs attention. Students tend to choose sources initially deemed appropriate, but they find it difficult to examine them critically. Therefore, time and learning experiences in the curriculum are necessary for students to develop these abilities [5].
Information literacy skills will increase with training. Research showed no significant difference in the information literacy ability of students who receive online, offline, or blended-learning information literacy training or teaching [6]. A study showed that the health information literacy ability of medical and health science students in Indonesia is low [7].
Information literacy skills encompass using computers, the internet, software operation, search engines, and software installation on computers. Students’ mastery of these abilities is still low, affecting their literacy skills [8,9]. Research on the information literacy skills of medical students in Indonesia is minimal. A previous study showed that students of the medical professional education program could carry out information literacy by searching for information, selecting relevant and credible information, evaluating the sources of information used, constructing new information, and re-communicating information to others. The study did not classify the students’ ability levels [10].
This study aimed to identify sociodemographic factors as predictors of the information literacy skills of medical students in North Sumatra, explore information literacy skills of medical students based on Information Literacy Self-Efficacy Scale for Medicine (ILSES-M) components, and explore learning methods and barriers to enhancing these skills.
Methods
1. Subjects
The population consisted of active medical students in North Sumatra Province. Research subjects were selected using a simple random sampling method. The sample size was calculated using the Slovin formula, resulting in 318 students. They were first- to sixth-year students from four medical schools. Indonesia’s undergraduate medical education curriculum is a 6-year program divided into two phases: the bachelor phase for 4 years, followed by 2 years of clerkships. At each phase, an information literacy module was taught to students. The modules conducted by medical schools are similar; for example, there were lectures and laboratory practice in the first year and a bachelor’s thesis in the fourth year. In addition, most medical schools in Indonesia use hybrid problem-based learning to enhance information literacy skills while students discuss learning issues based on valid references. Journal reading and case reports are activities conducted by medical schools in the clerkship phase to implement evidence-based education.
2. Instruments
This study used the ILSES-M questionnaire, which was translated and modified to fit the context in Indonesia. This questionnaire consists of 38 questions with a scale of 0–10 (strongly unconfident to highly confident). The questionnaire was first tested for readability with three students and then for validity and reliability. The validity test results showed that 35 questions had a correlation coefficient of 0.3610. Three questions had an r-value of <0.3610, but after consulting with experts, they were still included due to their representativeness of the assessed information literacy component. The reliability of this questionnaire is high, with a Cronbach’s alpha value of 0.957. The questionnaire has five constructs/components of information literacy skills, as seen in Table 1.
Table 1.
Information Literacy Self-Efficacy Scale for Medicine Questionnaire
| Component | Item |
|---|---|
| Evaluating and processing information | 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 28 |
| Medical information literacy skills | 12, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 |
| Searching and finding information | 1, 2, 3, 4, 5, 9, 11 |
| Using the library | 6, 7, 8, 10 |
| Bibliography | 24, 25, 26, 27 |
3. Procedures
This study was conducted in six stages. Firstly, we obtained ethical clearance from the Medical and Health Research Ethics Committee, Faculty of Medicine, Universitas Muhammadiyah Sumatra Utara, with reference number 552/KEPK/FKUMSU/2021. Secondly, we simultaneously tested the validity and reliability of the research questionnaire and then modified it according to the results. Thirdly, we requested permission to collect data from other medical schools in North Sumatra, after which we randomly selected samples. Then, we conducted the data collection by providing a Google Form link (Google LLC, Mountain View, USA) to consenting subjects. Finally, we processed and analyzed the data and drew conclusions.
4. Analysis
Data analysis on the information literacy abilities of medical students in North Sumatra involved bivariate analysis, which was followed by predictive logistic regression to analyze students’ characteristics (gender, ethnicity, study period, and grade point average [GPA]) as predictors of information literacy skills. Furthermore, the information literacy skills based on components of the ILSES-M questionnaire were analyzed to identify the details of students’ information literacy skills.
The qualitative data were analyzed using thematic analysis to explore learning activities and information literacy barriers students faced in their study. The authors read the data from the open questionnaire and formulated code in words based on the text written by respondents, continuing to determine patterns and themes related to the barriers to the information literacy framework [11], which consists of six components (authority is constructed and contextual, information creation as a process, information has value, research as inquiry, scholarship as conversation, and searching as strategic exploration), and metaliteracy that consists of seven components (understand format type and delivery mode, evaluate user feedback as active researcher, create a context for user-generated information, evaluate dynamic content critically, produce original content in multiple media formats, understand personal privacy, information ethics and intellectual property issues, share information in participatory environment [12]. Following this, the authors asked an expert to read and validate the code and themes that had been formulated. Finally, authors conclude the results and state recommendations.
Results
As the objectives of this study, the results were explained in three sections accordingly: from sociodemographic factors that predict information literacy skills, the methods that students used to develop their information literacy skills, and the challenges students faced in enhancing their information literacy skills.
1. Sociodemographic factors as predictors of information literacy skills
The expected number of research samples was 369 people. However, as of the time this report was made, the total sample size was 318 people from four medical schools in North Sumatra, Indonesia. The response rate was 86.18%.
Table 2 shows that female respondents (69.5%) surpass males (30.5%). Almost fifty female students (48.7%) had good information literacy skills, while male students with adequate information literacy skills accounted for 20.8%. Bivariate analysis showed no significant difference in information literacy between female and male students, and it could not significantly predict information literacy skills.
Table 2.
Information Literacy Skills of Medical Students by Sociodemographic Factors
| Characteristic | Information literacy skills |
p-value | |||
|---|---|---|---|---|---|
| Good | Sufficient | Poor | Total | ||
| Sex | 0.709 | ||||
| Male | 66 (20.8) | 31 (9.7) | 0 (0) | 97 (30.5) | |
| Female | 155 (48.7) | 66 (20.8) | 0 (0) | 221 (69.5) | |
| Ethnic | 0.246 | ||||
| Aceh | 9 (2.8) | 2 (0.6) | 0 (0) | 11 (3.4) | |
| Banten | 1 (0.3) | 0 (0) | 0 (0) | 1 (0.3) | |
| Bataknese | 113 (35.6) | 51 (16.0) | 0 (0) | 164 (51.6) | |
| Javanese | 34 (10.7) | 10 (3.2) | 0 (0) | 44 (13.9) | |
| Malay | 16 (5.0) | 3 (0.9) | 0 (0) | 19 (6.0) | |
| Minang | 13 (4.1) | 8 (2.6) | 0 (0) | 21 (6.6) | |
| Sundanese | 0 (0) | 1 (0.3) | 0 (0) | 1 (0.3) | |
| Tionghoa (Chinese) | 30 (9.4) | 21 (6.6) | 0 (0) | 51 (16.0) | |
| Tamil (Indian) | 4 (1.3) | 1 (0.3) | 0 (0) | 5 (1.6) | |
| Study period | 0.008 | ||||
| Year 1 | 11 (3.5) | 7 (2.2) | 0 (0) | 18 (5.7) | |
| Year 2 | 34 (10.7) | 23 (7.2) | 0 (0) | 57 (17.9) | |
| Year 3 | 85 (26.7) | 43 (13.5) | 0 (0) | 128 (40.3) | |
| Year 4 | 32 (10.1) | 15 (4.8) | 0 (0) | 47 (14.7) | |
| Year 5 | 31 (9.7) | 8 (2.5) | 0 (0) | 39 (12.3) | |
| Year 6 | 28 (8.8) | 1 (0.3) | 0 (0) | 29 (9.1) | |
| Grade point average | 0.05 | ||||
| Sufficient (<2.49) | 8 (2.5) | 7 (2.2) | 0 (0) | 15 (4.7) | |
| Satisfying (2.50–3.00) | 54 (17) | 32 (10.0) | 0 (0) | 86 (27.0) | |
| Very satisfying (3.01–3.50) | 120 (37.7) | 50 (15.7) | 0 (0) | 170 (53.5) | |
| With compliments (3.51–4.00) | 39 (12.3) | 8 (2.5) | 0 (0) | 47 (14.8) | |
Data are presented as number (%).
Most ethnic groups had good information literacy skills. Only two tribes of Indonesians, Banten and Sundanese, had few respondents. However, the information literacy skills did not differ among ethnicities based on bivariate analysis, and it was not a significant predictor of the information literacy skills.
The third-year students had the highest scores in information literacy skills, whereas the sixth-year students had the lowest. A significant gap in information literacy skills among students of different years affects these skills (Table 2).
Students with a sufficient GPA and good information literacy skills accounted for 2.5%, and their literacy skills were adequate for 2.2% (Table 2). Students with satisfactory GPAs and good literacy skills represented 17%, and those with sufficient literacy skills accounted for 10%. Half of the respondents were students with a very satisfying GPA; 37.7% had good information literacy skills, while 15.7% had sufficient information literacy skills.
Ethnicity, GPA, and study period were included in predictive logistic regression through backward methods, while sex was excluded (p>0.25). The dummy table results showed that the ethnic variable had eight dummy variables because the number of categories was nine. The GPA variable had five dummy variables because the number of categories was six, and the study period variable had three dummy variables because the categories were four. Results showed that the study period significantly influenced information literacy skills (p<0.05), and an odds ratio of 17.82, which means the study period 17.82 predicts the information literacy skills (Table 3).
Table 3.
Multivariate Logistic Regression Analysis of the Effect of Ethnicity, GPA, and Study Period on Literacy Information Skills
| Coefficient | SE | Wald | df | p-value | OR (95% CI) | |
|---|---|---|---|---|---|---|
| Ethnics | –1.490 | 0.864 | 2.976 | 8 | 0.085 | 0.225 (0.041–1.225) |
| GPA | 1.211 | 0.710 | 2.912 | 5 | 0.088 | 3.356 (0.835–13.483) |
| Study period | 2.880 | 1.127 | 6.535 | 3 | 0.011 | 17.818 (1.958–162.152) |
| Constant | 0.452 | 0.483 | 0.874 | 1 | 0.350 | 1.571 |
GPA: Grade point average, SE: Standard error, df: Degrees of freedom, OR: Odds ratio, CI: Confidence interval.
The overall literacy ability was generally good, as was the literacy ability of each component (Table 4). Using a library was a component of information literacy skills that showed the same percentage of good and sufficient. About 9% of students demonstrated poor library use, which means that some students found it challenging to locate information sources in the library, use the catalogue, and access different library materials. Moreover, 0.3% of students struggled with bibliography, which involves creating and organizing references using software, recording various materials, making citations, and using quotations in the text. The same results were stated in students’ responses to the open-ended question in the questionnaire.
Table 4.
Frequency of Information Literacy Skill Components
| Information literacy skills |
|||
|---|---|---|---|
| Good | Sufficient | Poor | |
| Evaluation and processing information | 225 (70.8) | 93 (29.2) | 0 (0) |
| Medical information literacy skills | 225 (70.8) | 93 (29.2) | 0 (0) |
| Searching and finding information | 233 (73.3) | 85 (26.7) | 0 (0) |
| Using the library | 192 (60.4) | 120 (37.7) | 6 (1.9) |
| Bibliography | 216 (67.9) | 101 (31.8) | 1 (0.3) |
Data are presented as number (%).
2. Learning methods to deliver information literacy
The qualitative data in this study align with the findings of previous research [13]. Quotations were made using the quote number based on participants’ responses in the transcript in Supplement 1. Based on the data obtained, the medical faculty’s learning methods for searching and managing information included some students who reported that there was no learning method or that they had forgotten it. Some students said that the search and management of information are taught through lectures:
“In lectures on literature search, we are taught how to search for information through, for example, Google Scholar, looking at or re-evaluating the information obtained to ensure its accuracy by listing the origin of the literature we will quote and use in the bibliography. We are also taught to read more reliable sources to improve our understanding of the literature or the information we seek. We are also taught in lectures how to use Mendeley to enhance our information literacy. This method makes it easier for students to understand and trust the information” (Q91).
Student experienced online learning to learn information literacy through an online platform:
“Using PPT in e-learning, which will be discussed on Zoom” (Q100).
Some students stated that information literacy skills were taught through all learning activities at the School of Medicine, with the following quotations:
“Almost all activities link or use methods in finding, storing, and using information, such as tutorials, lectures, expressing opinions, and even the thesis” (Q24).
“Literacy is taught in all learning methods, and it is emphasized that literacy skills are essential for a doctor and must be developed” (Q13).
Some students mentioned learning methods for finding and managing information through activities outside of campus, such as:
“Training webinar on using clinical key tools via Zoom” (Q124).
Meanwhile, some students explained how to find and manage information, but not how to use it. For example, students searched for health information using databases or search engines.
“Searching by case title on www.PubMed or other journal websites related to health, then filtering these journals to find the latest research” (Q9).
3. Barriers experienced by students in accessing and reviewing information
As shown in Table 5, students’ challenges in information literacy can be grouped into six themes that are related to the Association of College and Research Libraries and Metaliteracy frameworks, and the quotations were made based on the quote number based on participants’ responses in the transcript in Supplement 2.
Table 5.
Challenges of Information Literacy Faced by Medical Students
| No. | ACRL framework | Metaliteracy framework | Theme | Subtheme | Example quote |
|---|---|---|---|---|---|
| 1 | Learner as creator; Scholarship as conversation | Evaluate user feedback as active researcher; Create context for user-generated information | Self-efficacy | Self-confidence; Persistent | • Lack of self-confidence. (Q2) |
| • Less persistent and active in seeking information, leading to suboptimal results. (Q181) | |||||
| 2 | Searching as strategic exploration | Understand format type and delivery mode | Access to resources | Internet connection | • Unstable internet connection. (Q 111) |
| • Internet connection and data. (Q4) | |||||
| Paid journal | • The most common obstacle is that the year of publication does not match the title we want or the material we want is limited. Furthermore, the biggest obstacle is the lack of free or easy access to accurate information/data. (Q24) | ||||
| 3 | Searching as strategic exploration | Understand format type and delivery mode, evaluate dynamic content critically | Search for information | Limitation of sources | • Sometimes, when looking for a specific topic on Google or in books, it can be difficult to find due to the limitations of trusted medical books. (Q304) |
| Determine keywords | • There are too many things related to the keywords used to find the information needed so that it is still necessary to filter information manually by reading. (Q194) | ||||
| 4 | Authority is constructed and contextual, information creation as a process | Evaluate dynamic content critically, evaluate user feedback as active researcher | Evaluation of information | Appraise the article | • Confusion in determining if there are two journals with opposite views. (Q295) |
| Analyze valid information | • Unable to evaluate the entire context contained in the literacy material. (Q27) | ||||
| 5 | Information has value | Understand personal privacy, | Bibliography | Write references | • Writing bibliography from various sources. (Q121) |
| • Write references from the literature that I use. (Q15) | |||||
| 6 | All frames | information ethics and intellectual property issues Cross-cutting: support all domains | Language proficiency | Vocabulary | • Journals are usually in English, so sometimes the vocabulary is wide so I might misunderstand the information. (Q200) |
| English proficiency | • Constraints in the language (English) that make searching information take longer. (Q226) |
ACRL: Association of College and Research Libraries.
Students faced six groups of barriers in information literacy: self-efficacy, access to resources, searching for information, evaluating information, bibliography, and language proficiency. Each theme comprises two subthemes, excluding the bibliography.
Discussion
1. Socio-demographic findings
Becoming a lifelong learner and successfully meeting information demands are two crucial information literacy skills for medical students as information providers in their future careers. The information literacy skills of the majority of medical students in Sumatra Province were adequate. A previous study found that students had medium-level information literacy efficacy perception scores [4]. The students’ acquisition of this skill was good as a consequence of information literacy delivered well in the curriculum. Many factors influence information literacy skills, including gender, ethnicity, study period, and academic achievement. This study examined these factors to evaluate which significantly impact skill enhancement.
1) Gender
Regarding gender differences, female students displayed better information literacy skills than males. A previous study also revealed that many female students agreed that technology was essential to their college experience [14]. Male students tended to score higher in familiarity and confidence with digital literacy, which was crucial for information literacy [15]. In line with this study, another study reported no significant differences between the two genders regarding information literacy [16-18]. Females tended to be more discerning in evaluating internet sources, while males showed greater confidence in the credibility of search engine results [19]. Furthermore, personality traits such as openness to experience, which were more prevalent among females, significantly contributed to higher information competency. In contrast, extroversion, which is a trait more commonly associated with males, also influenced information competency, albeit to a lesser extent [20]. Both genders excelled in information literacy, but females often demonstrated higher proficiency and more effective use of information resources, influenced by their distinct information-seeking behaviors and personality traits.
2) Ethnicity
This study revealed no significant difference in information literacy skills among diverse ethnicities. It might be because most respondents were from Indonesia (83.4%), comprising Bataknese, Javanese, Minang, Sunda, and Aceh. In comparison, Chinese accounted for 16%, and 1.6% were of Indian descent. This result was in accordance with a study that found the same results, although the minority ethnic groups had a higher increase in information literacy scores [21]. Another study supports that social background does not affect information literacy skills [22]. Additionally, cultural competence and recognizing diverse values in medical education are crucial, as students from different ethnic backgrounds may have varying perceptions and approaches to health information [23]. Furthermore, health literacy, a component of information literacy, tends to be lower among ethnic minority students, impacting their ability to understand and use health-related information effectively [24]. The debate over multiculturalism in education also highlights the need for medical curricula to address students’ diverse cultural backgrounds to improve their information literacy and overall educational outcomes.
3) Study period
Based on the results of this study, the length of the study period did not correlate with the information literacy skills, since there was no significant difference among students from various years. The COVID-19 (coronavirus disease 2019) pandemic has negatively impacted first-year students’ digital health literacy, suggesting that disruptions in traditional learning environments can hinder skill acquisition. On the other hand, a previous study found that eHealth literacy, relating to personal knowledge and skills, was higher among graduate-level students than entry-level students, indicating that the curriculum and student experience positively impacted eHealth literacy [14,15,25]. A longitudinal study over a 6-year curriculum showed that information literacy self-efficacy increased with each academic year, emphasizing the importance of continuous training and practice [26].
4) Academic achievement
This study analyzed academic achievement as a predictor of enhancing information literacy skills, resulting in no significant effect, even though a recent study showed that cognitive variables such as deep learning significantly affect students’ level of information literacy [27]. Meanwhile, studies indicated a significant positive relationship between information literacy skills and academic performance among students. This suggests that students with higher information literacy tend to perform better academically [28,29]. Enhancing these skills through dedicated courses and integrating them into the medical curriculum can improve academic performance and better prepare students for their future careers.
2. Information literacy activities
This study showed that information literacy was taught through various learning methods such as lectures, practicums, problem-based learning, and patient case reports. The learning gained by students positively impacted their information literacy skills. Information literacy skills improved with training. Research showed no significant difference in the information literacy abilities of students who received online, offline, or blended-learning information literacy training or teaching [6]. Additionally, problem-based learning curricula, typically implemented in the later stages of medical education, have demonstrated greater effectiveness in cultivating advanced information literacy skills than traditional curricula, as they encourage active use of information and critical thinking [30]. For students to better use the full range of information technology (IT) resources available for learning and problem solving, there must be a greater integration of information literacy and IT training into medical curricula. University curricula should include education in digital health, focusing on practice-based digital applications that specifically handle privacy and security issues [14,31].
Moreover, creating and analyzing digital academic products like essays, presentations, videos, and podcasts can help students foster information literacy by requiring students to research, evaluate, and present information effectively, then further apply it in a real-world context [32]. Skills training that is integrated with structured oral examination is an effective learning method to enhance student performances and motivations, including information literacy skills [33]. Student can practice their knowledge and are given feedback directly after they demonstrate the skills. Practical methods such as interactive learning, authentic academic practices, and the use of educational technologies are effective in developing these competencies. Educators play a pivotal role in fostering these skills, preparing students to navigate and succeed in complex digital environments.
3. Challenges in enhancing information literacy skills
Today’s information-literate individual should be able to perform specific web searches, including selecting pertinent search words, formulating a logical search strategy, and efficiently evaluating information [34]. However, students faced challenges in information literacy, such as unstable internet connection, accessing paid journals, a lack of confidence, evaluating valid information, writing references, difficulty determining issues and keywords, and language barriers. In line with this study, previous studies suggest that challenges in enhancing information literacy skills in medical education include digital literacy, technological challenges, lack of engagement, staff-student interaction, and a negative attitude towards online learning [35-37].
1) Self-confidence
Self-efficacy is a student’s belief in their abilities, influencing their effort and persistence. However, students felt less confident and persistent in gathering information. Academic achievement fosters this confidence, which is essential for conquering obstacles. Additionally, recent studies have shown that students with strong academic self-efficacy demonstrate increased resilience and persevere longer in difficulties, resulting in enhanced academic achievement through consistent effort [38]. To support low-achieving students, teachers could consider using a motivational approach coupled with strategies to enhance their information-seeking skills to trigger their motivation to acquire new knowledge, which could increase self-efficacy [39].
Moreover, persistence in completing tasks is associated with better literacy skills. Children who exhibit higher task persistence tend to develop better literacy skills over time, which suggests that persistence can enhance information literacy [40]. Hence, programs incorporating motivational design and problem-based learning have significantly increased learners’ perceived confidence in their information literacy skills [41].
2) Access to resources
Strategies to overcome resource access challenges include providing physical and technological supports. Students who do not have access to necessary software, technology, or a reliable internet connection at home may benefit from having evening and weekend computer laboratories and the library available to them. By investing in dedicated spaces for online learning, students could more easily transition between online and in-person instruction. This would maximize teaching and learning time, as students might otherwise need to travel home to participate fully in online content in a suitable learning environment [35,42].
3) Search for information
Despite the increasing availability of digital resources, many students continue to face challenges in locating and utilizing academic information effectively. A study found that students with limited search experience had lower odds of retrieving relevant items from MEDLINE, indicating a gap between perceived and actual search skills [43]. Moreover, a study demonstrated that both medical students and practicing physicians exhibited deficiencies in identifying optimal Boolean phrases, with formal instruction not significantly improving these skills [44]. This gap between perceived and actual search skills suggests the need for more comprehensive training in information literacy.
4) Evaluation of information
In this digital age, critically evaluating information is essential for academic success and lifelong learning. However, many students face significant challenges in this area. Critical reading, which involves evaluating arguments and synthesizing information, remains a weak area for many learners. A study found that undergraduate students struggled to make inferences and analyze arguments due to language barriers and inadequate reading strategies [45]. Information literacy and critical thinking are related to each other and if one of them is missing, then the other one cannot exist. In order to be able to create an information-literate and critically thinking generation, information literacy is important for students to ask better questions, think critically, and learn as less biased individuals so that they can enhance their knowledge [46]. Integrating information literacy skills with applying research findings, analyzing and synthesizing information, for instance, applying critical appraisal of evidence-based education will provide students with a broad base of knowledge that is also connected to the clinical field and will strengthen their understanding [47].
5) Bibliography
Medical students in this study frequently encounter difficulties in mastering bibliographic skills, including proper referencing and citation. These challenges stem from various factors, such as limited information literacy, insufficient training, and the complexities of academic writing. Despite access to electronic databases, students often lack the necessary skills to effectively search for and utilize information, leading to inefficient use of resources and, in some cases, plagiarism [16]. Furthermore, the traditional teacher-centered learning approach prevalent in some medical schools may contribute to this problem. It can limit students’ motivation for self-directed learning, thereby impeding the development of essential skills like proper citation and referencing [48].
Addressing these challenges requires training sessions focused on effective literature search and citation practices can enhance students’ competencies [16], leveraging technology, such as citation management software and educational chatbots, can aid students in mastering bibliographic skills [49]. Encouraging students to engage in active learning exercises, such as peer reviews and practice assignments, can reinforce proper citation habits. Regular practice under supervision helps students internalize correct referencing techniques and reduces the likelihood of plagiarism.
6) Language proficiency
English language proficiency significantly predicted information literacy self-efficacy among medical students [50]. While the students in this study demonstrated adequate information literacy skills, they spent considerable time reading articles, which could lead to a misunderstanding of the key points and findings of the study. Medical students and practitioners often face challenges accessing and comprehending the vast medical literature, primarily due to language and terminology barriers. For instance, non-English speakers encounter difficulties retrieving information from authoritative medical websites, deficiencies in English vocabulary, which hinder their comprehension of scientific and medical texts [50,51].
Engaging students in peer-assisted learning can enhance language skills through collaborative learning [52], and offering online learning platforms and language apps can facilitate self-directed learning [53], which can be options for students to improve their language proficiency, thus assisting them to comprehensively understand scientific articles.
4. Conclusion
The information literacy skills of medical students were adequate, though some students experienced poor abilities to use the library. Their experiences and exposure to information and digital literacy were reflected in their abilities. These well-performed skills were fostered by varied learning methods students experienced, including lectures, problem-based learning, practicums, and all learning activities, even those outside the campus. Medical schools should seriously overcome the students’ barriers to information literacy, as it is a fundamental competency of medical students to become lifelong learners. The authors provide the following suggestions: the institution should support students with physical and technological resources by providing a good internet connection and subscriptions to journals and databases. Digital integration and familiarization with the library are an obligation in this digital era; thus, students might access the library from anywhere and use it properly.
The study revealed that the study period is significantly related to the information literacy skills of medical students. As students progress through their academic years, their ability to locate, evaluate, and effectively use information improves. This suggests that both exposure to academic tasks and accumulated learning experiences contribute to the development of these critical skills. However, it also highlights potential disparities in information literacy across different study periods, which may affect students’ academic performance and preparedness for evidence-based medical practice.
The study period is crucial in fostering information literacy; medical schools should integrate information literacy early, provide continuous skill development, monitor and support, and promote lifelong learning. They should begin by providing a foundation in digital literacy and language proficiency, especially English, and continue by familiarizing students with resources used in information literacy in their curricula. Following this, practical and meaningful activities have been proven to be effective methods to enhance information literacy. A formative and longitudinal assessment is needed to ensure students’ self-efficacy and skill acquisition of information literacy. It is a social accountability for medical schools to ensure their graduates perform competently in the community.
This study presents several limitations that should be acknowledged. First, although the study employed both quantitative and qualitative methods, the qualitative data were collected solely through open-ended survey responses rather than in-depth interviews or focus group discussions, which might have restricted the depth and richness of the data obtained. Additionally, using self-reported measures to explore student skills might introduce social desirability bias, as student might overestimate their actual competencies. Lastly, the design of the study limits the ability to observe changes in information literacy skills over time or to establish causality between the identified factors and student performance.
Footnotes
Acknowledgements
The Medical Education Unit and medical schools in Medan for permitting their students to participate in this study.
Funding
Universitas Muhammadiyah Sumatra Utara funded this research through an internal grant.
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contributions
All authors have undertaken this work collaboratively, with specific contributions. Ratih wrote the entire manuscript, Desi and Melviana performed the statistical analysis and wrote the results, and Hemma proofread the paper.
Supplementary materials
Supplementary files are available from https://doi.org/10.3946/kjme.2025.343
The Challenges Students Faced to Enhance Information Literacy.
The Learning Methods Students Experienced in Their University.
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Supplementary Materials
The Challenges Students Faced to Enhance Information Literacy.
The Learning Methods Students Experienced in Their University.