From Barriers to Competence: Multi-Institutional Exploratory Study of Perceived Competence, Attitudes, and Barriers in E-Patient Communication Among Chinese Medical Students

Abstract

Second-generation E-patients producing personal health data demand new clinical communication competencies, but the readiness of medical students—frontline doctors—remains unclear. This 17-institutional cross-sectional study of 310 Chinese medical students evaluated perceived competence, attitudes, barriers, and explored relationships via Structural Equation Modeling (SEM). Respondent profiles shifted toward male (70.32% vs. 48.70%), postgraduate (60.32% vs. 44.50%), Double First-Class university (63.55% vs. 47.06%), and eastern (64.19% vs. 52.94%) students, reflecting heightened issue saliency and professional leverage. While 78.71% of the students held positive attitudes and 55.16% reported high overall competence, granular assessments revealed profound proficiency deficits, specifically in digital clinical data interpretation (proficiency < 30.00%), alongside pervasive situational barriers. Multivariable modeling confirmed positive attitudes as the principal predictor of high competence (OR = 2.282, 95% CI: 1.292–4.032, p = 0.004). SEM further revealed a challenge-oriented pathway in which acute barrier awareness was positively related to attitudes (β = 0.394) and subsequent proficiency (β = 0.439). Despite small sample size limitations, the results underscore a significant mismatch between future physicians' digital health awareness and actual competence. We propose a model-driven framework to deconstruct communication barriers to catalyze attitudinal elevation and subsequent competence acquisition, preparing such digital-pioneer students for the data-rich E-patient landscape.