Telemedicine and digital literacy across medical training: a multicentric analysis of behavioral and educational determinants of readiness

Background The rapid digital transformation of healthcare organizations requires the acquisition of not only clinical but also digital and telemedicine competencies, starting from the academic path. However, despite the emergence of global and national initiatives, the integration of digital health training into medical education remains inconsistent. Objectives Through a multicentric study, this research aimed to (i) investigate the digital and eHealth literacy profiles among medical students and residents, (ii) assess their experiences, attitudes, and intentions toward telemedicine, and (iii) identify determinants of interest in future telemedicine utilization, focusing on the interplay between technical, behavioral, and educational factors. Methods A cross-sectional web-based survey was conducted (July 2024-February 2025) across five Italian universities. The survey explored two components of the readiness of future physicians, technical and behavioural. For the technical readiness, items from the IT-eHEALS scale and the DIGCOMP framework were included. Data were analyzed using nonparametric tests, random forest modeling, and multivariable logistic regression to identify predictors of telemedicine readiness. Results A total of 438 participants (285 students, 153 residents; 62% female) completed the survey. While 68% had heard of telemedicine, only 22% reported personal experience and 13% academic exposure. Most respondents expressed strong interest in telemedicine (83%) and a desire for specific training (83%). eHealth literacy was moderate-to-high (mean IT-eHEALS = 25.9 +/- 5.6), though higher-order evaluative skills showed variability across institutions. Logistic regression identified technology enthusiasm (OR = 4.76; p = 0.001), smartphone confidence (OR = 3.20; p = 0.015), and eHEALS score (p = 0.050) as independent predictors of telemedicine readiness, with a significant interaction between enthusiasm and confidence (p = 0.021). Conclusions Medical trainees show high motivation but uneven preparedness for telemedicine in practice. Educational reforms should embed structured, longitudinal digital-health training that combines technical proficiency with critical, ethical, and behavioral competencies. Strengthening digital readiness at all stages of medical education is essential to prepare physicians for technology-enabled, patient-centered healthcare.