Medical cyber crises and biotechnological syndromes: a multisite clinical simulation study focused on digital health complaints

Biotechnological syndromes refer to the illnesses that arise at the intersection of human physiology and digital technology. Implanted technologies can malfunction (eg, runaway pacemakers, hacked insulin pumps), and consumer technologies can be exploited to impose adverse health effects (eg, technology-facilitated abuse, hacks on epilepsy websites inducing seizures). Through a series of clinical simulation events, our study aimed to (1) evaluate the ability of physicians to respond to biotechnological syndromes, (2) explore gaps in training impeding effective patient care in digital cases, and (3) identify clinical cases due to digital technology arising in the population. This was a multisite clinical simulation study. Between Jan 1 and July 1, 2023, four half-day clinical simulation events focused on digital pathologies were delivered across three NHS sites in London and the East Midlands. Participants (n=14) ranged in seniority from clinical medical students through to hospital consultants. Ethics approval was attained from University College London. Participant performance was scored by one researcher, using mark schemes built from the Objective Structured Clinical Examinations (OSCEs) format of UK Medical Schools. Qualitative and quantitative feedback was collected from participants following each of the four scenarios. Participants were asked to identify clinical challenges present in each simulation, discuss cases within their own practice, and evaluate the usefulness of the educational material. Participants reported a wide range of examples within their own practice (eg, insulin pumps malfunctioning due to Apple watches, cardiac arrests due to faults in ventilators). Participants described barriers to treatment in simulations, including low diagnostic suspicion of technological failures, little education on biotechnological mechanisms, a lack of available expertise, and uncertainty regarding effective therapeutics. In the subjective feedback, participants reported the lowest levels of confidence when managing cases relating to software issues in medical devices, both in terms of confidence in their own ability to deliver care (mean scores: 3·6/10 junior staff, 5·8/10 senior staff) and in their teams (3·8/10 juniors, 6·8/10 seniors). In our digital society, clinical cases related to technology are likely to increase in the population. At present, a lack of clinical awareness, education, training material, and appropriate guidelines are some of the