Mobile technologies in medical education: AMEE Guide No. 105

ArticleinMedical Teacher 38(6):1-13 · March 2016with 213 Reads
Abstract
Mobile technologies (including handheld and wearable devices) have the potential to enhance learning activities from basic medical undergraduate education through residency and beyond. In order to use these technologies successfully, medical educators need to be aware of the underpinning socio-theoretical concepts that influence their usage, the pre-clinical and clinical educational environment in which the educational activities occur, and the practical possibilities and limitations of their usage. This Guide builds upon the previous AMEE Guide to e-Learning in medical education by providing medical teachers with conceptual frameworks and practical examples of using mobile technologies in medical education. The goal is to help medical teachers to use these concepts and technologies at all levels of medical education to improve the education of medical and healthcare personnel, and ultimately contribute to improved patient healthcare. This Guide begins by reviewing some of the technological changes that have occurred in recent years, and then examines the theoretical basis (both social and educational) for understanding mobile technology usage. From there, the Guide progresses through a hierarchy of institutional, teacher and learner needs, identifying issues, problems and solutions for the effective use of mobile technology in medical education. This Guide ends with a brief look to the future.
Ad

Do you want to read the rest of this article?

Request full-text
Request Full-text Paper PDF
  • Article
    University policies prohibiting use of mobile devices by medical students during clinical placements are contradicted by regular use by physicians. Consequently, many students use their mobile devices, which can be beneficial for learning but may put patient privacy at risk. This study explores the reasons underlying students' decisions about using mobile devices in clinical settings. We used a mixed-methods sequential explanatory design involving a questionnaire and focus groups. Qualitative data from the questionnaire and focus groups was analysed through thematic analysis. We found students were aware of the risks mobile devices posed to professionalism and medical practice. Despite prohibitions, many made individual decisions to use mobile devices because the benefits outweighed the risks. These students were influenced by an organised, strategic approach to learning and a motivation to comply with the beliefs and behaviours of their medical teams and conform to physicians' directives in order to participate in their community of practice. Many students appear to be transferring everyday use of mobile devices to clinical settings. There is a need to understand and promote aspects of learning that are enhanced by mobile devices in clinical settings, while articulating clear guidelines and boundaries compatible with the professional behaviour expected of students.
  • Article
    Full-text available
    Background: Ingrained assumptions about clinical placements (clerkships) for health professions students pursuing primary basic qualifications might undermine best educational use of mobile devices. Question: What works best for health professions students using mobile (hand-held) devices for educational support on clinical placements? Methods: A Best Evidence Medical Education (BEME) effectiveness-review of “justification” complemented by “clarification” and “description” research searched: MEDLINE, Educational Resource Information Center, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Central, Scopus (1988–2016). Reviewer-pairs screened titles/abstracts. One pair coded, extracted, and synthesized evidence, working within the pragmatism paradigm. Summary of results: From screening 2279 abstracts, 49 articles met inclusion-criteria, counting four systematic reviews for context. The 45 articles of at least Kirkpatrick K2 primary research mostly contributed K3 (39/45, 86.7%), mixed methods (21/45, 46.7%), and S3-strength (just over one-half) evidence. Mobile devices particularly supported student: assessment; communication; clinical decision-making; logbook/notetaking; and accessing information (in about two-thirds). Informal and hidden curricula included: concerns about: disapproval; confidentiality and privacy; security;—distraction by social connectivity and busy clinical settings; and mixed messages about policy. Discussion and conclusion: This idiosyncratic evidence-base of modest robustness suggested that mobile devices provide potentially powerful educational support on clinical placement, particularly with student transitions, metalearning, and care contribution. Explicit policy must tackle informal and hidden curricula though, addressing concerns about transgressions.
  • Article
    Full-text available
    Background Students use mobile devices extensively in their everyday life, and the new technology is adopted in study usage. Since 2013, the University of Helsinki has given new medical and dental students iPads for study use. Simultaneously, an action research project on mobile learning started focusing on these students’ mobile device usage throughout their study years. Note taking is crucial in academic studies, but the research evidence in this area is scarce. The aims of this study were to explore medical and dental students’ self-reported study uses of mobile devices and their best practices of mobile note taking. Method An action research project began in 2013 and followed the first student cohort (124 medical and 52 dental students) with iPads from the first until the fifth study year. We explored students’ descriptions of their most important study uses of mobile devices and their perceptions of note taking with iPads. The longitudinal data were collected with online questionnaires over the years. The answers to open-ended questions were examined using qualitative content analysis. The findings were triangulated with another question on note taking and focus-group interviews. Results The response rates varied between 73 and 95%. Note taking was the most frequently and consistently reported study use of iPads during the study years. While taking notes, students processed the new information in an accomplished way and personalised the digital learning materials by making comments, underlining, marking images and drawing. The visual nature of their learning materials stimulated learning. Students organised the notes for retention in their personalised digital library. In the clinical studies, medical students faced the teachers’ resistance and ambivalence to mobile device usage. This hindered the full-scale benefit of the novel technology in the clinical context. Conclusions Efficient digital note taking practices were pivotal to students in becoming mobile learners. Having all their notes and learning materials organised in their personal digital libraries enabled the students to retrieve them anywhere, anytime, both when studying for examinations and treating patients in the clinical practice. The challenges the medical students met using mobile devices in the clinical setting require further studies. Electronic supplementary material The online version of this article (10.1186/s12909-019-1529-7) contains supplementary material, which is available to authorized users.
  • Article
    Full-text available
    Background The number of resources available to medical students studying a degree in medicine is growing exponentially. In addition to traditional learning resources such as lectures and textbooks, students are increasingly using e-learning tools like commercially available question banks to supplement their learning. Student preference for learning resources has not been described in detail, and a better understanding of the tools perceived to be useful could provide essential information to medical educators when designing and implementing medical curricula. Methods We invited 1083 undergraduate and postgraduate medical students from two major Australian universities to complete an online survey. Questions asked students to indicate the frequency with which they use various types of resources when learning new material or when revising previous content. Results Approximately one third (32.3%, N = 350) of invited participants completed the survey, and of those who responded, the gender distribution was even with a median age of 25 years. Making written notes and reading textbooks were the most frequently utilized resources for learning new material. Online or downloaded question banks were the most frequently used resource for revision. In addition to the use of traditional learning tools, the majority of students report using a variety of e-learning tools including online teaching videos (92%, n = 322) and question banks (90.6%, n = 317). Conclusion Despite the trend towards e-learning, traditional resources like attendance at face-to-face lectures remain the most popular for learning new material. The increasing use of question banks raises potential issues of poor alignment to medical school curricula. With the advantages of exam technique practice, time efficiency and multiplatform availability, their popularity is likely to continue. Evaluation of existing question banks is required to facilitate appropriate integration into the curricula, with equitable access for all students.
  • Article
    Full-text available
    Resumo O parto é um momento delicado da vida das mulheres, onde um acompanhante bem esclarecido e com as informações adequadas pode fazer a diferença para um procedimento tranquilo e exitoso. Entretanto, a maioria dos acompanhantes não está preparada para auxiliar a parturiente da melhor forma. Os problemas mais comuns são a falta de experiência e a ausência de informações e conhecimentos necessários nesse momento tão crucial. Desta forma, este artigo apresenta o desenvolvimento de um aplicativo educativo voltado para orientar e capacitar a pessoa que estará acompanhando a parturiente na sala de parto. O conteúdo do aplicativo foi fundamentado em uma pesquisa realizada com 30 acompanhantes de parturientes, nos conhecimentos de uma médica obstetra com experiência na área e na Caderneta da Gestante do Ministério da Educação. Descritores: Acompanhante de parto; aplicação móvel; gestante. Abstract Childbirth is a delicate moment in a woman's life, where a well-informed birth companion with the right information can make the difference for a quiet, successful procedure. However, most of the birth companions are not prepared to assist the pregnant woman in the best way. The most common problems are the lack of experience and the lack of information and
  • Background: Mobile health (mHealth) technology is increasingly utilized to support lifestyle recommendations through nutrient and blood pressure tracking. As patients pose questions regarding the validity and use of this technology, curriculum targeting mHealth technology is essential for the future health professionals. This study evaluated the effectiveness of a curriculum expansion which addressed mHealth technology provided to physician assistant (PA) and clinical nutrition (CN) students enrolled in an academic health center. In addition, the validity of the mobile application (app), MyNetDiary, was determined. Methods: A smartphone application appraisal tool, based on scientific recommendations, was developed. Students were taught how to use this tool to evaluate mobile apps. Students received instruction on providing patient education on mobile apps used to track calories and nutrients and mobile medical apps to measure blood pressure. Pre-/post-surveys and objectively structured clinical examinations measured students' confidence and abilities in teaching patients to use MyNetDiary and Withings Health Mate apps. Wilcoxon rank sum tests evaluated statistical significance. Validity of nutrient estimates was determined using Spearman correlations. Results: Confidence levels improved significantly on all items measured for both PA and CN students (P < 0.001). During the objectively structured clinical examination, all students demonstrated effective communication skills with 98.4% successfully demonstrating of how to enter foods into the MyNetDiary app and 94.3% connecting the blood pressure cuff with the withings app. Significant correlations were found when comparing MyNetDiary to SuperTracker (all P < 0.001). Discussion: This study investigated and demonstrated the effectiveness of an expanded curriculum designed to enhance students' confidence and skills in providing lifestyle counseling incorporating the use of mHealth technology.
  • Article
    Background: Information technology (IT) is widely used in medical education. However, there are not enough studies about IT uses and preferences among traditional and problem-based learning (PBL) medical students. Aim: To compare IT skills, uses and preferences for education between traditional and PBL medical students’. Method: A cross-sectional study; a modified Educause Center for Analysis and Research online survey was sent to traditional curriculum 5th and PBL 4th year medical students of King Saud University. Results: Most of the responding 176 students prefer mobile devices and moderate amount of IT in education. Fourth and fifth year students perceived high academic value of Google (94.2 vs. 86.7%, p = 0.34), YouTube (90.7 vs. 92.2%, p = 0.83) and PubMed (83.7 vs. 86.7%, p = 0.06). More 4th year than 5th year students rated themselves as skilled in learning management system (54.7 vs. 21.1%, p = 0.0001) and Smartboard use (40.7 vs. 23.3%, p = 0.04). Most students rated faculty IT skills as effective. Students agreed that technology helps working faster (95.5%) and make learning creative (85.9%). Conclusions: More integration of information literacy and IT training in medical curricula is needed to enhance better utilization of full features of IT resources available for learning and problem solving. National multi-institutional studies are recommended.
  • Article
    Background Technological advances, free open‐access medical education (FOAM or #FOAMed), and social media have increased access to clinician‐oriented medical education resources and interactions at the point of care (POC); yet, how, when, and why medical providers use these resources remains unclear. In order to facilitate the development and design of intuitive POC resources, it is imperative that we expand our understanding of physician knowledge‐seeking behavior at the POC. Methods Individual semi‐structured interviews were conducted and analyzed using a qualitative, grounded theory approach. Twelve emergency medicine providers (3 medical students, 3 residents, and 6 attending physicians) were interviewed in person or via video‐chat to explore how POC resources are used in the emergency department. A coding system was developed by two investigators and merged by consensus. A third investigator audited the analysis. Results A conceptual framework emerged from the data describing the four main uses of POC resources (deep‐dive, advanced clinical decision‐making, teaching patients, and teaching learners) and how practitioners’ main use varied based on medical expertise. Junior learners prioritize their own broad learning. Experienced learners and physicians prefer to (1) seek answers to specific focused clinical questions and (2) disseminate POC information to teach patients and learners, allowing them to devote more of their time to other clinical and teaching tasks. Conclusion The conceptual framework describes how physician knowledge‐seeking behavior using POC resources in the emergency department evolves predictably throughout training and practice. Knowledge of this evolution can be used to enhance POC resource design and guide bedside teaching strategies. This article is protected by copyright. All rights reserved.
  • Article
    Full-text available
    Purpose: This study investigated student experiences of mobile technology in a medical English course using a free mobile classroom application, Socrative and its impact on student learning to help them achieve the competency expected in the course. Methods: Questionnaires were administered of year 2 medical students enrolled in a medical English course between 2016 and 2017 to investigate their experience in using Socrative. Learning outcomes were assessed by comparing students' academic performance with that of the 2015 cohort, who had taken the same course without using mobile technology, and also by measuring changes in their self-efficacy in English over time during the course. Results: This study found students' positive perceptions of and overall satisfaction with their experience in using mobile technology in the medical English course. There were no differences in the academic performance between the study cohort and the comparison group. The ratio of students who were in the remediation program after the mid-term examination was 11%, whereas the remediation ratio of the 2015 cohort was 21%. Students' self-efficacy in English improved significantly in the writing and reading domains (p<0.05). Conclusion: This study found several benefits of using Socrative in the medical English course. Socrative fostered the classroom interaction by encouraging input from every student and sharing it instantly with the whole class. There was also learning improvement with the use of Socrative. Furthermore, it has the potential to enhance assessment by offering more various forms of assessment than that of conventional audience response systems.
  • Article
    Full-text available
    This article is open-access. It can be viewed (and downloaded as a pdf) from: https://www.mededpublish.org/manuscripts/1528 Abstract: Introduction: In the 21st Century, medical personnel require electronic and written communication skills in order to communicate with colleagues and patients. These specific skills are seldom taught, as communication skills’ teaching and assessment currently emphasises face-to-face, verbal communications. This study aims at teaching some skills required for electronic communication, and evaluating the process. Methodology: We used a specific platform to teach 188 medical and health sciences students, working in groups, to develop e-posters that run as mobile apps, and evaluated the process in terms of resource demands, students’ experience (through an online survey), and e-poster quality. Results: From 188 students, a total of 144 students submitted 30 accessible e-posters, and 71 students participated in the survey. The resource demand was equivalent to resource demand for teaching paper poster design and creation. Despite technical problems not related to the platform, the students were able to produce acceptable quality e-posters with reasonable effort. Discussion and Conclusion: This study indicates that it is possible to teach medical and health sciences students the basics of e-poster design, and extend their communication abilities into the realm of electronic communication. This bodes well to prepare them to take their place as e-poster creators in a broad range of spheres, especially for academic conferences and patient communication.
  • Article
    Full-text available
    Introduction: The demand for mobile learning in the medical science educational program is increasing. The present review study gathers evidence highlighted by the experimental studies on the educational effects of mobile learning for medical science students. Methods: The study was carried out as a systematic literature search published from 2007 to July 2017 in the databases PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Knowledge (Thomson Reuters) , Educational Resources and Information Center (ERIC), EMBASE (Elsevier), Cochrane library, PsycINFO and Google Scholar. To examine quality of the articles, a tool validated by the BEME Review was employed. Results: Totally, 21 papers entered the study. Three main themes emerged from the content of papers: (1) improvement in student clinical competency and confidence, (2) acquisition and enhancing of students' theoretical knowledge, and (3) students' positive attitudes to and perception of mobile learning. Level 2B of Kirkpatrick hierarchy had been examined by all the papers and seven of them had reported two or more outcome levels, but level 4 was not reported in the papers. Conclusion: Our review showed that the students of medical sciences had positive response and attitudes to mobile learning. Moreover, implementation of mobile learning in medical sciences program might lead to valuable educational benefits and improve clinical competence and confidence along with theoretical knowledge, attitudes, and perception of mobile learning. The results indicated that mobile learning strategy in medical education can positively affect learning in all three domains of Bloom's Taxonomy.
  • Conference Paper
    Cardiac auscultation is a routine examination procedure that allows a medical professional to diagnose the condition of a patient’s heart. The ability to interpret heart sounds is key during the diagnosis and only achieved through extensive training. Currently, there is great concern among physicians regarding the loss of cardiac auscultation skills, and the effects on proper diagnoses that may lead to inadequate treatments. Current cardiac auscultation training employs equipment that completes the diagnose without the use of a stethoscope, diminishing the amount of practice trainees obtain with it. However, despite the decreased emphasis on stethoscope training, the stethoscope remains a cost-effective tool and relevant in several examination scenarios. This paper presents the development of a mobile virtual reality prototype for cardiac auscultation training. Our approach employs a virtual reality headset to facilitate training. We analyzed the effect of visual immersion on auscultation training, by comparing its usability perception to a non-VR auscultation training app.
  • Article
    Three milestone educational planning initiatives engaged the veterinary medical profession in the United States and Canada between 1987 and 2011, namely the Pew National Veterinary Education Program, the Foresight Project, and the North American Veterinary Medical Education Consortium. In a quantitative study, we investigated the impact of these initiatives on veterinary medical education through a survey of academic leaders (deans, previous deans, and associate deans for academics from veterinary medical schools that are members of the Association of American Veterinary Medical Colleges) to assess their perspectives on the initiatives and eight recommendations that were common to all three initiatives. Two of the recommendations have in effect been implemented: enable students to elect in-depth instruction and experience within a practice theme or discipline area (tracking), and increase the number of graduating veterinarians. For three of the recommendations, awareness of the issues has increased but substantial progress has not been made: promote diversity in the veterinary profession, develop a plan to reduce student debt, and develop a North American strategic plan. Lastly, three recommendations have not been accomplished: emphasize use of information more than fact recall, share educational resources to enable a cost-effective education, and standardize core admissions requirements. The educational planning initiatives did provide collaborative opportunities to discuss and determine what needs to change within veterinary medical education. Future initiatives should explore how to avoid and overcome obstacles to successful implementation.
  • Article
    Purpose Ultrasound training is associated with a long learning curve and use of substantial faculty resources. Self-directed ultrasound training may decrease the need for faculty-led teaching. Mobile apps seem promising for use in self-directed ultrasound training, but no studies have examined the cost-effectiveness of mobile app-guided training versus traditional formats such as textbook-guided training. This study evaluated the cost-effectiveness of mobile app-guided versus textbook-guided ultrasound training. Material and methods First-year residents (n = 38) with no previous ultrasound experience were randomized into mobile app-guided versus textbook-guided self-directed ultrasound training groups. Participants completed a transfer test involving four patient cases and a theoretical test on diagnostic accuracy. Two ultrasound experts assessed the residents’ performance using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. The costs of developing mobile app and textbook material were calculated and used for the analysis of cost-effectiveness. Results 34 participants completed the transfer test. There was no statistically significant difference in test performance or diagnostic accuracy between the mobile app-guided (mean-OSAUS 42.3 % [95 %CI38.5 – 46.0 %]) and textbook-guided groups (mean-OSAUS 45.3 % [95 %CI39.3 – 51.3 %]) (d.f. [1.33] = 0.45, p = 0.41). However, development costs differed greatly for each instructional format. Textbook-guided training was significantly more cost-effective than mobile app-guided training (Incremental Cost Effectiveness Ratio -861 967 [95 %CI-1071.7 to-3.2] USD/pct. point change in OSAUS score). Conclusion Mobile app-guided ultrasound training is less cost-effective than textbook-guided self-directed training. This study underlines the need for careful evaluation of cost-effectiveness when introducing technological innovations for clinical skills training.
  • Article
    Full-text available
    Medical education is rapidly changing, influenced by many factors including the changing healthcare environment, the changing role of the physician, altered societal expectations, rapidly changing medical science, and the diversity of pedagogical techniques. What would medicine be like in 20 years' time? Today's students will be practicing beyond the next 20 years and are expected and required to function effectively within ever-changing health systems. What are the future challenges for medical education and how can we prepare to effectively face them? The principal challenges in medical education can be categorized as changes occurring in the healthcare environment, the information explosion related to medicine and healthcare, and changes in the learner profile Changes in the healthcare environment are driven by advances in technology, increasing costs, diversity of providers and settings, changing expectations of patients and the public (including professionalism, ethics and communication) and commodification of healthcare. There is a global information explosion, which not only includes a rapid and exponential increase in published information but also the short-and long-term effects of this growth. The increasing quantum of knowledge in medicine no longer allows physicians to retain all knowledge that is necessary to provide quality patient care. Over 34000 references are added to MEDLINE each month from 4000 journals, and the doubling time of medical knowledge is estimated to be approximately 5 years. Knowledge is expanding faster than the ability to assimilate and apply it effectively; this is as true in education and patient care as it is in research.
  • Article
    Introduction The practice of medicine involves, among other things, managing ambiguity, interpreting context and making decisions in the face of uncertainty. These uncertainties, amplified for learners, can be negotiated in a variety of ways; however, the promise, efficiency and availability of mobile technologies and clinical decision supports make these tools an appealing way to manage ambiguity. Mobile technologies are becoming increasingly prevalent in medical education and in the practice of medicine. Because of this, we explored how the use of mobile technologies is influencing residents’ experiences of graduate medical education. Methods We conducted an 18-month qualitative investigation to explore this issue. Our research was conceptually and theoretically framed in sociomaterial studies of professional learning. Specifically, our methods included logging of technology use and related reflexive writing by residents (n=10), interviews with residents (n=12) and interviews with faculty (n=6). Results We identified three challenges for graduate medical education related to mobile technology use: (1) efficiency versus critical thinking; (2) patient context versus evidence-based medicine and (3) home/work-life balance. Discussion In this digital age, decontextualised knowledge is readily available. Our data indicate that rather than access to accurate knowledge, the more pressing challenge for medical educators is managing how, when and why learners choose to access that information.
  • Article
    Full-text available
    This paper presents different studies that present experiences of the use of mobile technologies in medical education. The researches are described separately, explaining the methodology used and highlighting their advantages and disadvantages observed in the study and, later, their similarities are shown. Resumo. Este artigo apresenta diferentes estudos realizados que apresentam experiências diferentes do uso de tecnologias móveis na educação médica. As pesquisas são descritas separadamente, explicando a metodologia utilizada e destacando as vantagens e desvantagens observadas no estudo e, posteriormente, são mostradas suas similaridades. 1. Introdução Os avanços tecnológicos têm causados impactos positivos em várias áreas do conhecimento humano. Diante disso, um novo paradigma está surgindo na educação e o papel do professor frente às novas tecnologias está mudando, permitindo o desenvolvimento de atividades que fazem seu uso e que possam melhorar a aprendizagem do aluno (Mercado 2012). Segundo Sharples e Roschelle (2010), o uso das tecnologias móveis em proveito de uma educação eficaz é chamado de Mobile Learning (ou m-Learning), que também abrange as pesquisas sobre tecnologias de aprendizagem sensíveis ao contexto. Pesquisas sobre a aprendizagem proporcionadas pelas tecnologias móveis, Figueroa et al. (2014), Yang e Pan (2013) e Marçal et al. (2014), destacam benefícios dessa abordagem na educação como: mobilidade para usar os recursos computacionais fora dos espaços escolares; aumento do incentivo ao desenvolvimento de competências em situações reais; uma maior facilidade para compartilhar e acessar conteúdos. Nesse contexto, este artigo apresenta um comparativo entre três pesquisas que mostram o uso das tecnologias móveis por professores de medicina para ensino, destacando suas vantagens e desvantagens. Para isso, as pesquisas são descritas separadamente e, posteriormente, são comparadas suas similaridades e diferenças. 2. Metodologia A seguir, são descritos três estudos que apresentam experiências práticas do uso das tecnologias móveis na educação médica, de forma a permitir uma análise comparativa posteriormente.
  • Article
    Background: Adaptive learning platforms (ALPs) can revolutionize medical education by making learning more efficient, but their potential has not been realized because students do not use them persistently. Methods: We applied educational data mining methods to study United States medical students who used an ALP called Osmosis ( www.osmosis.org ) from 1 August 2014 to 31 July 2015. Multivariate logistic regressions modeled persistence on Osmosis as the dependent variable and Osmosis-collected variables as predictors. Results: The 6787 students included in our analysis responded to a total of 887,193 items, with 2138 (31.5%) using Osmosis persistently. Number of items per student, mobile device use, subscription payment, and group membership were independently associated with persisting (p < 0.001 in all models). Persistent users rated quality more favorably (p < 0.01) but were not more confident in answer selections (p = 0.80). While persisters were more accurate than non-persisters (55% (SD 18%) vs 52% (SD 22%), p < 0.001), after adjusting for number of items, lower accuracy was associated with persistent use (OR 0.93 [95% CI 0.90-0.97], p < 0.01). Conclusions: Our study of a large sample of U.S. medical students illustrates big data medical education research and provides guidance for improving implementation of ALPs and further investigation.
  • Presentation
    Full-text available
  • Article
    Full-text available
    Background Tablet computers have emerged as a tool to capture, process and store data in examinations, yet evidence relating to their acceptability and usefulness in assessment is limited. Methods We performed an observational study to explore opinions and attitudes relating to tablet computer use in recording performance in a Anal year objective structured clinical examination at a single UK medical school. Examiners completed a short questionnaire encompassing background, forced-choice and open questions. Forced choice questions were analysed using descriptive statistics and open questions by framework analysis. Results Ninety-two (97% response rate) examiners completed the questionnaire of whom 85% had previous use of tablet computers. Ninety per cent felt checklist mark allocation was ‘very/quite easy', while approximately half considered recording ‘free-type’ comments was ‘easy/very easy'. Greater overall efficiency of marking and resource savings were considered the main advantages of tablet computers, while concerns relating to technological failure and ability to record free type comments were raised. Discussion In a context where examiners were familiar with tablet computers, they were preferred to paper checklists, although concerns were raised. This study adds to the limited literature underpinning the use of electronic devices as acceptable tools in objective structured clinical examinations.
  • Chapter
    Technology‐enhanced learning (TEL) fully address the multitude of intersections between technology use and medical education practices. Central to the concept of TEL is a focus on the mediating role of technology. Teachers teach and learners learn; it is how they do these things (and what follows) that is changed by their use of technology. This chapter considers a range of theoretical frames for appraising the use of technology in medical education, and from these sets out a series of techniques for developing, using, and evaluating technology‐enhanced learning in medical education. It provides a critical review of the positions, practices, opportunities, and challenges associated with using technology in contemporary medical education. The intersections between TEL and professionalism can be considered as a matter of 'digital professionalism'. Technologies can work as prostheses to compensate for suboptimal conditions.
  • Augmented reality, while not necessarily a new technology, is becoming more well-known and gaining some momentum in medical education through Google Glass and Microsoft’s HoloLens. Not only can augmented reality aid in student education, but it also can impact patient care through its ability to enhance medical training. Medical libraries can partake in this new endeavor by being aware of applications in augmented reality that can benefit students and educators.
  • Article
    The means to share educational materials have grown considerably over the years, especially with the multitude of Internet channels available to educators. This article describes an innovative use of YouTube as a publishing platform for clinical educational materials.The authors posted online a series of short videos for teaching clinical procedures anticipating that they would be widely used. The project Web site attracted little traffic, alternatives were considered, and YouTube was selected for exploration as a publication channel. YouTube's analytics tools were used to assess uptake, and viewer comments were reviewed for specific feedback in support of evaluating and improving the materials posted.The uptake was much increased with 1.75 million views logged in the first 33 months. Viewer feedback, although limited, proved useful. In addition to improving uptake, this approach also relinquishes control over how materials are presented and how the analytics are generated. Open and anonymous access also limits relationships with end users.In summary, YouTube was found to provide many advantages over self-publication, particularly in terms of technical simplification, increased audience, discoverability, and analytics. In contrast to the transitory interest seen in most YouTube content, the channel has seen sustained popularity. YouTube's broadcast model diffused aspects of the relationship between educators and their learners, thereby limiting its use for more focused activities, such as continuing medical education.
  • Article
    The recent publicity around the tragic case of Bronte Doyne has highlighted a pressing need in healthcare delivery: the need for doctors to know that their patients, "e-patients," know medicine. In turn, this requires our medical students to be trained in how best to utilise the potential of e-patients in healthcare delivery. "I can't begin to tell you how it feels to have to tell an oncologist they are wrong, it's a young person's cancer. I had to, I'm fed up of trusting them." - Bronte Doyne (Vize 2015).
  • Article
    The widespread use of digital media (both computing devices and the services they access) has blurred the boundaries between our personal and professional lives. Contemporary students are the last to remember a time before the widespread use of the Internet and they will be the first to practice in a largely e-health environment. This article explores concepts of digital professionalism and their place in contemporary medical education, and proposes a series of principles of digital professionalism to guide teaching, learning and practice in the healthcare professions. Despite the many risks and fears surrounding their use, digital media are not an intrinsic threat to medical professionalism. Professionals should maintain the capacity for deliberate, ethical, and accountable practice when using digital media. The authors describe a digital professionalism framework structured around concepts of proficiency, reputation, and responsibility. Digital professionalism can be integrated into medical education using strategies based on awareness, alignment, assessment, and accountability. These principles of digital professionalism provide a way for medical students and medical practitioners to embrace the positive aspects of digital media use while being mindful and deliberate in its use to avoid or minimize any negative consequences.
  • Article
    Full-text available
    The transition from medical school to the workplace can be demanding, with high expectations placed on newly qualified doctors. The provision of up-to-date and accurate information is essential to support doctors at a time when they are managing increased responsibility for patient care. In August 2012, the Wales Deanery issued the Dr.Companion© software with five key medical textbooks (the iDoc app) to newly qualified doctors (the intervention). The aim of the study was to examine how a smartphone app with key medical texts was used in clinical workplace settings by newly qualified doctors in relation to other information sources and to report changes over time. Participants (newly qualified - Foundation Year 1 - doctors) completed a baseline questionnaire before downloading the iDoc app to their own personal smartphone device. At the end of Foundation Year 1 participants (n = 125) completed exit questionnaires one year later. We used Wilcoxon Signed Rank test to analyse matched quantitative data. We report significant changes in our participants' use of workplace information resources over the year. Respondents reduced their use of hard-copy and electronic versions of texts on PCs but made more use of senior medical staff. There was no significant difference in the use of peers and other staff as information sources. We found a significant difference in how doctors felt about using a mobile device containing textbooks in front of patients and senior medical staff in the workplace. Our study indicates that a mobile app enabling timely, internet-free access to key textbooks supports the learning and practice of newly qualified doctors. Although participants changed their use of other resources in the workplace, they continued to consult with seniors. Rather than over-reliance on technology, these findings suggest that the app was used strategically to complement, not replace discussion with members of the medical team. Participants' uncertainty about using a mobile device with textbook app in front of others eased over time.
  • Article
    Historically, telecommunications companies have measured voice and data traffic for reasons related to service dimensioning and engineering management. Today, personalized devices make it possible to understand not only the requirements for the capacity needed in a network but also household and individual usage patterns. This has changed the way that companies now market their products and services and sell directly to individuals. Beyond marketing is the intimate knowledge gathered of why people do things, inferred by ?pattern-of-life data and metadata. This is the precise knowledge of customer behaviors, traits, habits, and characteristics.
  • Article
    Self-powered flexible inorganic electronic systems have been demonstrated to be the core of next-generation electronics due to their lightweight, thin, self-sustainable and biocompatible properties, which are applicable to cramped or corrugated surfaces. Many researchers have studied myriad approaches for high performance flexible electronics, e.g. energy harvesters, batteries, high-density memories, large-scale integration (LSI), light-emitting diodes (LEDs), and sensors. Moreover, innovative devices for in vivo biomedical applications have been demonstrated on curvilinear and isolated regions of human bodies for detecting or even treating diseases. This paper reviews recent advances in self-powered flexible inorganic electronics, covering material selection, mechanical design, fabrication method and their all-in-one integration on a single plastic substrate.
  • Article
    In clinical and research settings, objective range of motion measurement is an essential component of lower limb assessment and treatment evaluation. One reliable tool is the digital inclinometer; however, availability and cost preclude its widespread use. Smartphone apps are now widely available, allowing smartphones to be used as an inclinometer. Reliability and validity studies of new technologies are scarce. Intrarater and interrater reliability of the iHandy Level app installed on a smartphone and an inclinometer were assessed in 20 participants for ankle dorsiflexion using a weight-bearing lunge test. Criterion validity was assessed between a Fastrak and the app, and construct validity was assessed between the inclinometer and the app. Intraclass correlation coefficients2,1 demonstrated excellent intrarater and interrater reliability (intraclass correlation coefficient, 0.97 and 0.76, respectively). Tests of validity demonstrated excellent correlation between all three methods (r > 0.99). The smartphone app is both reliable and valid, provides a low-cost method of measuring range of motion, and can be easily incorporated into clinical practice.
  • Article
    Full-text available
    Objectives: The study aims to identify the impact of mini-mal support on medical students' mobile learning activities. Methods: The study was performed at the Sultan Qaboos University, Oman, on 129 medical students in their 7 th year. The study consisted of a quantitative survey of the students, focussing on their mobile learning activities during their 6 th year, while using their own mobile devices (such as smart phones) for mobile learning activities. In addition, their perceptions of barriers to, and advantages of, using mobile devices were investigated. Data were analysed using Mi-crosoft Excel and EpiInfo. Results: All students used their mobile device as telephones and used most of the sophisticated applications. There was significantly less usage made of medical applications, such as clinical guidelines and medical reference tools. Barriers were screen size, cost, limited memory and battery. Ad-vantages were time-saving, ease of access and use. Few students (14%) highlighted lack of institutional support as a problem. Conclusions: Lack of support does not mean lack of usage. It does, however, mean predominantly simple usage. Given the importance of mobile devices in modern medical practice, this has strong negative implications for the professional preparedness of students studying in such environments.
  • Article
    Full-text available
    Background As Family Medicine programs across Canada are transitioning into a competency-based curriculum, medical students and clinical teachers are increasingly incorporating tablet computers in their work and educational activities. The purpose of this pilot study was to identify how preceptors and residents use tablet computers to implement and adopt a new family medicine curriculum and to evaluate how they access applications (apps) through their tablet in an effort to support and enhance effective teaching and learning. Methods Residents and preceptors (n = 25) from the Family Medicine program working at the Pembroke Regional Hospital in Ontario, Canada, were given iPads and training on how to use the device in clinical teaching and learning activities and how to access the online curriculum. Data regarding the use and perceived contribution of the iPads were collected through surveys and focus groups. This mixed methods research used analysis of survey responses to support the selection of questions for focus groups. Results Reported results were categorized into: curriculum and assessment; ease of use; portability; apps and resources; and perceptions about the use of the iPad in teaching/learning setting. Most participants agreed on the importance of accessing curriculum resources through the iPad but recognized that these required enhancements to facilitate use. The iPad was considered to be more useful for activities involving output of information than for input. Participants’ responses regarding the ease of use of mobile technology were heterogeneous due to the diversity of computer proficiency across users. Residents had a slightly more favorable opinion regarding the iPad’s contribution to teaching/learning compared to preceptors. Conclusions iPad’s interface should be fully enhanced to allow easy access to online curriculum and its built-in resources. The differences in computer proficiency level among users should be reduced by sharing knowledge through workshops led by more skillful iPad users. To facilitate collection of information through the iPad, the design of electronic data-input forms should consider the participants’ reported negative perceptions towards typing data through mobile devices. Technology deployment projects should gather sufficient evidence from pilot studies in order to guide efforts to adapt resources and infrastructure to relevant needs of Family Medicine teachers and learners.
  • Article
    Full-text available
    Introduction: Patient access to health information and patient–provider communication is integral to medicine, and can be facilitated by mobile applications (“apps”). Traditionally, student training in mobile Health (mHealth) has focussed on health professionals as consumers of information, with negative impacts on the quality and value of medical apps. This study focuses on teaching medical students to develop their own medical apps. Methods: At Sultan Qaboos University, Oman, an app development environment, iBuildApp, was taught to medical students and used to develop their first apps. Students were surveyed on their perceptions of the project. Results: Of the 166 students, 107 (64.5%) completed the survey. There was an increase in the perceived need for such learning, apps were aimed primarily at patients, and previous programming experience was the strongest influencer of a positive experience. A majority (77.6%) wanted more sophisticated development environments in spite of their apparent struggles. Discussions: The impact of previous experience is similar to other studies; the perceived value and focus on patient apps is indicative of an awareness of patients’ use of the devices not reflected in all literature. Conclusion: It is possible to teach medical students the fundamentals of app design so that they may contribute to app development in the future.
  • Article
    Background: Although many medical learners and teachers are using mobile technologies within medical education, there has been little evidence presented describing how they use mobile devices across a whole curriculum. Methods: The Northern Ontario School of Medicine (NOSM) introduced a new mobile device program in 2010. Incoming undergraduate medical learners received a laptop and an iPad and learners entering year three of the four-year program received a laptop and an iPhone. A survey was sent to all learners to gather information on their use of and attitudes toward these devices. A combination of quantitative and qualitative methods was used to analyze the data and to generate a series of themes that synthesized student behaviors, perceptions and attitudes. Results: Context and learner autonomy were found to be important factors with learners using multiple devices for different purposes and adopting strategic approaches to learning using these devices. The expectation that school-issued devices would be regularly and enthusiastically used to replace more traditional study media was not reflected in practice. Conclusions: Learners' approaches to using mobile devices are heterogeneous as is the extent to which they use them. Learners adapt their use of mobile devices to the learning cultures and contexts they find themselves in.
  • Article
    Cultural-historical activity theory has evolved through three generations of research. The emerging third generation of activity theory takes two interacting activity systems as its minimal unit of analysis, inviting us to focus research efforts on the challenges and possibilities of inter-organizational learning. Activity theory and its concept of expansive learning are examined with the help of four questions: 1. Who are the subjects of learning? 2. Why do they learn? 3. What do they learn? 4. How do they learn? Five central principles of activity theory are presented, namely activity system as unit of analysis, multi-voicedness of activity, historicity of activity, contradictions as driving force of change in activity, and expansive cycles as possible form of transformation in activity. Together the four questions and five principles form a matrix which is used to present a study of expansive learning in a hospital setting in Finland. In conclusion, implications of the framework for our understanding of the increasingly important horizontal dimension of learning are discussed.
  • Article
    A Smartphone app could be useful in aiding patients in self-monitoring and self-managing their chronic pain-related symptoms. The purpose of this study was to systematically review English-language pain-related Smartphone apps available for download in the United States. During July 2012, official Android, BlackBerry, and iPhone Smartphone app platform stores were searched. "Pain" was entered into the search-bar of each Smartphone app store. Of the pain apps meeting inclusion criteria, the following were retrieved: release date, download cost (US dollars [US $], file size, documentation of a healthcare professional's (HCP) involvement in app development, primary purpose of the app (pain education, pain self-management, or a combination of pain education and self-management), targeted pain-related condition(s), and inclusion of features that addressed four common self-monitoring and/or management strategies. Of the 220 apps meeting inclusion criteria, the majority were available through the iPhone (80.0 percent). The cost for downloading each app ranged from US $0.00 to 89.99; however, the majority of apps were ≤US $4.99. There was no evidence of HCP involvement in the development of the majority of apps (65.0 percent). Chronic, nonspecific pain was the focus of half (50.5 percent) of the apps, followed by back and/or neck pain (25.9 percent). The primary purpose of the apps was categorized as follows: pain education (n = 53, 24.1 percent), pain self-management (n = 137, 62.3 percent), and both pain education and selfmanagement (n = 30, 13.6 percent). Overall, most of the pain-related apps included within our review not only lacked evidence of HCP input regarding development but also contained few evidence-based pain management features.
  • Article
    Team-based learning (TBL) is a teaching pedagogy for flipping the classroom that moves the focus of the classroom from the instructor conveying course concepts via lecture to the application of concepts by student teams. It has been used extensively in lecture courses; however, there is little evidence of its use in laboratory courses. The purpose of this report is to describe the implementation of TBL in a graduate exercise physiology laboratory course. Using TBL in a graduate laboratory course was very successful and well received by both the students and instructor. Students reported increased content learning, skill development, and retention. They took on the responsibility for learning and were more accountable. The learners drove the process and were guided by the instructor rather than through instructor-centered delivery.
  • Article
    Full-text available
    Health care providers are increasingly using wireless media tablets, such as the Apple iPad, especially in the hospital setting. In the absence of specific tablet disinfection guidelines the authors applied what is known about the contamination of other nonmedical mobile communication devices to create a "common sense" bundle to guide wireless media tablet infection prevention practices. Copyright © 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
  • Article
    The purpose of this study was to assess residents' usage patterns and opinions of the iPad as a tool for radiology education and clinical practice at an academic medical center. All 38 radiology residents in our radiology program (postgraduate years 2 to 5) were provided with iPad 2 tablets and subscriptions to e-Anatomy and STATdx. After 6 months of device use, residents were surveyed to assess their opinions regarding the technology as a tool for education and clinical practice. A total of 36 residents (95%) completed the survey. Eighty-six percent reported daily iPad use. Radiology-specific applications, particularly e-Anatomy, were used weekly or daily by 88% of respondents. Most preferred to read journal articles on the iPad (70%), but the number of respondents preferring to read textbooks on the iPad (48.5%) compared with the traditional bound form (48.5%) was evenly divided. Residents were also divided on the clinical utility of the iPad. Most had not used the iPad to view radiologic examinations (75%). Fewer than half (47%) used their iPads during readout. Finally, only 12% had used the iPad to edit dictated reports. The iPad has generated excitement within the radiology community, particularly among resident educators, who are increasingly recognizing the unique needs of "millennial learners." This study showed that the majority of residents at the authors' institution have incorporated the iPad as an educational tool and use it as a learning aid. Incorporation of the iPad into clinical workflow has been less pronounced.
  • Article
    Full-text available
    Background: The achievement of the millennium development goals may be facilitated by the use of information and communication technology in medical and health education. Aims: This study intended to explore the use and impact of educational technology in medical education in resource-constrained environments. Methods: A multiple case study was conducted in two Nepalese teaching hospitals. The data were analysed using activity theory as an analytical basis. Results: There was little evidence for formal e-learning, but the findings indicate that students and residents adopted mobile technologies, such as mobile phones and small laptops, as cultural tools for surprisingly rich 'informal' learning in a very short time. These tools allowed learners to enhance (a) situated learning, by immediately connecting virtual information sources to their situated experiences; (b) cross-contextual learning by documenting situated experiences in the form of images and videos ─ and re-using the material for later reflection and discussion and (c) engagement with educational content in social network communities. Conclusion: By placing the students and residents at the centre of the new learning activities, this development has begun to affect the overall educational system. Leveraging these tools is closely linked to the development of broad media literacy, including awareness of ethical and privacy issues.
  • Article
    Full-text available
    This exploratory research investigates how students and professionals use social network sites (SNSs) in the setting of developing and emerging countries. Data collection included focus groups consisting of medical students and faculty as well as the analysis of a Facebook site centred on medical and clinical topics. The findings show how users, both students and professionals, appropriate SNSs from their mobile phones as rich educational tools in informal learning contexts. First, unlike in previous studies, the analysis revealed explicit forms of educational content embedded in informal learning contexts in Facebook. Quizzes, case presentations and associated deliberate (e-)learning practices which are typically found in (more) formal educational settings were identified. Second, from a sociocultural learning perspective, it is shown how the participation in such virtual professional communities across national boundaries permits the announcement and negotiation of occupational status and professional identities.
  • Article
    Background: The incorporation of technology into medical education is critical for learners. Little is known about the effect of integrating iPad technology into undergraduate medical education. Aims: We introduced iPads into the first-year curriculum in 2011-2012. We aimed to evaluate students' use of, and attitudes toward, the iPad. Methods: We administered two surveys to students during the 2011-2012 academic year. Additionally, we conducted focus groups to further evaluate the effectiveness of iPad integration into the curriculum. Results: Survey data reflect mixed attitudes toward the use of the iPad in the preclinical curriculum. While a vast majority of students agree "the iPad has value in the medical curriculum" (79% in the first survey; 65% in the second survey), there was a decrease over time in the view that "the iPad is a positive addition to the curriculum" (75% in the first survey; 49% in the second survey). Focus group data indicate students appreciate certain aspects of iPad use in the curriculum, including improved curriculum interactivity, but the majority believe it cannot replace printed handouts at this time. Discussion: The iPad provides some benefits in undergraduate medical education. More studies are necessary to determine how the iPad is best incorporated into medical education.
  • Article
    Part one of this paper highlights how students today think and process information fundamentally differently from their predecessors, as a result of being surrounded by new technology. The author compares these “digital natives” with the older generation who are learning and adopting new technology naming them “digital immigrants”.
  • Article
    Full-text available
    The rapid adoption rate and integration of mobile technology (tablet computing devices and smartphones) by physicians is reshaping the current clinical landscape. These devices have sparked an evolution in a variety of arenas, including educational media dissemination, remote patient data access and point of care applications. Quantifying usage patterns of clinical applications of mobile technology is of interest to understand how these technologies are shaping current clinical care. A digital survey examining mobile tablet and associated application usage was administered via email to all ACGME training programs. Data regarding respondent specialty, level of training, and habits of tablet usage were collected and analyzed. 40 % of respondents used a tablet, of which the iPad was the most popular. Nearly half of the tablet owners reported using the tablet in clinical settings; the most commonly used application types were point of care and electronic medical record access. Increased level of training was associated with decreased support for mobile computing improving physician capabilities and patient interactions. There was strong and consistent desire for institutional support of mobile computing and integration of mobile computing technology into medical education. While many physicians are currently purchasing mobile devices, often without institutional support, successful integration of these devices into the clinical setting is still developing. Potential reasons behind the low adoption rate may include interference of technology in doctor-patient interactions or the lack of appropriate applications available for download. However, the results convincingly demonstrate that physicians recognize a potential utility in mobile computing, indicated by their desire for institutional support and integration of mobile technology into medical education. It is likely that the use of tablet computers in clinical practice will expand in the future. Thus, we believe medical institutions, providers, educators, and developers should collaborate in ways that enhance the efficacy, reliability, and safety of integrating these devices into daily medical practice.
  • Article
    Full-text available
    Background Advanced mobile communications and portable computation are now combined in handheld devices called “smartphones”, which are also capable of running third-party software. The number of smartphone users is growing rapidly, including among healthcare professionals. The purpose of this study was to classify smartphone-based healthcare technologies as discussed in academic literature according to their functionalities, and summarize articles in each category. Methods In April 2011, MEDLINE was searched to identify articles that discussed the design, development, evaluation, or use of smartphone-based software for healthcare professionals, medical or nursing students, or patients. A total of 55 articles discussing 83 applications were selected for this study from 2,894 articles initially obtained from the MEDLINE searches. Results A total of 83 applications were documented: 57 applications for healthcare professionals focusing on disease diagnosis (21), drug reference (6), medical calculators (8), literature search (6), clinical communication (3), Hospital Information System (HIS) client applications (4), medical training (2) and general healthcare applications (7); 11 applications for medical or nursing students focusing on medical education; and 15 applications for patients focusing on disease management with chronic illness (6), ENT-related (4), fall-related (3), and two other conditions (2). The disease diagnosis, drug reference, and medical calculator applications were reported as most useful by healthcare professionals and medical or nursing students. Conclusions Many medical applications for smartphones have been developed and widely used by health professionals and patients. The use of smartphones is getting more attention in healthcare day by day. Medical applications make smartphones useful tools in the practice of evidence-based medicine at the point of care, in addition to their use in mobile clinical communication. Also, smartphones can play a very important role in patient education, disease self-management, and remote monitoring of patients.
  • Article
    Recent research into the history of some of the most prominent and successful firms in the for-profit sector has shown that industry leadership is extraordinarily fragile. Over and over; in industries as diverse as microelectronics, steel, motorcycles, and software, leading firms whose management practices at one point were widely admired and imitated have stum-bled badly and even failed. The factor that consistently has triggered these failures has not been complacent, arrogant, or bureaucratic management. It has been the emergence in their markets of disruptivem technology—simple, convenient-to-use innovations that initially are used only by unsophisticated customers at the low end of markets. Ironically, two of the funda-mental paradigms of good management—the importance of listening closely to customers and the necessity of bringing to market a regular flow of improved products that can be sold at higher profit margins—are the reasons why well-managed companies have consistently failed when confronted by disruptive technologies in their markets. This paper asserts that in a very analogous way, disruptive innovations in continuing education for managers and for health care professionals pose a significant threat to the impact and profitability of the continuing education programs of the leading schools of medicine and business. Through their focus on the leading edges of technology, therapy, and practice, many of these programs have lost sight of a very different set of educational needs among the fastest growing health care institutions in our environment. The paper suggests that unless leading providers of continuing medical education at medical schools aggressively begin offering courses that are customized to the needs of specific health care providers, in formats and venues that are conveniently accessi-ble, they will increasingly be displaced by new providers of these services.
  • Article
    The authors hypothesized that ownership of a mobile electronic device would result in more time spent learning radiology. Current trends in radiology residents' studying habits, their use of electronic and printed radiology learning resources, and how much of the funds allotted to them are being used toward printed vs electronic education tools were assessed in this study. A survey study was conducted among radiology residents across the United States from June 13 to July 5, 2011. Program directors listed in the Association of Program Directors in Radiology e-mail list server received an e-mail asking for residents to participate in an online survey. The questionnaire consisted of 12 questions and assessed the type of institution, the levels of training of the respondents, and book funds allocated to residents. It also assessed the residents' study habits, access to portable devices, and use of printed and electronic radiology resources. Radiology residents are adopters of new technologies, with 74% owning smart phones and 37% owning tablet devices. Respondents spend nearly an equal amount of time learning radiology from printed textbooks as they do from electronic resources. Eighty-one percent of respondents believe that they would spend more time learning radiology if provided with tablet devices. There is considerable use of online and electronic resources and mobile devices among the current generation of radiology residents. Benefits, such as more study time, may be obtained by radiology programs that incorporate tablet devices into the education of their residents.
  • Article
    The advent of the Internet heralded predictions that e-learning would transform and disrupt teaching practices in higher education. E-learning also promised to expand opportunities for lifelong and flexible learning, and offered a panacea for practical issues such as decreased funding and increasing student numbers.The anticipated disruption to teaching and learning has not come to fruition however. Although technology is now common place in most higher education institutions – most institutions have invested in a virtual learning environment (VLE) and employ staff dedicated to supporting e-learning – there is little evidence of significant impact on teaching practices and current implementations are accused of being focused on improving administration and replicating behaviourist, content-driven models.This paper discusses a preliminary analysis, rooted in Activity Theory, of the transformation of teaching practices, which did or did not take place in our university following the institution-wide deployment of a VLE. In particular, factors limiting a full uptake of the VLE more advanced functionalities by the wider university community are explored.
  • Article
    The paper describes the findings from a study of students’ use and experience of technologies. A series of in-depth case studies were carried out across four subject disciplines, with data collected via survey, audio logs and interviews. The findings suggest that students are immersed in a rich, technology-enhanced learning environment and that they select and appropriate technologies to their own personal learning needs. The findings have profound implications for the way in which educational institutions design and support learning activities.
  • Article
    Full-text available
    The goal of this study was to compare scores on house staff evaluations of "overall teaching quality" during a rotation in anesthesia for orthopedics in the first six months (n=11 residents were provided with curriculum in a printed binder) and in the final six months (n=9 residents were provided with the same curriculum in a tablet computer (iPad, Apple®, Inc, Cupertino, Ca)). At the beginning of the two-week rotation, the resident was given an iPad containing: a syllabus with daily reading assignments, rotation objectives according to the ACGME core competencies, and journal articles. Prior to the study, these curriculum materials had been distributed in a printed binder. The iPad also provided peer reviewed internet sites and direct access to online textbooks, but was not linked to the electronic medical record. At the end of the rotation, residents anonymously answered questions to evaluate the rotation on an ordinal scale from 1 (unsatisfactory) to 5 (outstanding). All residents were unaware that the data would be analyzed retrospectively for this study. The mean global rating of the rotation as assessed by "overall teaching quality of this rotation" increased from 4.09 (N=11 evaluations before intervention, SD 0.83, median 4, range 3-5) to 4.89 (N=9 evaluations after intervention, SD 0.33, median 5, range 4-5) p=0.04. Residents responded favorably to the introduction of an innovative iPad based curriculum for the orthopedic anesthesia rotation. More studies are needed to show how such mobile computing technologies can enhance learning, especially since residents work at multiple locations, have duty hour limits, and the need to document resident learning in six ACGME core competencies.
  • Article
    Full-text available
    Mobile technology is increasingly being used by clinicians to access up-to-date information for patient care. These offer learning opportunities in the clinical setting for medical students but the underlying pedagogic theories are not clear. A conceptual framework is needed to understand these further. Our initial questions were how the medical students used the technology, how it enabled them to learn and what theoretical underpinning supported the learning. 387 medical students were provided with a personal digital assistant (PDA) loaded with medical resources for the duration of their clinical studies. Outcomes were assessed by a mixed-methods triangulation approach using qualitative and quantitative analysis of surveys, focus groups and usage tracking data. Learning occurred in context with timely access to key facts and through consolidation of knowledge via repetition. The PDA was an important addition to the learning ecology rather than a replacement. Contextual factors impacted on use both positively and negatively. Barriers included concerns of interrupting the clinical interaction and of negative responses from teachers and patients. Students preferred a future involving smartphone platforms. This is the first study to describe the learning ecology and pedagogic basis behind the use of mobile learning technologies in a large cohort of undergraduate medical students in the clinical environment. We have developed a model for mobile learning in the clinical setting that shows how different theories contribute to its use taking into account positive and negative contextual factors.The lessons from this study are transferable internationally, to other health care professions and to the development of similar initiatives with newer technology such as smartphones or tablet computers.
  • Article
    This article proposes a continuum of ‘Visitors’ and ‘Residents’ as a replacement for Prensky’s muchdcriticised Digital Natives and Digital Immigrants. Challenging the basic premises upon which Prensky constructed his typology, Visitors and Residents fulfil a similar purpose in mapping individuals’ engagement with the Web. We argue that the metaphors of ‘place’ and ‘tool’ most appropriately represent the use of technology in contemporary society, especially given the advent of social media. The Visitors and Residents continuum accounts for people behaving in different ways when using technology, depending on their motivation and context, without categorising them according to age or background. A wider and more accurate representation of online behaviour is therefore established.
  • Article
    Full-text available
    Social Networking Sites (SNSs) are virtual communities where users can create individual public profiles, interact with real-life friends, and meet other people based on shared interests. They are seen as a 'global consumer phenomenon' with an exponential rise in usage within the last few years. Anecdotal case study evidence suggests that 'addiction' to social networks on the Internet may be a potential mental health problem for some users. However, the contemporary scientific literature addressing the addictive qualities of social networks on the Internet is scarce. Therefore, this literature review is intended to provide empirical and conceptual insight into the emerging phenomenon of addiction to SNSs by: (1) outlining SNS usage patterns, (2) examining motivations for SNS usage, (3) examining personalities of SNS users, (4) examining negative consequences of SNS usage, (5) exploring potential SNS addiction, and (6) exploring SNS addiction specificity and comorbidity. The findings indicate that SNSs are predominantly used for social purposes, mostly related to the maintenance of established offline networks. Moreover, extraverts appear to use social networking sites for social enhancement, whereas introverts use it for social compensation, each of which appears to be related to greater usage, as does low conscientiousness and high narcissism. Negative correlates of SNS usage include the decrease in real life social community participation and academic achievement, as well as relationship problems, each of which may be indicative of potential addiction.
  • Article
    Smartphone applications (or apps) are becoming increasingly popular. The lack of regulation or guidance for health-related apps means that the validity and reliability of their content is unknown. We have conducted a review of available apps relating to the generic condition of pain. The official application stores for five major smartphone platforms were searched: iPhone, Android, Blackberry, Nokia/Symbian and Windows Mobile. Apps were included if they reported a focus on pain education, management or relief, and were not solely aimed at health-care professionals (HCPs). A total of 111 apps met the inclusion criteria. The majority of apps reviewed claimed some information provision or electronic manual component. Diary tracking of pain variables was also a common feature. There was a low level of stated HCP involvement in app development and content. Despite an increasing number of apps being released, the frequency of HCP involvement is not increasing. Pain apps appear to be able to promise pain relief without any concern for the effectiveness of the product, or for possible adverse effects of product use. In a population often desperate for a solution to distressing and debilitating pain conditions, there is considerable risk of individuals being misled.
  • Article
    Full-text available
    In the Information Age, the communication patterns between doctor and patient are changing. Using Everett Rogers' theory of Diffusion of Innovations, this paper begins by examining the diffusion of the Internet in the world and in Oman. It then considers the emergence of e-patients. The characteristics of e-patients are described in some detail. The paper ends by describing steps that should be taken when teaching medical students in Oman so that they can be prepared for e-patients.
  • Article
    As part of an international faculty development conference in February 2010, a working group of medical educators and physicians discussed the changing role of instructional technologies and made recommendations for supporting faculty in using these technologies in medical education. The resulting discussion highlighted ways technology is transforming the entire process of medical education and identified several converging trends that have implications for how medical educators might prepare for the next decade. These trends include the explosion of new information; all information, including both health knowledge and medical records, becoming digital; a new generation of learners; the emergence of new instructional technologies; and the accelerating rate of change, especially related to technology. The working group developed five recommendations that academic health leaders and policy makers may use as a starting point for dealing with the instructional technology challenges facing medical education over the next decade. These recommendations are (1) using technology to provide/support experiences for learners that are not otherwise possible-not as a replacement for, but as a supplement to, face-to-face experiences, (2) focusing on fundamental principles of teaching and learning rather than learning specific technologies in isolation, (3) allocating a variety of resources to support the appropriate use of instructional technologies, (4) supporting faculty members as they adopt new technologies, and (5) providing funding and leadership to enhance electronic infrastructure to facilitate sharing of resources and instructional ideas.
  • Article
    Increases in the daily work load of medical residents, coupled with constraints on their work hours have made personal digital assistants (PDAs) an increasingly popular management resource. No comprehensive review of PDA utilization among medical residents has been published. The purpose is to review and analyze current literature addressing PDA use by medical residents and to asses the future impact handheld computers may have on the daily practices of residents. A systematic literature search was completed to identify publications that describe the use of PDAs by medical residents. Particular attention and priority was given to articles addressing patient care, information management, and educational outcomes. The rate of PDA utilization has dramatically increased in the past decade. Today, 70% of residents report using a PDA daily. PDAs are most commonly used for referencing medication-prescribing guides, medical textbooks, patient documentation programs, and medical calculators. No articles have reported the impact of housestaff PDA use on educational or patient care outcomes. PDAs are perceived as a valuable resource by most medical residents. Further studies are necessary to confirm that daily PDA use by housestaff confers an educational, institutional, and patient care benefit.
  • Article
    Full-text available
    In our previous projects, students and residents have readily adopted personal digital assistants (PDAs), but faculty have generally been reluctant. The objective of the project reported here was to maximize adoption of PDAs by our faculty, using a combination of strategies. Through cost-shared funding, we provided full-time and community teachers with PocketPCs or Handspring Visors, along with preinstalled medical software. Use patterns and satisfaction were assessed by structured questionnaire and focus group discussions. For the calendar, address book, and pharmacopoeia, we found that 83% of faculty use these two to three times per day. Cost sharing and software preinstallation were popular. Device synchronization and e-mail showed potential but caused problems. Easy access to technical support from peers and a variety of information-sharing structures eased maintenance issues. Point-of-care data access was important to faculty. With the right support structures, faculty adopt PDAs in clinical and teaching settings.
  • Article
    The United States health care system is an outdated model in need of fundamental change. As part of this change, the system must explore and take advantage of the potential benefits of the "e-revolution," a phenomenon that includes everyday use of the Internet by the general public. During 2002, an estimated 100 million Americans will have obtained information--including health information--from the Web as a basis for making decisions. The Internet is thus an influential force; and, as such, this medium could have a revolutionary role in retooling the trillion-dollar United States health care industry to improve patient self-management, patient satisfaction, and health outcomes. As a group, physicians use the Internet more than do many other sectors of the general adult population. However, physicians have not received sufficient information to convince them that they can provide higher-quality care by using the Internet; indeed, few studies have assessed the Internet's value for improving patients' medical self-management and health behavior, as well as their clinical outcomes and relationships with health care practitioners. New e-technology formats introduced to the growing consumer movement will drive the next generation of self-care by allowing patients to manage their own health conveniently and proficiently.
  • Article
    Full-text available
    To assess the educational effectiveness on learning evidence based medicine of a handheld computer clinical decision support tool compared with a pocket card containing guidelines and a control. Randomised controlled trial. University of Hong Kong, 2001. 169 fourth year medical students. Factor and individual item scores from a validated questionnaire on five key self reported measures: personal application and current use of evidence based medicine; future use of evidence based medicine; use of evidence during and after clerking patients; frequency of discussing the role of evidence during teaching rounds; and self perceived confidence in clinical decision making. The handheld computer improved participants' educational experience with evidence based medicine the most, with significant improvements in all outcome scores. More modest improvements were found with the pocket card, whereas the control group showed no appreciable changes in any of the key outcomes. No significant deterioration was observed in the improvements even after withdrawal of the handheld computer during an eight week washout period, suggesting at least short term sustainability of effects. Rapid and convenient access to valid and relevant evidence on a portable computing device can improve learning in evidence based medicine, increase current and future use of evidence, and boost students' confidence in clinical decision making.
  • Article
    Full-text available
    This study implemented and evaluated a point-of-care, wireless Internet access using smart phones for information retrieval during daily clinical rounds and academic activities of internal medicine residents in a community hospital. We did the project to assess the feasibility of using smart phones as an alternative to reach online medical resources because we were unable to find previous studies of this type. In addition, we wanted to learn what Web-based information resources internal medicine residents were using and whether providing bedside, real-time access to medical information would be perceived useful for patient care and academic activities. We equipped the medical teams in the hospital wards with smart phones (mobile phone/PDA hybrid devices) to provide immediate access to evidence-based resources developed at the National Library of Medicine as well as to other medical Websites. The emphasis of this project was to measure the convenience and feasibility of real-time access to current medical literature using smart phones. The smart phones provided real-time mobile access to medical literature during daily rounds and clinical activities in the hospital. Physicians found these devices easy to use. A post-study survey showed that the information retrieved was perceived to be useful for patient care and academic activities. In community hospitals and ambulatory clinics without wireless networks where the majority of physicians work, real-time access to current medical literature may be achieved through smart phones. Immediate availability of reliable and updated information obtained from authoritative sources on the Web makes evidence-based practice in a community hospital a reality.
  • Article
    With e-learning now part of the medical education mainstream, both educational and practical technical and informatics skills have become an essential part of the medical teacher's portfolio. The Guide is intended to help teachers develop their skills in working in the new online educational environments, and to ensure that they appreciate the wider changes and developments that accompany this 'information revolution'. The Guide is divided into two parts, of which this is the second. The first part introduced the basic concepts of e-learning, e-teaching, and e-assessment, the day-to-day issues of e-learning, looking both at theoretical concepts and practical implementation issues. This second part covers topics such as practical knowledge of the forms of technology used in e-learning, the behaviours of teachers and learners in online environments and the design of e-learning content and activities. It also deals with broader concepts of the politics and psychology of e-learning, as well as many of its ethical, legal and economical dimensions, and it ends with a review of emerging forms and directions in e-learning in medical education.
  • Article
    In just a few years, e-learning has become part of the mainstream in medical education. While e-learning means many things to many people, at its heart it is concerned with the educational uses of technology. For the purposes of this guide, we consider the many ways that the information revolution has affected and remediated the practice of healthcare teaching and learning. Deploying new technologies usually introduces tensions, and e-learning is no exception. Some wish to use it merely to perform pre-existing activities more efficiently or faster. Others pursue new ways of thinking and working that the use of such technology affords them. Simultaneously, while education, not technology, is the prime goal (and for healthcare, better patient outcomes), we are also aware that we cannot always predict outcomes. Sometimes, we have to take risks, and 'see what happens.' Serendipity often adds to the excitement of teaching. It certainly adds to the excitement of learning. The use of technology in support of education is not, therefore, a causal or engineered set of practices; rather, it requires creativity and adaptability in response to the specific and changing contexts in which it is used. Medical Education, as with most fields, is grappling with these tensions; the AMEE Guide to e-Learning in Medical Education hopes to help the reader, whether novice or expert, navigate them. This Guide is presented both as an introduction to the novice, and as a resource to more experienced practitioners. It covers a wide range of topics, some in broad outline, and others in more detail. Each section is concluded with a brief 'Take Home Message' which serves as a short summary of the section. The Guide is divided into two parts. The first part introduces the basic concepts of e-learning, e-teaching, and e-assessment, and then focuses on the day-to-day issues of e-learning, looking both at theoretical concepts and practical implementation issues. The second part examines technical, management, social, design and other broader issues in e-learning, and it ends with a review of emerging forms and directions in e-learning in medical education.