A balancing act: a phenomenological exploration of medical students' experiences of using mobile devices in the clinical setting

Abstract

ObjectiveThe aims of this study were to describe the experiences of senior students using mobile devices in a clinical setting while learning and interacting with clinical teachers, patients and each other, and to identify challenges that facilitated or impeded the use of such devices in the hospital.DesignInterpretative phenomenology was chosen to guide our enquiry. Semi-structured interviews were conducted to examine the experiences of five senior medical students using mobile devices in the clinical setting.Setting and participantsSenior medical students at an international medical school in the Middle East.ResultsThree main themes emerged from the data analysis: learning; professional identity and transitioning from student to doctor. The findings showed that using mobile devices in the clinical area as a learning tool was not a formalised process. Rather, it was opportunistic learning at the bedside and on occasion a source of distraction from clinical teaching. Students needed to negotiate relationships between themselves, the clinical teacher and patients in order to ensure that they maintained an acceptable professional image. Participants experienced and negotiated the change from student to doctor making them mindful of using their devices at the bedside.ConclusionsMobile devices are part of daily life for a medical student and there is a need to adapt medical education in the clinical setting, to allow the students to use their devices in a sensitive manner.

A Best Evidence Medical Education (BEME) systematic review of: What works best for health professions students using mobile (hand-held) devices for educational support on clinical placements? BEME Guide No. 52

“…Early years' ambivalence and later years valuing mobile devices in clinical work illustrated such "asymmetries of use." A particular strength was to bring theory into practice via immediate and easy point-of-care ("just-in-time") access to information integrated in one source (Johansson et al 2013;Willemse and Bozalek 2015;Rashid-Doubell et al 2016). Even with unreliable Internet access in resource-limited settings (Willemse and Bozalek 2015) or off-line use generally (Shurtz and von Isenburg 2011), mobile devices added value to clinical work via convenience, portability, and immediacy (Witt et al 2016).…”

“…Green et al (2015) found that medical students' self-reported frequency and proficiency of use were each significantly associated with their agreement that the device was enhancing their learning. Rashid-Doubell et al (2016) also reported medical students' distractions during patient observation, when social connectivity displaced information-checking.…”

“…Others reported actual staff disapproval of students using the devices (Dearnley et al 2008;Bogossian et al 2009;Davies et al 2012;Ellaway et al 2014;Rashid-Doubell et al 2016). Examples included students noting that staff: were "old-school" and assumed personal use (Rashid-Doubell et al 2016); perceived that patients would be uncomfortable (such as Johansson et al 2013 renursing students with psychiatric in-patients); or opposed signing off a clinical task on the device (Green et al 2015). Of Green et al's (2015) senior medical students using an official-issue iPhone (loaded with academic, assessment, and reflective software), only 37.4% agreed that assessors responded well to completing a mini-CEX on it.…”

“…Sometimes, staff in clinical settings were positive about students using a device, such as: rural supervisors in Johansson et al's (2013) study of nursing students; staff nurses working with nursing students on their 10-week clinical placement on a medical-surgical unit (Wittmann-Price et al 2012); or "new school" consultants encouraging Rashid-Doubell et al's (2016) medical students to check information on ward-rounds. Staff might indeed actively encourage students to use the devices, e.g.…”

“…A recurrent theme was that students were reluctant to use mobile devices in front of patients to avoid being seen as unprofessional (Fisher and Koren 2007;Dearnley et al 2008;Farrell and Rose 2008;Bogossian et al 2009;Davies et al 2012;Theroux 2013;Green et al 2015;Khraim et al 2015;Willemse and Bozalek 2015;Witt et al 2016;Rashid-Doubell et al 2016), e.g. :…”