Real-time use of the iPad by third-year medical students for clinical decision support and learning: a mixed methods study

Abstract

PurposeDespite widespread use of mobile technology in medical education, medical students’ use of mobile technology for clinical decision support and learning is not well understood. Three key questions were explored in this extensive mixed methods study: 1) how medical students used mobile technology in the care of patients, 2) the mobile applications (apps) used and 3) how expertise and time spent changed overtime.MethodsThis year-long (July 2012–June 2013) mixed methods study explored the use of the iPad, using four data collection instruments: 1) beginning and end-of-year questionnaires, 2) iPad usage logs, 3) weekly rounding observations, and 4) weekly medical student interviews. Descriptive statistics were generated for the questionnaires and apps reported in the usage logs. The iPad usage logs, observation logs, and weekly interviews were analyzed via inductive thematic analysis.ResultsStudents predominantly used mobile technology to obtain real-time patient data via the electronic health record (EHR), to access medical knowledge resources for learning, and to inform patient care. The top four apps used were Epocrates®, PDF Expert®, VisualDx®, and Micromedex®. The majority of students indicated that their use (71%) and expertise (75%) using mobile technology grew overtime.ConclusionsThis mixed methods study provides substantial evidence that medical students used mobile technology for clinical decision support and learning. Integrating its use into the medical student's daily workflow was essential for achieving these outcomes. Developing expertise in using mobile technology and various apps was critical for effective and efficient support of real-time clinical decisions.

Use of Mobile Devices to Access Resources Among Health Professions Students: A Systematic Review

“…Other uses of mobile devices included knowledge management [17,18,25,32] and access to EMR [18,25,29]. The use of mobile applications to improve learning and enhance workplace performance and communications were also reported in 10 studies.…”

“…The 5 studies with mixed methods included quantitative methods of pretest-posttest random control group design and one-group pretestposttest design in combination with qualitative methods such as focus group, interview, observation, and narrative report. A majority of studies (n=17) used questionnaires as data collection methods; 6 studies included observation, content analysis, usage log, and feedback; 5 studies employed focus groups; 2 studies administered objective performance tests [16,17]; only one study included interview [18]. None of the selected studies provided any evidence of reliability of the questionnaires administered to participants; only 3 studies had limited information on face and content validity of questionnaires used [16,19,20].…”

“…These resources came in the forms of question banks, self-assessment applications [18,19,25], calculators [26,27], multimedia learning resources [16,24,28], or curriculum-related materials [24,[29][30][31]. In a study by Bruce-Low, et al, mobile learning devices for students to use (Samsung NC10 Netbook) were loaded with a video of an ECG technique incorporating multiple choice quizzes and interactive exercise [16].…”

“…These resources included drug guides, handbooks, manuals, dictionaries, encyclopedias, online textbooks, lab values, nursing procedures, and specialty resources (e.g., internal medicine, radiology, pathology, neurology, neurosurgery). A few others were visual resources of mobile applications such as VisualDX [18], DrawMD [18], and anatomy atlases [21][22][23][24].…”

“…The use of mobile applications to improve learning and enhance workplace performance and communications were also reported in 10 studies. Examples of these applications included a multiplatform journaling app Evernote [25], the iPad "air-play-mirroring" for presentations, FaceTime, Dropbox [29], Skyscape [33], KeyNote [17], DocTool Cross Library Search Tool [23], PDFExpert for reading and editing PDF files on the iPad, and QuickOffice [18]. Various clinical tools were used to access EMR (DICOM viewers), make call schedules, and access PACS and EMR remotely via the Citrix Receiver [24]; Cisco WebEx Meeting videoconference software was installed for iPad users to make didactic and case-conference lectures anywhere with an Internet connection; the ResponseWare app was embedded into the iPad to offer the capability of audience response during resident training events [24].…”