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Rating: 5.0/5 (2 votes cast)

Authors Institution
Adam Julius
Charles S. Hall
Thomas Chase
Joht Chandan
Ryan Burnett
Benedict Lyle Phillips
Betsy Anagnostelis
Deborah Gill
Bimbi Fernando
Royal Free Hospital, Pond St, London NW3 2QG
UCL Medical School, University College London, Gower Street, London WC1E 6BT
Theme
3AA Mobile learning and social networks
Attitudes To mLearning With Tablet Computers Amongst Medical Students: An Observational Study in a University Teaching Hospital
Background

In the context of Medical Schools expending resources in equipping, distributing and supporting mobile devices for large cohorts of students, more research is needed to ensure tablet computing devices are used and useful in clinical settings.

  • Evidence into the utility of mobile devices in completing e-portfolios is small. A PDA based study demonstrated positive attitudes to a PDA based portfolio, but was limited by “inherent interface restrictions” of PDAs (Garrett and Jackson, 2006).
  • Higher levels of feedback were seen amongst students using PDAs, compared to previous PC based feedback (Coulby et al., 2011).
Summary of Work
  • A prospective observational study involving 126 medical student at the Royal Free Hospital, were offered an iPad Mini for the duration of the six-week rotation.
  • 101 were enrolled and issued tablet devices preloaded with apps, links and medical texts.
  • Data was collected in the form of pre-study and post-study questionnaires examining their attitudes. Unstructured verbal feedback was collected from the students in the form of a discussion about their experience.
  • Attitudes to the iPad devices were modelled using a 5-point Likert scale, with candidates expressing their level of agreement with a statement describing an advantage or disadvantage of the devices.

The surveys were anonymous to encourage honest feedback. Results were collected using Google Drive’s survey functionality and the data formatted using the Alteryx analytics platform. The data was analysed with an unpaired t-test with an alpha value of 0.05 running on SPSS v22.

Conclusion

Students had high expectations of the devices, that were mostly met during their 6 week experience and that their perceived disadvantages of using a tablet computer were refuted.

Barriers to adoption lie in the lack of Internet access, expense and the risk of loss or damage. Students did not consider the tablets problematic either in their interaction with patients or clinicians.

Take-home Messages
  • How institutions and clinicians-in-training maximise the benefits of tablet computing is an area that requires further research.
  • Students are strongly in favour of medical education using tablet devices and any misgivings they have are generally allayed once they are using the devices on the wards.
  • When considering mLearning rollouts, medical schools should regard backend infrastructure provision of Internet access in clinical areas as critical.
  • Barriers to adoption include cost and risk of loss or damage.
Acknowledgement

Steven Bembridge & Ruth Muscat, UCL Library.

UCL School of Life and Medical Sciences Innovation fund

References

[1] Hall, C. S., Fottrell, E., Wilkinson, S. and Byass, P. Assessing the impact of mHealth interventions in low-and middle-income countries–what has been shown to work? Global health action, 72014).

[2] Gormley, G. J., Collins, K., Boohan, M., Bickle, I. C. and Stevenson, M. Is there a place for e-learning in clinical skills? A survey of undergraduate medical students' experiences and attitudes. Medical teacher, 31, 1 2009), e6-e12.

[3] Perez, B. A., von Isenburg, M. A., Yu, M., Tuttle, B. D. and Adams, M. B. Exploring the impact of tablet computers on medical training at an academic medical center. Journal of the Medical Library Association: JMLA, 101, 2 2013), 154.

[4] Aungst, T. Apple app store still leads Android in total number of medical apps. City, 2013.

[5] Boruff, J. T. and Storie, D. Mobile devices in medicine: a survey of how medical students, residents, and faculty use smartphones and other mobile devices to find information. Journal of the Medical Library Association: JMLA, 102, 1 2014),

 

Summary of Results

Advantages of tablet computing

Students strongly agreed with most of the proposed advantages of tablet computers. They were particularly supportive of statements referencing portability, speed and access to information. Although they were still broadly supportive, they did not feel as strongly regarding opportunities for group study, the production of better notes or increased efficiency of study time.

There were 4 statistically significant changes in attitude between perceived advantages in the Pre- and Post- studies.

  • Students were more strongly supportive of the opportunity to produce better notes (p=0.008) but there was a small decline in agreement with the multimedia advantages of the devices (p=0.007), accessing more up-to date resources (p=0.023) and speed and ease of finding information (p=0.046)
  • All post-study means remained >3.0, indicating overall agreement with each advantage proposed in the questionnaires.

 

Disadvantages of tablet computing

By the end of the study, not only had 11 of the 12 mean Likert scores for perceived disadvantages significantly decreased, but only 3 of the 12 questions had means above >3.0. The students disagreed with 9 of the 12 perceived disadvantages categories by the end of the study (compared to 0 out of 10 perceived advantages categories).

The largest changes concerned the notion that the iPads may be perceived negatively by clinicians (-39.3%, p<0.05) or perceived negatively by patients and their relatives (-36.7%, p<0.05). This is corroborated in that students did not feel the iPads distracted from the clinical environment (-28%, p<0.05) or their communication with patients (-25%, p<0.05).

Our data suggests the iPad did not act as a distractor in consultations, or become a source of negative feedback from senior clinicians who may not be accustomed with mLearning. Our findings support the hypothesis that iPads could act as an icebreaker in consultations [11], and verbal feedback suggested many engaging and suggesting further applications to download e.g. Vidyo for remote tutorials.

The perceived negatives regarding practicalities (‘cost of device’, ‘risk of damage, loss or theft’, ‘risk of unauthorised access to personal data’) all significantly decreased over the study period. However, participants still perceived two-thirds of these (cost and risk of damage, loss or theft) as >3 mean Likert score in the post-study survey, demonstrating that the higher cost and fragility of tablet devices is definitely a consideration in long term use.

Students agreed strongly that lack of internet access was a significant drawback. There was still a statistically significant change in agreement with this statement, suggesting that some students did not consider lack of internet as important a drawback as was the case before they spent time with the devices.  Lack of internet access in clinical areas may explain why there were statistically significant decreases in agreement with several positive statements: ‘Easier and faster to find information’, ‘Access to more up to date resources’ and ‘Access to multimedia learning resources’.

Regarding the pedagogical aspects of using an iPad (Encourages acquisition of superficial layers of knowledge rather than in depth learning’, ‘Information overload’ and ‘Reliance on mobile device rather than own initiative/skills’), superficial learning was the only topic to contain a non-significant change. There was a large change in attitude regarding reliance on mobile devices (-24.03% p-value <0.05), with initial concerns of dependence upon the iPads refuted. The devices facilitated and supplemented learning but did not replace retained knowledge or skills.

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Background
Summary of Work
Conclusion
Take-home Messages
Acknowledgement
References
Summary of Results
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