Librarians’ story of the PDA Service at the University of Queensland Rural Clinical School by Kaye Lasserre, William Chun & Lisa Kruesi NSW Health Libraries Forum Gosford 2007 Focus on the User Environment: Techniques and Technologies

Abstract Librarians’ story of the PDA Service at the University of Queensland Rural Clinical School The University of Queensland Library and the School of Medicine conducted the first major Australian trial of Personal Digital Assistants' (PDAs) use by medical students at the Rural Clinical School during 2003 and 2004. The trial became an ongoing PDA Service from 2005, and its role in enhancing medical education has been demonstrated by continued funding and senior management support. The PDA Service has helped to provide key health information resources for students on rural placements. Adoption of the Service has addressed some of the equity issues caused by inadequate Information Communication and Technology (ICT) infrastructure beyond urban centres. Rural students’ use of information at the point of care facilitates learning and establishes good practice for future clinical decision making. This presentation will discuss the Rural Clinical School Librarians' story about the implementation of the PDA Service, the lessons learnt and why it was a component of "An Integrated Package of Innovative Rural Medical Education: Enhancing Student Outcomes and Increasing the Rural Medical Workforce", 2006 Carrick Award Winner for Australian University Teaching.

Librarians’ story of the PDA Service at the University of Queensland Rural Clinical School

The University of Queensland Library and the School of Medicine conducted the first major Australian trial of Personal Digital Assistants' (PDAs) use by medical students at the Rural Clinical School during 2003 and 2004. The trial became an ongoing PDA Service from 2005, and its role in enhancing medical education has been demonstrated by continued funding and senior management support.

The PDA Service has helped to provide key health information resources for students on rural placements. Adoption of the Service has addressed some of the equity issues caused by inadequate Information Communication and Technology (ICT) infrastructure beyond urban centres. Rural students’ use of information at the point of care facilitates learning and establishes good practice for future clinical decision making. This presentation will discuss the Rural Clinical School Librarians' story about the implementation of the PDA Service, the lessons learnt and why it was a component of "An Integrated Package of Innovative Rural Medical Education: Enhancing Student Outcomes and Increasing the Rural Medical Workforce", 2006 Carrick Award Winner for Australian University Teaching.

Outline Background PDA Project - objectives and overview Key Findings PDA Service Lessons Learnt – issues and solutions Future

Background

PDA Project - objectives and overview

Key Findings

PDA Service

Lessons Learnt – issues and solutions

Future

UQ School of Medicine Operates throughout Queensland Offers the postgraduate medical (MBBS) program Clinical Schools provide teaching, learning and research activities

Operates throughout Queensland

Offers the postgraduate medical (MBBS) program

Clinical Schools provide teaching, learning and research activities

Rural Clinical School Fourteen Rural Clinical Schools in Australia University of Queensland Rural Clinical School located at South West and Central Queensland

Fourteen Rural Clinical

Schools in Australia

University of Queensland

Rural Clinical School

located at South West

and Central Queensland

PDA Project Issues of access to information in rural and remote areas Successful PDA implementations No significant trials in Australian medical schools Funding opportunity arose

Issues of access to information in rural and remote areas

Successful PDA implementations

No significant trials in Australian medical schools

Funding opportunity arose

Project Objectives Provide access to authoritative, evidence-based information to medical students at their point of learning Contribute to a positive rural medical education experience and address equity issues for students in remote or isolated areas and have limited access to information and technology infrastructure Optimise the application of contemporary information and telecommunications technologies in healthcare education and to prepare students for the practicing medicine in 21 st Century Provide a platform for the University of Queensland, School of Medicine to evaluate and report on the applicability of th is technology to the teaching and learning environment Provide the University of Queensland, School of Medicine and the University Library with experience in the provision resources, training and support for PDAs

Provide access to authoritative, evidence-based information to medical students at their point of learning

Contribute to a positive rural medical education experience and address equity issues for students in remote or isolated areas and have limited access to information and technology infrastructure

Optimise the application of contemporary information and telecommunications technologies in healthcare education and to prepare students for the practicing medicine in 21 st Century

Provide a platform for the University of Queensland, School of Medicine to evaluate and report on the applicability of th is technology to the teaching and learning environment

Provide the University of Queensland, School of Medicine and the University Library with experience in the provision resources, training and support for PDAs

Project Phase March to December 2004 95 units distributed Participants - 3 rd and 4 th year medical students and staff of the Rural Clinical School Training and support by Librarians

March to December 2004

95 units distributed

Participants - 3 rd and 4 th year

medical students and staff

of the Rural Clinical School

Training and support by

Librarians

Project Resources MIMS for PDA (including MIMS Interact ) Micromedex (drug information database) Textbooks Oxford handbook of clinical medicine Oxford handbook of clinical specialties Oxford concise medical dictionary Archimedes ( Clinical calculator) Clinical Evidence *UpToDate *Harrisons on Hand Adobe Acrobat and the Mobipocket readers Outlook contacts and academic calendar

MIMS for PDA (including MIMS Interact )

Micromedex (drug information database)

Textbooks

Oxford handbook of clinical medicine

Oxford handbook of clinical specialties

Oxford concise medical dictionary

Archimedes ( Clinical calculator)

Clinical Evidence

*UpToDate

*Harrisons on Hand

Adobe Acrobat and the Mobipocket readers

Outlook contacts and academic calendar

A day in the life of a medical student using a PDA MBBS 3, Rural Clinical School, Toowoomba Ward rounds – medicine how to diagnose suspected rheumatoid arthritis Oxford Handbook of Clinical Medicine Clinical question : endocervical swabs vs urinalysis reminder to look up later What does xanthelasma mean and indicate? Oxford Concise Medical Dictionary Drugs drugs drugs…losartan Australian Medicines Handbook precautions and interactions dosages

A day in the life of a medical student using a PDA MBBS 3, Rural Clinical School, Toowoomba

Ward rounds – medicine

how to diagnose suspected rheumatoid arthritis

Oxford Handbook of Clinical Medicine

Clinical question : endocervical swabs vs urinalysis

reminder to look up later

What does xanthelasma mean and indicate?

Oxford Concise Medical Dictionary

Drugs drugs drugs…losartan

Australian Medicines Handbook

precautions and interactions

dosages

PDA Usage 64% 14% 10% 12% Once a week or less Several times a day Several times a week Once a day Never use it

Use of Information Resources 0% 20% 40% 60% 80% 100% Oxford Concise Medical Dictionary Archimedes medical calculator MIMs on PDA MIMs Interact on PDA Oxford Handbook of Clinical Medicine Oxford Handbook of Clinical Specialities Useful Very useful

Perceived Value of Technology

Access and EBM Research indicates many clinical questions go unanswered Lack of access to information a factor ‘ Just in time’ education to keep up-to-date with medical knowledge Use PDA to learn on the spot or record questions for later study Integrate learning/CPD with daily clinical work

Research indicates many clinical questions go unanswered

Lack of access to information a factor

‘ Just in time’ education to keep up-to-date with medical knowledge

Use PDA to learn on the spot or record questions for later study

Integrate learning/CPD with daily clinical work

Access Enhances Learning Do you think that access to the reference materials on the PDA contributes to your educational experience? 86% agreed Value of learning in context “ Yes. It can make clinical situations teaching moments when questions can be explored with the clinician in combination with PDA resources” “ Access information quicker and still in the clinical context, therefore it is more relevant. I am more likely to look something up if I don’t have to remember to look it up later” “ Yes, definitely. It enables answers to some questions immediately – particularly for drug information or quick reminders of different diseases, so can better apply knowledge to that patient straight away”

Do you think that access to the reference materials on the PDA contributes to your educational experience?

86% agreed

Value of learning in context

“ Yes. It can make clinical situations teaching moments when questions can be explored with the clinician in combination with PDA resources”

“ Access information quicker and still in the clinical context, therefore it is more relevant. I am more likely to look something up if I don’t have to remember to look it up later”

“ Yes, definitely. It enables answers to some questions immediately – particularly for drug information or quick reminders of different diseases, so can better apply knowledge to that patient straight away”

Organisation, IT and Equity “ I found the PDA very useful in terms of organisation. It’s probably the most organised I’ve been in the last three years…” “ Encouraging use of IT in clinical practice at a time when, as a student you are still working out a routine and are able to incorporate the use into your practice.” “ The nurses are all asking me for advice about drugs and don’t realise that the only reason that I can come up with answers is the PDA on my belt! Well, not always the only reason - but often!”

“ I found the PDA very useful in terms of organisation. It’s probably the most organised I’ve been in the last three years…”

“ Encouraging use of IT in clinical practice at a time when, as a student you are still working out a routine and are able to incorporate the use into your practice.”

“ The nurses are all asking me for advice about drugs and don’t realise that the only reason that I can come up with answers is the PDA on my belt! Well, not always the only reason - but often!”

Summary PDAs, by optimising access to information support EBM and improve the performance of a clinician enhance student learning by facilitating learning in context

PDAs, by optimising access to information

support EBM and improve the performance of a clinician

enhance student learning by facilitating learning in context

PDA Service Project became ongoing service in 2005 for permanent students Focus changed in 2006 Distribution to 3 rd year students doing Rural Medicine Rotation Five rotations per year All 3 rd year medical students can try a PDA

Project became ongoing service in 2005 for permanent students

Focus changed in 2006

Distribution to 3 rd year students doing Rural Medicine Rotation

Five rotations per year

All 3 rd year medical

students can try a PDA

PDA Resources The Oxford handbook of clinical medicine The Oxford concise medical dictionary Australian medicines handbook Australian College of Rural and Remote Medicine (ACRRM) Clinical Guidelines Royal College of Pathologists of Australasia (RCPA) Handbook Archimedes clinical calculator

The Oxford handbook of clinical medicine

The Oxford concise medical dictionary

Australian medicines handbook

Australian College of Rural and Remote Medicine (ACRRM) Clinical Guidelines

Royal College of Pathologists of Australasia

(RCPA) Handbook

Archimedes clinical calculator

Use On Rural Rotation Aust Med Handbook – Med Super asked me what were the normal dosages of an anti-elliptic and I was able to inform him using the PDA. He now wants to get some for his staff. Medical dictionary – whilst in consultations with my preceptor so I didn’t interrupt, but could follow the case accurately.

Aust Med Handbook – Med Super asked me what were the normal dosages of an anti-elliptic and I was able to inform him using the PDA. He now wants to get some for his staff.

Medical dictionary – whilst in consultations with my preceptor so I didn’t interrupt, but could follow the case accurately.

Hardware choice – why PDA and not laptop Characteristics needed Operating System choice – why MS over Palm Past versus present and future Information access Standalone Network Lessons Learnt: Procurement

Hardware choice – why PDA and not laptop

Characteristics needed

Operating System choice – why MS over Palm

Past versus present and future

Information access

Standalone

Network

Point of care and Reference/study Value/cost and Overlap User interface Licence issues Palm docs (.pdb) – using eReader on Pocket PCs Publishing for mobile devices Lessons Learnt: Information Resources

Point of care and Reference/study

Value/cost and Overlap

User interface

Licence issues

Palm docs (.pdb) – using eReader on Pocket PCs

Publishing for mobile devices

Initial set up and packaging: Create image – tasks, contacts Exceptions to initial load and Serials Registry edits – scroll bars, 802.11g…. Final image Turnover process: Re-imaging, cleaning and other administrative tasks Hardware servicing Hiring students Lessons Learnt: Roll-out and Maintenance

Initial set up and packaging:

Create image – tasks, contacts

Exceptions to initial load and Serials

Registry edits – scroll bars, 802.11g….

Final image

Turnover process:

Re-imaging, cleaning and other administrative tasks

Hardware servicing

Hiring students

Projection (MS Remote Display Control) Target audience: No PDA exposure…….experienced users Training aims: Familiarisation of the PDA and the information resources 2. Apply Adult Learning Principles to up the “personal motivation” to: want to take a PDA use the information resources on the PDA Improve focus: Testimonials: to show value of PDA to previous students Role play examples: clinical usage scenario Work sheet: helps resource familiarisation Lessons Learnt: Distribution and Training

Projection (MS Remote Display Control)

Target audience:

No PDA exposure…….experienced users

Training aims:

Familiarisation of the PDA and the information resources

2. Apply Adult Learning Principles to up the “personal motivation” to:

want to take a PDA

use the information resources on the PDA

Improve focus:

Testimonials: to show value of PDA to previous students

Role play examples: clinical usage scenario

Work sheet: helps resource familiarisation

Support at a distance Phone/email support User re-imaging Exchange SD cards Faults and solutions log Continuous improvement Return surveys Resource selection Improve training Fault reporting (Quality Control and Quality Assurance) Find more uses (Value adding) Faults and solutions log Lessons Learnt: Support and Improvements

Support at a distance

Phone/email support

User re-imaging

Exchange SD cards

Faults and solutions log

Continuous improvement

Return surveys

Resource selection

Improve training

Fault reporting (Quality Control and Quality Assurance)

Find more uses (Value adding)

Faults and solutions log

Future Stand alone versus Wireless Wide Area Network (WAN) resources End of the road for pure PDAs? Move to: Convergence devices / Smartphones Tablets/Laptops Role of Librarians

Stand alone versus Wireless Wide Area Network (WAN) resources

End of the road for pure PDAs?

Move to:

Convergence devices / Smartphones

Tablets/Laptops

Role of Librarians

References Ely JW, Osheroff JA, Ebell MH, Chambliss ML, Vinson DC, Stevermer JJ, Pifer EA.Obstacles to answering doctors’ questions about patient care with evidence: qualitative study. BMJ . 2002 Mar 23;324(7339):710 Green ML, Ruff TR. Why do residents fail to answer their clinical questions? A qualitative study of barriers to practicing evidence-based medicine. Acad Med . 2005 Feb;80(2):176-82

Ely JW, Osheroff JA, Ebell MH, Chambliss ML, Vinson DC, Stevermer JJ, Pifer EA.Obstacles to answering doctors’ questions about patient care with evidence: qualitative study. BMJ . 2002 Mar 23;324(7339):710

Green ML, Ruff TR. Why do residents fail to answer their clinical questions? A qualitative study of barriers to practicing evidence-based medicine. Acad Med . 2005 Feb;80(2):176-82

Acknowledgements Professor Peter Baker, Associate Professor Bruce Chater, Dr Di Eley, Ms Donna Georgeson, Ms Janelle Coe, Mr Keith Webster Mrs Janine Schmidt, Ms Heather Todd, Mr Andrew Heath, Ms Yasmin Childs, Mr Daryl Healing.

Professor Peter Baker,

Associate Professor Bruce Chater,

Dr Di Eley,

Ms Donna Georgeson,

Ms Janelle Coe,

Mr Keith Webster

Mrs Janine Schmidt,

Ms Heather Todd,

Mr Andrew Heath,

Ms Yasmin Childs,

Mr Daryl Healing.

Questions

Further information Kaye Lasserre [email_address] William Chun [email_address] Lisa Kruesi [email_address]

Kaye Lasserre

[email_address]

William Chun

[email_address]

Lisa Kruesi

[email_address]