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1115 wed morar fairclough & vincent

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  • In 2005, BSMS became the first UK medical school to introduce the widespread use of PDAs to its students.(Pilot: Group of year 2 students, 2004)1st release (autumn 2005): All year 3, 4 and 5 studentsloaned a PDA and the Dr Companion card for length of theircourse.Worked with MedHand International (already had architecture and content in mobile form) to provide an SD card with Dr Companiontm software, which contained a suite of carefully selected medical texts [listed later]. Provided core reference material to students ‘at the point of need’.[Information delivers value – technology only enables]What did we provide?
  • What we gave them(PDA = personal digital assistant)Portable,convenient method of conveying and exchanging information – now old technology but was advanced in early 2000s!Functionality including diary, calculator, email, games, file storageProvided Dr Companion software and also the module handbooks.3. The software also viewable on the PC. It had to be synchronised manually by plugging it into a PC in order for students to receive updates and us to receive usage data.
  • How do you establish an initiative like this?Set-up:Strategic meetings between all stakeholdersContracts and financeProcurement or hardware and softwareRoll-out:Notification talks in advanceDistribution sessions (hardware, software, contracts)Practical training sessions (syncho cards, using resources, charging)Educational training sessionsOngoing support:Weekly surgeries for technical supportEmail support[A]And then research supportWho does this?[A] Team of 7 people (3 CRFs)
  • Just give student PDAs and expect them to know how to use them? Use them effectively?Ran specific training sessions on how the devices could be usedE.g:Answer?[A]EBM:CardiovascularSecondary prevention of ischaemic cardiac eventsReduce mortality and cardiovascular eventsEvidence summariesACE inhibitors BNF:Index – ramiprilCheck indicationsCheck dose2.5mg bd started 3-10 days post infarct
  • Why mobile technology? How did mobile technology come on to the agenda at BSMS?“PDAs will be as common as the stethoscope”
  • What were our objectives?How much do medical students really use mobile devices to access learning resources? They might use them for social and personal use but to access/read medical reference texts? Big assumption.What are the pros and cons of accessing mobile information resources in the real-life clinical setting? Complex psychosocial factors could impact use of mobile devices in a significant wayUltimately, what is the impact on their learning?Provide a learning opportunity of gaining experience of using mobile devices and resources (cf Tomorrow’s Doctors)Direct students to high quality learning resources
  • Focus groups Four held with different studentsFeasibility study 181 respondentsInterim survey 9.6% (12/125)Post-study survey 57.4% (140 / 244)Usage tracking 124 students
  • Tracking:124/387 students, 10 month period
  • Dictionary use so high because the search tool is character accurate – won’t give near answers as modern search engines tend to do – so had to be exact spelling
  • Thematic analysis of the focus groups identified three major themes:Access to knowledgeConsolidation of knowledgeNeed for changeSee article in BMC Medical Education open access
  • Practicalityof using the devices for learning:Pros:Mobility – highly portable, can take in it into clinical areas and on transportImmediacy – Relevant at the point of need, just prior, during, or just after the real clinical encounter. Also, (once in to the book) finding info is only a few clicks away, hyperlinks to connected info, or cross search all the infoCons:Speed of access – although sometimes quick, the operating system was felt to be slow[A]
  • Two devices – was a significant problem [A]
  • How students use the device and information:Quick reference information – not long / primary exposure but short facts relevant to situation immediately prior, during, or postRepetition – used it multiple timesBetter use of ‘wasted’ time – waiting in clinical areas / travelling
  • [A]Quick reference information – not long / primary exposure but short facts relevant to situation immediately prior, during, or post exposure to trigger
  • [A]Repetition – used it multiple times
  • [A] Better use of ‘wasted’ time – waiting in clinical areas / travelling
  • Attitudinal and psychosocial domain on part of the students, healthcare staff, patients
  • [A] Attitude, behaviour, approach – learning curveResistance to change – psychosocial factors of multimedia devices in clinical settings
  • [A]
  • There are a few questions that we have:[A] Resources:Students have an increasing number of medical education apps available to them, and research shows they are willing to pay for them. Do we have to provide anything? Do we enter in some sort of validation? What if they are not bundled into one single app – can’t cross search[A] Technology:Ebook readers: Kindle – if these are static resources, should students just have a (cheaper) ebook reader?Tablets: iPads, Galaxy tab, RIM Playbook, Kindle Fire – more on the screen and could become better interface for interactive media e.g. medical imaging(January: Apple announce iBooks Author)(2010: University of Central Florida College of Medicine, Florida, provide iPads for all their students)[A] End the initiative?Is it an effective use of resources for the impact on training modern doctors? They have the information available in paper and electronically anyway… Consign it to the history books as valid and useful research but not where we want to invest…?[A] Impact on information retrievalWhat is the impact of encouraging medical students to look information up? Become reliant to the detriment of recall without the device?
  • So, in what direction should we continue with mobile provision in this climate of reduced budgets, increasing expectations, changing technologies?
  • Technology has moved on at an incredible pace, with significant developments affecting the way that information is stored and retrieved.Jan 2007: Steve Jobs unveils the iPhoneOctober 2008: Apple announces sales of 4.7m iPhones (13% of smartphone market)Nov 2008: First android phone, the G1 launches. May 2010: iPad launched in UKApril 2011: Apple becomes the largest smartphone vendor
  • Asked the students:BSMS do not provide students with any mobile learning devices nor resources to accompany themBSMS continue to provide a basic PDA and DrCompanion resourcesStudents use their own smartphone and BSMS provide resources compatible with those phonesBSMS provide students with a smartphone and DrCompanion resources for the duration of the course
  • 4 month trial (Nov 2011 – Feb 2012)Invited year 3-5 students with own iOS device (iPhone/iPodTouch/iPad); 48 students agreed to participate.Worked with MedHand to develop novel logging to track usage (using ‘push’ tech) – more detailed and reliable than manual PDA version.Contract to provide data for research:Weekly diary usageParticipate in at least 1 focus groupPre and post study questionnaireStill analyzing the data but has been v helpful in honing the effectiveness of the app, esp novel data collection process.(Reduced set of resources (based on most commonly used in PDA research vs cost):)BNF 60OH Clinical Medicine OH General PracticeOH Clinical SurgeryOH Emergency MedicineOH Clinical Examination and Practical SkillsHarrison´s Manual of Medicine
  • Where do we go next?(Still analysing the data but has been very insightful and helpful in helping decide what our future direction should be)Both our research and the significant change in technology since we started, has led us to move to a new model of focussing solely on the provision of the resources rather than trying to provide the devices as well. Much easier, popular, and cost effective! We focus on providing the resources and let the student decide on the technology.Make suite of key resources available via the Dr Companion app on iPhone or Android operating systemsOffered to all students in years 3-5 with a smartphone can obtain the resourcesPDAs for those without (until next academic year)Blackberry? Windows mobile? Have the opportunity to go in this direction if we want to
  • [Information delivers value – technology only enables]For the moment, we are confident that this an effective tool that supports learning but it is an ever-changing world so we will need to be aware of this each step of the way.
  • Transcript

    • 1. Mobile Medical Education (MoMEd): What is the impact of putting digitalmobile resources in the hands of medical students? Tim Vincent, Learning Technologist Jil Fairclough, Medical School Librarian
    • 2. Brighton & Sussex Medical School
    • 3. In 2005, BSMS became the first UK medical school to introduce the widespread use of mobile devices to its students Offered to all Year 3, 4, and 5 students (approx. 350 students)Loaned PDA and software for free
    • 4. Providing mobile hardware and software @
    • 5. Resources on the Dr Companion cardBritish National Formulary Oxford Concise Medical Dictionary Chemical Laboratory References Oxford Handbook of Emergency MedicineClassification of SurgicalOperations & Procedures Oxford Handbook of Clinical & Lab Investigation Clinical Evidence Oxford Handbook ofCochrane Abstracts Clinical Medicine DSM IV Oxford Handbook ofICD 10 Clinical Surgery NICE Compilation Oxford Handbook of Guidance Practical Drug TherapyNetter Atlas of Human Oxford Handbook ofAnatomy General Practice Evidence Based Medicine Oxford Handbook of Medical SciencesPatient Organizations
    • 6. Supporting set-up, roll-out, maintenance, and trainingDir. of Undergraduate Studies Divisional assistant Everyone! IT Manager IT Technicians x2 Librarian Learning Technologist Clinical Research Fellow
    • 7. Useful mobile technology in the clinical setting The CCU consultant asks you “What evidence is there for the use of ACE inhibitors in secondary prevention post MI?” “And what dose is the SHO writing up?”
    • 8. Why mobile technology in medical training? The future of education lies in BSMS, as a new medical the adoption of technology, school, wants students to such as mobile and wireless, become familiar with mobile that connects people, unifies technology and take the education process and advantage of the technology enhances learning. to explore innovative approaches to teaching and learning.Dr John D. Halamka, Associate Dean, Harvard Medical School, 2002 Prof Jon Cohen, Dean of BSMS, 2003
    • 9. GMC‟s: Tomorrow‟s Doctors (2009) expectsdoctors to be able to “use information effectively in a medical context”“Access information sources and use the information in relation to patient care, health promotion, advice andinformation to patients, and research and education” “Make effective use of computers and other information systems, including storing and retrieving information.”
    • 10. What is the impact of putting digital mobileresources in the hands of medical students? How much do medical What are the advantages student really use mobile and disadvantages of devices to access learning mobile devices in the resources? clinical setting What is the impact on students’ learning?
    • 11. Data collectionFocus groups Questionnaires Usage stats on server
    • 12. Results: Amount of use over 10 month period Questionnaire Tracking Daily 101 – 1 – 10 Hardly 200 ever Once a week 51 – Once a 100 11 – 50 month
    • 13. Results: Most popular resource Questionnaire TrackingChoose 3 most No. of Votes Most popular resourcepopular resources usesBNF 91 OH Clinical Medicine 3,385OH Clinical Medicine 89 BNF 3,137Medical dictionary 22 Medical dictionary 1,867Netter‟s anatomy 19 OH General Practice 791 OH Clinical Surgery 884
    • 14. Analysis: Three major themes identified Access to Consolidation Need for knowledge of knowledge changeMobile Medical Education (MoMEd) - how mobile information resources contribute to learning forundergraduate clinical students: a mixed methods study. Bethany S Davies, Jethin Rafique, Tim RVincent, Jil Fairclough, Mark H Packer, Richard Vincent and Inam Haq.BMC Medical Education 2012, 12:1 doi:10.1186/1472-6920-12-1http://www.biomedcentral.com/1472-6920/12/1/abstract
    • 15. Theme 1: Access to knowledge Mobility Speed of accessImmediacy Two devices
    • 16. Theme 1: Access to knowledge Mobility Speed of accessImmediacy Two devices“The only thing is, you don‟t havethat many pockets. I would havemy wallet in one pocket, myphone in another. I found it quitehard to carry [the PDA] aroundwith me all the time.”“The whole two devices thing ismy major gripe.”
    • 17. Theme 2: Consolidation of knowledgeQuick reference information RepetitionBetter use of „wasted‟ time
    • 18. Theme 2: Consolidation of knowledgeQuick reference information “It has enhanced [my knowledge] Repetition by reinforcing key points at point- Better use of „wasted‟ time of-need. If you want to know then-and-there, you can find it then-and-there. It‟s just the memory jog you need to reinforce the point a bit more. It doesn‟t mean you‟re relying on the PDA – it just helps to reinforce and consolidate the knowledge a bit better.”
    • 19. Theme 2: Consolidation of knowledgeQuick reference information “The more repetition I get, the Repetition more I‟m able to look atBetter use of „wasted‟ time something quickly – when I need to - the more it‟s likely to stick. Because you can look and say „oh ok, that‟s what it is again‟” “Initially, you may look at it three times and then after that you will become more confident in saying „yes I know this now‟”
    • 20. Theme 2: Consolidation of knowledgeQuick reference information “One of the drivers for me of Repetition using it might be more general isBetter use of „wasted‟ time just my dislike of wasted time particularly during the day.” “I agree. Actually, that‟s one of the reasons I have started to use it a lot more. There and then when there isn‟t anything to do you can make use of time.”
    • 21. Theme 3: ChangeAttitude, behaviour, approach Resistance to change Establishing change Next section
    • 22. Theme 3: ChangeAttitude, behaviour, approach “…if you remember to take it Resistance to change with you” Establishing change “I think it‟s about adopting a different mentality.” “I‟m worried that the nurses or patients will think I am texting or emailing”
    • 23. Theme 3: ChangeAttitude, behaviour, approach “What changed your mind?” Resistance to change “Finding I did use the PDA Establishing change and it did come in handy several times. It just makes life a bit easier.” “...I have definitely got used to having that type of reference at my fingertips. I would definitely look into ways of continuing that.”
    • 24. Questions1. What could you/your organisation contribute to a mobile initiative in an HEI (any subject)? (New/different apps? Types of resource? Usage tracking?)2. If you were in charge of MoMEd, what models would you choose for the next three years? Give hardware with/without software? Don‟t provide anything??3. What do you think is the impact on student learning (particularly in a practice-based setting) of mobile initiatives such as MoMEd? (Is it improving retention of knowledge? Or creating over-reliance? How will you feel if your doctor looks everything up on electronic devices? )
    • 25. Is this the right approach?
    • 26. The future of MoMEd
    • 27. The emergence of smartphones BSMS becomes the first UK Apple announces sales Apple becomes medical school to introduce of 4.7m iPhones largest smartphone the widespread use of PDAs vendor to its students First Android phone (G1) launches Smartphone sales make Steve Jobs unveils Apple up 31% of the iPhone launches 1.8bn devices iPad sold globally2005 2006 2007 2008 2009 2010 2011 2012 2013
    • 28. What do the students want? NothingSmartphone + PDA +DrCompanion DrCompanion Own smartphone + DrCompanion
    • 29. iPhone pilot4 month trial (Nov 2011-Feb 2012)48 students with own iOS deviceNovel logging to track usageContract to recording usage andresearch participation
    • 30. Changing the model to information over technologyOffered to all students in years 3-5 with their own device
    • 31. ThanksDr Inam Haq – Director of Undergraduate StudiesDr Anna Jones, Dr Bethany Davies, Dr Jethin Rafique – Clinical ResearchFellowsMark Packer – BSMS IT ManagerJil Fairclough – BSMS LibrarianTim Vincent – BSMs Learning TechnologistTim Lambert – IT Technician

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