Mobile Computing For Decision Support and Learning While You Work
Mobile Computing For Decision
Support and Learning While You Work!
Michael P. D'Alessandro, M.D.!
University of Iowa College of Medicine / University of Iowa Children's Hospital!
Jeffrey R. Galvin, M.D.!
University of Maryland and American Institute for Radiologic Pathology!
James J. Choi, M.D.!
Handout at www.radiologyebooks.com/rsna.html!
How master clinicians achieve + maintain mastery!
• 1. Maintain a learning portfolio!
• 2. Situate learning in practice!
• Perform point-of-care / just-in-time learning!
• 3. Participate in educational social networks!
• 4. Increase experience through simulation!
• 5. Stay current!
• With journals!
• Organize a personal medical library!
• With societies!
What We Propose To Do!
• Hands-on tour of mobile computing educational
resources that are mainly free!
• We use these tools in the course of our work!
• We have experience + opinions + material to cover!
• But - we want this to be an interactive
• Demographics of audience: >> 50% outside US + > 50%
in private practice!
• You have experience + opinions as well and we want to
hear from you and we want you to ask questions!
• To fully participate
in a hands-on
encourage you to
following free apps
now into your
mobile device so
you can follow
along if you wish…!
Shift to the Mobile Internet!
• If > 30 years old, primary computing device is desktop or laptop!
• Internet is experienced though single app = Web browser!
• Tablet replaces desktop / laptop + still experience Internet through Web
• If < 30 years old, primary computing device is mobile phone!
• Internet is experienced through numerous apps!
• Don't use Web browser, Web not important, leads to narrowing of
information sources used!
- Owen Williams, Smartphones: The Silent Killer of the Web As You Know It, The Next Web, May 5, 2014!
Check Your Institution First!!
• For subscriptions to!
• eBooks (including PDFs)!
• Web-based decision
• For discounts on all of
• Your library should have
How the Medical Apprentice Learns!
• Clinical skills related to experience!
• When seeing a new case you encapsulate it in an
"illness script" which you pattern match to previous
cases "illness scripts" in order to diagnose!
• Case-based reasoning / Storytelling!
• Expert is the person who can best capture, organize,
and retrieve their experience (cases)!
• Work up driven by medical knowledge!
- Schmidt HG, Norman GR, Boshuizen HPA. A Cognitive Perspective on Medical Expertise:
Theory and Implications. Acad Med 1990 Oct;65(10):611-21.!
• A digital archive of your life !
• Made possible / inevitable by!
• Most memories are digital!
• Near-inﬁnite space to store them!
• Ever-improving technology to recall
• Captures, stores, organizes and
makes retrievable your
experience + reﬂected wisdom!
• You become the librarian,
archivist, cartographer and
curator of your professional life!
- Gordon Bell and Jim Gemell, Total Recall (2nd Ed. Is Your
Life Uploaded) !
A Framework to Hang Your Learning On
Capturing + Organizing + Retrieving Your Experience / Cases!
Evernote (Android+iOS+Win) OneNote (Android+iOS+Win) Excel (Android+iOS+Win)!
• For each case!
• Image annotated with: Question ~ Story ~ Answer ~ Impact on Practice (Reﬂection) ~ Resources
• Diary of your learning ~ Archive of your medical educational life + experience!
• Is a knowledge management system!
• Educational construct!
• Adult learning theory = Learning situated in practice!
• Schon's theory of clinical problem solving / model of reﬂective practice / learning cycle!
• Case-Based Learning!
• Constructionism ~ Learning by doing / Learning artifacts!
• Portfolio-based learning!
• To situate learning in practice - questions are starting point for learning ~ Point-of-care CME!
• For sharing - individuals in person, groups in conferences / lectures, globally on Internet!
Learning is an Apprenticeship!
"In what may be called the natural
method of teaching, the student
begins with the patient, continues
with the patient, and ends his studies
with the patient using books and
lectures as tools, as means to an
! ! ! !- Sir William Osler, 1903!
Future of Medical Education
Best way to change physicians' knowledge, attitude, and behaviors!
And thus positively inﬂuence patients' care, outcomes, and lives!
Is to connect education to practice + shift learning to the point-of-care!
- ACCME, CME as a Bridge to Quality, 2006!
- Josiah Macy Foundation, Continuing Education in the Health Professions, 2008!
- IOM, Redesigning Continuing Education in the Health Professions, 2009!
- Molly Cooke, David M. Irby, Bridget C. O'Brien. Educating Physicians: A Call For Reform of
Medical School and Residency, Jossey-Bass, 2010!
Personal Learning Environment
Learning From Your Experience / Cases!
All the Apps / Ebooks / Journals / Podcasts / Web sites you use!
Decision Support - Web Browser
The Killer App!
Safari (iOS) Chrome (Android) Edge (Win)!
• Situating Learning in Practice!
• Use radiology-speciﬁc search engines to search the best
free Web resources!
• goldminer.arrs.org - GoldMiner Global in 35 languages!
• Small units of learning over a short time!
• Receiving CME!
• Get 0.5 hours Category 1 CME credit / question (up to 20
hours / year) at goldminer.arrs.org + myrsna.rsna.org!
Clinical Question Searches Using Google vs.
Evidence-Based Summary Resources!
"The authors found no signiﬁcant differences in speed or accuracy
between searches initiated using Google versus summary resources."!
- Kim S et.al. Searching for Answers to Clinical Questions Using Google Versus Evidence-Based
Summary Resources: A Randomized Controlled Crossover Study, Acad Med. 2014;89:940-943.!
• StatDx guides you immediately to the right answer vs.
SearchingRadiology.com guides you to journal review articles for
eventual answer in context!
• From which method do you better learn + retain the information?!
Decision Support - Apps
Medscape (Android+iOS) IASLC Staging Atlas (Android+iOS) e-Anatomy(Android+iOS) Radiographics(Android+iOS)!
What are your favorite decision support apps?!
Decision Support - Ebooks!
Kindle (Android+iOS+Win) Google Play Books (Android+iOS) iBooks (iOS) Freda (Win)!
Kindle [.azw /.azw3] EPUB [.epub] EPUB [.epub]+iBooks2 [.ibooks] EPUB [.epub] !
3,630 educational radiology Ebooks were found in the Kindle (3,287), iTunes (93) and Play (250) stores!
Spectrum of Ebooks - Static (Kindle / EPUB) vs. Interactive (iBooks2) vs. Educational App!
!What is the advantage of an Ebook over a PDF?!
!What is the advantage of a dedicated Ebook reader?!
Hands-On Decision Support!
• What are the best practices for imaging
patients with Ebola?!
• What are the current recommendations for
performing lung cancer screening with CT?!
• What are the best practices for dose
reduction in imaging?!
• What questions do you want to research?!
• Participate in an educational social network!
Educational Social Network =
Community of Practice!
"Communities of practice are groups of people who share a concern, a
set of problems, or a passion about a topic, and who deepen their
understanding of this area by interacting on an ongoing basis." !
- Wenger E. et. al. Cultivating Communities of Practice: A Guide to Managing Knowledge!
• Educational construct = Interdependent Learning Theory!
• Teaching each other = collaborative learning = sharing the wisdom!
• Can be easily done by sharing learning portfolios on educational social networks!
Share With Your Community of Practice
Sharing Your Experience / Cases!
Blog Twitter / Instagram Figure1!
www.pediatriceducation.org #FOAMRad #FOAMPed #PedRad www.ﬁgure1.com!
Practice Social Media Hygiene!
• Be aware of your online persona + keep it professional +
• AMA, Opinion 9.124 - Professionalism in the Use of Social
• Protect patient privacy!
• Use privacy settings to safeguard personal information to the
• Maintain appropriate boundaries!
• Consider separating personal and professional information!
• Act on unprofessional posted content!
• Weigh how your actions online may negatively affect your
reputation and undermine public trust in the medical profession!
• Never reveal protected health information / de-identify
The Learning Continuum
Capturing + Organizing + Retrieving, Learning From, and Sharing Your Experience / Cases!
Data -> Information -> Knowledge - > Wisdom / Mastery!
[acquired] [organized] [reﬂected] [shared] !
Learning Portfolio (LP) -> Personal learning environment (PLE) -> Community of practice (COP)!
! ! ! ! ! !
[focus on individual] [focus on group] !
Create cases in LP -> Learn about cases in PLE -> Share cases with COP
• Increase experience through simulation!
iBook Ebooks (Kindle or EPUB) Web - caseinpoint.acr.org !
We know what we see, we see what we know!
Simulation – Apps
Radiology 2.0 One Night In The ED (iOS) CTisus iQuiz (iOS) Radiology Pocket Game (Android+iOS)!
• What are your favorite simulation apps?!
Small units of learning over a short time ~ For when you have few free minutes anywhere!
Radiology Tag Ontology – www.symplur.com/healthcare-hashtags/ontology/radiology/!
Radiology Education List - twitter.com/pedsimaging/lists/radiology-education!
• Stay current!
• With journals!
• Organize a personal medical library!
• With societies!
Staying Current With the Literature
Really Simple Syndication (RSS)!
RSS Feedly (Android+iOS) Phonly (Win)!
• Is a newsfeed generated by a Web site when it is updated!
• Lets you subscribe to Web site + be notiﬁed when it is updated!
• Think of it as distributed version of Facebook + Twitter!
• Subscribe to RSS feeds of journal Web sites!
• Receive stream of journal articles !
• The Old Reader Web browser-based feed reader is an alternative to apps!
• What is advantage of using app to access journals vs. Web browser?!
Listening to Podcasts + Vodcasts!
iTunes (iOS) Podcasts (iOS) Podcast Republic (Android) Podcasts (Win)!
• Examples - CTisUS, LearningRadiology, Radiology, AJNR!
• Simple on iOS!
• All podcasts indexed in iTunes Store or Podcasts app!
• Difﬁcult on Android + Windows!
• Find XML ﬁle containing RSS feed of podcast + type it into podcast aggregator (feed:// )!
• Podcast Republic integrates with iTunes!
• What is your favorite podcast app?!
Organizing a Library of Journal Articles
!Medical Literature Database!
Dedicated App ! ! Cloud-based ﬁle system! !
Papers (iOS+MacOS+Win) Mendeley (Android+iOS+Win) Storage: Drive / Dropbox / iCloud / OneDrive (Android+iOS+Win) !
"iTunes for PDFs" ! Viewer: Adobe Reader (Win) / ezPDF (Android) / GoodReader (iOS)!
• How to create a ﬁle system on a mobile device?!
• What is best way to handle PDFs organized in folders so you can read them when ofﬂine?!
• Nota Bene - Don't trust the cloud, always have backup of your data in the cloud!
• How do you manage your journal articles?!
Staying Current With Societies
Twitter (Android+iOS+Win) Facebook (Android+iOS+Win)!
• Subscribe to the accounts (Twitter) and pages (Facebook) of the ACR,
ARRS, RSNA, and subspecialty societies!
• Receive stream of society news!
• Filter with lists!
SoundNote (iOS) Notability (iOS) PenUltimate (iOS) PaperPort Notes (iOS)!
What are your favorite note taking apps for Android +
Keynote (iOS) Remote (iOS) OsiriX (iOS) GoToMeeting (Android+iOS+Win) LogMeIn (Android+iOS)!
• Keynote / Remote - Mobile device as presentation device ~ Present
from the cloud!
• OsiriX - Review, sharing, presentation of DICOM images!
• GoToMeeting - Collaborative review of cases with colleagues!
• LogMeIn - Control a work computer and read images!
Wearable Computing / Augmented Reality!
• Mobile computing is but a step
towards wearable computing!
• Your Internet connection follows
you everywhere you go through
• Minimalist, elegant, mobile solution!
• You will be presented with an
augmented version of reality!
• The Internet overlaid upon what you
• Google Glass, Magic Leap!
To Learn More
Index of Free educational radiology Ebooks and radiology Apps!
Totals in November 2015: Ebooks - iBooks  - Kindle  - PDF  - Play  + Apps: Android  - iOS  - Windows Phone  + Podcasts: !
Don't You Forget About Me…
Index of Best Radiology Sites!
Hundreds of free high-quality radiology educational Web sites!
Handout at www.radiologyebooks.com/rsna.html!
• 5 Steps to achieving + maintaining mastery in medicine!
• Learning portfolio ~ Situate learning in practice ~ Social networks ~ Simulation ~ Stay current!
• This talk is a start. Review these slides at:!
• Web sites to start with:!
• Please ﬁll out course evaluation forms!
• Questions and Comments?!