A balancing act: a phenomenological exploration of medical students' experiences of using mobile devices in the clinical setting

Connecting Actors With the Introduction of Mobile Technology in Health Care Practice Placements (4D Project): Protocol for a Mixed Methods Study

BACKGROUND

The learning process in clinical placements for health care students is a multifaceted endeavor that engages numerous actors and stakeholders, including students, clinical tutors, link teachers, and academic assessors. Successfully navigating this complex process requires the implementation of tasks and mentorships that are synchronized with educational and clinical processes, seamlessly embedded within their respective contexts. Given the escalating number of students and the rising demand for health care services from the general population, it becomes imperative to develop additional tools that support the learning process. These tools aim to simplify day-to-day clinical practice, allowing a concentrated focus on value-based activities. This paper introduces a project funded by the European Commission that involves 5 European countries. The project's objective is to comprehensively outline the entire process of development and ultimately implement mobile technology in practice placements. The project tackles the existing gap by constructing tailored mobile apps designed for students, teachers, tutors, and supervisors within each participating organization. This approach leverages practice-based learning, mobile technology, and technology adoption to enhance the overall educational experience.

OBJECTIVE

This study aims to introduce mobile technology in clinical practice placements with the goal of facilitating and enhancing practice-based learning. The objective is to improve the overall effectiveness of the process for all stakeholders involved.

METHODS

The "4D in the Digitalization of Learning in Practice Placement" (4D Project) will use a mixed methods research design, encompassing 3 distinct study phases: phase 1 (preliminary research), which incorporates focus groups and a scoping review, to define the problem, identify necessities, and analyze contextual factors; phase 2 (collaborative app development), which involves researchers and prospective users working together to cocreate and co-design tailored apps; and phase 3, which involves feasibility testing of these mobile apps within practice settings.

RESULTS

The study's potential impact will primarily focus on improving communication and interaction processes, fostering connections among stakeholders in practice placements, and enhancing the assessment of training needs. The literature review and focus groups will play a crucial role in identifying barriers, facilitators, and factors supporting the integration of mobile technology in clinical education. The cocreation process of mobile learning apps will reveal the core values and needs of various stakeholders, including students, teachers, and health care professionals. This process also involves adapting and using mobile apps to meet the specific requirements of practice placements. A pilot study aimed at validating the app will test and assess mobile technology in practice placements. The study will determine results related to usability and design, learning outcomes, student engagement, communication among stakeholders, user behavior, potential issues, and compliance with regulations.

CONCLUSIONS

Health care education, encompassing disciplines such as medicine, nursing, midwifery, and others, confronts evolving challenges in clinical training. Essential to addressing these challenges is bridging the gap between health care institutions and academic settings. The introduction of a new digital tool holds promise for empowering health students and mentors in effectively navigating the intricacies of the learning process.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53284.

Technology Complements Physical Examination and Facilitates Skills Development among Health Sciences Clerkship Students: An Integrative Literature Review

Background

Technology is increasingly present in the clinical environment. There is a dearth of investigation of the relationship between technology and touch concerning student learning of physical examination practices.

Method

Integrative review methods were used to synthesise empirical literature to provide a comprehensive understanding of the relationship between physical examination, learning and technology in the context of health professional student clerkships.

Results

Three databases including MEDLINE, CINAHL and Eric were searched for all articles published from 2014 to 2021 using terms relating to (i) physical examination, (ii) technology, and (iii) student clerkships. Thirty-three studies met the inclusion criteria. From the analysis, it is evident that technologies that intersect with learning of physical examination may broadly be apportioned into two categories: 1) technologies that mediate physical examination practices; and 2) technologies that mediate the learning of physical examination.

Conclusions

This review indicates that technologies may have multiple roles in the student learning of physical examination, including technology mediating increased diagnostic accuracy and access to supplementary learning material relating to physical examination that is integrated for the clinical clerkship environment. It highlights a need to further understand the touch versus technology relationship and explore the dynamic intersection.

Understanding the Impact of Generation Gap on Teaching and Learning in Medical Education: A Phenomenological Study

PURPOSE

This study contributes to discourses and dilemmas where students/teachers experience intergenerational learning environments. It explores the underarticulated differences between post-millennials and baby boomers sharing accounts of the lived experiences of learners and educators on either side of such divides shedding a light on generation gaps hoping to inform faculty development.

METHODS

Interpretative phenomenology was chosen to articulate "whatness" and extract meaningful understandings. Purposive sampling identified three teachers and three third-year students from an Indonesian medical school. Online semi-structured interviews were conducted and transcriptions analyzed using interpretative phenomenological analysis (IPA). Emerging themes were connected and re-presented in the form of a metaphorical story to showcase the entirety of data while maintaining idiosyncratic focus.

FINDINGS

Themes from the teachers' subset were changing characteristics of medical students, changing paradigms surrounding the role of a teacher, relationship with students, and relationship with other teachers. Themes from the students' subset were hierarchical educational environment, relationship with teachers, and emotional response towards learning experiences. Themes were integrated into three existing theories, community of practice, self-concept, and control-value theory of achievement emotions. Findings revealed power dynamics between stakeholders in an unrecognized community of practice hence failing to shape the legitimacy of peripheral participation. Consequently, the rigidity of the hierarchical educational environment left little room for meaning construction and might hinder development of positive self-concept. Unawareness of students' achievement emotions led to low perception of control and value, affecting their behavior and motivation towards learning.

CONCLUSION

Medical educators could benefit from faculty development targeted to facilitate changing roles of teachers in facing the more recent generation of students. Curricula could be designed to foster collaborative educational environments which promote legitimate participation, authentic expression of emotions, and positive self-concept.

Mobile learning in clinical settings: unveiling the paradox

PURPOSE

The use of mobile devices among medical students and residents to access online material in real-time has become more prevalent. Most literature focused on the technical/functional aspects of mobile use. This study, on the other hands, explored students, doctors and patients' preferences and reasons towards the use of mobile devices in clinical settings underpinned by the Technology Acceptance Model 2 (TAM 2).

METHODS

This research employs an exploratory research design using survey and semi-structured interviews. An online survey was administered to clinical year medical students, followed by semi-structured interviews with the doctors and patients. Questions for the online survey and semi-structured interviews were derived from previous literature and was then reviewed by authors and an expert panel. A convenience sampling was used to invite voluntary participants.

RESULTS

Survey findings showed that most medical students used their devices to find drug information and practice guidelines. The majority of the students accessed UpToDate followed by Google to access medical resources. Key barriers that students often encountered during the use of mobile devices were internet connectivity in the clinical settings, reliability of the information, and technical issues. Thematic analysis of the interviews revealed four themes: general usage by students, receptivity of the use of mobile devices by students, features in selecting resources for mobile learning, and limitation in the current use of mobile devices for learning.

CONCLUSION

The findings from this study assist in recommending suitable material using mobile devices to enhance learning in the clinical environment and expand the TAM 2.

'Doctors can't be doctors all of the time': a qualitative study of how general practitioners and medical students negotiate public-professional and private-personal realms using social media

OBJECTIVE

The objective of this study is to explore the experiences and perspectives of general practitioners' and medical students' use of, and behaviour on, social media and to understand how they negotiate threats to professional and personal life on social media.

DESIGN

A two-phase qualitative design was used, consisting of semistructured interviews and follow-up vignettes, where participants were asked to respond to vignettes that involved varying degrees of unprofessional behaviour. Data were analysed using template analysis.

SETTING AND PARTICIPANTS

Participants were general practitioner tutors and third year medical students who had just completed placement on the University of Limerick longitudinal integrated clerkship. Five students and three general practitioners affiliated with the medical school were invited to participate in one-to-one interviews.

RESULTS

Three overarching themes, each containing subthemes were reported. 'Staying in contact and up to date' outlines how social media platforms provide useful resources and illustrates the potential risks of social media. 'Online persona' considers how social media has contributed to changing the nature of interpersonal relationships. 'Towards standards and safety' raises the matter of how to protect patients, doctors and the medical profession.

CONCLUSION

Guidance is required for students and medical practitioners on how to establish reasonable boundaries between their personal and professional presence on social media and in their private life so that poorly judged use of social media does not negatively affect career prospects and professional efficacy.

E-Learning during COVID-19 pandemic; Turning a crisis into opportunity: A cross-sectional study at The University of Jordan

Objectives

To assess the medical students' satisfaction and knowledge attainment through distant learning during the COVID-19 pandemic.

Methods

This is a cross-sectional, self-reported, questionnaire-based study that was conducted at the School of Medicine at the University of Jordan in April 2020. The targeted population was the students at the school of medicine. An online questionnaire was created using Google Forms. Satisfaction and knowledge attainment among students were assessed using independent-samples t-test.

Results

A total of 1000 medical students completed the survey, 506 (50.6%) basic science students and 494 (49.4%) were clinical science students. 655 (65.5%) of all students were either satisfied or neutral with e-learning. 63.6% of basic science students and 59.5% of clinical students stated that they gained and understood knowledge in the same way as or better than they did before initiation of exclusive e-learning. Satisfaction and knowledge gain were significantly affected by student preparedness (p < 0.000), teacher performance (p < 0.000), and website accessibility (p < 0.000).

Conclusion

Transition from traditional in-class teaching to distant learning, whether full or blended, is an inevitable step. In our sample, students were generally satisfied with e-learning and the knowledge attained using it. There was a significant relation between satisfaction and attainment and preparedness of students, teachers, and the medical school.

•

There is a difference in student’s satisfaction from e-learning between basic science students and clinical students.

•

Teachers' performance, and Accessibility to websites had a significant impact on student satisfaction.

•

Students' experience in using e-learning platforms and websites, also had a significant impact on student satisfaction.

•

76.3% of all the students believe that the electronic devices did not cause any financial burden.

•

The most popular devices used to connect to the internet were mobile phones and laptops.

Influences on the Implementation of Mobile Learning for Medical and Nursing Education: Qualitative Systematic Review by the Digital Health Education Collaboration

Background

In the past 5 decades, digital education has increasingly been used in health professional education. Mobile learning (mLearning), an emerging form of educational technology using mobile devices, has been used to supplement learning outcomes through enabling conversations, sharing information and knowledge with other learners, and aiding support from peers and instructors regardless of geographic distance.

Objective

This review aimed to synthesize findings from qualitative or mixed-methods studies to provide insight into factors facilitating or hindering implementation of mLearning strategies for medical and nursing education.

Methods

A systematic search was conducted across a range of databases. Studies with the following criteria were selected: examined mLearning in medical and nursing education, employed a mixed-methods or qualitative approach, and published in English after 1994. Findings were synthesized using a framework approach.

Results

A total of 1946 citations were screened, resulting in 47 studies being selected for inclusion. Most studies evaluated pilot mLearning interventions. The synthesis identified views on valued aspects of mobile devices in terms of efficiency and personalization but concerns over vigilance and poor device functionality; emphasis on the social aspects of technology, especially in a clinical setting; the value of interaction learning for clinical practice; mLearning as a process, including learning how to use a device; and the importance of institutional infrastructure and policies.

Conclusions

The portability of mobile devices can enable interactions between learners and educational material, fellow learners, and educators in the health professions. However, devices need to be incorporated institutionally, and learners and educators need additional support to fully comprehend device or app functions. The strategic support of mLearning is likely to require procedural guidance for practice settings and device training and maintenance services on campus.

A Best Evidence Medical Education (BEME) systematic review of: What works best for health professions students using mobile (hand-held) devices for educational support on clinical placements? BEME Guide No. 52

BACKGROUND

Ingrained assumptions about clinical placements (clerkships) for health professions students pursuing primary basic qualifications might undermine best educational use of mobile devices.

QUESTION

What works best for health professions students using mobile (hand-held) devices for educational support on clinical placements?

METHODS

A Best Evidence Medical Education (BEME) effectiveness-review of "justification" complemented by "clarification" and "description" research searched: MEDLINE, Educational Resource Information Center, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Central, Scopus (1988-2016). Reviewer-pairs screened titles/abstracts. One pair coded, extracted, and synthesized evidence, working within the pragmatism paradigm.

SUMMARY OF RESULTS

From screening 2279 abstracts, 49 articles met inclusion-criteria, counting four systematic reviews for context. The 45 articles of at least Kirkpatrick K2 primary research mostly contributed K3 (39/45, 86.7%), mixed methods (21/45, 46.7%), and S3-strength (just over one-half) evidence. Mobile devices particularly supported student: assessment; communication; clinical decision-making; logbook/notetaking; and accessing information (in about two-thirds). Informal and hidden curricula included: concerns about: disapproval; confidentiality and privacy; security;-distraction by social connectivity and busy clinical settings; and mixed messages about policy.

DISCUSSION AND CONCLUSION

This idiosyncratic evidence-base of modest robustness suggested that mobile devices provide potentially powerful educational support on clinical placement, particularly with student transitions, metalearning, and care contribution. Explicit policy must tackle informal and hidden curricula though, addressing concerns about transgressions.

Integration of Mobile Devices to Facilitate Patient Care and Teaching During Family-Centered Rounds

OBJECTIVES

The increasing prevalence of mobile devices in clinical settings has the potential to improve both patient care and education. The benefits are particularly promising in the context of family-centered rounds in inpatient pediatric settings. We aimed to increase mobile device usage by inpatient rounding teams by 50% in 6 months. We hoped to demonstrate that use of mobile devices would improve access to patient care and educational information and to determine if use would improve efficiency and perceptions of clinical teaching.

METHODS

We designed a mixed-methods study involving pre- and post-implementation surveys to residents, families, and faculty as well as direct observations of family-centered rounds. We conducted rapid cycles of continual quality improvement by using the Plan-Do-Study-Act framework involving 3 interventions.

RESULTS

Pre-intervention, the mobile computing cart was used for resident education on average 3.3 times per rounding session. After cycle 3, teaching through the use of mobile devices increased by ∼79% to 5.9 times per rounding session. On the basis of survey data, we determined there was a statistically significant increase in residents' perception of feeling prepared for rounds, receiving teaching on clinical care, and ability to teach families. Additionally, average time spent per patient on rounds decreased after implementation of mobile devices.

CONCLUSIONS

Integration of mobile devices into a pediatric hospital medicine teaching service can facilitate patient care and perception of resident teaching by extending the utility of electronic medical records in care decisions and by improving access to knowledge resources.

[Creatine kinase and isoenzymes in full-term newborn and premature infants]

Serum creatine kinase activity was measured during the first post-natal days in healthy full-term and premature infants. The CK isoenzymes (CK-MM, MB and BB) were separated using ion-exchange column chromatography. Total CK activity is lower for premature infants than for full-term infants at the same time-periods. However the separation of the CK isoenzymes shows that the same normal values for the CK-BB (expressed as U/l) may be used for the two groups of infants.