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Kalantarion M, Ahmady S, Kallestrup P, Katibeh M, Sadoughi MM, Khajeali N, Faghihi SA. How to create a successful mobile learning strategy for medical education during lockdowns? J Educ Health Promot 2024; 13:70. [PMID: 38559490 PMCID: PMC10979768 DOI: 10.4103/jehp.jehp_167_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/24/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Mobile learning has played an important role during the COVID-19 pandemic and medical schools now consider it as an effective educational method in current and future crises. In this qualitative study, an attempt was made to demonstrate the principles of designing a mobile learning strategy in medical education from the perspective of experts. MATERIALS AND METHODS The study was conducted by the qualitative content analysis method. The data were collected from July 2022 to Feb 2023. Twelve participants were included in this study from Iran's medical universities, consisting of two members of the Higher Council of Virtual Education, three educational directors, three clinical faculty members, two faculty members specializing in e-learning and medical education, an educational vice, and a dean. Data were collected using semi-structured interviews and analyzed by Granheim and Lundman's (2004) method. RESULTS Out of twelve participants in the study, eight (66%) were males and four (44%) females. Data were classified into eight categories and one theme. Based on the participants' experiences, the main theme, that is, "the principles of medical education design in mobile learning," included pedagogical component, interactive design, effective and comprehensive analysis, achieving objectives with the mobile learning platform, generating micro- and interactive e-content, teaching-learning interactive methods, course implementation and interactive evaluation at both micro- and macro-levels. CONCLUSION Data analysis revealed that in addition to the eight principles in the medical education design in mobile learning, the participants prioritized the two principles of pedagogical component and interactive design over other principles in educational design. Using a successful mobile learning strategy in situations of restrictions limiting physical presence may improve the quality of medical education.
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Affiliation(s)
- Masomeh Kalantarion
- Department of Medical Education, School of Medical Education and Learning Technologies, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soleiman Ahmady
- Department of Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Per Kallestrup
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Marzieh Katibeh
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mohammad Mehdi Sadoughi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Khajeali
- Department of Medical Education, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Aliakbar Faghihi
- Department of Medical Education, Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Goodman MC, Chesner JH, Pourmand K, Farouk SS, Shah BJ, Rao BB. Developing a Novel Case-Based Gastroenterology/Hepatology Online Resource for Enhanced Education During and After the COVID-19 Pandemic. Dig Dis Sci 2023; 68:2370-2378. [PMID: 36920667 PMCID: PMC10015521 DOI: 10.1007/s10620-023-07910-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic reshaped the delivery of medical education, necessitating novel modes of instruction to facilitate distance learning. Online medical education resources provide opportunities for self-directed and asynchronous learning. GISIM is a free, open access educational website dedicated to gastroenterology (GI)/hepatology, which teaches pathophysiology and disease management, and supports clinical reasoning skill development through interactive, dynamic, case presentation-based journeys. AIMS (1) To describe the creation of a mobile-optimized, GI/hepatology educational resource for medical trainees, and (2) to report on trainee feedback on completing and authoring GISIM cases. METHODS GISIM was created on WordPress and modeled after NephSIM, an e-learning platform dedicated to Nephrology. Content was developed by internal medicine residents and GI/hepatology fellows and attendings. Cases are interactive, prompting users to select differential diagnoses and management plans, with immediate feedback provided on response. Self-reported user demographics and website feedback were collected with an embedded survey. A separate survey evaluated case authors' experiences. RESULTS GISIM launched in February 2021 and received 12,184 website views and 2003 unique visitors between February 1 2021 and February 28 2022. New cases are disseminated bimonthly. Sixty-one user surveys were collected, with a majority completed by fellows (38%) and residents (26%). All users found the website easy to use and most reported enhanced understanding of case topic areas. Nine author surveys were collected. Authors reported significant learning on chosen topics and improved clinical knowledge through their participation. CONCLUSIONS We developed a novel GI/hepatology case-based resource that enables distance learning and was perceived as a valuable educational tool by users and authors.
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Affiliation(s)
- Morgan C Goodman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaclyn H Chesner
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kamron Pourmand
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samira S Farouk
- Barbara T. Murphy Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brijen J Shah
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bhavana Bhagya Rao
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Atticus Wolfe. Incongruous identities: Mental distress and burnout disparities in LGBTQ+ health care professional populations. Heliyon 2023; 9. [PMID: 37009240 PMCID: PMC10039783 DOI: 10.1016/j.heliyon.2023.e14835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/28/2023] Open
Abstract
Health care professionals are chronically overworked due to structural workplace demands and institutional challenges [1]. During the COVID-19 pandemic, US biomedical health care professionals experienced additional environmental strain [2]. Health care professionals who occupy socio-politically minoritized identities are more likely to report symptoms of distress and workplace overburden than their counterparts [2]. While minority stress and identity formation theories explain the relationship between socially constructed identity and environmental strain, these theories remain largely unexplored in LGBTQ+ health care professional populations. Furthermore, contemporary investigations into health care professional burnout and mental distress fail to include differential impacts of identity-based stress, particularly within LGBTQ+ groups. This paper proposes a theoretical explanation for differential stress experiences by health care professionals and calls for research to investigate identity congruence as a key aspect of professionalization in medical schools. Health professions researchers need to attend to identity-based stress models to address discriminatory experiences with burnout and mental distress.
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Kumi R, Reychav I, Azuri J, Sabherwal R. Tablet in the Consultation Room and Physician Satisfaction. International Journal of Healthcare Information Systems and Informatics 2023. [DOI: 10.4018/ijhisi.318445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The purpose of the study is to investigate patient-physician interactions during a clinical encounter to ascertain the impact of tablet computing on physician satisfaction during a clinical encounter. This study was conducted at a primary care clinic, and the physicians who participated could use a tablet during their clinical encounters. The authors compared satisfaction between physicians who used the tablet during a clinical encounter and those who did not using data from 122 clinical encounters involving 82 patients. The results indicate that physicians who used the tablet during clinical encounters are more satisfied than those who did not. Additionally, there was a meaning difference in satisfaction between physicians who used the tablet to educate patients and share information than those who did not. HITs have potential benefits, but they also come with risks. To effectively manage the risks and benefits of HITs, healthcare providers should be deliberate and strategic in the implementation of HITs.
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Affiliation(s)
| | | | - Joseph Azuri
- Sackler Faculty of Medicine, Tel Aviv University, Israel
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Balch H, Gradick C, Kukhareva PV, Wanner N. Association of Mobile Workstations and Rounding-in-Flow with Resident Efficiency: A Controlled Study at an Academic Internal Medicine Department. J Gen Intern Med 2022; 37:3700-3706. [PMID: 35513750 PMCID: PMC9585150 DOI: 10.1007/s11606-022-07636-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Residents commonly use a batched workflow to round on hospitalized patients, creating redundancy and decreasing efficiency. OBJECTIVE To improve resident efficiency through a novel workflow using mobile laptops and modified rounding-in-flow. DESIGN, SETTING, PARTICIPANTS A controlled experimental study conducted at an academic medical center for 3 months. One internal medicine team served as the intervention group, and two other teams served as a control group; 34 interns and 20 senior residents participated. INTERVENTION Residents in the intervention group were provided a novel workflow and a mobile laptop to allow them to round "in-flow." Control group residents rounded as usual (batched workflow without laptops). MAIN MEASURES Fourteen interns were monitored for a time-motion study. Time-stamped electronic medical record (EMR) data were used to assess percentage of progress notes and orders placed during rounds (9 a.m.-12:30 p.m.) and percentage of discharge summaries signed within 24 h of discharge. A post-intervention survey measured perceived efficiency. RESULTS A time-motion study showed non-significant differences between time in the intervention group and that in the control group: communication time with patients (128 min vs 105 min, p = 0.37) and computer time (289 min vs 306 min, p = 0.71). EMR data for 664 visits in the control group and 374 in the intervention group showed that rounding-in-flow was associated with an odds ratio (OR) of 1.5 for placing progress notes during rounds (95% CI: 1.2-1.7, p < 0.001), an OR of 1.1 for placing non-discharge orders during rounds (95% CI: 1.0-1.2, p = 0.01), and an OR of 3.9 for signing discharge summaries within 24 h of discharge (95% CI: 2.3-7.2, p < 0.001). Post-intervention survey, completed by 23 of 34 interns, showed that interns in the intervention group perceived that orders were completed during rounds more often than the control group (OR 7.8; 95% CI: 1.3-60.1, p = 0.03). CONCLUSIONS Using mobile laptops with modified rounding-in-flow was associated with earlier completion of residents' work, suggesting improved efficiency.
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Affiliation(s)
- Heather Balch
- Department of Internal Medicine, University of Utah, 30 N. 1900 E., RM 5R218, Salt Lake City, UT, 84132, USA.
| | - Casey Gradick
- Department of Internal Medicine, University of Utah, 30 N. 1900 E., RM 5R218, Salt Lake City, UT, 84132, USA
| | - Polina V Kukhareva
- Department of Internal Medicine, University of Utah, 30 N. 1900 E., RM 5R218, Salt Lake City, UT, 84132, USA
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Nathan Wanner
- Department of Internal Medicine, University of Utah, 30 N. 1900 E., RM 5R218, Salt Lake City, UT, 84132, USA
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Roszak M, Sawik B, Stańdo J, Baum E. E-Learning as a Factor Optimizing the Amount of Work Time Devoted to Preparing an Exam for Medical Program Students during the COVID-19 Epidemic Situation. Healthcare (Basel) 2021; 9:1147. [PMID: 34574923 PMCID: PMC8469934 DOI: 10.3390/healthcare9091147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 pandemic had a huge impact on the learning and teaching processes, particularly in healthcare education and training, because of the principal position of the cutting-edge student-patient interaction. Replacing the traditional form of organization and implementation of knowledge evaluation with its web-based equivalent on an e-learning platform optimizes the whole didactic process not only for the unit carrying it out but, above all, for students. This research is focused on the effectiveness of the application of e-learning for computer-based knowledge evaluation and optimizing exam administration for students of medical sciences. The proposed approach is considered in two categories: from the perspective of the providers of the evaluation process, that is, the teaching unit; and the recipients of the evaluation process, that is, the students.
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Affiliation(s)
- Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
| | - Bartosz Sawik
- Department of Business Informatics and Engineering Management, AGH University of Science and Technology, 30-059 Krakow, Poland
- Haas School of Business, University of California at Berkeley, Berkeley, CA 94720, USA
- Department of Statistics, Computer Science and Mathematics, Public University of Navarra, 31006 Pamplona, Spain
| | - Jacek Stańdo
- Centre of Mathematics and Physics, Lodz University of Technology, 90-924 Lodz, Poland;
| | - Ewa Baum
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
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Bock A, Elvers D, Peters F, Kramer C, Kniha K, Hölzle F, Spreckelsen C, Modabber A. Effects of mobile learning on writing panoramic radiograph reports: a quasi-experimental trial in dental education. BMC Med Educ 2021; 21:466. [PMID: 34470635 PMCID: PMC8411548 DOI: 10.1186/s12909-021-02889-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In dentistry, the reporting of panoramic radiographs is particularly challenging, as many structures are depicted in one image and pathologies need to be identified completely. To enhance the learning process for these interpretations, the advantages of the increasingly popular education method of mobile learning could be used. Therefore, this study aimed to determine the effectiveness of learning to report panoramic radiographs using an application (app) on a mobile device. METHODS The existing e-learning programme 'PantoDict' was further developed into a mobile app with a new training section. Participants of a dental radiology course were divided into two groups, one of which additionally had the chance to practise reporting panoramic radiographs using the app. A test to assess the knowledge gained was conducted at the end of the semester; the course and the app were also evaluated. RESULTS The group that used the app showed significantly better results in the test than the control group (p < 0.05). Although the app group approved a high satisfaction using the app as an additional supplement to the course, this did not result in a higher overall satisfaction with the course. Further, these students observed that the traditional face-to-face seminar could not be replaced by the app. CONCLUSION By using the PantoDict app, students were offered better training options for writing reports on panoramic radiographs, which resulted in significantly better test results than the results of the control group. Therefore, the mobile app is a useful supplement to classical education formats within the context of a blended learning approach.
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Affiliation(s)
- Anna Bock
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Dirk Elvers
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Florian Peters
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Chris Kramer
- Department of Medical Informatics, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Kristian Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Cord Spreckelsen
- Institute of Medical Statistics, Computer and Data Sciences, University Hospital Jena, Nachstraße 18, 07743, Jena, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
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Vinall G, Cogan T, Jeffery A, Tivers M. Staphylococcal bacterial contamination of portable electronic devices in a large veterinary hospital. J Small Anim Pract 2020; 62:253-256. [PMID: 33368313 DOI: 10.1111/jsap.13289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/30/2020] [Accepted: 11/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Portable electronic devices are used regularly within the veterinary and medical environments. Use of these in clinical areas may predispose them to bacterial contamination and they could act as fomites, transmitting infection between clinicians and patients. AIM To determine the prevalence, origin and nature of Staphylococcal bacterial contamination on the surface of portable electronic devices used in a large small animal hospital. MATERIALS AND METHODS Staff were surveyed on the frequency of portable electronic device use and device-cleaning routines. Portable electronic devices were swabbed for staphylococcus species. Cultured cocci were tested for antimicrobial resistance and identified at the species level to help determine the likely source (human or animal). FINDINGS Forty one of 48 (85%) of staff used a portable electronic device every day within the hospital. Useable swabs were obtained from 47 portable electronic devices. Staphylococci were found on 68% of portable electronic devices. Vancomycin and Oxacillin resistance were seen in 17 of 46 (37%) and 1 of 46 (2%) isolated colonies respectively, including four vancomycin resistant, coagulase-positive staphylococci. 44% of staff never cleaned their device. CLINICAL SIGNIFICANCE Portable electronic devices are commonly used in veterinary hospitals, but few staff routinely disinfect them. The use of disinfectant to reduce colony counts should be implemented when forming protocols for these devices in the hospital. The majority of staphylococci found were of likely human origin. It is suggested that contamination is therefore more likely to be originating from staff rather than patients.
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Affiliation(s)
- G Vinall
- Bristol Veterinary School, University of Bristol, Langford Bristol, BS40 5DU, UK.,Highcroft Veterinary Referrals, Whitchurch, Bristol, BS14 9BE, UK
| | - T Cogan
- Bristol Veterinary School, University of Bristol, Langford Bristol, BS40 5DU, UK
| | - A Jeffery
- Bristol Veterinary School, University of Bristol, Langford Bristol, BS40 5DU, UK
| | - M Tivers
- Bristol Veterinary School, University of Bristol, Langford Bristol, BS40 5DU, UK
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Abstract
Purpose. Powered by big data, predictive models provide individualized risk stratification to inform clinical decision-making and mitigate long-term morbidity. We describe how to transform a large institutional dataset into a real-time, interactive clinical decision support mobile user interface for risk prediction. Methods. A clinical decision point ideal for risk stratification and modification was identified. Demographics, medical comorbidities, and operative characteristics were abstracted from the electronic medical record (EMR) using ICD-9 codes. Surgery-specific predictive models were generated using regression modeling and corroborated with internal validation. A clinical support interface was designed in partnership with an app developer, followed by subsequent beta testing and clinical implementation of the final tool. Results. Individual, specialty-specific, and preoperatively actionable models incorporating clustered procedural codes were created. Using longitudinal inpatient, outpatient, and office-based data from a large multicenter health system, all patient and operative variables were weighted according to ß-coefficients. The individual risk model parameters were incorporated into specialty-specific modules and implemented into an accessible iOS/Android compatible mobile application. Conclusions. As proof of concept, we provide a framework for developing a clinical decision support mobile user interface, through the use of clinical and administrative longitudinal data. Point-of-care applications, particularly ones designed with implementation and actionability in mind, have the potential to aid clinicians in identifying and optimizing risk factors that impact the outcome of interest's occurrence, thereby enabling clinicians to take targeted risk-reduction actions. In addition, such applications may help facilitate counseling, informed consent, and shared decision-making, leading to improved patient-centered care.
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Affiliation(s)
- Jaclyn T Mauch
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Arturo J Rios-Diaz
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.,Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Geoffrey M Kozak
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.,Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Basta MN, Kozak GM, Broach RB, Messa CA 4th, Rhemtulla I, DeMatteo RP, Serletti JM, Fischer JP. Can We Predict Incisional Hernia?: Development of a Surgery-specific Decision-Support Interface. Ann Surg 2019; 270:544-53. [PMID: 31318790 DOI: 10.1097/SLA.0000000000003472] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to identify procedure-specific risk factors independently associated with incisional hernia (IH) and demonstrate the feasibility of preoperative risk stratification through the use of an IH risk calculator app and decision-support interface. SUMMARY BACKGROUND DATA IH occurs after 10% to 15% of all abdominal surgeries (AS) and remains among the most challenging, seemingly unavoidable complications. However, there is a paucity of readily available, actionable tools capable of predicting IH occurrence at the point-of-care. METHODS Patients (n = 29,739) undergoing AS from 2005 to 2016 were retrospectively identified within inpatient and ambulatory databases at our institution. Surgically treated IH, complications, and costs were assessed. Predictive models were generated using regression analysis and corroborated using a validation group. RESULTS The incidence of operative IH was 3.8% (N = 1127) at an average follow-up of 57.9 months. All variables were weighted according to β-coefficients generating 8 surgery-specific predictive models for IH occurrence, all of which demonstrated excellent risk discrimination (C-statistic = 0.76-0.89). IH occurred most frequently after colorectal (7.7%) and vascular (5.2%) surgery. The most common occurring risk factors that increased the likelihood of developing IH were history of AS (87.5%) and smoking history (75%). An integrated, surgeon-facing, point-of-care risk prediction instrument was created in an app for preoperative estimation of hernia after AS. CONCLUSIONS Operative IH occurred in 3.8% of patients after nearly 5 years of follow-up in a predictable manner. Using a bioinformatics approach, risk models were transformed into 8 unique surgery-specific models. A risk calculator app was developed which stakeholders can access to identify high-risk IH patients at the point-of-care.
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Beier M, Alschuler K, Amtmann D, Hughes A, Madathil R, Ehde D. iCAMS: Assessing the Reliability of a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) Tablet Application. Int J MS Care 2020; 22:67-74. [PMID: 32410901 DOI: 10.7224/1537-2073.2018-108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background This study aimed to develop a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) tablet application, "iCAMS," and examine equivalency between the original paper-based and the tablet-based assessments. Methods This study enrolled 100 participants with physician-confirmed multiple sclerosis (MS). Interrater reliability, parallel forms reliability, and concurrent validity were evaluated by incorporating two test administrators in each session: one scoring participant responses with the original paper assessments and the other with iCAMS. Although the participant was exposed to the material only once, responses were recorded on both administration methods. In addition to the standard test procedures, each research assistant used a stopwatch to measure the amount of time required to administer and score each version of BICAMS. Results Pearson correlation coefficients (r) revealed strong and significant correlations for all three tests. Excellent agreement was observed between iCAMS and paper versions of the BICAMS tests, with all intraclass correlation coefficients exceeding 0.93. The scores from all the cognitive tests were not statistically significantly different, indicating no proportional bias. Including scoring, administration of the iCAMS application saved approximately 10 minutes over the paper version. Conclusions Preliminary findings suggest that the tablet application iCAMS is a reliable and fast method for administering BICAMS.
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Stamm T, Triller I, Hohoff A, Blanck-Lubarsch M. The tablet computer’s impact on learning and National Dental Examination scores in orthodontics - a mixed-method research. Head Face Med 2019; 15:11. [PMID: 31053159 PMCID: PMC6498559 DOI: 10.1186/s13005-019-0195-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background To assess the educational impact of a one-to-one tablet PC (TPC) program by analysing university students’ learning skills and related scores of the National Dental Examination (NDE) in Germany. Methods The study design was a mixed-method approach consisting of a survey and a comparison of NDE scores. Students received a loaned non-preloaded and non-managed TPC during three consecutive orthodontic semesters. Usability and learning benefits in clinical and nonclinical settings were assessed by a survey. After the participating students had passed the NDE in a standard period of study, their grades were compared with those of students from the semester prior to TPC introduction. Results One hundred and eight students (36 females and 72 males) received an TPC and participated in the survey. Of these, 53 passed the NDE in a standard period of study. 64 students from the semester before TPC introduction, who passed in the regular period of study, were chosen as non-TPC control group. Survey: Students’ expectations concerning TPC benefits increased significantly after TPC usage (P = 0.000). TPCs were rated more useful for learning at places outside the clinic setting than for inside (P = 0.000). PDFs and communication applications were used more in nonclinical settings (P = 0.008 and 0.000, respectively). NDE scores: Concerning the examination parts relating to theoretical knowledge and clinical knowledge, students with full TPC use achieved higher scores than did those without TPC use (P = 0.006 and 0.002, respectively). Scores for manual skills showed no differences, neither for students with and without TPC, nor within the semester after TPC introduction (P = 1.000). Conclusions This is the first study to analyse a one-to-one TPC program in the orthodontic curriculum and measure the effect of TPC usage on NDE scores. Students’ expectations concerning the TPC benefit in the orthodontic curriculum improved significantly after using the devices. We have shown that NDE scores in theoretical knowledge increased significantly after TPC deployment whereas scores in motor skills remained unchanged. The results suggest that the TPC has a positive learning effect on theoretical knowledge in orthodontics. Trial registration Permission to conduct this study was given by the Ethics Committee of the Department of Medicine of the University of Münster, Germany (2012-12-13).
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Wynter L, Burgess A, Kalman E, Heron JE, Bleasel J. Medical students: what educational resources are they using? BMC Med Educ 2019; 19:36. [PMID: 30683084 PMCID: PMC6347772 DOI: 10.1186/s12909-019-1462-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/09/2019] [Indexed: 05/10/2023]
Abstract
BACKGROUND The number of resources available to medical students studying a degree in medicine is growing exponentially. In addition to traditional learning resources such as lectures and textbooks, students are increasingly using e-learning tools like commercially available question banks to supplement their learning. Student preference for learning resources has not been described in detail, and a better understanding of the tools perceived to be useful could provide essential information to medical educators when designing and implementing medical curricula. METHODS We invited 1083 undergraduate and postgraduate medical students from two major Australian universities to complete an online survey. Questions asked students to indicate the frequency with which they use various types of resources when learning new material or when revising previous content. RESULTS Approximately one third (32.3%, N = 350) of invited participants completed the survey, and of those who responded, the gender distribution was even with a median age of 25 years. Making written notes and reading textbooks were the most frequently utilized resources for learning new material. Online or downloaded question banks were the most frequently used resource for revision. In addition to the use of traditional learning tools, the majority of students report using a variety of e-learning tools including online teaching videos (92%, n = 322) and question banks (90.6%, n = 317). CONCLUSION Despite the trend towards e-learning, traditional resources like attendance at face-to-face lectures remain the most popular for learning new material. The increasing use of question banks raises potential issues of poor alignment to medical school curricula. With the advantages of exam technique practice, time efficiency and multiplatform availability, their popularity is likely to continue. Evaluation of existing question banks is required to facilitate appropriate integration into the curricula, with equitable access for all students.
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Affiliation(s)
- Lucinda Wynter
- The University of Sydney School of Medicine – Education Office, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Annette Burgess
- The University of Sydney School of Medicine – Education Office, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Education Research Network (SHERN), The University of Sydney, Sydney, Australia
| | - Eszter Kalman
- The University of Sydney School of Medicine – Education Office, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jack Edward Heron
- The University of Sydney School of Medicine – Education Office, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jane Bleasel
- The University of Sydney School of Medicine – Education Office, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Education Research Network (SHERN), The University of Sydney, Sydney, Australia
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Clifton DC, Benjamin RW, Brown AR, Ostrovsky DA, Narayan AP. A Tablet-Based Educational Tool: Toward More Comprehensive Pediatric Patient Education. Clin Pediatr (Phila) 2018; 57:1176-1182. [PMID: 29575940 DOI: 10.1177/0009922818766621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is a paucity of data on the impact of mobile technology on physician-led education in the pediatric population. We performed a prospective pilot study in a pediatric diabetes clinic to evaluate the impact of tablet-based patient education. A total of 106 patients and caregivers completed postclinic surveys, 64 (60%) in the intervention group and 42 (40%) in the control group. The majority of the intervention group patients (86%) liked tablet use and felt it was better or similar (99%) to baseline. Moreover, a majority receiving tablet-based education perceived an increase in diabetes knowledge (57%) compared with baseline (39%), though the difference did not reach statistical significance ( P = .059). Those who received tablet-based education felt they were educated on more diabetes-related topics. As the use of mobile technology in medicine grows, additional research is needed to compare mobile technology with traditional methods in providing education to the pediatric population.
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Sweeney M, Paruchuri K, Weingart SN. Going Mobile: Resident Physicians' Assessment of the Impact of Tablet Computers on Clinical Tasks, Job Satisfaction, and Quality of Care. Appl Clin Inform 2018; 9:588-594. [PMID: 30089332 DOI: 10.1055/s-0038-1667121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There are few published studies of the use of portable or handheld computers in health care, but these devices have the potential to transform multiple aspects of clinical teaching and practice. OBJECTIVE This article assesses resident physicians' perceptions and experiences with tablet computers before and after the introduction of these devices. METHODS We surveyed 49 resident physicians from 8 neurology, surgery, and internal medicine clinical services before and after the introduction of tablet computers at a 415-bed Boston teaching hospital. The surveys queried respondents about their assessment of tablet computers, including the perceived impact of tablets on clinical tasks, job satisfaction, time spent at work, and quality of patient care. RESULTS Respondents reported that it was easier (73%) and faster (70%) to use a tablet computer than to search for an available desktop. Tablets were useful for reviewing data, writing notes, and entering orders. Respondents indicated that tablet computers increased their job satisfaction (84%), reduced the amount of time spent in the hospital (51%), and improved the quality of care (65%). CONCLUSION The introduction of tablet computers enhanced resident physicians' perceptions of efficiency, effectiveness, and job satisfaction. Investments in this technology are warranted.
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Affiliation(s)
- Megan Sweeney
- Department of Quality Improvement and Patient Safety, Tufts Medical Center, Boston, Massachusetts, United States
| | - Kaavya Paruchuri
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Saul N Weingart
- Department of Quality Improvement and Patient Safety, Tufts Medical Center, Boston, Massachusetts, United States
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Monroe KS, Evans MA, Mukkamala SG, Williamson JL, Jabaley CS, Mariano ER, O'Reilly-Shah VN. Moving anesthesiology educational resources to the point of care: experience with a pediatric anesthesia mobile app. Korean J Anesthesiol 2018; 71:192-200. [PMID: 29739184 PMCID: PMC5995022 DOI: 10.4097/kja.d.18.00014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/08/2018] [Accepted: 02/19/2018] [Indexed: 11/22/2022] Open
Abstract
Background Educators in all disciplines recognize the need to update tools for the modern learner. Mobile applications (apps) may be useful, but real-time data is needed to demonstrate the patterns of utilization and engagement amongst learners. Methods We examined the use of an anesthesia app by two groups of learners (residents and anesthesiologist assistant students [AAs]) during a pediatric anesthesiology rotation. The app calculates age and weight-based information for clinical decision support and contains didactic materials for self-directed learning. The app transmitted detailed usage information to our research team. Results Over a 12-month period, 39 participants consented; 30 completed primary study procedures (18 residents, 12 AAs). AAs used the app more frequently than residents (P = 0.025) but spent less time in the app (P < 0.001). The median duration of app usage was 2.3 minutes. During the course of the rotation, usage of the app decreased over time. ‘Succinylcholine’ was the most accessed drug, while ‘orientation’ was the most accessed teaching module. Ten (33%) believed that the use of apps was perceived to be distracting by operating room staff and surgeons. Conclusions Real-time in-app analytics helped elucidate the actual usage of this educational resource and will guide future decisions regarding development and educational content. Further research is required to determine learners’ preferred choice of device, user experience, and content in the full range of clinical and nonclinical purposes.
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Affiliation(s)
- Katherine S Monroe
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA.,Division of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Michael A Evans
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA.,Division of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Shivani G Mukkamala
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA.,Division of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Julie L Williamson
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA.,Division of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Craig S Jabaley
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Vikas N O'Reilly-Shah
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA.,Division of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Abstract
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.
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Affiliation(s)
- Angela S Byrd
- Pediatric Residency Program, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana
| | - Pamela M McMahon
- Pediatric Residency Program, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana
| | - Richard J Vath
- Pediatric Residency Program, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana
| | - Michael Bolton
- Pediatric Residency Program, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana
| | - Melissa Roy
- Pediatric Residency Program, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana
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Saleem JJ, Savoy A, Etherton G, Herout J. Investigating the need for clinicians to use tablet computers with a newly envisioned electronic health record. Int J Med Inform 2017; 110:25-30. [PMID: 29331252 DOI: 10.1016/j.ijmedinf.2017.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/05/2017] [Accepted: 11/19/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The Veterans Health Administration (VHA) has deployed a large number of tablet computers in the last several years. However, little is known about how clinicians may use these devices with a newly planned Web-based electronic health record (EHR), as well as other clinical tools. The objective of this study was to understand the types of use that can be expected of tablet computers versus desktops. METHODS Semi-structured interviews were conducted with 24 clinicians at a Veterans Health Administration (VHA) Medical Center. RESULTS An inductive qualitative analysis resulted in findings organized around recurrent themes of: (1) Barriers, (2) Facilitators, (3) Current Use, (4) Anticipated Use, (5) Patient Interaction, and (6) Connection. CONCLUSIONS Our study generated several recommendations for the use of tablet computers with new health information technology tools being developed. Continuous connectivity for the mobile device is essential to avoid interruptions and clinician frustration. Also, making a physical keyboard available as an option for the tablet was a clear desire from the clinicians. Larger tablets (e.g., regular size iPad as compared to an iPad mini) were preferred. Being able to use secure messaging tools with the tablet computer was another consistent finding. Finally, more simplicity is needed for accessing patient data on mobile devices, while balancing the important need for adequate security.
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Affiliation(s)
- Jason J Saleem
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA; Center for Ergonomics, University of Louisville, Louisville, KY, USA.
| | - April Savoy
- Center for Health Information and Communication, Health Services Research and Development Service, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Gale Etherton
- Department of Internal Medicine, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Jennifer Herout
- Human Factors Engineering, Health Informatics, Office of Informatics and Analytics, Veterans Health Administration, Washington, DC, USA
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Maneval R, Mechtel M. Replacing Smartphones With Mini Tablet Technology: An Evaluation. Nurse Educ 2018; 43:97-100. [PMID: 28817475 DOI: 10.1097/NNE.0000000000000433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Handheld technology allows students to access point-of-care resources throughout the clinical experience. To assess the viability of replacing student smartphones with tablets, an evaluation project was undertaken. Overall, students were equally dissatisfied with the 2 types of tablets that were evaluated. Students saw the potential usefulness of tablets to manage clinical assignments, interact with the learning management system, and communicate with faculty, but not for retrieving information currently accessible on their phones.
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Chreiman KM, Prakash PS, Martin ND, Kim PK, Mehta S, McGinnis K, Gallagher JJ, Reilly PM. Staying connected: Service-specific orientation can be successfully achieved using a mobile application for onboarding care providers. Trauma Surg Acute Care Open 2017; 2:e000085. [PMID: 29766089 PMCID: PMC5877901 DOI: 10.1136/tsaco-2017-000085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/13/2017] [Indexed: 11/04/2022] Open
Abstract
Communicating service-specific practice patterns, guidelines, and provider information to a new team of learners that rotate frequently can be challenging. Leveraging individual and healthcare electronic resources, a mobile device platform was implemented into a newly revised resident onboarding process. We hypothesized that offering an easy-to-use mobile application would improve communication across multiple disciplines as well as improve provider experiences when transitioning to a new rotation. A mobile platform was created and deployed to assist with enhancing communication within a trauma service and its resident onboarding process. The platform had resource materials such as: divisional policies, Clinical Practice Guidelines (CMGs), and onboarding manuals along with allowing for the posting of divisional events, a divisional directory that linked to direct dialing, text or email messaging, as well as on-call schedules. A mixed-methods study, including an anonymous survey, aimed at providing information on team member's impressions and usage of the mobile application was performed. Usage statistics over a 3-month period were analyzed on those providers who completed the survey. After rotation on the trauma service, trainees were asked to complete an anonymous, online survey addressing both the experience with, as well as the utility of, the mobile app. Thirty of the 37 (81%) residents and medical students completed the survey. Twenty-five (83%) trainees stated that this was their first experience rotating on the trauma service and 6 (20%) were from outside of the health system. According to those surveyed, the most useful function of the app were access to the directory (15, 50%), the divisional calendar (4, 13.3%), and the on-call schedules (3, 10%). Overall, the app was felt to be easy to use (27, 90%) and was accessed an average of 7 times per day (1-50, SD 9.67). Over half the survey respondents felt that the mobile app was helpful in completing their everyday tasks (16, 53.3%). Fifteen (50%) of the respondents stated that the app made the transition to the trauma service easier. Twenty-five (83.3%) stated it was valuable knowing about departmental events and announcements, and 17 (56.7%) felt more connected to the division. The evolution of mobile technology is rapidly becoming fundamental in medical education and training. We found that integrating a service-specific mobile application improved the learner's experience when transitioning to a new service and was a valuable onboarding instrument. Level of evidence IV.
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Affiliation(s)
- Kristen M Chreiman
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Priya S Prakash
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Niels D Martin
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Patrick K Kim
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Samir Mehta
- Department of Orthopaedic Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Kelly McGinnis
- Department of Orthopaedic Surgery, University of Pennsylvania, Pennsylvania, USA
| | - John J Gallagher
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Patrick M Reilly
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, USA
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MacLeod A, Fournier C. Residents’ use of mobile technologies: three challenges for graduate medical education. BMJ STEL 2017; 3:99-105. [DOI: 10.1136/bmjstel-2016-000185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 11/04/2022]
Abstract
IntroductionThe practice of medicine involves, among other things, managing ambiguity, interpreting context and making decisions in the face of uncertainty. These uncertainties, amplified for learners, can be negotiated in a variety of ways; however, the promise, efficiency and availability of mobile technologies and clinical decision supports make these tools an appealing way to manage ambiguity.Mobile technologies are becoming increasingly prevalent in medical education and in the practice of medicine. Because of this, we explored how the use of mobile technologies is influencing residents’ experiences of graduate medical education.MethodsWe conducted an 18-month qualitative investigation to explore this issue. Our research was conceptually and theoretically framed in sociomaterial studies of professional learning. Specifically, our methods included logging of technology use and related reflexive writing by residents (n=10), interviews with residents (n=12) and interviews with faculty (n=6).ResultsWe identified three challenges for graduate medical education related to mobile technology use: (1) efficiency versus critical thinking; (2) patient context versus evidence-based medicine and (3) home/work-life balance.DiscussionIn this digital age, decontextualised knowledge is readily available. Our data indicate that rather than access to accurate knowledge, the more pressing challenge for medical educators is managing how, when and why learners choose to access that information.
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Greysen SR, Magan Mendoza Y, Rosenthal J, Jacolbia R, Rajkomar A, Lee H, Auerbach A. Using Tablet Computers to Increase Patient Engagement With Electronic Personal Health Records: Protocol For a Prospective, Randomized Interventional Study. JMIR Res Protoc 2016; 5:e176. [PMID: 27599452 PMCID: PMC5030452 DOI: 10.2196/resprot.4672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 05/18/2016] [Accepted: 06/04/2016] [Indexed: 12/02/2022] Open
Abstract
Background Inadequate patient engagement in care is a major barrier to successful transitions from the inpatient setting and can lead to preventable adverse events after discharge, particularly for older adults. While older adults may be less familiar with mobile devices and applications, they may benefit from focused bedside training to engage them in using their Personal Health Record (PHR). Mobile technologies such as tablet computers can be used in the hospital to help bridge this gap in experience by teaching older, hospitalized patients to actively manage their medication list through their PHR during hospitalization and continue to use their PHR for other post-discharge tasks such as scheduling follow-up appointments, viewing test results, and communicating with providers. Bridging this gap is especially important for older, hospitalized adults as they are at higher risk than younger populations for low engagement in transitions of care and poor outcomes such as readmission. Greater understanding of the advantages and limitations of mobile devices for older adults may be important for improving transitions of care. Objective To better understand the effective use of mobile technologies to improve transitions in care for hospitalized, older adults and leverage these technologies to improve inpatient and postdischarge care for older adults. Methods We will compare an intervention group with tablet-based training to engage effectively with their PHR to a control group also receiving tablets and basic access to their PHR but no additional training on how to engage with their PHR. Results Patient enrollment is ongoing. Conclusions Through this grant, we will further develop our preliminary dataset and practical experience with these mobile technologies to catalyze patient engagement during hospitalization. ClinicalTrial ClinicalTrials.gov NCT02109601; https://clinicaltrials.gov/ct2/show/NCT02109601 (Archived by WebCite at http://www.webcitation.org/6jpXjkwM8)
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Affiliation(s)
- S Ryan Greysen
- University of California, San Francisco, Division of Hospital Medicine, San Francisco, CA, United States.
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Ortiz M, Ottolini M, Agrawal D. Written and Online Residency Guidebook to Improve Resident Efficiency and Knowledge of Best Patient Care Practices. MedEdPORTAL 2016; 12:10424. [PMID: 31008204 DOI: 10.15766/mep_2374-8265.10424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Residents at most institutions change rotations every 2 to 4 weeks. It often takes significant time for residents to become acclimated to the different protocols, expectations, and environments of each unique rotation. As a result, residents often spend time searching for answers, time that could be spent in outside learning and direct patient care. The goal of this resource is to provide a novel guidebook that improves residents' efficiency and knowledge of best patient care practices. Methods The guidebook begins with an introductory chapter with key contact information that can be filled in for the user's institution, which is followed by 16 rotation-specific chapters. A rotation-based approach was chosen as it focuses the content on the most pertinent information. Thus, trainees can quickly read a chapter to cover the most pertinent content for their current rotation. As a surrogate marker for efficiency, noon-conference attendance logs were queried to assess improvement in on-time attendance after introduction of the guidebook. Results After introduction of the learning resources, on-time arrival to noon conference improved for all residents and interns. Guidebook survey results were universally favorable; however, around half of respondents stated that they used the guidebook once or less per rotation. Discussion Underutilization of these resources potentially contributed to the lack of a statistically significant improvement overall. Future directions should focus on augmenting the quality and utilization of the guidebook and then reevaluating if, once well adopted, there is a sustained benefit.
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Abstract
Mobile technologies (including handheld and wearable devices) have the potential to enhance learning activities from basic medical undergraduate education through residency and beyond. In order to use these technologies successfully, medical educators need to be aware of the underpinning socio-theoretical concepts that influence their usage, the pre-clinical and clinical educational environment in which the educational activities occur, and the practical possibilities and limitations of their usage. This Guide builds upon the previous AMEE Guide to e-Learning in medical education by providing medical teachers with conceptual frameworks and practical examples of using mobile technologies in medical education. The goal is to help medical teachers to use these concepts and technologies at all levels of medical education to improve the education of medical and healthcare personnel, and ultimately contribute to improved patient healthcare. This Guide begins by reviewing some of the technological changes that have occurred in recent years, and then examines the theoretical basis (both social and educational) for understanding mobile technology usage. From there, the Guide progresses through a hierarchy of institutional, teacher and learner needs, identifying issues, problems and solutions for the effective use of mobile technology in medical education. This Guide ends with a brief look to the future.
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Affiliation(s)
- Ken Masters
- a Sultan Qaboos University , Sultanate of Oman
| | | | | | | | - Rebecca J Hogue
- c University of Ottawa , Canada
- d University of Massachusetts , USA
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Affiliation(s)
- Rhonda McEwen
- University of Toronto Room 3005 3359 Mississauga Road North Mississauga ON Canada L5L 1C6
| | - Adam K. Dubé
- University of Toronto Room 7020 130 St. George Street Toronto ON Canada M5S 1A5
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Piazza O, Miccichè V, Esposito C, Romano G, De Robertis E. Individualised prediction of postoperative cardiorespiratory complications after upper abdominal surgery. Trends in Anaesthesia and Critical Care 2016. [DOI: 10.1016/j.tacc.2016.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Schooley B, Walczak S, Hikmet N, Patel N. Impacts of mobile tablet computing on provider productivity, communications, and the process of care. Int J Med Inform 2016; 88:62-70. [PMID: 26878764 DOI: 10.1016/j.ijmedinf.2016.01.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/15/2016] [Accepted: 01/22/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Health information technology investments continue to increase while the value derived from their implementation and use is mixed. Mobile device adoption into practice is a recent trend that has increased dramatically and formal studies are needed to investigate consequent benefits and challenges. The objective of this study is to evaluate practitioner perceptions of improvements in productivity, provider-patient communications, care provision, technology usability and other outcomes following the adoption and use of a tablet computer connected to electronic health information resources. METHODS A pilot program was initiated in June 2013 to evaluate the effect of mobile tablet computers at one health provider organization in the southeast United States. Providers were asked to volunteer for the evaluation and were each given a mobile tablet computer. A total of 42 inpatient and outpatient providers were interviewed in 2015 using a survey style questionnaire that utilized yes/no, Likert-style, and open ended questions. Each had previously used an electronic health record (EHR) system a minimum of one year outside of residency, and were regular users of personal mobile devices. Each used a mobile tablet computer in the context of their practice connected to the health system EHR. RESULTS The survey results indicate that more than half of providers perceive the use of the tablet device as having a positive effect on patient communications, patient education, patient's perception of the provider, time spent interacting with patients, provider productivity, process of care, satisfaction with EHR when used together with the device, and care provision. Providers also reported feeling comfortable using the device (82.9%), would recommend the device to colleagues (69.2%), did not experience increased information security and privacy concerns (95%), and noted significant reductions in EHR login times (64.1%). Less than 25% of participants reported negative impacts on any of these areas as well as on time spent on order submission, note completion time, overall workload, patient satisfaction with care experience and patient outcomes. Gender, number of years in practice, practice type (general practitioner vs. specialist), and service type (inpatient/outpatient) were found to have a significant effect on perceptions of patient satisfaction, care process, and provider productivity. CONCLUSIONS Providers found positive gains from utilizing mobile devices in overall productivity, improved communications with their patients, the process of care, and technology efficiencies when used in combination with EHR and other health information resources. Demographic and health care work environment play a role in how mobile technologies are integrated into practice by providers.
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Affiliation(s)
- Benjamin Schooley
- Integrated Information Technology Department, University of South Carolina, 1301 Gervais St., Columbia, SCS, USA.
| | - Steven Walczak
- Integrated Information Technology Department, University of South Carolina, 1301 Gervais St., Columbia, SCS, USA; School of Information & Florida Center for Cybersecurity, University of South Florida, Tampa, FL, USA.
| | - Neset Hikmet
- Integrated Information Technology Department, University of South Carolina, 1301 Gervais St., Columbia, SCS, USA.
| | - Nitin Patel
- Midlands Internal Medicine, Palmetto Health Richland, Columbia, SC, USA.
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Wittich CM, Wang AT, Fiala JA, Mauck KF, Mandrekar JN, Ratelle JT, Beckman TJ. Measuring Participants' Attitudes Toward Mobile Device Conference Applications in Continuing Medical Education: Validation of an Instrument. J Contin Educ Health Prof 2016; 36:69-73. [PMID: 26954248 DOI: 10.1097/ceh.0000000000000031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Mobile device applications (apps) may enhance live CME courses. We aimed to (1) validate a measure of participant attitudes toward using a conference app and (2) determine associations between participant characteristics and attitudes toward CME apps with conference app usage. METHODS We conducted a cross-sectional validation study of participants at the Mayo Clinic Selected Topics in Internal Medicine Course. A conference app was developed that included presentation slides, note-taking features, search functions, social networking with other attendees, and access to presenter information. The CME app attitudes survey instrument (CMEAPP-10) was designed to determine participant attitudes toward conference apps. RESULTS Of the 602 participants, 498 (82.7%) returned surveys. Factor analysis revealed a two-dimensional model for CMEAPP-10 scores (Cronbach α, 0.97). Mean (SD) CMEAPP-10 scores (maximum possible score of five) were higher for women than for men (4.06 [0.91] versus 3.85 [0.92]; P = .04). CMEAPP-10 scores (mean [SD]) were significantly associated (P = .02) with previous app usage as follows: less than once per month, 3.73 (1.05); monthly, 3.41 (1.16); weekly, 4.03 (0.69); and daily or more, 4.06 (0.89). Scores were unrelated to participant age, specialty, practice characteristics, or previous app use. DISCUSSION This is the first validated measure of attitudes toward CME apps among course participants. App usage was higher among younger participants who had previously used educational or professional apps. Additionally, attitudes were more favorable among women and those who had previously used apps. These findings have important implications regarding efforts to engage participants with portable and accessible technology.
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Affiliation(s)
- Christopher M Wittich
- Dr. Wittich: Clinical Practice Chair and Associate Professor of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN. Dr. Wang: Assistant Professor of Medicine, Division of General Internal Medicine, Harbor-University of California Los Angeles Medical Center, Torrance, CA. Dr. Fiala: Resident in Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Dr. Mauck: Associate Professor of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN. Dr. Mandrekar: Professor of Biostatistics and Neurology, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. Dr. Ratelle: Instructor in Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN. Dr. Beckman: Education Chair and Professor of Medicine and Medical Education, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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Crowson MG, Kahmke R, Ryan M, Scher R. Utility of Daily Mobile Tablet Use for Residents on an Otolaryngology Head & Neck Surgery Inpatient Service. J Med Syst 2016; 40:55. [PMID: 26645319 DOI: 10.1007/s10916-015-0419-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
The objective of this study was to investigate the utility of electronic tablets and their capacity to increase hospital floor productivity, efficiency, improve patient care information safety, and to enhance resident education and resource utilization on a busy Otolaryngology - Head & Neck Surgery inpatient service. This was a prospective cohort study with a 2-week pre-implementation period with standard paper census lists without mobile tablet use, and a 2-week post-implementation period followed with electronic tablets used to place orders, look up pertinent clinical data, educate patients as appropriate, and to record daily to-dos that would previously be recorded on paper. The setting for the study was Duke University Medical Center in Durham, North Carolina, with 13 Otolaryngology residents comprising the study population. The time for inpatient rounding was shorter with the use tablets (p = 0.037). There was a non-significant trend in the number of times a resident had to leave rounds to look up a clinical query on a computer, with less instances occurring in the post-implementation study period. The residents felt that having a tablet facilitated more detailed and faster transfer of information, and improved ease of documentation in the medical record. Seventy percent felt tablets helped them spend more time with patients, 70 % could spend more time directly involved in rounds because they could use the tablet to query information at point-of-care, and 80 % felt tablets improved morale. The utility of a mobile tablet device coupled with the electronic health record appeared to have both quantitative and qualitative improvements in efficiency, increased time with patients and attendance at academic conferences. Tablets should be encouraged but not mandated for clinical and educational use.
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Prochaska MT, Bird AN, Chadaga A, Arora VM. Resident Use of Text Messaging for Patient Care: Ease of Use or Breach of Privacy? JMIR Med Inform 2015; 3:e37. [PMID: 26611620 PMCID: PMC6858010 DOI: 10.2196/medinform.4797] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/23/2015] [Indexed: 11/13/2022] Open
Abstract
Background Short message service (SMS) text messaging is an efficient form of communication and pervasive in health care, but may not securely protect patient information. It is unclear if resident providers are aware of the security concerns of SMS text messaging when communicating about patient care. Objective We sought to compare residents’ preferences for SMS text messaging compared with other forms of in-hospital communication when considering security versus ease of use. Methods This study was a cross-sectional multi-institutional survey of internal medicine residents. Residents ranked different communication modalities based on efficiency, ease of use, and security using a Likert scale. Communication options included telephone, email, hospital paging, and SMS text messaging. Respondents also reported whether they had received confidential patient identifiers through any of these modalities. Results SMS text messaging was preferred by 71.7% (94/131) of respondents because of its efficiency and by 79.8% (103/129) of respondents because of its ease of use. For security, 82.5% (104/126) of respondents preferred the hospital paging system, whereas only 20.6% (26/126) of respondents preferred SMS text messaging for secure communication. In all, 70.9% (93/131) of respondents reported having received patient identifiers (first and/or last name), 81.7% (107/131) reported receiving patient initials, and 50.4% (66/131) reported receiving a patient’s medical record number through SMS text messages. Conclusions Residents prefer in-hospital communication through SMS text messaging because of its ease of use and efficiency. Despite security concerns, the majority of residents reported receiving confidential patient information through SMS text messaging. For providers, it is possible that the benefits of improved in-hospital communication with SMS text messaging and the presumed improvement in the coordination and delivery of patient care outweigh security concerns they may have. The tension between the security and convenience of SMS text messaging may represent an educational opportunity to ensure the compliance of mobile technology in the health care setting.
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Affiliation(s)
- Micah T Prochaska
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States.
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Chipidza FE, Wallwork RS, Stern TA. Impact of the Doctor-Patient Relationship. Prim Care Companion CNS Disord 2015; 17:15f01840. [PMID: 26835164 DOI: 10.4088/pcc.15f01840] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/12/2015] [Indexed: 01/10/2023] Open
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Abstract
BACKGROUND Although direct patient care is necessary for experiential learning during residency, inpatient perceptions of the roles of resident and attending physicians in their care may have changed with residency duty hours. OBJECTIVE We aimed to assess if patients' perceptions of who is most involved in their care changed with residency duty hours. DESIGN This was a prospective observational study over 12 years at a single institution. PARTICIPANTS Participants were 22,408 inpatients admitted to the general medicine teaching service from 2001 to 2013, who completed a 1-month follow-up phone interview. MAIN MEASURES Percentage of inpatients who reported an attending, resident, or intern as most involved in their care by duty hour period (pre-2003, post-2003-pre-2011, post-2011). KEY RESULTS With successive duty hour limits, the percentage of patients who reported the attending as most involved in their care increased (pre-2003 20 %, post-2003-pre-2011 29 %, post-2011 37 %, p < 0.001). Simultaneously, fewer patients reported a housestaff physician (resident or intern) as most involved in their care (pre-2003 20 %, post-2003-pre-2011 17 %, post-2011 12 %, p < 0.001). In multinomial regression models controlling for patient age, race, gender and hospitalist as teaching attending, the relative risk ratio of naming the resident versus the attending was higher in the pre-2003 period (1.44, 95 % CI 1.28-1.62, p < 0.001) than the post-2003-pre-2011 (reference group). In contrast, the relative risk ratio for naming the resident versus the attending was lower in the post-2011 period (0.79, 95 % CI 0.68-0.93, p = 0.004) compared to the reference group. CONCLUSIONS After successive residency duty hours limits, hospitalized patients were more likely to report the attending physician and less likely to report the resident or intern as most involved in their hospital care. Given the importance of experiential learning to the formation of clinical judgment for independent practice, further study on the implications of these trends for resident education and patient safety is warranted.
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Affiliation(s)
- Vineet M Arora
- Section of General Medicine, University of Chicago, Chicago, IL, USA,
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Abstract
Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians. Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM) in July and August of 2012. Results. There were 76 medical student responses (26% response rate) and 66 resident/fellow responses to this survey (21% response rate). Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035). The most common reported uses were for accessing medical reference applications (46%), e-Books (45%), and board study (32%). Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010), review radiology images (27% vs. 12%, p = 0.019), and enter patient care orders (26% vs. 3%, p < 0.001). Discussion. This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks. Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on resident physicians. Further study is needed better understand how tablet computers and other mobile devices may assist in medical education and patient care.
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Affiliation(s)
- Robert Robinson
- Department of Internal Medicine, Southern Illinois University School of Medicine , Springfield, IL , USA
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Baysari MT, Adams K, Lehnbom EC, Westbrook JI, Day RO. iPad use at the bedside: a tool for engaging patients in care processes during ward rounds? Intern Med J 2015; 44:986-90. [PMID: 24989476 DOI: 10.1111/imj.12518] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/24/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous work has examined the impact of technology on information sharing and communication between doctors and patients in general practice consultations, but very few studies have explored this in hospital settings. AIMS To assess if, and how, senior clinicians use an iPad to share information (e.g. patient test results) with patients during ward rounds and to explore patients' and doctors' experiences of information sharing events. METHODS Ten senior doctors were shadowed on ward rounds on general wards during interactions with 525 patients over 77.3 h, seven senior doctors were interviewed and 180 patients completed a short survey. RESULTS Doctors reported that information sharing with patients is critical to the delivery of high-quality healthcare, but were not seen to use the iPad to share information with patients on ward rounds. Patients did not think the iPad had impacted on their engagement with doctors on rounds. Ward rounds were observed to follow set routines and patient interactions were brief. CONCLUSIONS Although the iPad potentially creates new opportunities for information sharing and patient engagement, the ward round may not present the most appropriate context for this to be done.
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Affiliation(s)
- M T Baysari
- Centre for Health Systems and Safety Research, University of New South Wales, Sydney, New South Wales, Australia; Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
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Varcadipane JC, Dupaix JP, Nishimura S, Chun M, Scarcella N, Belcher G, Castelo J, Atkinson RE. Mobile computing as a tool in orthopaedic surgery residency training: a pilot study. Current Orthopaedic Practice 2015; 26:376-81. [DOI: 10.1097/bco.0000000000000245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patel RK, Sayers AE, Patrick NL, Hughes K, Armitage J, Hunter IA. A UK perspective on smartphone use amongst doctors within the surgical profession. Ann Med Surg (Lond) 2015; 4:107-12. [PMID: 25905017 PMCID: PMC4404414 DOI: 10.1016/j.amsu.2015.03.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/20/2015] [Accepted: 03/21/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Hospitals are increasingly looking for mobile solutions to meet their information technology needs. Medical professionals are using personal mobile devices to support their work, because of limitations in both time and space. Our aims were to assess smartphone use amongst UK surgical doctors, the prevalence of medical app use and online activity. Methods A thirteen-item questionnaire was derived to identify the proportion of surgical doctors of all grades using smartphones within the workplace. The following factors were evaluated: use of medical apps; use of online medical resources and if users were willing to use their own smartphone for clinical use. Results A total of 341 participants were surveyed with a complete response rate: 93.5% of which owned a smartphone, with 54.2% of those owning medical apps and 86.2% using their device to access online medical resources. Junior doctors were more likely to use medical apps over their senior colleagues (p = 0.001) as well as access the Internet on their smartphone for medical information (p < 0.001). Overall, 79.3% stated that they would be willing to use their smartphone for clinical use, which was found not to be dependent on seniority (p = 0.922). Conclusion Online resources contribute significantly to clinical activities with the majority of smartphone users willing to use their own device. The information gathered from this study can aid developers to create software dedicated to the smartphone operating systems in greatest use and to potentially increase the use of a bring your own device (BYOD) scheme. Doctors use their own mobile devices to support their work due to limitations in time and space. Of those surveyed >90% owned a smartphone. 80% owning smartphones were willing to use their own device within the workplace in a ‘BYOD’ manner. >50% of smartphone users own medical apps and >85% use the Internet to access medical information. It may valuable to further develop software that recognises this potential of mobile access.
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Affiliation(s)
- Rikesh K Patel
- Academic Surgical Unit, Castle Hill Hospital, Castle Road, Cottingham HU16 5RX, England, UK
| | - Adele E Sayers
- Academic Surgical Unit, Castle Hill Hospital, Castle Road, Cottingham HU16 5RX, England, UK
| | - Nina L Patrick
- Wrexham Maelor Hospital, Croesnewydd Rd, Wrexham LL13 7TD, Wales, UK
| | - Kaylie Hughes
- The Royal Liverpool & Broadgreen University Hospitals, Kent Lodge, Broadgreen Hospital, Thomas Road, Liverpool L14 3LB, England, UK
| | - Jonathan Armitage
- Academic Surgical Unit, Castle Hill Hospital, Castle Road, Cottingham HU16 5RX, England, UK
| | - Iain Andrew Hunter
- Academic Surgical Unit, Castle Hill Hospital, Castle Road, Cottingham HU16 5RX, England, UK
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Niehaus W, Boimbo S, Akuthota V. Physical Medicine and Rehabilitation Resident Use of iPad Mini Mobile Devices. PM R 2015; 7:512-8. [DOI: 10.1016/j.pmrj.2015.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 10/24/2022]
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George P, Newey CR, Bhimraj A. The tablet device in hospital neurology and in neurology graduate medical education: a preliminary study. Neurohospitalist 2015; 5:15-21. [PMID: 25553224 DOI: 10.1177/1941874414548802] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE There is limited literature on tablet devices for neurohospitalists and in neurological graduate medical education. This study evaluated utilization, benefits, and limitations of customized tablets on inpatient neurology practice and resident education. The hypothesis was the perception of the tablet would be positive, given their portability, convenience to accessing point-of-care reference, and accessibility to the electronic medical record. METHODS Second-generation iPads with neurology-specific applications and literature were provided to our in-hospital general, stroke, and consult neurology teams. After 1 year, residents on these teams were surveyed on demographic data, familiarity, and utilization of the iPad and their perceptions of the device. RESULTS All 27 residents responded to the survey. Most participants (23 of 27) used a tablet while on inpatient service. Twelve regularly utilized the neurology-specific apps and/or accessed scientific articles. Technologically savvy residents felt significantly more comfortable using tablets and were more quickly acquainted with the features. Thirteen respondents wanted a formal orientation on the advanced features of the tablet independent of their familiarity with the device or level of technological comfort. CONCLUSION Overall, the perception was that the tablet was beneficial for inpatient clinical care and as an educational reference. Participants became easily familiarized with the device features quickly, regardless of whether they owned one previously or not. Most physicians indicated interest in advanced features of tablets; however, a formal orientation may be beneficial for optimal utilization. A reliable network connection is essential to in-hospital use of tablet devices. Additional research pertaining to patient outcomes, objective educational benefit, and cost-effectiveness is necessary.
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Affiliation(s)
- Pravin George
- Cerebrovascular Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Christopher R Newey
- Neurological Intensive Care Unit, The University of Chicago, Chicago, IL, USA
| | - Adarsh Bhimraj
- Department of Infectious Diseases, The Cleveland Clinic Foundation, Cleveland, OH, USA
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Bottiger B, McCartney S, Akushevich I, Nicoara A, Yanamadala M, Swaminathan M. Use of mobile tablet devices and reduction in time to perioperative transesophageal echocardiography reporting: a historical cohort study. Can J Anaesth 2015; 62:31-6. [PMID: 25348162 DOI: 10.1007/s12630-014-0250-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Timely communication of intraoperative transesophageal echocardiography (TEE) findings to the postoperative care team is critical to optimizing patient care. We compared the use of a personal computer (PC) system with the use of a mobile tablet device (MTD) system for point-of-care TEE data entry and hypothesized that the MTD-based system would reduce the time to preliminary TEE reporting and decrease the incidence of delinquent reporting by 50%. METHODS In this historical cohort study, we reviewed 508 perioperative TEE reports entered by cardiothoracic anesthesia fellows. Reports were grouped based on whether data were entered on a PC (PC group) or a MTD (MTD group). Time to TEE reporting was defined as the time from the patient leaving the operating room to the time the TEE report was generated. Delinquent reports were defined as those generated >24 hr after the initial exam. Time to TEE reporting and incidence of delinquent reports were compared between the two groups. RESULTS Mean (SD) time to TEE reporting was significantly improved with MTD data entry vs PC data entry [233 (676) min vs 1,103 (3,830) min, respectively; mean difference 870 min; 95% confidence interval (CI) 293 to 1,448; P = 0.003], and median (IQR) time was also significantly improved [46 (163) min vs 126 (1,000) min, respectively; median difference 80 min; P = 0.0002]. The incidence of report delinquency with MTD data entry vs PC data entry was also significantly reduced [2.1% vs 6.8%, respectively; mean difference 2.2%; 95% CI 0.5 to 9.0; P = 0.02]. CONCLUSION Implementation of a MTD system for data entry leads to improved TEE reporting time and reduces TEE reporting delinquency. Further studies are required to determine whether this strategy enhances quality of reporting, optimizes communication between care teams, and improves outcomes without increasing costs.
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Nuss MA, Hill JR, Cervero RM, Gaines JK, Middendorf BF. Real-time use of the iPad by third-year medical students for clinical decision support and learning: a mixed methods study. J Community Hosp Intern Med Perspect 2014; 4:25184. [PMID: 25317266 PMCID: PMC4185144 DOI: 10.3402/jchimp.v4.25184] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/01/2014] [Accepted: 08/05/2014] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Despite widespread use of mobile technology in medical education, medical students' use of mobile technology for clinical decision support and learning is not well understood. Three key questions were explored in this extensive mixed methods study: 1) how medical students used mobile technology in the care of patients, 2) the mobile applications (apps) used and 3) how expertise and time spent changed overtime. METHODS This year-long (July 2012-June 2013) mixed methods study explored the use of the iPad, using four data collection instruments: 1) beginning and end-of-year questionnaires, 2) iPad usage logs, 3) weekly rounding observations, and 4) weekly medical student interviews. Descriptive statistics were generated for the questionnaires and apps reported in the usage logs. The iPad usage logs, observation logs, and weekly interviews were analyzed via inductive thematic analysis. RESULTS Students predominantly used mobile technology to obtain real-time patient data via the electronic health record (EHR), to access medical knowledge resources for learning, and to inform patient care. The top four apps used were Epocrates(®), PDF Expert(®), VisualDx(®), and Micromedex(®). The majority of students indicated that their use (71%) and expertise (75%) using mobile technology grew overtime. CONCLUSIONS This mixed methods study provides substantial evidence that medical students used mobile technology for clinical decision support and learning. Integrating its use into the medical student's daily workflow was essential for achieving these outcomes. Developing expertise in using mobile technology and various apps was critical for effective and efficient support of real-time clinical decisions.
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Affiliation(s)
| | - Janette R Hill
- College of Education, University of Georgia, Athens, GA, USA
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Lewis TL, Wyatt JC. mHealth and mobile medical Apps: a framework to assess risk and promote safer use. J Med Internet Res 2014; 16:e210. [PMID: 25223398 PMCID: PMC4180335 DOI: 10.2196/jmir.3133] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/11/2014] [Accepted: 04/11/2014] [Indexed: 12/16/2022] Open
Abstract
The use of mobile medical apps by clinicians and others has grown considerably since the introduction of mobile phones. Medical apps offer clinicians the ability to access medical knowledge and patient data at the point of care, but several studies have highlighted apps that could compromise patient safety and are potentially dangerous. This article identifies a range of different kinds of risks that medical apps can contribute to and important contextual variables that can modify these risks. We have also developed a simple generic risk framework that app users, developers, and other stakeholders can use to assess the likely risks posed by a specific app in a specific context. This should help app commissioners, developers, and users to manage risks and improve patient safety.
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Peace JM, Edelson DP. Reply to Letter: Electronic documentation of cardiac arrests. Electronic resuscitation documentation: Tremendous promise with real-world challenges. Resuscitation 2014; 85:e143. [DOI: 10.1016/j.resuscitation.2014.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 11/18/2022]
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Archibald D, Macdonald CJ, Plante J, Hogue RJ, Fiallos J. Residents' and preceptors' perceptions of the use of the iPad for clinical teaching in a family medicine residency program. BMC Med Educ 2014; 14:174. [PMID: 25138307 PMCID: PMC4236569 DOI: 10.1186/1472-6920-14-174] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/05/2014] [Indexed: 05/15/2023]
Abstract
BACKGROUND As Family Medicine programs across Canada are transitioning into a competency-based curriculum, medical students and clinical teachers are increasingly incorporating tablet computers in their work and educational activities. The purpose of this pilot study was to identify how preceptors and residents use tablet computers to implement and adopt a new family medicine curriculum and to evaluate how they access applications (apps) through their tablet in an effort to support and enhance effective teaching and learning. METHODS Residents and preceptors (n = 25) from the Family Medicine program working at the Pembroke Regional Hospital in Ontario, Canada, were given iPads and training on how to use the device in clinical teaching and learning activities and how to access the online curriculum. Data regarding the use and perceived contribution of the iPads were collected through surveys and focus groups. This mixed methods research used analysis of survey responses to support the selection of questions for focus groups. RESULTS Reported results were categorized into: curriculum and assessment; ease of use; portability; apps and resources; and perceptions about the use of the iPad in teaching/learning setting. Most participants agreed on the importance of accessing curriculum resources through the iPad but recognized that these required enhancements to facilitate use. The iPad was considered to be more useful for activities involving output of information than for input. Participants' responses regarding the ease of use of mobile technology were heterogeneous due to the diversity of computer proficiency across users. Residents had a slightly more favorable opinion regarding the iPad's contribution to teaching/learning compared to preceptors. CONCLUSIONS iPad's interface should be fully enhanced to allow easy access to online curriculum and its built-in resources. The differences in computer proficiency level among users should be reduced by sharing knowledge through workshops led by more skillful iPad users. To facilitate collection of information through the iPad, the design of electronic data-input forms should consider the participants' reported negative perceptions towards typing data through mobile devices. Technology deployment projects should gather sufficient evidence from pilot studies in order to guide efforts to adapt resources and infrastructure to relevant needs of Family Medicine teachers and learners.
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Affiliation(s)
- Douglas Archibald
- Department of Family Medicine, University of Ottawa, 43 Bruyère St., Ottawa, ON K1N 5C8, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St., Annex E, Ottawa, ON K1N 5C8, Canada
| | - Colla J Macdonald
- Faculty of Education, University of Ottawa, 145 Jean-Jacques-Lussier Private, Ottawa, Ontario K1N 6N5, Canada
| | - Judith Plante
- Department of Family Medicine, University of Ottawa, 43 Bruyère St., Ottawa, ON K1N 5C8, Canada
- Pembroke Regional Hospital, 705 Mackay St., Pembroke, Ontario K8A 1G8, Canada
| | - Rebecca J Hogue
- Faculty of Education, University of Ottawa, 145 Jean-Jacques-Lussier Private, Ottawa, Ontario K1N 6N5, Canada
| | - Javier Fiallos
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St., Annex E, Ottawa, ON K1N 5C8, Canada
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Tran K, Morra D, Lo V, Quan SD, Abrams H, Wu RC. Medical students and personal smartphones in the clinical environment: the impact on confidentiality of personal health information and professionalism. J Med Internet Res 2014; 16:e132. [PMID: 24855046 PMCID: PMC4051746 DOI: 10.2196/jmir.3138] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/28/2014] [Accepted: 04/27/2014] [Indexed: 11/30/2022] Open
Abstract
Background Smartphones are becoming ubiquitous in health care settings. The increased adoption of mobile technology such as smartphones may be attributed to their use as a point-of-care information source and to perceived improvements in clinical communication and efficiency. However, little is known about medical students’ use of personal smartphones for clinical work. Objective The intent of the study was to examine final-year medical students’ experience with and attitudes toward using personal mobile technology in the clinical environment, with respect to the perceived impact on patient confidentiality and provider professionalism. Methods Cross-sectional surveys were completed by final-year medical students at the University of Toronto. Respondents were asked about the type of personal mobile phone they use, security features on their personal phone, experiences using their personal phone during clinical rotations, and attitudes about using their personal phone for clinical work purposes. Results The overall response rate was 45.4% (99/218). Smartphone ownership was prevalent (98%, 97/99) with the majority (86%, 85/99) of participants using their personal phones for patient-related communication during clinical rotations. A total of 26% (26/99) of participants reported not having any type of security feature on their personal phone, 94% (90/96) of participants agreed that using their personal phone for clinical work makes them more efficient, and 86% (82/95) agreed that their personal phone allows them to provide better patient care. Although 68% (65/95) of participants believe that the use of personal phones for patient-related communication with colleagues poses a risk to the privacy and confidentiality of patient health information, 22% (21/96) of participants still use their personal phone to text or email identifiable patient data to colleagues. Conclusions Our findings suggest that the use of personal smartphones for clinical work by medical students is prevalent. There is a need to more fully address the threat to patient confidentiality posed by the use of unsecured communication devices such as smartphones.
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Affiliation(s)
- Kim Tran
- University Health Network, Centre for Innovation in Complex Care, Toronto, ON, Canada.
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Lin YF, Shie HH, Yang YC, Tseng VS. Design of a real-time and continua-based framework for care guideline recommendations. Int J Environ Res Public Health 2014; 11:4262-79. [PMID: 24743843 DOI: 10.3390/ijerph110404262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 11/16/2022]
Abstract
Telehealth is an important issue in the medical and healthcare domains. Although a number of systems have been developed to meet the demands of emerging telehealth services, the following problems still remain to be addressed: (1) most systems do not monitor/predict the vital signs states so that they are able to send alarms to caregivers in real-time; (2) most systems do not focus on reducing the amount of work that caregivers need to do, and provide patients with remote care; and (3) most systems do not recommend guidelines for caregivers. This study thus proposes a framework for a real-time and Continua-based Care Guideline Recommendation System (Cagurs) which utilizes mobile device platforms to provide caregivers of chronic patients with real-time care guideline recommendations, and that enables vital signs data to be transmitted between different devices automatically, using the Continua standard. Moreover, the proposed system adopts the episode mining approach to monitor/predict anomalous conditions of patients, and then offers related recommended care guidelines to caregivers so that they can offer preventive care in a timely manner.
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Abstract
BACKGROUND Although many medical learners and teachers are using mobile technologies within medical education, there has been little evidence presented describing how they use mobile devices across a whole curriculum. METHODS The Northern Ontario School of Medicine (NOSM) introduced a new mobile device program in 2010. Incoming undergraduate medical learners received a laptop and an iPad and learners entering year three of the four-year program received a laptop and an iPhone. A survey was sent to all learners to gather information on their use of and attitudes toward these devices. A combination of quantitative and qualitative methods was used to analyze the data and to generate a series of themes that synthesized student behaviors, perceptions and attitudes. RESULTS Context and learner autonomy were found to be important factors with learners using multiple devices for different purposes and adopting strategic approaches to learning using these devices. The expectation that school-issued devices would be regularly and enthusiastically used to replace more traditional study media was not reflected in practice. CONCLUSIONS Learners' approaches to using mobile devices are heterogeneous as is the extent to which they use them. Learners adapt their use of mobile devices to the learning cultures and contexts they find themselves in.
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Affiliation(s)
- Lauren Block
- Department of Medicine, Hofstra North Shore-LIJ School of Medicine, 2001 Marcus Ave, Suite S160, Lake Success, NY, 11042, USA,
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Alegría DAH, Boscardin C, Poncelet A, Mayfield C, Wamsley M. Using tablets to support self-regulated learning in a longitudinal integrated clerkship. Med Educ Online 2014; 19:23638. [PMID: 24646438 PMCID: PMC3955768 DOI: 10.3402/meo.v19.23638] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/14/2014] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The need to train physicians committed to learning throughout their careers has prompted medical schools to encourage the development and practice of self-regulated learning by students. Longitudinal integrated clerkships (LICs) require students to exercise self-regulated learning skills. As mobile tools, tablets can potentially support self-regulation among LIC students. METHODS We provided 15 LIC students with tablet computers with access to the electronic health record (EHR), to track their patient cohort, and a multiplatform online notebook, to support documentation and retrieval of self-identified clinical learning issues. Students received a 1-hour workshop on the relevant features of the tablet and online notebook. Two focus groups with the students were used to evaluate the program, one early and one late in the year and were coded by two raters. RESULTS Students used the tablet to support their self-regulated learning in ways that were unique to their learning styles and increased access to resources and utilization of down-time. Students who used the tablet to self-monitor and target learning demonstrated the utility of tablets as learning tools. CONCLUSIONS LICs are environments rich in opportunity for self-regulated learning. Tablets can enhance students' ability to develop and employ self-regulatory skills in a clinical context.
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Affiliation(s)
- Dylan Archbold Hufty Alegría
- Office of Technology Enhanced Learning, School of Medicine, University of California- San Francisco, San Francisco, CA, USA; Research and Development in Medical Education, School of Medicine, University of California-San Francisco, San Francisco, CA, USA;
| | - Christy Boscardin
- Office of Technology Enhanced Learning, School of Medicine, University of California- San Francisco, San Francisco, CA, USA; Research and Development in Medical Education, School of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Ann Poncelet
- Department of Neurology, University of California-San Francisco, San Francisco, CA, USA
| | - Chandler Mayfield
- Office of Technology Enhanced Learning, School of Medicine, University of California- San Francisco, San Francisco, CA, USA; Research and Development in Medical Education, School of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Maria Wamsley
- Department of Internal Medicine, University of California-San Francisco, San Francisco, CA, USA
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Tomasko JM, Adams NE, Garritano FG, Santos MC, Dillon PW. Collaborating to increase access to clinical and educational resources for surgery: a case study. J Surg Educ 2014; 71:32-35. [PMID: 24411420 DOI: 10.1016/j.jsurg.2013.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/06/2013] [Accepted: 03/06/2013] [Indexed: 06/03/2023]
Abstract
A case study is described in which collaborations between a Department of Surgery, a Department of Information Technology, and an academic health sciences library resulted in the development of an electronic surgical library available at the bedside, the deployment of tablet devices for surgery residents, and implementation of a tablet-friendly user interface for the institution's electronic medical record.
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Affiliation(s)
- Jonathan M Tomasko
- Department of Surgery, Penn State Hershey Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Nancy E Adams
- Penn State Hershey George T. Harrell Health Sciences Library, Hershey, Pennsylvania.
| | - Frank G Garritano
- Department of Surgery, Penn State Hershey Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Mary C Santos
- Department of Surgery, Penn State Hershey Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Peter W Dillon
- Department of Surgery, Penn State Hershey Milton S. Hershey Medical Center, Hershey, Pennsylvania
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