Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use

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Nov 12, 2013 (4 years and 1 month ago)

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Scoping of mobile apps for the
education of healthcare
professionals: issues of pedagogy
and use

Heather
Wharrad

University of Nottingham

Developing Health and

Social Care learning
resources and elearning
interventions

Partnerships



HE, FE, NHS Trusts,

charities, institutes and EU
partners

Research & Evaluation

programmes

Health E
-
learning & Media Group

The Mental Health Act
The Mental Health Act
Reusable learning objects

Questions


What is the evidence that smartphones and
apps are being used for learning by healthcare
professionals?


Acceptance of m
-
learning amongst HCPs


Scope and quality of apps available for
learning


Evidence of effectiveness in different learning
contexts

Outline


2 studies

focus on learning in the workplace



Smartphone and app use among medical students and
doctors


small, unfunded, regional study in Trent region



Scoping project to inform the development of mobile
applications for the education of healthcare professionals.
Funded by NHS education Scotland (NES). (December 16
th
-

January 15
th

2012)




Reference to another study ‘Mobile learning for the
NHS’ (Norman, 2011)

Smartphone and app use among
medical students and doctors

PI:

Karl Payne (doctor working in Trent Deanery)

CI: Kim Watts (midwife lecturer)




257 medical students (response rate 15%)



131 junior doctors (22%; 8 different hospitals)



Online questionnaire


use and type of
smartphone
;
ownership and use of apps; types of apps used; time
spent using apps for education/practice purposes


Smartphone ownership

Medical Students (n=257)

Junior Doctors (n=131)

203 (79%)

98 (75%)

115

(57%)

67 (68%)

38 (19%)

17 (17%)

50 (25%)

14 (14%)

Smartphone ownership amongst adults in the general population increased from
13% in 2010 to 31% in 2011

. Ipsos
-
Mori (2011)
http://www.ipsos
-
mori.com/

iPhone




Android




Other

Types of mobile devices used in or outside work

Norman (2011
)

(n=125)

Practitioners

Managers

Mobile phone (no
internet access)

54

29

Mobile phone

(with
internet but kind
unknown)

14

10

iPhone

10 (8%)

5 (17%)

Android smartphone

4 (3%)

2 (7%)

Nokia smartphone

1 (<1%)

1 (4%)

Blackberry

10 (8%)

13 (45%)

Other
eg

ipad
,

Nintendo DS,
itouch
,
3G dongle

24

9

From: ‘Mobile learning for the NHS’ EPIC

Ownership of smartphone apps

Medical Student

(n=203)

Junior

doctor

(n=98)

No apps

20% (41)

25% (24)

1
-
5 apps

52% (106)

51% (50)

6
-
10 apps

17%

(34)

20% (20)

11
-
30+

apps

11% (22)

4.1% (4)


Significantly more males than females owned apps (p<0.05)



iPhone owners were significantly more likely to own apps (p<0.001)



For both groups, the majority of those who use apps use them daily and
the
approx

average time spent in a working day using apps was between 1
and 30 minutes


Types of apps used

Medical students (n=203)

Doctors (n=98)

Future app development

Medical students


Quiz/test app


Timetable linked app


Objectives for
lectures/modules in an app


Revision note app


Logbook


Hospital map


University “to do list” app


Doctors


Antibiotic formulary app


Hospital management
guideline app


Rota and Annual leave app


Electronic patient record
app


On
-
call contact details app


Acute medical/surgical
conditions app


Desired Apps

Medical Students


“I believe smartphone use is ideal
for medical students as it allows
easy access to material within
seconds, which would take longer
searching a textbook. If the
university had an app it would
assist in accessing lecture notes
and enhance student learning”
Student 13



“Revising using an app is easier, in
a car or plane and on holidays”
Student 22


Doctors


“I would use an app with clinical
guidelines that are hospital
specific, including management
advice for common conditions.
This would be very useful on a
busy ward because with only a
few computers it is difficult to get
a monitor when they are needed
for urgent clinical work” Doctor 6



“Please make a hospital app this
will save so much time, we can
actually treat patients and not
spend all day sat at a computer!!”
Doctor 19



Negative aspects of smartphone use
for learning in the clinical environment

Medical students


“I find it very annoying that so
much emphasis is placed on
smartphones, as not everyone can
afford one” Student 45



“I would love to use the BNF on
the iPhone but it is very
expensive!” Doctor 29



“It is difficult to find free or cheap
apps that contain enough
material to last longer than a few
uses, before all the material has
been seen” Student 26


Doctors


“I think it appears extremely rude
both to patient and colleagues to
appear to be looking at your
phone whilst on the ward, as it is
usually misinterpreted as
checking texts or emails” Doctor 8



“The culture of looking lazy or
uninterested by playing on your
phone needs to be overcome.
Once patients and consultants
realise the phone use is work
related I will feel more
comfortable” Doctor 31


Discussion points: Benefits


apps use over a year is 73 hours per clinician


? improved
access to accurate, evidence based information in line with EU
time directive for junior doctors and more time for patient
contact.



Timely learning


apps were providing knowledge at point of
care


also Norman 2011 study


‘reassurance about
professional judgements’



Supported decision making


(drug) reference material



Maximise use of ‘dead time’











Challenges



Still large number NOT using smartphones


Not universal acceptance


This professional group likely to be highest
users (least need for training in Norman study)


Cultural shift


use of mobiles in hospitals;
patients’ views of mobile phone use


Consent, confidentiality


Inequality of access


cost; training need;
resistance


Experience of m
-
learning in interprofessional
healthcare practitioners and managers

70 of 125 respondents had little or no experience of mobile learning (Nov
-
Mar2011)


From: ‘Mobile learning for the NHS’ Norman (2011) EPIC

Practitioners Managers

Scoping project to inform the development
of mobile applications for the education of
healthcare professionals

PI: Charles Crooke RA: Anupama Roy

1.
Scoping of existing mobile applications which are
used for the education of healthcare professionals

2.
Review of the evidence


of app use by
practitioners and perceived benefits of this
technology

3.
Recommendations of new apps to develop

4.
List of ‘recommended’ apps for the NHS Education
Scotland Effective Practitioner website




Healthcare & Medical Apps


Apps for HCP education/learning not patient education;
health promotion




Estimated 17,000 mobile medical apps currently available
1



Downloads to reach 44 Million next
y
ear, rising to 142
million in 2016
1



1. http://juniperresearch.com/mobile_markets_and_strategies

Apps


82 apps catalogued


19 selected for EP website

Anatomy (9)

Calculators
(3)

Cardiology
(7)

Clinical Decision
Support/EBP (2)

Clinical Laboratory
(2)

Diagnostic
(6)

Dictionaries
(4)

Eyecare

(1)

Recording
data (1)

Reference information (19)

Decision Making
(3)

Training/Learning
(18)

Medical
news/Information (1)

Non
-
Clinical Staff/Patient
Interaction (1)

Pharmacology/Drug Reference
(2)

Psychiatry/Mental Health
(2)

Study
Tools/Exam

Ultrasound images (
Sonoaccess
)


Little information on their effectiveness


evaluation restricted to customer
rating scores


Jordan, V (2011)

Useful iphone Apps Guide


Countess of Chester
Hospital Education and
Training Centre Library


Over 200 apps for
clinical/non
-
clinical staff &
Patients



Evidence of Use/Effectiveness


Effective usability and effective engagement


Effective usability


Zhang &
Adipat

(2005)


9
attributes (learnability, efficiency, memorability,
errors, user satisfaction, simplicity,
comprehensibility, learning performance)


Effective engagement


how welcome are
opportunities of such apps within the community:
are they taken up/used frequently?


How do they integrate with
ongoing

practice and
to what benefit for the user at the moment of use, or
in some longer term?



There were
relatively few
studies looking at effective
usability or
engagement in this
population


Effective
engagement needs to
be judged against particular
ecologies of use and cultures of
users


No classification
system for apps
or quality
criteria


‘Contexts of Learning’

Situated, just
-
in
-
time

learning
-

in
the workplace

Consolidation of practice

by learning


deeper more
active engagement.

Also reflection, recording
and sharing experiences

Anytime, anywhere
‘private study’
decoupled from the
workplace

Engagement and m
-
learning

Ready
-
to

hand reference materials valued by learners (Hansen et al 2011)


Learners don’t engage if they have to carry more than one mobile device


Just
-
in
-
time information at point of contact with patients improves
confidence and supports decision making (cited in Norman 2011)


Learners will tend not to carry out substantive study on small screen
devices (Nestel et al, 2010)


Learners will use and value audio modality for ‘anytime anywhere’ study


Learners will use m
-
learning in ‘deadtime’ or on the bus but materials
need to be designed for this purpose ie short nuggets of learning

Mobile apps incorporating blogs and social media to allow timely reflection
on practice along with collaboration with tutors and peers (Boulos &
Wheeler, 2007)


Assessment and reflection through improved access to e
-
portfolios (cited in
Norman ,2011)

LOAM tool


Pedagogy of Mobile apps: Class 1



Interactivity:


Reference
material with little pedagogical structure or
sequencing



Environment:


low
granularity and exclusively text based


searchable databases of static
information



Role:


learner
is passive recipient of information


targeted
at broad groups of health care learners


performance
support; reassurance


e
g

Eponyms, HD antibiotics, medical
encyclopedia

,
Epocrates

Rx


Pedagogy of Mobile apps: Class
2



Interactivity


Some interaction with
the content and/or manipulate
the content


Environment


Reference
materials, question banks, calculators, charts
with minimal or no pedagogical structure


Low granularity but with some multimodal media
richness

eg

short
videoclips

to demonstrate a
skill


Role


Some
pre
-
requisite specialist knowledge

e
g

Blausen

Human atlas; ABG medical calculator,
iResus
;



Pedagogy
of Mobile apps: Class
3




Role


Addresses
a learning issue not always explicitly stated
but implicit in the content
eg

takes the learner through
guidelines


Environment


multimodal media
richness/choice of media to suit
learning styles
eg

podcasts


Minimal scaffolding/feedback
but some sequencing of
learning
tasks


Interactivity



Apps contain some activities/assessments


Eg

STAT cardiac clearance; ECG Guide, Nurse Central


Pedagogy of Mobile apps: Class
4



Role


-
problematized learning goals with tasks that the learner has to
actively
solve


Environment


-

media rich with high quality and appropriate media for knowledge
transfer on a mobile
device


excellent scaffolding, sequencing of tasks and feedback for the skill
level of the learner
eg

small performance support nuggets or
feedback on inputted data


Interactivity


-

interactivities and self
-
assessments appropriate to the learning
tasks


-

-
may
stimulate social learning by linking
to networks of learners or
tutor via blogs or
txts


Eg

ACLS simulator; diagnose the disease game; medical educator


Alignment of apps design with the
learning context

Some Conclusions


S
martphones are being increasingly used for
learning by HCPs


Acceptance of smartphones for learning is not
universal across professional groups


Evidence of the effectiveness of apps for learning is
growing but difficult to interpret because of lack of
classification of apps and the different contexts of
learning.


Principles established in RLO design, pedagogy and
use may transfer to developing content for m
-
learning.


Apps for Effective Practitioner Website



‘3D Brain’ App provides image and reference material for the brain



Muscle in Head and Neck System’ App helps you to memorise the muscles in the head and neck.



Adult Drug Calculations UK is designed for nurses and midwives



ECG Guide is a comprehensive ECG app in the iTunes Store



Heart Murmur Pro App is a heart sound recognition app. available from the iTunes Store.



Medical Lab Tests App covers the most common laboratory tests and their interpretation.



BMI Tool App is a weight management tool



Bio Dictionary developed by the University of Nottingham covers most of general biological terms.



Critical Care ACLS Guide gives immediate access to critical information...



Dynamed

a clinical reference tool created by physicians for physicians and other health care professionals for use primarily
at the 'point
-
of
-
care'.



iMedicalApp

is the leading online destination used by medical professionals for coverage of mobile medical technology and
apps.



iResus

is provided free of charge by the Resuscitation Council (UK) to provide its most up to date guidance in the hands of
those who need it.



Medscape is a medical resource app most used by physicians, medical students, nurses and other healthcare professionals
for clinical information.



Skyscape

is a clinical decision
-
support tool app.



Shoulder Dystocia is an interactive experience, the user is guided through the management of the obstetric emergency



BoardReview

contains 20 electronic review cards that help you learn important drug information on your iPhone or
iTouch

anytime, anyplace.



Student BMJ is a monthly international medical journal for medical students and junior doctors.