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Leeds School of Medicine changes learning culture with work-based iPhone devices

iPhone devices at the school of medicine help give students more training, feedback, and resources.

How do medical students get most learning value from working in distant doctors’ surgeries and on busy hospital wards? Away from campus for weeks on end, students on clinical placement can lose touch with tutors. Clinicians rarely have long-term contact with students, and may not have the resources to advise them. Students can’t carry around medical textbooks, and free computers are hard to find.

Leeds University’s School of Medicine has a radical solution to an age-old problem. Personal iPhones give in-practice students anywhere access to learning resources and fast online feedback. The effects are far-reaching, say tutors. Students are taking more responsibility for building lifelong skills and knowledge. Relationships between students, clinicians, and academic staff could be changing forever.

“Working with patients and health professionals in the community is critical experience for medical students, and forms a lengthy part of their training,” says Dr Richard Fuller, Director of the MBChB medical degree course at Leeds School of Medicine. “Capturing that experience, and helping students learn from it, has always been a major challenge.”

“The iPhone is much more than an easy communication tool for students off campus. It helps capture in-practice experience, and immediate and meaningful assessment from clinicians, patients, and tutors — using simple app forms. Students can then track performance over time and make informed decisions about how to improve their capabilities. Students, clinicians, and patients are now a truly tripartite collaboration of medical learning — a real change in our culture.”

iPhone offers access to information

In-practice learning and assessment has long been a focus area for Leeds School of Medicine and its staff. It heads the Assessment and Learning in Practice Settings (ALPS) group of universities and health professionals, encouraging evaluation of new ideas about how to assess students in work-based practice. Gareth Frith, Technology Enhanced Learning Manager, explains why in-practice issues are so compelling today:

“When they are in work-based practice, 4th-year students are only in the School one day a week, and 5th-year students twice a term. So it is very important that they have the right framework for learning off campus. Yet assessment has often been a piece of paper from the clinician, saying the student has passed or failed a part of the course. That might have been written days after seeing the student — when the clinician finally had time to do the paperwork. It gave the student and tutor little information about what skills needed to be strengthened.

“This has become a growing problem as tutors try to assess so-called ‘soft’ competencies — communication, ethical practice, and team-working skills, for example. Tutors need more than scraps of paper to understand and help improve student performance in these areas.

“Another new problem for students off campus is how they get access to medical textbooks. The days are past when they could carry around a prescribing manual in the pocket of their hospital ward coats. Hygiene demands have put an end to that. So students have relied on accessing resources through shared in-practice computers, but those computers are often busy.”

The App Store offers the relevant content

Looking for solutions to these issues, Leeds School of Medicine explored how emerging mobile technology could help students off campus. Early PDAs were trialed, and despite the limits of their technology, they offered potential value in a number of areas.

“Out of our PDAs study came the idea of an e-portfolio for students, where clinician assessment reports could be sent online and students could build their own learning database,” says Gareth Frith.

“We also looked at new online processes to make assessment faster, easier, and more interactive. The problem at the time was that 2G devices were slow, and speed was a big barrier to progress. We wanted to capture near-patient experience, and the clinician’s response to a student’s performance there and then — not later in the day, when fine detail could be forgotten.”

Developments in 3G smartphones and Apple’s App Store revolution were what Gareth describes as “a technology catalyst for changing behavior”. The School of Medicine assessed a number of devices, and quickly made a groundbreaking decision. A personal iPhone was supplied to each of its 520 4th- and 5th-year students.

“We chose the iPhone because it was so flexible for creating a comprehensive learning solution,” Gareth says. “It was also easy to use and engaging for students, and that was very important. If the device was going to be a vital tool for learning, we had to be sure students would want to use it, not leave it uncharged in the bottom of a bag.

“Another key benefit was that the iPhone’s sleek design meant it could be kept clean in the patient environment by using simple antiseptic wipes — unlike notepads, loose-leaf folders, and textbooks, which can harbor germs. Added to all that, the Apple App Store was growing rapidly, and many medical apps were starting to be developed. So the iPhone became the ideal platform for us.”

Students value a new learning environment

The School worked with third parties to build a preloaded learning infrastructure for the iPhones, based on the ALPS assessment suite. There are assessment apps, with easy-to-use forms for clinicians to complete quickly and easily in collaboration with the student being assessed. It created self-testing apps for students to monitor their own progress in specialist areas, and apps for students to capture and report on their own in-practice experience.

Another key element of the iPhone project is medical content. Students can buy or download other relevant medical apps, recommended by clinicians, tutors, and peers.

The School sources the iPhone, and contracts it to the student as a loan. It provides unlimited mobile broadband connection so students can easily stay in email contact with tutors. The School protects its budget by requiring students to pay for their own voice and SMS charges.

The iPhone has now been used by 4th- and 5th-year students for a complete academic year. Responses from students, staff, and clinicians are strongly positive.

“Seriously impressive”

According to 4th-year student Prab Kler, the iPhone provides immediate assessment from clinicians she is working with, adding powerful learning value to her in-practice experience. It also gives her easy access to a wide range of resources for her own research.

“Before we had the iPhone off campus, you would write down things in a notebook that you wanted to know more about, and look them up at home or when you were next in the library — but by then, the urgency and importance could well be gone. Now you can just look up what you need on the iPhone app at a convenient moment, much more quickly.”

Fellow 4th-year student Adam Grice says that the iPhone’s versatility makes using it in-practice “seriously impressive”.

“The things you can do and the speed you can do them makes it fantastic as a tool — whether I need to get onto the Internet to look things up, use the books we have preloaded, or email my tutor. It’s made me realize how easy it was to waste learning opportunities working in-practice in the past. I can now capture in my e-portfolio what I need to learn more about. That might be in the form of assessments, or even little notes I send to myself. It really helps with revising for exams too.”

iPhone offers a platform for lifetime learning

Dr Richard Fuller is both a clinician and a senior member of the academic staff, and therefore sees the in-practice mobile project from both sides. After only one year, he is certain that it heralds a transformation in relationships. Clinicians are working more closely with students and their tutors, and are getting much more engaged in the learning process. He believes it is an important development for the future of medicine.

“Students need to absorb a basic core of today’s available medical knowledge, and we all need to prepare doctors for a lifetime of learning complex skills,” he says. “That requires much greater collaboration between all parts of the curriculum, and between students, health service professionals, and academic staff.”

It also requires students to take a strong lead in their own learning process, not wait to be told what they need to know. “More and more, medical education understands students need to recognize how and when to say ‘I need help with this’,” Dr Fuller says. “We need to reshape what medical learning is all about, how and where to find new knowledge and apply this to patients. The iPhone is the start of a long process, but it’s an important start.”

Gareth Frith says the School is already planning ahead. A new learning suite app will help tutors build their own assessment processes. The university is in talks with Apple about becoming an iTunes U provider to distribute medical learning content. The School will develop a mobile portal to extend ease of use for students working in-practice.

Most importantly, technology-enhanced learning now underpins the School’s MBChB medical degree curriculum. “It is reshaping assumptions about the methods of preparing tomorrow’s doctors,” Dr Fuller says.

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