e-Learning
Medical students’ online learning technology needs Heeyoung Han, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois Erica Nelson, Department of Obstetrics & Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois Nathan Wetter, Southern Illinois University School of Medicine, Springfield, Illinois
SUMMARY Purpose: This study investigated medical students’ online learning technology needs at a medical school. The study aimed to provide evidence-based guidance for technology selection and online learning design in medical education. Methods: The authors developed a 120-item survey in collaboration with the New Technology in Medical Education (NTIME) committee at the Southern Illinois University School of Medicine (SIUSOM). Overall, 123 of 290 medical students (42%) at the medical school participated in the survey. The survey focused on
five major areas: students’ hardware and software use; perception of educational technology (ET) in general; online behaviours; perception of ET use at the school; and demographic information. Results: Students perceived multimedia tools, scheduling tools, communication tools, collaborative authoring tools, learning management systems and electronic health records useful educational technologies for their learning. They did not consider social networking tools useful for their learning, despite their frequent use. Third-year students were less satisfied with current technology integration in
the curriculum, information sharing and collaborative learning than other years. Students in clerkships perceived mobile devices as useful for their learning. Students using a mobile device (i.e. a smartphone) go online, text message, visit social networking sites and are online during classes more frequently than non-users. Conclusions: Medical students’ ET needs differ between preclinical and clinical years. Technology supporting ubiquitous mobile learning and health information technology (HIT) systems at hospitals and out-patient clinics can be integrated into clerkship curricula.
This study investigates medical students’ online learning technology needs at medical school
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 15–19 15
tct_12092.indd 15
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Students’ daily INTRODUCTION use of technology oday’s students in medical can easily be school are the Millennial repurposed for Generation, having lived in learning the omnipresence of online
T
technology their whole lives. They prefer new media technologies and online learning.1 Their technology-integrated lives create new ways of learning. Although many studies have found positive effects of online learning in medical education,2–4 integration is not simple.5 Medical students’ learning occurs beyond classrooms: in clinics, operating rooms and simulation labs. A technology-needs assessment can provide evidence-based guidance on technology consideration for effective learning, and how it can be integrated into medical curricula. When identifying students’ needs, a pragmatic understanding of how technology is embedded in their lives is necessary. Students’ daily use of technology can easily be repurposed for learning.6 For example, people using YouTube to view movie trailers and music videos can also use it for learning and school projects; however, students’ use of online learning technology is not only determined by perceived easiness,7 but also by usefulness.8 Moreover, the largest determinant to perceived usefulness is subjective, based on social influences and pressure on performance.8 Therefore, it is essential to investigate students’ perception of the usefulness of technology in their learning context. Despite the importance of assessments of educational technology usefulness and need, few empirical studies have been published. The purpose of this study is to investigate medical students’ technology use, online behaviours, and perceived usefulness of technology for their learning. The results could provide evidence-based guidance for
technology selection and online learning design in medical education.
METHODS Participants The research site was the Southern Illinois University School of Medicine (SIUSOM). The school has a problem-based learning (PBL) curriculum, two teaching hospitals and two large multispecialty physician groups. Students learn basic science and clinical knowledge through the PBL curriculum for the first 2 years and six clerkship rotations in the third year. In the fourth year, students participate in additional clerkships, electives and residency planning activities. Educational technology used in the school’s curriculum includes a learning management system (LMS), web email, a curriculum homepage and three electronic health record (EHR) systems. The study was exempt from Institutional Review Board review. A total of 123 (42%) medical students participated in the study. The mean age was 26 years, with 53 per cent males and 47 per cent females. The representation from each year was: 36 students from year 1; 22 students from year 2; 38 students from year 3; 19 students from year 4; and eight students did not provide the training year information. Additionally, 23 graduate non-medical students responded. Needs-assessment survey In collaboration with a committee at SIUSOM we developed a needs-assessment survey, with 120 questions scored on a four-point Likert scale, and with categorical items based on literature regarding learning and living technology and usefulness.6–8 The survey instrument was revised based on feedback and insights from the committee. The survey focused on five major
areas: (1) students’ hardware and software technology use for personal activities, learning or both; (2) perception of technology usefulness for learning; (3) online behaviours; (4) perception of educational technology use at the medical school; and (5) demographic information. Data collection A web-based survey was distributed via e-mail and a student web page. Data were collected over 2 months from March to April 2011. The software package spss was used for quantitative data analysis (PASW Statistics 18).
RESULTS Students’ use of software (Figure 1) and hardware (Figure 2) technologies were identified, and their perceived usefulness of various technologies is categorised in Table 1. They perceived tools for collaborative authoring (Google Docs, wikis), multimedia (podcasts, YouTube), scheduling (Google Calendar), communication (Skype), LMS and EHR as useful for learning. Students did not consider blogging (blogs, RSS feeds, Twitter), social networking (Facebook, LinkedIn) or games useful for their learning. Interestingly, as seen in Figure 1, although Facebook use
16 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 15–19
tct_12092.indd 16
1/6/2014 10:21:28 AM
Email Online conferencing Instant messaging Wikis Google docs
Personal use
Google calendar Audio/video podcasts Learning activities at school
YouTube LinkedIn Facebook
Both
RSS Feeds Twitter Blogs
Do not use
MS Office Other productivity SW Learning management system EHR Games 0%
40%
20%
60%
80%
100%
Figure 1. Students’ usage of software technology
is pervasive for their personal activities, students did not perceive it as useful for learning. The students’ perception of the usefulness of educational technology differed across years. Analysis of variance (ANOVA) and Dunnett’s T3 post-hoc tests showed that medical students in year 2 (p < 0.0001) and year 3 (p < 0.0001) saw Google Calendar as more useful, compared with the rating from students in year 1. Students in year 2 saw wikis as more useful than the rating by students in year 3 (p < 0.001). Year 1 (p < 0.004) and year 2 (p < 0.015) saw LMS as more useful than did year 3. Year 2 (p < 0.003), year 3 (p < 0.011) and year 4 (p < 0.040) saw EHR as more useful than did year 1. Year-3 clerkship students have different perceptions from students in other years. Whereas
most students thought it was easy to access instructional resources, year-3 perceptions were lower than in year 1 (p < 0.016) and in year 4 (p < 0.047). Year-3 students did not perceive that existing technology facilitates the sharing of information as much as year 1 (p < 0.002). They identified less of a collaborative learning community than year 1 (p < 0.021) and year 4 (p < 0.027). Moreover, their perception of faculty member’s use of educational technology for teaching was lower than year-2 students (p < 0.025). They identified a lower self-directed learning atmosphere than year 2 (p < 0.024). Year-3 students perceived a lower integration of appropriate educational technologies in instructional activities than year 1 (p < 0.028). Students believed that mobile learning is beneficial (mean
Laptop computer Desktop computer
Personal use
Tablet computer Cell phone
Learning activities at school
Smart phone Pager
Both
Portable media player Portable E-book readers
Do not use
Digital camera Video camcorder
score = 3.15, SD = 0.74). Moreover, students with clerkship experience strongly agreed that a mobile device can be useful for clerkship learning (mean score = 3.35, SD = 0.71). As seen in Figure 3, most students are active in texting and checking information online. Students using a smartphone showed more frequent online behaviours than those who did not. ANOVA showed that smartphone users were online (F = 17.1, p < 0.00001), texting (F = 11.7, p < −.001), checking information (F = 267.1, p < 0.00001), visiting social networking sites (F = 5.9, p < 0.017) and online during classes (F = 5.6, p < 0.019) more frequently than non-users. The medical students’ preference towards mobile learning was higher than non-medical graduate students (F = 6.34, p < 0.013).
Students want to access learning resources at the point of opportunity during clinical rotations
DISCUSSION Our study showed that year-3 students are less satisfied than other years with the use of educational technology. A factor for this difference may be related to the different curriculum environments and activities between clinical and preclinical learning. Whereas preclinical learning activities and schedules are stable and predictable, learning in clerkships is more individual, opportunistic, unstructured, spontaneous and diverse.9 Teaching and learning moments occur in various places, while students follow attendings and residents. Students must find time for individual study between or after clerkship activities, yet activity schedules change with little notice. Therefore, students want to access learning resources at the point of opportunity during clinical rotations. This requires a more flexible, ubiquitous and just-in-time learning environment for clinical years.
Web cam Handheld game console Video game console 0%
20%
40%
Figure 2. Students’ usage of hardware technology
60%
80%
100%
Mobile learning environments can provide pedagogical potential to enhance clerkship curricula through enhanced flexibility and © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 15–19 17
tct_12092.indd 17
1/6/2014 10:21:30 AM
Integrating mobile technology with appropriate pedagogy can create an effective clinical learning environment
A recent study reported that 64 per cent of the respondent clerkship programmes allowed students to use EHRs either for reading only or for both reading and documentation.11 This study also showed that students in clinical rotations view EHRs as a useful tool for learning. Given these findings, it will be necessary to seamlessly integrate HIT (i.e. EHRs) into the medical curriculum; however, few studies have investigated how hospital HIT systems can effectively be integrated into the medical curriculum. Pedagogical integration of HIT into the medical curriculum should be investigated further.
Table 1. Descriptive statistics of perceived usefulness of technology* n
Mean
SD
109
3.36
0.727
105
2.95
0.859
Messenger
127
1.94
0.859
Online conference (Skype)
130
2.85
0.938
Scheduling tools Google Calendar
111
3.37
0.785
Social networking Facebook tools Linkedln
113
1.99
0.871
102
1.81
0.739
Multimedia/ resource tools
YouTube
116
3.04
0.806
Audio/video podcasts
109
3.25
0.784
Blogs
109
1.99
0.822
RSS feeds
106
2.08
0.813
Microblogging
Twitter
107
1.62
0.709
Entertainment
Games
107
1.69
0.806
Other
Learning 117 management system
3.30
0.746
Electronic 114 health record systems
3.50
0.790
Collaborative Google docs authoring tools Wikis Communication tools
Blogging tools
*Scale: 4, strongly agree; 3, agree; 2, disagree; 1, strongly disagree.
ubiquity of learning. This study showed that students in the clinical learning environment had a strong preference towards mobile learning. In addition, students using a smartphone showed more frequent online behaviours. A recent study also reported a positive effect of mobile devices (tablet computers) on curricula in a residency
programme.10 Considering these findings, integrating mobile technology with appropriate pedagogy can create an effective clinical learning environment. The medical students’ learning environment in clinical settings extends to health information technology (HIT) systems at hospitals and out-patient clinics.
I am online. I am online during classes. I text using my mobile phone.
Always
I check my emails/news using my Smart phone
Often
I visit social networking sites (Facebook).
Sometimes
I blog.
Rarely
I tweet.
Never
I am a technology early adopter. I play video games. 0%
20%
40%
60%
80%
100%
Despite the students’ frequent use of social networking tools,12 these should be carefully considered for medical curriculum. Although a few articles have identified that students have a positive perception of social networking tools for learning,13 our students’ actual use of it for learning appears to be questionable. More rigorous studies are needed to ascertain the effectiveness of social networking tools in medical curriculum while addressing concerns of The Health Insurance Portability and Accountability Act Privacy Rule and online professionalism.14,15 This study has several limitations. First, the findings are based on students’ perceptions rather than objective measures. Actual technology usage should be investigated in future studies. Second, the response rate was relatively low, both the overall response as well as for individual groups by year of training, potentially leading to type-II error. The small sample size may not be sufficient to detect statistical difference. Additionally, the small number of participants in each training year may result in potential type-I error. Therefore, it is recommended to include more subjects in future studies.
Figure 3. Students’ online behaviours
18 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 15–19
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In conclusion, this study highlights that the curricular difference between preclinical and clinical years requires different educational technology design and integration processes. Mobile learning technology environments have pedagogical potential, especially for clerkship curricula, by providing more flexible and ubiquitous learning experiences. Additionally, given that clerkship learning is a transition from classroom learning to workplace learning, the seamless integration of HIT systems from hospitals and out-patient clinics into the medical curriculum is urgently needed. Finally, in the unique situation of clinical learning, which involves the constraints of using sensitive patient information, social networking technologies, despite their popularity among medical students, should be considered with caution in medical curricula. REFERENCES 1. Gormley GJ, Collins K, Boohan M, Bickle IC, Stevenson M. Is there a place for e-learning in clinical skills? A survey of undergraduate medical students’
experiences and attitudes. Med Teach 2009;31:e6–e12. 2. Boye S, Moen T, Vik T. An e-learning course in medical immunology: Does it improve learning outcome? Med Teach 2012;34:e649–e653. 3. Pelayo M, Cebrian D, Areosa A, Agra Y, Izquierdo JV, Buendia F. Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians. BMC Fam Pract 2011;12:37–47. 4. Raupach T, Munscher C, Pukrop T, Anders S, Harendza S. Significant increase in factual knowledge with web-assisted problembased learning as part of an undergraduate cardio-respiratory curriculum. Adv Health Sci Educ 2010;15:349–356. 5. Grant J, Owen H, Sandars J, Walsh K, Richardson J, Rutherford A, Siddiqi K, Ibison J, Maxted M. The challenge of integrating new online education packages into existing curricula: A new model. Med Teach 2011;33:328–330. 6. Hosein A, Ramanau R, Jones C. Learning and living technologies: a longitudinal study of first-year students’ frequency and competence in the use of ICT. Learning, Media and Technology 2010;35:403–418. 7. Lee MKO, Cheung CMK, Chen ZH. Acceptance of Internet-based learning medium: the role of extrinsic and intrinsic motivation. Information & Management 2005;42:1095–1104.
8. Park SY. An Analysis of the Technology Acceptance Model in Understanding University Students’ Behavioral Intention to Use e-Learning. Educational Technology & Society 2009;12:150–162. 9. Smith P, Morrison J. Clinical clerkships: students can structure their own learning. Med Educ 2006;40:884–892. 10. Tanaka PP, Hawrylyshyn KA, Macario A. Use of Tablet (iPad®) as a Tool for Teaching Anesthesiology in an Orthopedic Rotation. Rev Bras Anestesiol 2012;62:214–222.
Curricular difference between preclinical and clinical years requires different educational technology design and integration
11. Hammoud MM, Margo K, Christner JG, Fisher J, Fischer SH, Pangaro LN. Opportunities and Challenges in Integrating Electronic Health Records Into Undergraduate Medical Education: A National Survey of Clerkship Directors. Teaching and learning in medicine. 2012;24:219–224. 12. Sandars J, Homer M, Pell G, Crocker T. Web 2.0 and social software: the medical student way of e-learning. Med Teach 2010;30:308–312. 13. Wells KM. Social media in medical school education. Surgery 2011;150:2–4. 14. Chretien KC, Goldman EF, Beckman L, Kind T. It’s Your Own Risk: Medical Students’ Perspectives on Online Professionalism. Acad Med 2010;85:S68–S71. 15. Lee KL, Ho MJ. Online social networking versus medical professionalism. Med Educ 2011;45:523.
Corresponding author’s contact details: Dr Heeyoung Han, Department of Medical Education, Southern Illinois University School of Medicine, 913 North Rutledge St. PO Box 19681, Springfield, IL 62794–9681, USA. E-mail: [email protected].
Funding: None. Conflict of interest: None. Ethical approval: This study was reviewed by the institutional review board at Southern Illinois University School of Medicine and deemed exempt from ethical review. doi: 10.1111/tct.12092
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 15–19 19
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Medical students’ online learning technology needs Heeyoung Han, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois Erica Nelson, Department of Obstetrics & Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois Nathan Wetter, Southern Illinois University School of Medicine, Springfield, Illinois
SUMMARY Purpose: This study investigated medical students’ online learning technology needs at a medical school. The study aimed to provide evidence-based guidance for technology selection and online learning design in medical education. Methods: The authors developed a 120-item survey in collaboration with the New Technology in Medical Education (NTIME) committee at the Southern Illinois University School of Medicine (SIUSOM). Overall, 123 of 290 medical students (42%) at the medical school participated in the survey. The survey focused on
five major areas: students’ hardware and software use; perception of educational technology (ET) in general; online behaviours; perception of ET use at the school; and demographic information. Results: Students perceived multimedia tools, scheduling tools, communication tools, collaborative authoring tools, learning management systems and electronic health records useful educational technologies for their learning. They did not consider social networking tools useful for their learning, despite their frequent use. Third-year students were less satisfied with current technology integration in
the curriculum, information sharing and collaborative learning than other years. Students in clerkships perceived mobile devices as useful for their learning. Students using a mobile device (i.e. a smartphone) go online, text message, visit social networking sites and are online during classes more frequently than non-users. Conclusions: Medical students’ ET needs differ between preclinical and clinical years. Technology supporting ubiquitous mobile learning and health information technology (HIT) systems at hospitals and out-patient clinics can be integrated into clerkship curricula.
This study investigates medical students’ online learning technology needs at medical school
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 15–19 15
tct_12092.indd 15
1/6/2014 10:21:27 AM
Students’ daily INTRODUCTION use of technology oday’s students in medical can easily be school are the Millennial repurposed for Generation, having lived in learning the omnipresence of online
T
technology their whole lives. They prefer new media technologies and online learning.1 Their technology-integrated lives create new ways of learning. Although many studies have found positive effects of online learning in medical education,2–4 integration is not simple.5 Medical students’ learning occurs beyond classrooms: in clinics, operating rooms and simulation labs. A technology-needs assessment can provide evidence-based guidance on technology consideration for effective learning, and how it can be integrated into medical curricula. When identifying students’ needs, a pragmatic understanding of how technology is embedded in their lives is necessary. Students’ daily use of technology can easily be repurposed for learning.6 For example, people using YouTube to view movie trailers and music videos can also use it for learning and school projects; however, students’ use of online learning technology is not only determined by perceived easiness,7 but also by usefulness.8 Moreover, the largest determinant to perceived usefulness is subjective, based on social influences and pressure on performance.8 Therefore, it is essential to investigate students’ perception of the usefulness of technology in their learning context. Despite the importance of assessments of educational technology usefulness and need, few empirical studies have been published. The purpose of this study is to investigate medical students’ technology use, online behaviours, and perceived usefulness of technology for their learning. The results could provide evidence-based guidance for
technology selection and online learning design in medical education.
METHODS Participants The research site was the Southern Illinois University School of Medicine (SIUSOM). The school has a problem-based learning (PBL) curriculum, two teaching hospitals and two large multispecialty physician groups. Students learn basic science and clinical knowledge through the PBL curriculum for the first 2 years and six clerkship rotations in the third year. In the fourth year, students participate in additional clerkships, electives and residency planning activities. Educational technology used in the school’s curriculum includes a learning management system (LMS), web email, a curriculum homepage and three electronic health record (EHR) systems. The study was exempt from Institutional Review Board review. A total of 123 (42%) medical students participated in the study. The mean age was 26 years, with 53 per cent males and 47 per cent females. The representation from each year was: 36 students from year 1; 22 students from year 2; 38 students from year 3; 19 students from year 4; and eight students did not provide the training year information. Additionally, 23 graduate non-medical students responded. Needs-assessment survey In collaboration with a committee at SIUSOM we developed a needs-assessment survey, with 120 questions scored on a four-point Likert scale, and with categorical items based on literature regarding learning and living technology and usefulness.6–8 The survey instrument was revised based on feedback and insights from the committee. The survey focused on five major
areas: (1) students’ hardware and software technology use for personal activities, learning or both; (2) perception of technology usefulness for learning; (3) online behaviours; (4) perception of educational technology use at the medical school; and (5) demographic information. Data collection A web-based survey was distributed via e-mail and a student web page. Data were collected over 2 months from March to April 2011. The software package spss was used for quantitative data analysis (PASW Statistics 18).
RESULTS Students’ use of software (Figure 1) and hardware (Figure 2) technologies were identified, and their perceived usefulness of various technologies is categorised in Table 1. They perceived tools for collaborative authoring (Google Docs, wikis), multimedia (podcasts, YouTube), scheduling (Google Calendar), communication (Skype), LMS and EHR as useful for learning. Students did not consider blogging (blogs, RSS feeds, Twitter), social networking (Facebook, LinkedIn) or games useful for their learning. Interestingly, as seen in Figure 1, although Facebook use
16 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 15–19
tct_12092.indd 16
1/6/2014 10:21:28 AM
Email Online conferencing Instant messaging Wikis Google docs
Personal use
Google calendar Audio/video podcasts Learning activities at school
YouTube LinkedIn Facebook
Both
RSS Feeds Twitter Blogs
Do not use
MS Office Other productivity SW Learning management system EHR Games 0%
40%
20%
60%
80%
100%
Figure 1. Students’ usage of software technology
is pervasive for their personal activities, students did not perceive it as useful for learning. The students’ perception of the usefulness of educational technology differed across years. Analysis of variance (ANOVA) and Dunnett’s T3 post-hoc tests showed that medical students in year 2 (p < 0.0001) and year 3 (p < 0.0001) saw Google Calendar as more useful, compared with the rating from students in year 1. Students in year 2 saw wikis as more useful than the rating by students in year 3 (p < 0.001). Year 1 (p < 0.004) and year 2 (p < 0.015) saw LMS as more useful than did year 3. Year 2 (p < 0.003), year 3 (p < 0.011) and year 4 (p < 0.040) saw EHR as more useful than did year 1. Year-3 clerkship students have different perceptions from students in other years. Whereas
most students thought it was easy to access instructional resources, year-3 perceptions were lower than in year 1 (p < 0.016) and in year 4 (p < 0.047). Year-3 students did not perceive that existing technology facilitates the sharing of information as much as year 1 (p < 0.002). They identified less of a collaborative learning community than year 1 (p < 0.021) and year 4 (p < 0.027). Moreover, their perception of faculty member’s use of educational technology for teaching was lower than year-2 students (p < 0.025). They identified a lower self-directed learning atmosphere than year 2 (p < 0.024). Year-3 students perceived a lower integration of appropriate educational technologies in instructional activities than year 1 (p < 0.028). Students believed that mobile learning is beneficial (mean
Laptop computer Desktop computer
Personal use
Tablet computer Cell phone
Learning activities at school
Smart phone Pager
Both
Portable media player Portable E-book readers
Do not use
Digital camera Video camcorder
score = 3.15, SD = 0.74). Moreover, students with clerkship experience strongly agreed that a mobile device can be useful for clerkship learning (mean score = 3.35, SD = 0.71). As seen in Figure 3, most students are active in texting and checking information online. Students using a smartphone showed more frequent online behaviours than those who did not. ANOVA showed that smartphone users were online (F = 17.1, p < 0.00001), texting (F = 11.7, p < −.001), checking information (F = 267.1, p < 0.00001), visiting social networking sites (F = 5.9, p < 0.017) and online during classes (F = 5.6, p < 0.019) more frequently than non-users. The medical students’ preference towards mobile learning was higher than non-medical graduate students (F = 6.34, p < 0.013).
Students want to access learning resources at the point of opportunity during clinical rotations
DISCUSSION Our study showed that year-3 students are less satisfied than other years with the use of educational technology. A factor for this difference may be related to the different curriculum environments and activities between clinical and preclinical learning. Whereas preclinical learning activities and schedules are stable and predictable, learning in clerkships is more individual, opportunistic, unstructured, spontaneous and diverse.9 Teaching and learning moments occur in various places, while students follow attendings and residents. Students must find time for individual study between or after clerkship activities, yet activity schedules change with little notice. Therefore, students want to access learning resources at the point of opportunity during clinical rotations. This requires a more flexible, ubiquitous and just-in-time learning environment for clinical years.
Web cam Handheld game console Video game console 0%
20%
40%
Figure 2. Students’ usage of hardware technology
60%
80%
100%
Mobile learning environments can provide pedagogical potential to enhance clerkship curricula through enhanced flexibility and © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 15–19 17
tct_12092.indd 17
1/6/2014 10:21:30 AM
Integrating mobile technology with appropriate pedagogy can create an effective clinical learning environment
A recent study reported that 64 per cent of the respondent clerkship programmes allowed students to use EHRs either for reading only or for both reading and documentation.11 This study also showed that students in clinical rotations view EHRs as a useful tool for learning. Given these findings, it will be necessary to seamlessly integrate HIT (i.e. EHRs) into the medical curriculum; however, few studies have investigated how hospital HIT systems can effectively be integrated into the medical curriculum. Pedagogical integration of HIT into the medical curriculum should be investigated further.
Table 1. Descriptive statistics of perceived usefulness of technology* n
Mean
SD
109
3.36
0.727
105
2.95
0.859
Messenger
127
1.94
0.859
Online conference (Skype)
130
2.85
0.938
Scheduling tools Google Calendar
111
3.37
0.785
Social networking Facebook tools Linkedln
113
1.99
0.871
102
1.81
0.739
Multimedia/ resource tools
YouTube
116
3.04
0.806
Audio/video podcasts
109
3.25
0.784
Blogs
109
1.99
0.822
RSS feeds
106
2.08
0.813
Microblogging
107
1.62
0.709
Entertainment
Games
107
1.69
0.806
Other
Learning 117 management system
3.30
0.746
Electronic 114 health record systems
3.50
0.790
Collaborative Google docs authoring tools Wikis Communication tools
Blogging tools
*Scale: 4, strongly agree; 3, agree; 2, disagree; 1, strongly disagree.
ubiquity of learning. This study showed that students in the clinical learning environment had a strong preference towards mobile learning. In addition, students using a smartphone showed more frequent online behaviours. A recent study also reported a positive effect of mobile devices (tablet computers) on curricula in a residency
programme.10 Considering these findings, integrating mobile technology with appropriate pedagogy can create an effective clinical learning environment. The medical students’ learning environment in clinical settings extends to health information technology (HIT) systems at hospitals and out-patient clinics.
I am online. I am online during classes. I text using my mobile phone.
Always
I check my emails/news using my Smart phone
Often
I visit social networking sites (Facebook).
Sometimes
I blog.
Rarely
I tweet.
Never
I am a technology early adopter. I play video games. 0%
20%
40%
60%
80%
100%
Despite the students’ frequent use of social networking tools,12 these should be carefully considered for medical curriculum. Although a few articles have identified that students have a positive perception of social networking tools for learning,13 our students’ actual use of it for learning appears to be questionable. More rigorous studies are needed to ascertain the effectiveness of social networking tools in medical curriculum while addressing concerns of The Health Insurance Portability and Accountability Act Privacy Rule and online professionalism.14,15 This study has several limitations. First, the findings are based on students’ perceptions rather than objective measures. Actual technology usage should be investigated in future studies. Second, the response rate was relatively low, both the overall response as well as for individual groups by year of training, potentially leading to type-II error. The small sample size may not be sufficient to detect statistical difference. Additionally, the small number of participants in each training year may result in potential type-I error. Therefore, it is recommended to include more subjects in future studies.
Figure 3. Students’ online behaviours
18 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 15–19
tct_12092.indd 18
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In conclusion, this study highlights that the curricular difference between preclinical and clinical years requires different educational technology design and integration processes. Mobile learning technology environments have pedagogical potential, especially for clerkship curricula, by providing more flexible and ubiquitous learning experiences. Additionally, given that clerkship learning is a transition from classroom learning to workplace learning, the seamless integration of HIT systems from hospitals and out-patient clinics into the medical curriculum is urgently needed. Finally, in the unique situation of clinical learning, which involves the constraints of using sensitive patient information, social networking technologies, despite their popularity among medical students, should be considered with caution in medical curricula. REFERENCES 1. Gormley GJ, Collins K, Boohan M, Bickle IC, Stevenson M. Is there a place for e-learning in clinical skills? A survey of undergraduate medical students’
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Curricular difference between preclinical and clinical years requires different educational technology design and integration
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Corresponding author’s contact details: Dr Heeyoung Han, Department of Medical Education, Southern Illinois University School of Medicine, 913 North Rutledge St. PO Box 19681, Springfield, IL 62794–9681, USA. E-mail: [email protected].
Funding: None. Conflict of interest: None. Ethical approval: This study was reviewed by the institutional review board at Southern Illinois University School of Medicine and deemed exempt from ethical review. doi: 10.1111/tct.12092
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