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Page 1: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

Scoping of mobile apps for the education of healthcare

professionals: issues of pedagogy and use

Heather WharradUniversity of Nottingham

Page 2: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

Developing Health andSocial Care learning resources and elearning interventions

Partnerships – HE, FE, NHS Trusts, charities, institutes and EU partners

Research & Evaluationprogrammes

Health E-learning & Media Group

Page 3: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

The Mental Health ActThe Mental Health Act

Reusable learning objects

Page 4: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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

Page 5: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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 16th- January 15th 2012)

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

Page 6: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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

Page 7: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

Smartphone ownershipMedical 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

Page 8: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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

Page 9: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

Ownership of smartphone appsMedical 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

Page 10: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

Types of apps used

Medical students (n=203) Doctors (n=98)

Page 11: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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

Page 12: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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

Page 13: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

Negative aspects of smartphone use for learning in the clinical environmentMedical 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

Page 14: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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’

Page 15: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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

Page 16: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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

Page 17: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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

healthcare professionalsPI: 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 develop4. List of ‘recommended’ apps for the NHS Education

Scotland Effective Practitioner website

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Healthcare & Medical Apps• Apps for HCP education/learning not patient education;

health promotion

• Estimated 17,000 mobile medical apps currently available1

• Downloads to reach 44 Million next year, rising to 142 million in 20161

1. http://juniperresearch.com/mobile_markets_and_strategies

Page 19: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

Apps • 82 apps catalogued • 19 selected for EP websiteAnatomy (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/ExamUltrasound 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

Page 20: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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?

Page 21: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

• 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

Page 22: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

‘Contexts of Learning’Situated, just-in -timelearning - in the workplace

Consolidation of practice by learning – deeper more active engagement. Also reflection, recording and sharing experiences

Pedagogical design

Situated learning

Anytime, anywhere ‘private study’ decoupled from the workplace

Page 23: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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)

Page 24: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

LOAM tool

Page 25: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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

eg Eponyms, HD antibiotics, medical encyclopedia , Epocrates Rx

Page 26: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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 eg Blausen Human atlas; ABG medical calculator, iResus;

Page 27: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

Pedagogy of Mobile apps: Class 3Role

• 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 tasksInteractivity

• Apps contain some activities/assessments• Eg STAT cardiac clearance; ECG Guide, Nurse Central

Page 28: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

Pedagogy of Mobile apps: Class 4Role

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

• - 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 dataInteractivity

• - 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

Page 29: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

Alignment of apps design with the learning context

Page 30: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

Some Conclusions• Smartphones 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.

Page 31: Scoping of mobile apps for the education of healthcare professionals: issues of pedagogy and use Heather Wharrad University of Nottingham

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.


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