To begin talking about the clamor to use technology in our medical school clinical curricula, let’s start by talking about the predecessor to tablet computers, the humble sheet of white paper. It can be big or folded to fit in almost any pocket; edited by anyone with a computer, pen or pencil; lost; shredded to protect information; and it is very cheap (unless you’re a tree). But no one agrees on the best way to use it. How many different slides have you seen printed out on the topic of fluids and electrolytes? How many types of lists and checkboxes have you used since the third year of medical school until now? How useful is someone else’s version of the perfect inpatient service list to you?
So, paper has been around for thousands of years and we can’t agree on the perfect way to use it for teaching or patient care. It should be no surprise that while tablets are cool and exciting, exactly what we will do with them remains in question a few years later. (Although for the nostalgic, you can play a game that simulates crumpling paper and throwing it in a trashcan that is surprisingly addictive.)
The solution for using iPads (most schools favor iOS over Android for this purpose due to control over security and homogeneity) has been to dive in. In 2012 The Ohio State University College of Medicine began supplying iPads to all incoming students, along with the implementation of our new curriculum. When students reached the third year, they changed to iPad Mini’s that fit into the pocket of a white coat (basically). We have used them for mobile access to our learning management system (LMS), electronic medical record (EMR) and assessment.
OSU has used a home-grown LMS for many years (Carmen) and recently developed one specific for the medical school (called VITALS) that integrates calendar, curriculum tracking (linking objectives & teaching methods) and distribution (videos, e-modules). The podcast style videos that we made of our surgery lectures several years ago are there, along with new modules that we created for the new curriculum (e.g., Evaluation of the Acute Abdomen). Those systems are designed to be accessible on the iPads. We encourage students to use time waiting between cases to view those, although from speaking them students that rarely happens. Mobile access to the EMR by students has worked out well with students able to quickly look up information for the team and check on results while on rounds.
The main new use for us with iPads has been in assessment. Our school uses Exam Soft for all testing, which is now available on the iPad. Each week before their didactic time students gather for 30 minutes to take a 6-item quiz on the topic for that day. This makes up a tiny fraction of their grade, but it does help them track their studying and hold them somewhat accountable for preparing for the small group discussion that follows. This requires a proctor both for test security and for troubleshooting software/connectivity issues. We also purchased software called MyProgress that allows us to create checklists and track their completion. For example, we developed an oral presentation checklist that is used during case presentations in small group and on rounds, as well as an abdominal exam checklist that is used in clinic or the ED.
The technical challenges with passing out tablets to hundreds of students (we have about 200 per year) are real but surmountable. Whether we as faculty, with help from our students and residents, can really learn to use them to teach better than we could by handing out paper remains to be seen.