Getting in trouble for mobile medical learning

Last year I gave my brother an iPad for his birthday since he was starting his rotations as a 3rd year medical student and I knew he would be doing more mobile learning since most of his time would be spent in the wards.

He had downloaded medical iBooks and other medical apps to help him on his clerkship rotations and the initial experiences with the iPad were great. He was using a logitech keyboard case (our favorite for physicians) and stated he hardly used his laptop anymore. He said his iPad was great for looking up clinical reference material during and inbetween rounds — enabling him to “learn on the go”.

When I checked in with him during his 3rd clerkship rotation, his enthusiam had markedly dampened.

He told me he had stopped using his iPad in his current rotation — citing a bad evaluation as the reason. When I read the evaluation I was shocked.  Apparently he was “relying on his iPad too much” during clinical rounds to look up information, and not relying enough on textbooks.  So the issue wasn’t looking up information — rather, he was looking up too much “electronic” information.

Reading between the lines, my suspicion is they felt he was using his iPad for “non-medical purposes”.

Obviously, this is just one anedcotal example. But this reminded me of an article I wrote a few months ago titled, “Do you avoid using your iPhone’s medical apps in the hospital for social reasons?”  In the article I discussed the social issues related to using an iPad and iPhone in the hospital. When you pick up a textbook people know exactly what you’re doing: Either pretending to read, or actually learning. When you pick up an iPad during rounds, you could be playing Angry birds or using it for clincal utility.

I’m not sure how to remedy a situation such as this. I think the onus is on the medical school for instilling a culture of mobility — this would prevent medical students and residents from feeling any sort of stigma associated with using mobile devices.


Iltifat Husain, MD

Founder, Editor-in-Chief of Assistant Professor of Emergency Medicine and Director of Mobile App curriculum at Wake Forest University School of Medicine. He is also the founder of iPrescribeApps, a platform for prescribing apps to patients. Dr. Husain has given lectures on digital medicine globally. He went to North Carolina State University for undergrad and went to medical school at Wake Forest School of Medicine.

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13 Responses to Getting in trouble for mobile medical learning

  1. steersbylitning January 20, 2013 at 10:49 am #

    I’m a medical librarian who support several residency programs. On Friday, the director of one of the programs asked that we help the residents get *into* the habit of quickly looking up information to help them during their practice, rather than leaving questions unanswered because it was not convenient to do so at the time. That is the antithesis of what you have reported with your brother’s medical school. The burden should be not on the format of learning material, but whether it is good quality evidence, and whether the answers that are being provided truly answer the question. Using mobile medical apps is truly the best way to get a quick answer, in my opinion. The emphasis needs to be on the quality of the information provided, and luckily, there are many good, evidence-based apps out there.

    • Iltifat Husain, MD January 20, 2013 at 10:52 am #

      great, great, great point! i think in general, a “culture of mobility” is important to foster as well.

  2. Marc-Emile Plourde January 20, 2013 at 5:12 pm #

    This is a multifaceted problem that probably only time will resolve. Lots of MDs tend to perceive electronically retrieved information as inferior to good old print. That being said, I think the main problem here is that people simply DO use their devices for non-medical reasons A LOT during the day.

  3. David Ahn, MD January 20, 2013 at 9:08 pm #

    great post, iltifat. the interesting thing is that I thought that was one of the strengths of the iPad (in that other people can see what you are looking at). Little did I realize that people can judge you even FOR looking up medical information.

    another facet of this is that the testing framework of our profession (step 1-2-3, board exams) seem to hurt those of us who rely more on peripheral brains and mobile references. obviously, there are times where decisions need to be made at the speed of now (CPR, etc), but sometimes I am frustrated by the testing of minutiae and “zebras” on such exams.

  4. Ariella T January 21, 2013 at 1:15 am #

    I’m an inpatient attending and have absolutely no problem at all with a resident or student looking up medically relevant information on their mobile device while on rounds. I also don’t have a problem with them occasionally responding to a personal text message. Even though I’m ancient (i.e., past 50), I love my iPad and my iPhone! And I often use them to look up patient lab values or find out other information during rounds as part of the group process.

    I am bothered when people are constantly looking things up rather than being an active participant in rounds. Sometimes I get the sense that they are doing a google search and being distracted for 90 sec rather than asking a question that I could answer in 5 seconds. It actually makes it harder for me to get a sense of what they do and don’t know, which I guess is their goal. If they were taking time away from the discussion to look up info that was shared with the group and benefitted the care of the patient, I would be more likely to view the distraction as being offset by the benefits to the learning and clinical processes.

    I am also bothered when the team is in the midst of talking with a patient and they are rapidly texting away. Believe me, patients notice when people aren’t paying attention! And they are much less charitable than I would be. In this regard, my standards are no different for electronic media than for someone walking around with a board review book hanging on the end of their nose,

    Above all, I’m bothered by those who are dumb enough to do Facebook, look at risqué photos, play games (not just Angry Birds) and other non-educational activities even when they should realize that I’m able to see their screen!

  5. Warren Wiechmann January 21, 2013 at 3:09 am #

    Great discussion so far and thanks for posting the original article Iltifat. I wholeheartedly believe that the next step to meaningful widespread adoption of technology in medicine is establishing a change in culture. Mobility and other emerging technologies are not going away and for their to be institutional and widespread change, we need to address the medical culture.
    There about 30+ medical schools now adopting mobile platforms in the curriculum and it is great that you’re getting your brother on board as well Iltifat. The next generation of physicians will develop a more technology-infused culture, but what do we do during this transition?
    I have heard a number of these similar stories and it prompted us at UC Irvine to develop a “Mobile Etiquette Checklist” to help students, residents, and attendings help establish a context for device usage to minimize perception problems. Anecdotally it has been quite helpful…we are studying it in clinical practice now.
    Would love to hear feedback on the checklist or other similar anecdotes to Iltifat’s. Here’s the link for more information:

  6. mick January 21, 2013 at 7:34 am #

    i’ve had similar situations as a student myself

    they continue to not infrequently arise during my practice as well

    i’ve become quite sensitive to the perception, and often will inform patients or seniors what i’m doing. working in an informal ED with a decent patient population, they often appreciate a bit of humour when i’m checking a clinical score i’ll tell them i’m checking my facebook status.

  7. Tom Lewis January 23, 2013 at 5:39 am #

    One thing to consider in all this which no-one has mentioned yet is the patient side of things. A quick pubmed search shows there is minimal evidence or research looking into patient perceptions of doctors using mobile devices. It would be interesting to see what patients think of doctors using mobile devices (even if they would never raise the point themselves for fear of offending their doctor!)

    I really like the point by Ariella saying that there are occasions when time is wasted trying to look up an answer that really should be known. I think the key is to find the appropriate balance.

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