[This is a preview of some of the exciting mHealth research being presented at the this week’s Medicine 2.0 Congress on September 15-16. This abstract and others are candidates for the iMedicalApps-Medicine 2.0 mHealth Research Award]

By: Youngsung Lee, Arafeh Karimi, Paul Kim, Eun-jung Lee
iMedicalApps-Medicine 2.0 Award Finalist

Medical students are not only expected to master an enormous body of knowledge, but they also need to achieve high levels of critical thinking and self-assessment to be successful. However, medical academics and practitioners have raised concerns about the low levels of critical thinking and social skills of medical students.

In an attempt to fill this gap, our study analyzed the effects of team-based mobile inquiry-based learning environment on students’ critical thinking and engagement level. Specifically, the study utilized the Stanford Mobile Inquiry-based Learning Environment (SMILE), a mobile-based Multiple Choice Question (MCQ) generator application, to engage medical students in self-assessment and peer assessment through the question solutions and peer ratings.

Many researchers have suggested implementing activities that improve cognitive skills in medical schools. In response to this need, medical schools have adopted learner-centered approaches such as inquiry-based learning and have reported positive changes in students’ performance, engagement, and social and communication skills.

Technology has contributed to a more learner-centered environment in the classroom, but there is a lack of understanding concerning how best to implement new technologies in classrooms. In addition, there is a need to research what social aspects should be taken into account, and how pedagogy, technology and social interactions should be balanced to maximize students’ engagement and learning.

SMILE provides a means by which medical students can create questions, share solutions with their peers and critically evaluate those solutions according to given criteria. The peer review process is purported to have numerous benefits for students, both for those producing the feedback and those who receive the feedback.

The SMILE application is developed in two versions; Ad-hoc and Global. The (SMILE Ad-hoc) operates on the local ad hoc network and is mainly used for the developing world where there is absence of any type of network. The Ad-hoc SMILE enables medical students to engage in SMILE activities and exchange inquiries with peers in their classrooms or own faculty. The (SMILE Global) is the Internet version and operates as a mobile network linked to the Internet. SMILE Global enables medical students and practitioners around the world to exchange their inquiries regardless of their location.

Both SMILE Ad-hoc and SMILE Global allow medical students to incorporate multimedia components in their questions (Images for SMILE Ad-hoc and mages, audio, and video for SMILE Global). The advantages of SMILE Global are that it allows users to generate inquiries using mobile devices without being in the same place at the same time. Moreover, it promotes the exchange of inquiries on common topics from learners of all regions, while still allowing learners to share experiences from their local contexts and cultures.

Both SMILE applications consist of two software elements: 1) a student mobile-based application; and 2) activity management server application run by the facilitator. In each SMILE activity learners pose challenging and media-rich multiple-choice questions on mobile devices and then share these questions with their classmates using the mobile-based application. Learners can then share questions with the entire class and globally using the SMILE activity management application, answer each other’s questions, and rate questions on creativity and depth of analysis required.

This process of sharing-out, serves as a basis for deepening class discussions around difficult concepts and linking material to prior knowledge, real-world applications and outside concepts. The SMILE activity management application also allows faculty members to control the progress of the activity in real time, participate in question generation, and monitor users’ data.

This on-going study investigated the implementation of SMILE Global in a team-based activity in a core medical course at Chungbuk National University Medical School in South Korea with 30 senior medical students and three faculty members. Qualitative and quantitative data were collected through survey and open-ended questions. Students generated questions, and their peer evaluation results were qualitatively analyzed. During the SMILE activity, an evaluation rubric was introduced to the student and the possibilities of using SMILE as an assessment tool was explored in more depth in study results.

The critical thinking level of generated questions was measured using a revised version of Bloom’s Taxonomy. Participants’ engagement level in different collaboration modes has been collected via survey and open-ended questions and further quantitatively analyzed. In addition, students’ and faculty members’ peer evaluation results were analyzed to further investigate the critical thinking level and the quality of generated questions.

Preliminary results revealed a high level of engagement in the team-based collaboration in SMILE activities, whereas critical thinking analysis of generated questions indicated mixed results. Students preferred using web based content instead of their textbooks to understand the topic, but then often used their textbook and group discussions for deeper understanding. Follow up studies showed that by the end of the activity, the students were thrilled with the activity and were pleasantly surprised by how deeply it required them to think about the topic.

Participants’ high level of technology exposure accelerated the process of inquiry generation and interaction with SMILE. Participants spent 60% of the time on inquiry making task. Informing them that there would be global access to their questions was added motivational factor to encourage them to create high quality inquiries.

Participants’ usage of videos to support their SMILE inquiries, and questions’ media richness was another highlight in this experience. However, learners’ overall low-level of English proficiency negatively affected the process, as it slowed down the student inquiry generation process. For future practices usage of an automatic translator of questions would be beneficial for those who speak English as a second language. With easily accessible translation tools, students from all regions will be able to contribute and exchange inquiries freely. For medical students, exchanging inquiries on medical knowledge through a global inquiry exchange tool such as SMILE Global seems like a beneficial avenue for research, particularly for students attending medical schools in the developing world.

In conclusion, SMILE application can be used to facilitate a more engaging student-centered learning environment in medical education classrooms and that it can promote a higher level of critical thinking among students.

Young Sung Lee, MD, PhD, has been leading MedRIC (Medical Research Information Center), a Ministry of Education, Science and Technology funded organization in S. Korea, focusing on research and development in medical informatics, medical data visualization, telematics, Virtual Reality-based medical training, and health communication and promotion policies and programs.

Dr. Lee is Professor, College of Medicine, Chungbuk National University, and has a concurrent office as Director, Division of Cancer Epidemiology and Management, National Cancer Center, taking charge of cancer control policy and management at national level.

Arafeh Karimi is an e-learning specialist. She holds a Master’s degree in multimedia and e-learning technologies and is a research assistant at Seeds of Empowerment organization, a non-profit spin off of Stanford University, School of Education.

Dr. Paul Kim is the Chief Technology Officer for the School of Education at Stanford University. He is currently a senior researcher for Programmable Open Mobile Internet, a National Science Foundation project aimed at developing and evaluating wireless mobile computing and interactive systems for formal and informal learning and assessment scenarios.

Eun Jung Lee, M.D., Ph.D., is an instructor of College of Medicine, Chungbuk National University, specialized in Health policy and management. Dr. Lee is now working on medical informatics and Virtual Reality-based medical training, as a €member of MedRIC (Medical Research Information Center).