How a mobile app supports the learning and practice of newly qualified doctors in the UK: an intervention study

The development of smartphones and tablets with enhanced capacity and function, improved memory, larger screens, the ability to access the internet and download software has resulted in them becoming ever-present within medicine. Through their wide range of uses, including communication, diagnostics, self-monitoring and access to specialist medical software packages or ‘apps’ [1], mobile devices are increasingly employed by medical students and physicians in the workplace [2,3]. Smartphone technology would seem to be part of a technological revolution within medical practice [4]. Identifying and keeping up-to-date with developments in technology to support workplace learning is a key challenge for medical educators. The position and appropriation of technology within the learning sphere is that it should support, serve and develop learning, rather than drive the learning experience [5]. Technology which provides help when needed and is responsive to learners’ developing knowledge and skills can offer a form of dynamic scaffolding [6]. Sfard [7] argues that learners need both to acquire knowledge and participate in learning processes, thereby acknowledging and incorporating the context of learning through participation as well as the individual attainment of knowledge.

The premise that learning entails both knowledge acquisition and participation is central to workplace education and training and is especially relevant at significant points of participatory learning such as during the transition from medical student to newly qualified doctor. The development of learning through the acquisition of explicit knowledge (for example, from textbooks) and processes of learning through participation are both central to the new medical practitioners’ learning experience in the workplace. Mobile technology has the potential to support not only the acquisition of explicit knowledge but also the new doctors’ engagement in the workplace by, for example, supporting their preparation for patient encounters and their dialogue with members of medical teams. However, much of the research on the use of mobile technology is confined to medical curricular and evidence on how mobile resources may support trainee doctors’ learning in the workplace is limited. The pace and spread of developments in mobile technology and medically relevant applications is in stark contrast to the much slower rhythms of research and subsequent publication of evidence.

In this paper we report findings from the evaluation of an intervention which provided newly qualified doctors in Wales with a library of cross-searchable medical texts on their own smartphone devices via an app. The first years of medical practice are a time when rapid access to reliable information resources is essential for learning and practice. While several studies have explored how smartphones can improve communication within education and training, few have considered how smartphones are used as a reference resource within workplace (typically hospital) settings [8].

The main emphasis in current research is on exploring attitudes to smartphone use, estimating the extent and primary purpose of use, and identifying perspectives on potential benefits and challenges [1,9,10]. In terms of availability, there are some differences in the projected numbers of doctors or medical students using mobile technology. One systematic review [11] concluded that within health care, uptake and use of personal digital assistants (PDAs), a forerunner to smartphones, had increased but was variable. More recently, high rates of smartphone ownership amongst medical students and junior doctors have been reported [12]. Another study [13] found high usage, with 77% of medical students in Monash University, Australia, owning a smartphone, of which 76% used medical apps. Students were identified as having positive opinions about smartphones, with the conclusion that smartphone devices have the potential to play a significant role within medical education. A review of the literature on use of PDAs by health professionals and medical students also reported a positive attitude towards their use in medicine [14] and another review found evidence of clinicians making effective use of handheld devices to access information and guidelines and improve diagnostic decisions [15].

The repeated message from research is widespread support for the use of smartphones within medicine. However, the availability of mobile technology does not equate to it being used to enhance learning and training. Concerns have been expressed about the potential of mobile devices to cause doctor distraction [16] and dependency on technology and its use as a substitute for critical clinical thinking [12,17]. The widespread informal use of mobile technology in medical education and the difficulties of researching formal use make it hard to assess benefits to learning and training. Practical barriers to smartphone use have also been recognised including: cost, availability of technology, effective monitoring of use and problems of synchronisation with alternative resources [12].

Although we know a lot about medical students’ and doctors’ views on use of mobile devices in the support of learning, less is known about how they are actually used by newly qualified doctors in practice. In a previous phase of our project, we documented that having access to a smartphone library of medical texts improved user confidence and enhanced patient care [18]. In this article we contribute to the field by examining how smartphones are used in relation to other types of resources available in the workplace and report changes in their use over time. We also consider the perceived need for smartphones in the workplace and how at ease the participants’ felt on using the device in front of patients and ward staff.