Can Tablet Computers Enhance Faculty Teaching?

Transcription

1 Can Tablet Computers Enhance Faculty Teaching? Aditee P. Narayan, MD, MPH Shari A. Whicker, EdD, MEd Robert W. Benjamin, MD Jeffrey Hawley, BS Kathleen A. McGann, MD Abstract Background Learner benefits of tablet computer use have been demonstrated, yet there is little evidence regarding faculty tablet use for teaching. Objective Our study sought to determine if supplying faculty with tablet computers and peer mentoring provided benefits to learners and faculty beyond that of non tablet-based teaching modalities. Methods We provided faculty with tablet computers and three 2-hour peer-mentoring workshops on tabletbased teaching. Faculty used tablets to teach, in addition to their current, non tablet-based methods. Presurveys, postsurveys, and monthly faculty surveys assessed feasibility, utilization, and comparisons to current modalities. Learner surveys assessed perceived effectiveness and comparisons to current modalities. All feedback received from open-ended questions was reviewed by the authors and organized into categories. Results Of 15 eligible faculty, 14 participated. Each participant attended at least 2 of the 3 workshops, with 10 to 12 participants at each workshop. All participants found the workshops useful, and reported that the new tablet-based teaching modality added value beyond that of current teaching methods. Respondents developed the following tablet-based outputs: presentations, photo galleries, evaluation tools, and online modules. Of the outputs, 60% were used in the ambulatory clinics, 33% in intensive care unit bedside teaching rounds, and 7% in inpatient medical unit bedside teaching rounds. Learners reported that common benefits of tablet computers were: improved access/convenience (41%), improved interactive learning (38%), and improved bedside teaching and patient care (13%). A common barrier faculty identified was inconsistent wireless access (14%), while no barriers were identified by the majority of learners. Conclusions Providing faculty with tablet computers and having peer-mentoring workshops to discuss their use was feasible and added value. Editor s Note: The online version of this article contains the learner periodic survey used in the study and a table of faculty feedback regarding tablet-based applications in teaching. Aditee P. Narayan, MD, MPH, is Associate Professor of Pediatrics, Associate Program Director of Duke Pediatric Residency Training Program, Department of Pediatrics, Duke University Medical Center; Shari A. Whicker, EdD, MEd, is Assistant Professor of Medical Education and Faculty Development, Office of ContinuingProfessionalDevelopment, Virginia TechCarilion Schoolof Medicine; Robert W. Benjamin, MD, is Assistant Professor of Pediatrics, Department of Pediatrics, Duke University Medical Center; Jeffrey Hawley, BS, is Analyst/ Programmer II, Duke Office of Clinical Research, Duke University Medical Center; and Kathleen A. McGann, MD, is Professor of Pediatrics, Vice Chair of Education, Office of Pediatric Education, Duke University Medical Center. Funding: The authors report no external funding source for this study. Conflict of interest: The authors declare they have no competing interests. The authors would like to thank the Duke pediatrics faculty, residents, and other learners who participated in this study, and the Duke Office of Clinical Research, including Richard Sloane, MPH. Corresponding author: Aditee P. Narayan, MD, MPH, Duke University Medical Center, DUMC Box 3127, Durham, NC 27710, , aditee.narayan@duke.edu Received August 19, 2014; revisions received December 12, 2014, and January 23, 2015; accepted February 11, DOI: Introduction Mobile technology, including phones, tablet computers (tablets), and other handheld devices, has become an integral part of medicine. 1,2 Learners and faculty alike use mobile technology in patient care, 3,4 and uses include reviewing patient data on rounds, entering orders, and reviewing records. 5,6 In addition to enhancing patient care, mobile technology has been used to facilitate education. Medical and allied health schools have provided tablets to students for their education, 7 9 with demonstrated acceptance of tablets and increased satisfaction with learning. 10,11 Although learner benefits have been demonstrated, and prior studies have assessed faculty perceptions and experience using technology, 12 there is little evidence on the efficacy of faculty use of tablets to teach residents. We conducted a prospective study to determine if supplying faculty with tablets and peer mentoring provided benefits to faculty and learners beyond the current, non tabletbased teaching modality. We assessed feasibility measures, development and use of tablet-based curricula, faculty and learner satisfaction, and barriers to using tablets for teaching. 242 Journal of Graduate Medical Education, June 2015

2 Methods Settings and Participants We used a mixed methods analysis, pre-post design with a purposive sample of Duke pediatrics faculty from September 2012 through October Of 22 eligible rotation directors/core faculty, 15 were invited to participate; those invited best represented various clinical roles and settings. Fourteen agreed to participate, and 1 declined due to competing time commitments. Intervention After providing informed consent, each participant attended a 2-hour orientation workshop and was given a tablet (16GB WiFi ipad 2 or 3). Participants learned basic tablet operation, including how to use features and download applications. Participants were asked to incorporate the tablets into teaching as they saw fit; no set time commitment was required. Tablet-based teaching was to be delivered in addition to our current curriculum, Curriculum Online for Resident Education (CORE), an online repository of educational resources organized in a standardized format for each rotation, developed with direct involvement of the directors and key faculty. CORE includes traditional resources, such as recommended articles, book chapters, videos, slide sets, and web-based modules, 13 and allows flexibility in the selection of instructional methods to meet educational objectives. All participants were familiar with and/or contributed to CORE before this study. Tabletbased teaching had not been a formal part of CORE. In addition to the September 2012 orientation, 2 additional workshops were held in December 2012 and August 2013 based on a peer-mentoring model. 14 Sessions were conducted in the evening and lasted 2 hours. Study leaders and selected participants led each workshop. Participants shared tablet use, identified new applications, and described challenges and successes. The format was a PowerPoint presentation followed by an open questionand-answer discussion. The workshop curriculum is available from the authors on request. Presurveys and postsurveys were administered to faculty before and after the intervention and tracked feasibility, faculty confidence, and barriers in using tablets to teach. We also tracked development of tablet-based curricula (ie, evaluation tools, presentations, online modules) and use of commercial applications. The presurvey also collected demographic information and, using a previously validated instrument, determined participants baseline attitudes toward and experience with computers. 15 Participants were also sent monthly electronic surveys to track the amount and type of tablet-based curricular What was known and gap Tablet computers have become common, yet how they can benefit faculty teaching has not been studied. What is new Providing faculty with tablet computers and peer mentoring for their use was feasible and added value. Limitations Single site, single specialty study reduces generalizability; grant funding for tablet purchase may reduce feasibility in other settings. Bottom line Faculty provided tablet-based teaching and generated educational materials using this modality. Learners valued the enhancement to presentations that were feasible through this technology. outputs over time as well as barriers to using tablets. A minimum of 5 anonymous learner surveys were collected for each participant. At the end of tablet-based teaching sessions, learners were provided with a link to a brief survey. The survey was developed by the authors and the Duke Office of Clinical Research and is available as online supplemental material. Learner surveys assessed perceived effectiveness of tablet-based outputs and value of the tabletbased platform compared with the current teaching modalities. Learners described how the tablet-based platform added value to or detracted from their learning. Learners could decline participation without adverse consequence. Outcomes The following outcomes were measured: feasibility (time, costs, and acceptability of the tablets); description of how the tablets were used to teach (number and type of new outputs); faculty and learner satisfaction with tablet platform; and barriers to tablet-based teaching. Duke University Medical Center s Institutional Review Board deemed this study exempt. Analysis The Duke Office of Clinical Research assisted with independent data collection and statistical analysis, primarily to preserve confidentiality. Study data were collected and managed using REDCap electronic data capture tools hosted at Duke University. 16 Data analyses were conducted individually and in aggregate. All faculty surveys were tracked with confidential identifiers known only to the Duke Office of Clinical Research. All learner surveys were collected anonymously and contained no identifying learner information. All feedback received from open-ended questions was reviewed by the authors and organized into categories. Journal of Graduate Medical Education, June

3 TABLE Samples of Faculty Feedback on How Tablet-Based Teaching Outputs Added Value to the Current Non Tablet-Based Teaching Modalities Output Type Orientation tool Evaluation tool Presentations Online modules Photo galleries Selected Feedback Improved Access/Convenience Brought all of the orientation information together in a usable format. Allowed easier access in clinical settings. Instead of using a computer and logging in, you can pass around an ipad. Offered mobile point-of-care information. Allowed better access to teaching sessions via shared presentation platforms (eg, WebEx and Air Sketch). No comments provided. Allowed quick access to showing interesting case pictures. Supplemented textbook images in a more accessible way. Improved Interactive Learning Medical students and residents use my orientation tool at the beginning of their diabetes rotation. This has been uniformly met with enthusiasm from learners in clinic. They really liked the hands-on approach, touch-screen use, and ability to go at their own pace. They were surprised that such a resource existed. Allowed for collaborative review of evaluation. Students and residents both really enjoy the interactive presentations. I used an open-story format where learners will be directed down a path depending on their answers, thus mimicking real life in clinic. They really liked this approach. They provide a stimulating, interactive, and fun way to learn about visual clinical findings. I was able to prepare a series of schematics and graphs that I could easily use on rounds. I could also mark on these images (ie, whiteboard) to enhance teaching points. Results Fourteen faculty members participated (8 men and 6 women). The mean age was 39 years old (SD 5 9 years), and participants included 5 primary care pediatricians, 4 subspecialists, 2 intensivists, 1 hospitalist, and 1 pharmacist. Settings included 9 outpatient clinics, 3 intensive care units, and 1 inpatient medical unit. Thirteen faculty were familiar with CORE, and 11 reported it to be useful or very useful. Feasibility Measures Each participant attended at least 2 of the 3 workshops, with 10 to 12 participants at each workshop. All workshop attendees reported that the workshops were useful. Grant funds paid for the tablets, applications, and workshop dinners. Each ipad was $499, and applications varied from free to $20. Workshop dinners cost $10 to $15 per person for each workshop. The tablet platform had high levels of acceptability before the study. The majority of the faculty agreed or strongly agreed with statements related to their comfort using technology (mean on a 4-point scale, SD 5 0.6). Ten participants had used tablets previously, but only 2 had used them for teaching. Twelve participants reported increased tablet utilization for teaching by the end of the study. Use of Tablets for Teaching At the end of the study, all participants reported increased confidence in using tablets to teach, and all reported that the platform added value beyond the prior approach. Participants used tablets to design educational materials, including presentations, photo galleries, evaluation tools, and online modules. Products developed by participants were used in the outpatient clinics, intensive care units, and inpatient medical units. Participants also used tablets outside of direct teaching. Participants reported that their tablet-based outputs added value beyond current teaching modalities (T ABLE). At the start of the study, there were a high number of outputs, with continued development/use each month, although the rates were lower for the remainder of the study (F IGURE 1). Applications were found to have varying levels of perceived usefulness (provided as online supplemental material), which included presentation platforms, medical knowledge repositories, video editors, readers, and electronic whiteboards. Learner Satisfaction with Tablet-Based Teaching Participants collected an average of 9.6 learner surveys each (114 overall). Ninety comments were received on how the tablet-based platform added value. The most common themes included improved access/convenience (41%, 37 of 90), improved interactive learning (38%, 34 of 90), and improved bedside teaching and patient care (13%, 12 of 90). For each output, nearly 100% of learners reported that they valued the tablet-based platform over the current teaching modality (F IGURE 2). 244 Journal of Graduate Medical Education, June 2015

4 FIGURE 1 Number of New Outputs Generated by Faculty (in Aggregate) Over Time a Denotes peer-mentoring session months. Initial orientation was held in September FIGURE 2 Learner Preference for Tablet-Based Teaching Outputs Compared to Current Non Tablet-Based Platform Barriers to Tablet-Based Teaching Faculty identified few barriers to tablet use, including inconsistent wireless access (14%, 2 of 14) and concerns regarding theft (14%, 2 of 14). Faculty reported that the initial time investment in identifying new tablet-based outputs was only a barrier at the beginning of the study (21%, 3 of 14). Learner feedback encompassed the following themes: screen size too small for group teaching (20%, 12 of 60 comments received); inconsistent wireless access (12%, 7 of 60); and teaching with the tablets was more time consuming (20%, 12 of 60). No barriers were identified by a majority of the respondents (58%, 35 of 60 comments received). Discussion Our study demonstrated that tablet use was acceptable to and feasible for pediatrics faculty and residents. Although development of new teaching outputs was most prevalent in the beginning of the study, faculty continued to generate new outputs throughout the year. Faculty and residents perceived benefits to teaching via tablets beyond that of other teaching modalities and reported few barriers. Our study is among the first to show perceived benefits of providing faculty with tablets to teach. 7 9 Prior interventions targeting faculty did not necessarily show sustained perceived usefulness of tablets in teaching. 11 Tablet-based teaching may also have been more feasible in the outpatient setting and critical care units compared with inpatient medical units, although our numbers were small. Learners reported benefits in the areas of increased one-onone teaching and focus on different learning preferences. Our study has several limitations, including the fact that it was conducted at a single institution setting, using faculty members already engaged in teaching. It is possible that enthusiasm about new, free technology may have affected perceptions regarding benefits. We supported our Note: Learners reported value only on the outputs with which they were taught. intervention through grant funding, which may not be available at all institutions, thereby reducing feasibility. An additional limitation is that faculty could select which learners participated in the voluntary survey, and participating learners may have had a more positive perception than those who did not participate. Finally, learners may not have interpreted the survey questions as intended. Next steps include training residents in tablet-based teaching, assessing educational outcomes for recipients of tablet-based teaching, training faculty to use tablets in the inpatient medical units, and providing tablets/training to teachers from various health disciplines. Conclusion Providing pediatrics faculty members with tablets and peerbased training increased their use of tablet-based teaching. Learners particularly valued presentations that were enhanced with the use of this modality. Few barriers to use were reported. Providing faculty with tablets and training to enhance medical education may be a worthwhile investment. References 1 Franko O, Tirrell TF. Smartphone app use among medical providers in ACGME training programs. J Med Syst. 2012;36(5): Ventola CL. Mobile devices and apps for health care professionals: uses and benefits. PT. 2014;39(5): Cook DJ, Moradkhani A, Doublas KS, Prinsen SK, Fischer EN, Schroeder DR. Patient education self-management during surgical recovery: combining mobile (ipad) and a content management system. Telemed J E Health. 2014;20(4): Marcano Belisario JS, Huckvale K, Greenfield G, Car J, Gunn LH. Smartphone and tablet self management apps for asthma. Cochrane Database Syst Rev. 2013;11:CD Cummings A, Parker CD, Kwapniowski LA, Reynolds G. Using mobility technology to improve pharmacist workflow in the PICU rounding process. J Healthc Inf Manag. 2008;22(4): Ray SM, Clark S, Jeter JW, Treadway SA. Assessing the impact of mobile technology on order verification during pharmacist participation in patient rounds. Am J Health Syst Pharm. 2013;70(7): Journal of Graduate Medical Education, June

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