Undergraduate medical education: Is there an iPad app for that?
Matthew J E Turnock, MSc*
1. MD Candidate 2014, Faculty of Medicine, University of Toronto, 1 King’s
College Circle, Toronto, ON, M5S 1A8
matthew.turnock@utoronto.ca
Abstract: N/A, News and Views
Introduction
The iPad. By now you have probably seen it in person. Maybe it was only a fleeting
glimpse of silver on the bus. Or perhaps someone close to you has shunned all
contact with the outside world in favor of one more game of Angry BirdsTM. Labeled
Wired Magazine’s “Most Significant Gadget” of 20101, it is impossible to deny that
this touch-screen enabled tablet has made an impact on both techies and
technophobes alike. But does this “gadget” have a significant role to play in the way
medical students are educated? The Stanford School of Medicine2 and UC Irvine
School of Medicine3 seem to think it will. In 2010, both schools awarded all
incoming medical students an iPad loaded with course content as part of two
distinct pilot programs aimed at transforming the way medical education is
delivered. Dr. Charles Prober, Associate Dean for medical education at Stanford
stated “Because the population of new students is extremely tech-savvy, it makes
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sense to teach them through the use of the electronic devices they’re familiar
with…We can either say, ‘That’s silly. They have to learn the old-fashioned way.’ Or
we embrace where they are.”2
The purpose of this article is not to restate the benefit of computers and other
technology in the classroom, there is an entire journal dedicated to that.4 Instead, it
will familiarize the reader with the specific features of the iPad, highlight some of
the device’s capabilities with respect to undergraduate medical education, and
discuss some of the challenge to consider when adopting the iPad as both an
individual and institution. As the iPad is still in its infancy, less than a year old at the
time of writing, much of the information is anecdotal and from the Internet, along
with my own personal experience using the iPad for the past six months as a first
year undergraduate medical student.
Device Features
The iPad is a touch-screen enabled tablet device with wireless Internet capability
through WiFi and 3G. It comes in 16GB, 32GB, or 64GB flash hard drive sizes,
enabling storage and playback of 720p video or audio files through its built-in
speakers. There is also the ability to connect peripheral devices, such as a physical
keyboard, using Bluetooth technology or the proprietary Apple 30-pin connector.5
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Most importantly, an iPad user can customize its functionality in a wide variety of
ways by downloading applications, or “Apps”, from Apple’s online App Store.
Having spoken to many iPad owners, by far the most acclaimed feature of the iPad is
its portability and convenience. Weighing 0.68 kg and measuring 19.0 x 24.3 x 1.3
cm, this device boasts plenty of screen real-estate (a 9.7” display) and the ability to
fit almost anywhere you would carry a paper notebook.5 In fact, one fourth year
student writes that “the iPad should fit comfortably [in] your white coat.”6
Combined with up to 10-hours of active-use battery life5, which I frequently achieve,
and almost instantaneous loading time from sleep-mode, you can pull it out and
have it running faster than any laptop available today.
Technology develops at a rapid rate, and the iPad is no exception. Many common
concerns raised during the initial release of the iPad, such as the inability to run
multiple applications simultaneously (multitasking), lack of Adobe Flash support or
camera have either been addressed or are becoming no longer valid. With the
release of iOS 4, Apple Inc. added multitasking support, and the recent iPad 2
announcement indicates the inclusion of a front and back facing camera. There also
seems to be a decreased reliance on Adobe Flash for web video encoding7,
illustrated by YouTube’s recent shift away from the use of Adobe Flash on its
website. Claims by Encoding.com, a company that encoded over 5 million web
videos in 2009 for websites such as WebMD and MTV, states that Adobe Flash
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requests had declined during that period from 69% to 26%8. This also seems to be
supported by a survey of 30,000,000 web videos on 30,000 web sites emphasizing
the increased use of HTML5 supported H.264 encoded video as an alternative to
Adobe Flash.9
In the Classroom
First, it is important to note that much of the undergraduate medical curriculum at
the University of Toronto is accessible online through recorded lectures,
supplementary readings, and course evaluations. For those who are smartphone
enabled, which appears to be almost every medical student these days, you can
synchronize your personal course timetable to update automatically with your
phone. This level of technological support, however, is not unique to the University
of Toronto. A recent survey of 88 American medical schools found that 97% offered
online course materials, 97% had wireless access, 95% used an electronic course
management system for graduate medical education, such as WebCT and eMed10,
and 90% provided online teaching evaluations.11
Many students have asked if it is possible to take lecture notes on an iPad. A
significant benefit of the iPad is the move towards a life free of paper. In my time as
a medical student, rarely did I have to carry paper copies of lecture or seminar
notes, workbooks, or handouts. All of them are accessible and annotatable as PDFs
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and Word documents on my iPad through the applications like iAnnotate PDF,
GoodReader, Pages, or any number of the many Apps designed specifically for that
purpose. They provide the capacity to edit and highlight text, freehand write and
draw, or type directly on the documents. However, though the device supports
iPad-optimized applications for spreadsheets, word processing, and presentation,
the built-in touch keyboard can take a bit of getting used to. For demanding
keyboard use, there are many physical keyboard accessories available. Best of all is
the absence of heavy textbooks, many of which are becoming available in an
electronic format, or are already optimized for iPad use, such as the Thieme Atlas of
Anatomy12 and Ganong’s Review of Medical Physiology.
The savvy iPad user will also find an abundance of useful (and some not-so-useful)
educational apps, including many popular flashcard sets12, such as the Netter’s
series of flash cards, and online resources that they can access, quite literally, at
their fingertips, such as the MicroMedex drug database and Epocrates. To top it off,
these resources are with me anytime and anywhere I carry my iPad, regardless of
the ability to wirelessly access the Internet. A great resource for those who are
starting out is iMedicalApps13, an online blog website that regularly reviews the
latest applications for both the iPhone and iPad.
As mentioned above, some schools have already adopted the iPad as a new tool for
delivering medical education. The Stanford School of Medicine distributed the iPad
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to 91 first-year medical students “to improve the student learning experience” and
“give students flexible access to the content that they need whether it is a virtual
cadaver in the dissection lab, annotated lecture slides and videos in the classroom,
or journal articles…”.2 UC Irvine School of Medicine pre-loaded their iPads with
handouts, slide presentations, first-year textbooks, as well as audio libraries for
heart and breath sounds and video lectures. 3 Administering examinations has also
been explored as another use for the iPad in the educational setting. A recent article
published in eLearn Magazine describes a mock gross anatomy exam administered
by the Faculty of Medicine at the University of Ottawa using two models of tablet,
one of which was iPad.14 Unfortunately, these programs are still in the initial pilot
phase, and while Stanford has indicated that it will monitor their use through
regular surveys2, it is unclear how the students will use their iPads, whether future
students will receive the same iPad treatment, or whether the programs will reveal
any definitive benefits to students.
Adopting the iPad
Before a student chooses to invest time and money adopting a new technology, both
institutional and personal factors must be addressed. Less support of educational
technology from the school and faculty may mean more effort for a student trying to
integrate the iPad into their everyday learning. A significant roadblock may also be
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encountered if the student is technology-averse or not open to new methods of
learning.
First, your own institution’s specific educational technology services should be
considered. Does the school provide lecture notes online, record lectures, and
provide web-based instructional tools such as histology or gross anatomy tutorials?
The underlying network infrastructure and Internet accessibility are key
components of the successful incorporation of the device into your own learning
workflow. For instance, access to high-speed wireless Internet connectivity, while
not essential, is certainly a substantial component to successful iPad use. Adequate
technical support staff who are familiar with current technologic trends is also
extremely helpful. Souza et al. also found that medical schools with centralized
educational technology support services dedicated to medical students, as opposed
to sharing institution-wide support services, improves teaching and learning using
technology.15
Second, prospective iPad users should consider their own affinity for learning new
technology, as there can be a significant learning curve with the iPad while
discovering its quirks and characteristics. The iPad is not an instant solution; time
must be dedicated for discovering how best to use it alongside your own learning
method. It may also require changing the way you typically do things like taking
notes, watching lectures, and reading textbooks that may be difficult or frustrating
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at first, but becomes increasingly easier and more effective with experience. Be
aware that, in my experience, the iPad has not and cannot replace a home computer,
on which I am currently writing this article.
From an institutional perspective, complete or partial adoption of the iPad should
be considered as more students begin to use them in their everyday lives. Adoption
and support for the iPad can be justified in the same way as other computer
technologies. Greenhalgh16 discusses strong arguments for adopting new
educational technology including its unique presentational benefits, economies of
scale, and competitive advantage afforded students. A review of online computeraided instruction in medical education showed that the greatest educational benefit
comes from learning materials that are not readily available in a printed format, for
instance audio and video samples, and interactive clinical exercises. Simply
reproducing lecture notes in an electronic format showed no performance
improvement.17 They also showed that electronic materials made it possible to
reach a larger audience without increases in cost. 17 This is an important
consideration as more medical schools open satellite campuses. However, true costbenefit ratios are often obscured by hidden costs, is highly individualized, and
dependent on specific changes to educational delivery methods.18 Finally,
integrating the iPad into the educational curriculum could provide a competitive
advantage for graduates, as they have increasingly been used in the clinical setting
for patient records, and patient education19. It has been suggested that as
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technology develops, and is incorporated into common medical practice, curriculum
changes should be made to support students’ educational familiarization with this
technology.20
Institutional technical support must also be adapted to provide opportunities for
students and instructors with various technological backgrounds and comfort levels
to familiarize themselves with the iPad and its use in medical education. A survey of
students for their technology readiness index (TRI)20 by Calson et al.21 found that
rural nurses have a low TRI, male medical students have a greater TRI than female
medical students, and students over 25 years of age have a negative score. This may
suggest the need to tailor technical support and instructional sessions for different
groups. Other studies have also shown that the impact of technology on content
acquisition and higher-order thinking skills among university students was highly
dependent on the strength of teacher leadership, openness to change, and frequency
of interaction with the technology22, 23, all of which may benefit from structured iPad
educational sessions.
Conclusion
There is no doubt that the iPad is an extremely capable and flexible device. Does it
have a significant role to play in medical education? Unfortunately, the iPad is too
new, and the evidence too sparse, to answer that question definitively.
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Furthermore, traditional research tools for evaluating the impact of technology in
medical education are becoming outdated as technology develops24.
While it has certainly made my life more convenient and hassle-free, it would be a
leap to say that it has revolutionized my learning. I continue to remain optimistic,
however, as 2011 seems to be gearing up to be the year of the tablet. The iPad has
already seen use in the operating room25, alongside emerging medical accessories
such as vital signs monitors26, stethoscopes27 and blood pressure cuffs28, 29, which
may herald the beginning of a medical device revolution. Until then, I will be the one
at the back of the class playing Angry BirdsTM on my iPad.
References
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