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Web Annex B: Health Professionals' Mobile Digital Education

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Web Annex B: Health Professionals' Mobile Digital Education WHO Guideline: Recommendations on Digital Interventions for Health Systems Strengthening Web Annex B: Health professionals’ mobile digital education: a systematic review of factors influencing implementation and adoption (unpublished review) Link to pre-print for publication: http://preprints.jmir.org/preprint/12895 Lall, P., Rees, R.W.1, Law, G.C.Y., Dunleavy, G.2, Cotic, Z., Car, J.2,3 1Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Department of Social Science, UCL Institute of Education, University College London, 18 Woburn Square, London, WCIH0NR, UK; 2Centre of Population Health Services (CePHeS), Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232; 3Faculty of Medicine, School of Public Health, Imperial College London, UK Abstract Background In the past five decades, electronic learning has increasingly been used in health professional education. Mobile learning (mLearning), an emerging form of educational technology using mobile devices, has been used to supplement learning outcomes through enabling conversations, the sharing of information and knowledge with other learners; and, aiding support from peers and instructors regardless of geographic distance. Objectives This review synthesises findings from qualitative or mixed methods studies to provide insight into factors facilitating or hindering implementation of mLearning strategies for medical and nursing education. Methods A systematic search was conducted across a range of databases. Studies were selected on the basis that they were examining mLearning in medical and nursing education, employed a mixed methods or qualitative approach, and were published in English after 1995. Findings were synthesised using a framework synthesis approach. Main results A total of 1946 citations were screened and 47 studies were selected for inclusion. Most evaluated pilot mLearning interventions. Synthesis identified valued aspects of mobile devices related to efficiency and interactive and reflective learning. Also identified were challenges to do with device functionality, learning how to use a device, learning as a professional and within a clinical setting, and the importance of institutional infrastructure and policies. Conclusion The portability of mobile devices makes mLearning unique among forms of eLearning for health professionals; it can enable interactions between learners and educational material, fellow learners 1 WHO Guideline: Recommendations on Digital Interventions for Health Systems Strengthening and educators in a way that is particularly applicable to health professional education, where students are expected to merge training with clinical practice. As with any complex tool used for educational purposes however, devices need to be appropriately incorporated into the structures of academic and medical institutions. Furthermore, learners and educators need support so that they fully comprehend the functions of each mobile device or app used for learning. This study points to strategies to complete these two objectives, such as developing procedural guidance for practice settings, and device training and maintenance services on campus. Systematic review registration This review is registered with PROSPERO – an international prospective register of systematic reviews (record number CRD42016035411).) 2 WHO Guideline: Recommendations on Digital Interventions for Health Systems Strengthening Summary of Qualitative Findings Summary of review finding Device usability Portability means efficiency but also vigilance PL-F1 Enthusiasm for mobile device often centred around time saving that could lead to improved learning, and was more than once summed up with the phrase ‘efficient and effective’ (35, 48). Participants emphasised the speed with which reference material could be retrieved for various purposes (27, 34, 56), but also the quick enabling of dialogue with others (face-to-face as well as virtually), and the rapid storage of material in varied forms (e.g. text and images) for later use (54). In clinical settings students valued being able to reduce their reliance on memory, both of things that needed to be recalled, and of gaps in knowledge that needed to be remedied (39, 49). As one put it, ‘it’s a lot easier [to] look up things there and then instead of trying to remember to go back and read up on it.’ (39) (p927) PL-F2 The portable nature of the mobile device was, also, referred to as a source of vigilance by students and their tutors, who discussed the need for care in surgical or post-operation scenarios and possible electromagnetic interference from devices or the risk of contamination (44, 57, 60). Other potential threats to the device were voiced in terms of loss (11, 39, 59, 68), damage if it was on loan (39) or theft (11), especially as there was a concern that mobile usage itself could “attract thieves” (11, 68). Fit for purpose hardware, software and data PL-F3 Reports of problems attributed to hardware and software were seen in a range of studies. Reported criticisms of hardware included a screen being too small for reading documents (36, 39, 61), devices being ill suited for note taking (24, 32, 38, 60-62) and screens having a poor resolution (51, 61). Size and weight were also emphasised as important for portability (32, 61). PL-F4 Software was not always judged as sufficiently intuitive (11, 26), or could interfere with an important learning task, such as self-assessment (39). The ability of software to transfer and synchronize data or files with a desktop computer or between platforms (27, 61) was given importance in more than one study, as were experiences with technical issues. The latter included devices freezing or stopping (11, 26), the loss of information with system crashes (11, 26, 37), difficulties with attachments or scanning (26, 37) and system incompatibility with platforms or applications (44, 65). Ownership, personalisation and sense of self PL-F5 Despite costs, some students preferred to own devices because this provided opportunities to engage with technology in an informal manner (33, 37), or at times that suited them (27). In one study where devices were provided, learners who already owned a device preferred to continue to use their own (32). Across several studies participants emphasised the value of being able to personalise the learning content (24, 27, 35, 36, 49, 50, 68) or programme layout (26) within mobile devices to suit their own needs. PL-F6 The perceived personal significance of mobile devices for learning is intimated by students using phrases to sum-up PDA or smartphone use such as, ‘a way of life’ (65) pADD) and ‘it is part of my life now’ (53) (:1401), as well as others’ concerns about developing over dependency on their device (11, 27, 32, 33, 56, 59). Linking their device use to their own cognitive capacity, some were concerned about technology failure (11, 59) or that their loss of recall ability would be problematic during exams (32). 1 WHO Guideline: Recommendations on Digital Interventions for Health Systems Strengthening Social Technology Devices can impact on care and learning relationships PL-F7 Although students (32) and tutors (47) noted that use of mobile devices could potentially strengthen communication between clinicians and patients; both these groups expressed a diversity of concerns related to the perceived inhibiting effects of the devices on interactions with patients. Use of mobile devices was seen by trainee doctors and nurses as interfering with activities at the bedside (56, 57), specifically with medical consultations, clinical observations (56), and teamwork (57). Some voiced reservations in using mobile devices in front of patients (11, 40, 56) as they felt ‘rude’ (36, 56, 58), ‘awkward’ (30, 58), were wary of appearing ‘insincere or disingenuous’ (56), or felt discomfort due to a lack of technological skills (24). Not being able to maintain good eye contact with patients was reported as causing difficulties with conversation (56, 58). Consequently, mobile device use presented a challenge to student building of relationships between themselves and other actors (30, 56). Reluctance for device use could remain, despite encouragement from senior clinical staff for device use while with patients (40)- learners in one study described it as a ‘discretionary dilemma’ (67). Devices raise issues of professionalism and practice boundaries PL-F8 Some students feared they would be viewed as unprofessional by either patients or colleagues because devices were perceived as being purely for leisure (11, 30, 33, 39, 56). Some reported concerns that mobile devices were actually being used for non-work-related and recreational purposes during worktime (56, 57). Others, however, perceived that use of mobile devices could strengthen their own professional identity or that of their institution (32) or saw others as competent if they used devices to retrieve information (34) PL-F9 In terms of practice boundaries, there was some discussion of how mobile technology may blur the boundaries between clinicians’ personal and professional spaces through the increased availability of work-related information. One student described colleagues as ‘actual prisoners to their phones’ (56). Negotiating the social aspect of mobile technology PL-F10 Students described how it could help if patients were given explanations for device use (30, 39, 47) and this was also described as helpful for managing
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