The use of hand-held Personal Digital Assistants (PDAs) for scheduling, email, note taking and storing addresses and phone numbers, has become increasingly popular in recent years. In May 2001, Harvard Medical School announced that it would be the first educational institution in the US to adopt PDAs as the information standard, in effect entering a post-PC era1. PDAs have the potential to play an important role in curriculum delivery and daily clinical activities of medical students and staff. Their compact size is convenient for clinical students who have to move from location to location to see patients. The PDA can keep them on track and help reduce some of their anxieties so they can focus on learning1.
Although most institutions have based PDA trials on the Palm operating system with PC synchronisation, an attractive alternative is the Pocket Personal Computer (PPC) which uses Microsofts Pocket PC 2002 operating system, and which has a colour screen, large memory capacity for storage and wireless capability. Several medical schools have initiated trials of PDA-based curriculum delivery, but wireless technology and online formative assessments have largely not been assessed. In a pilot project, we evaluated the use of wireless PPCs for medical curriculum delivery and online formative assessment for medical students at the National University Hospital.
Twelve final-year medical students posted to the Department of Neonatology in October 2001 were the first to experience the use of wireless technology in their curriculum. Each student was loaned a PPC at the beginning of the one-week posting in the Department, where a wireless networking point was located. The medical students used HP Jornada 565 PPCs fitted with Ylez compact flash (CF) wireless LAN cards operating on a 802.11b wireless network standard in the 2.4 GHz spectrum, that enabled internet access in defined locations. The PPCs were preloaded with: (1) a posting schedule, (2) pre-tutorial reading materials, (3) objectives for the posting and for each tutorial, and (4) Adobe Acrobat reader. In addition, the PPCs were equipped with wireless email access for each student. The reading materials were designed to promote independent and active learning as well as critical thinking. References were hypertext-linked for direct access on the Internet to facilitate evidence-based learning. The students could print via an infrared-enabled printer. One of the tutorials involved interactive use of the PPCs, in which teaching materials consisting of case scenarios and images in Acrobat format were beamed to students before the session, eliminating the need for a projector and screen.
The students were given a formative assessment at the end of the posting. The assessment consisted of 64 questions in multiple-choice, true-false, match-the-following and image-based formats. A unique single-use password was created for each student. Questions and choices were visible in a single screen navigated by vertical scrolling only. Images were reduced to fit the PPC screen but could be easily enlarged with a screen tap for better resolution. The questions were viewed sequentially in a forward manner but previous questions could be accessed and reviewed randomly. Questions that were skipped were highlighted in a separate row. Before submission, the user was alerted to review the responses. After submission, scores were instantly displayed as percentages. Correct and incorrect answers could be reviewed for learning. A three-point Lickert scale consisting of disagree, agree, or strongly agree, was used to record a post-trial online feedback survey of all students.
The students were extremely enthusiastic about the use of PPCs and the results of the study were very encouraging. All the students agreed that instructions provided for the use of the PPCs were adequate and 83% did not require further assistance. Prior to the study, 75% of the students had been familiar with the use of PPCs. 100% agreed, of whom 42% strongly agreed, that the PPC was useful and convenient for the retrieval of online reading materials compared to a hard copy format. 100% agreed that wirelessly accessible reference materials were timesaving and 83% said that they might not have searched for the reference material, had it not been accessible on the PPC. 100% agreed that having posting schedules on the PPC was very useful. All agreed that the PPC could play an important role in medical education. All twelve students completed the assessment within the stipulated time of one hour. No interruptions in the wireless connection were encountered. All agreed that the questions were navigated with ease, that the physical formatting of multiple choice and true-false questions was good, that the ability to review answers was useful and that they found the PPC an effective learning tool. 92% and 83% agreed that the formatting of match-the-following and image-based questions was good, respectively.
The project was conceived by the Department of Neonatology, which took the initiative in its design and execution. CITA-Med (Centre for IT and Applications Medicine) was involved in the practical aspects of planning and testing software and hardware and their procurement, set-up and maintenance for the project, and funding. The project took seven weeks from planning to execution, including three weeks for writing PPC software to format the questions, which was carried out by Grapevyn, a local software consultancy firm.
The project successfully demonstrated the feasibility and high end-user satisfaction in the use of PDAs for curriculum delivery to medical students. In spite of the smaller display, the easy accessibility of reference material on PDAs may promote student learning. Our pilot project also demonstrated the feasibility of using PDAs in small interactive sessions without the need for a screen projector. The results demonstrated that the wireless PPC can be effectively applied to realise learning paradigms in medical education. We speculate that wireless PPCs can substitute for networked desktop or laptop computers for curriculum delivery, online feedback and formative assessment, while reducing costs and increasing mobility.
- Harvard to Use PDAs in Medical School Training. The Boston Globe. 08 May 2001.
We gratefully acknowledge the excellent technical assistance of Mr Chew Liong Hong, Leo Fern Eke and Zaaba bin Abdul Rahman, CITA-Med, Faculty of Medicine.