Christoph Pimmer

Mobile learning in resource-constrained environments: A case study of medical education

Background: The achievement of the millennium development goals may be facilitated by the use of information and communication technology in medical and health education. Aims: This study intended to explore the use and impact of educational technology in medical education in resource-constrained environments. Methods: A multiple case study was conducted in two Nepalese teaching hospitals. The data were analysed using activity theory as an analytical basis. Results: There was little evidence for formal e-learning, but the findings indicate that students and residents adopted mobile technologies, such as mobile phones and small laptops, as cultural tools for surprisingly rich ‘informal’ learning in a very short time. These tools allowed learners to enhance (a) situated learning, by immediately connecting virtual information sources to their situated experiences; (b) cross-contextual learning by documenting situated experiences in the form of images and videos ─ and re-using the material for later reflection and discussion and (c) engagement with educational content in social network communities. Conclusion: By placing the students and residents at the centre of the new learning activities, this development has begun to affect the overall educational system. Leveraging these tools is closely linked to the development of broad media literacy, including awareness of ethical and privacy issues.

Contextual dynamics in clinical workplaces: learning from doctor–doctor consultations

Medical Education 2013: 47: 463–475

Reframing clinical workplace learning using the theory of distributed cognition.

In medicine, knowledge is embodied and socially, temporally, spatially, and culturally distributed between actors and their environment. In addition, clinicians increasingly are using technology in their daily work to gain and share knowledge. Despite these characteristics, surprisingly few studies have incorporated the theory of distributed cognition (DCog), which emphasizes how cognition is distributed in a wider system in the form of multimodal representations (e.g., clinical images, speech, gazes, and gestures) between social actors (e.g., doctors and patients) in the physical environment (e.g., with technological instruments and computers). In this article, the authors provide an example of an interaction between medical actors. Using that example, they then introduce the important concepts of the DCog theory, identifying five characteristics of clinical representations—that they are interwoven, co-constructed, redundantly accessed, intersubjectively shared, and substantiated—and discuss their value for learning. By contrasting these DCog perspectives with studies from the field of medical education, the authors argue that researchers should focus future medical education scholarship on the ways in which medical actors use and connect speech, bodily movements (e.g., gestures), and the visual and haptic structures of their own bodies and of artifacts, such as technological instruments and computers, to construct complex, multimodal representations. They also argue that future scholarship should “zoom in” on detailed, moment-by-moment analysis and, at the same time, “zoom out” following the distribution of cognition through an overall system to develop a more integrated view of clinical workplace learning.

Towards Work-Based Mobile Learning: What We Can Learn from the Fields of Work-Based Learning and Mobile Learning

Mobile devices are increasingly being used to support learning in work contexts. In exploring the emerging field of work-based mobile learning WBML, researchers need to give consideration to the theoretical and empirical findings from mobile and work-based learning. In this paper, the authors provide an overview of key issues and dominant debates in these fields with the aim of providing a systematic introduction for mobile learning researchers interested in exploring the use of mobile devices for learning in work-based contexts. This papers focus is aimed at scoping possible commonalities across mobile and work-based learning in order to establish a baseline for future conceptual work in empirical research towards WBML.

Smartphones as multimodal communication devices to facilitate clinical knowledge processes: randomized controlled trial.

Background Despite the widespread use and advancements of mobile technology that facilitate rich communication modes, there is little evidence demonstrating the value of smartphones for effective interclinician communication and knowledge processes. Objective The objective of this study was to determine the effects of different synchronous smartphone-based modes of communication, such as (1) speech only, (2) speech and images, and (3) speech, images, and image annotation (guided noticing) on the recall and transfer of visually and verbally represented medical knowledge. Methods The experiment was conducted from November 2011 to May 2012 at the University Hospital Basel (Switzerland) with 42 medical students in a master’s program. All participants analyzed a standardized case (a patient with a subcapital fracture of the fifth metacarpal bone) based on a radiological image, photographs of the hand, and textual descriptions, and were asked to consult a remote surgical specialist via a smartphone. Participants were randomly assigned to 3 experimental conditions/groups. In group 1, the specialist provided verbal explanations (speech only). In group 2, the specialist provided verbal explanations and displayed the radiological image and the photographs to the participants (speech and images). In group 3, the specialist provided verbal explanations, displayed the radiological image and the photographs, and annotated the radiological image by drawing structures/angle elements (speech, images, and image annotation). To assess knowledge recall, participants were asked to write brief summaries of the case (verbally represented knowledge) after the consultation and to re-analyze the diagnostic images (visually represented knowledge). To assess knowledge transfer, participants analyzed a similar case without specialist support. Results Data analysis by ANOVA found that participants in groups 2 and 3 (images used) evaluated the support provided by the specialist as significantly more positive than group 1, the speech-only group (group 1: mean 4.08, SD 0.90; group 2: mean 4.73, SD 0.59; group 3: mean 4.93, SD 0.25; F 2,39=6.76, P=.003; partial η2=0.26, 1–β=.90). However, significant positive effects on the recall and transfer of visually represented medical knowledge were only observed when the smartphone-based communication involved the combination of speech, images, and image annotation (group 3). There were no significant positive effects on the recall and transfer of visually represented knowledge between group 1 (speech only) and group 2 (speech and images). No significant differences were observed between the groups regarding verbally represented medical knowledge. Conclusions The results show (1) the value of annotation functions for digital and mobile technology for interclinician communication and medical informatics, and (2) the use of guided noticing (the integration of speech, images, and image annotation) leads to significantly improved knowledge gains for visually represented knowledge. This is particularly valuable in situations involving complex visual subject matters, typical in clinical practice.

The convergence of mobile and social media: Affordances and constraints of mobile networked communication for health workers in low- and middle-income countries

The increasing convergence of mobile and social media is highly transformational because it is shifting the dominant form of digital communication from bilateral towards mobile and networked communication among distributed interactants. This paper explores the affordances and constraints of this dynamics for global health in low- and middle-income countries (LMICs). In these settings, research and practice have focused on one- or two-way communication designs and on approaches that position health workers as passive actors. To extend current views, three domains of mobile social media usage are theorized: (a) sociocognitive learning; (b) Sociocultural professional participation; and (c) Concertive peer and multistakeholder control. The theoretical discussion is illustrated with empirical examples from a nonsystematic literature review to account for the wide and interdisciplinary problem space. In the second part of this analysis, suggestions are discussed regarding how to anchor and facilitate mobile social media spaces within existing institutional structures. Finally, this paper argues that leveraging the affordances of mobile social-media-based communication requires the consideration of several constraints and challenges, including the economics of participation, privacy and surveillance, regulation and information quality, equal sociocultural participation, and technical competencies and professionalism.

Using mobile phones and social media to facilitate education and support for rural-based midwives in South Africa

Background Empirical studies show the value of mobile phones as effective educational tools to support learning in the nursing profession, predominantly in high income countries. Problem statement The rapidly increasing prevalence of mobile phone technology in Africa nourishes hopes that these tools could be equally effective in lowly resourced contexts, specifically in efforts to achieve the health-related Millennium Development goals. The purpose of this study was to investigate the perception and use of mobile phones as educational and professional tools by nurses in lowly resourced settings. Methodology A quantitative survey using self-administered questionnaires was conducted of rural advanced midwives. Results Fifty-six nurses (49.6%) from the 113 rural-based midwives attending an advanced midwifery training programme at the University of KwaZulu-Natal, South Africa, filled in a questionnaire. The results showed that, whilst nurses regarded their technology competences as low and although they received very little official support from their educational and professional institutions, the majority frequently used mobile functions and applications to support their work and learning processes. They perceived mobile devices with their voice, text, and email functions as important tools for the educational and professional activities of searching for information and engaging with facilitators and peers from work and study contexts. To a lesser extent, the use of social networks, such as WhatsApp and Facebook, were also reported. Conclusion and recommendation It is concluded that educational institutions should support the appropriate use of mobile phones more systematically; particularly in relation to the development of mobile network literacy skills.

Mobile learning as boundary crossing: an alternative route to technology-enhanced learning?

ABSTRACT This paper examines digital and mobile learning that goes beyond bounded communities and closed domains. While recent work from the field of mobile learning has emphasized the importance of learning across “contexts,” little analytical attention has been paid to the underlying dynamics of this phenomenon. To illuminate this, the four learning mechanisms of identification, coordination, reflection and transformation from the framework of boundary crossing are linked with mobile learning practices. It is argued that mobile phones and specifically mobile social media serve as boundary crossing tools: tools that are used by learners to generate multimodal representations that reflect their experiences and identities, and to share them across their digital and non-digital social networks. The four learning mechanisms are facilitated by the learners’ engagement with more heterogeneous and peripheral spaces of their social networks in ways not previously possible.

Facilitating professional mobile learning communities with instant messaging

Abstract Although Mobile Instant Messaging (MIM) is a massive communication phenomenon and its educational use can be seen as a genuine form of mobile learning, it has been studied to a limited extent to date. The present study examined the use of MIM to engage young professionals in mobile learning communities during their school-to-work transition. This transition is one of the most central but also challenging developmental phases marked by the experience of knowledge gaps and a lack of belonging. To assess knowledge and socio-professional learning effects associated with the use of MIM, this study adopted a quasi-experimental, survey-based approach with an intervention and control condition (n = 114) in the setting of an international research project. In the intervention condition, newly graduated nurses from Nigeria participated in WhatsApp groups in which moderators shared knowledge and stimulated professional discussions over a period of 6 months. Data were collected via online surveys and knowledge tests. The findings show that participants in the moderated WhatsApp groups had significantly higher knowledge and exhibited fewer feelings of professional isolation compared with the control group, which was not subject of any treatment. The effects were even more pronounced when controlling for active contributions (writing vs reading messages), which also amounted to significantly higher levels of professional identification. In addition, across intervention and control groups, the self-reported general active use of WhatsApp (outside of the intervention) was positively associated with the measures of professional social capital maintained with school connections, professional identity, (lower) professional isolation, job satisfaction, and the perceived transfer of school knowledge to work practice. Whereas knowledge and socio-professional effects can be triggered through moderated WhatsApp interventions yet the general (and thus informal) use of WhatsApp is associated with socio-professional connectedness. The findings are of particular relevance in the developing context under investigation, which is marked by a lack of alternative support structures.

Facebook for supervision? Research education shaped by the structural properties of a social media space

Abstract This study analyses the use of a group space on the social networking site Facebook as a way to facilitate research supervision for teams of learners. Borrowing Lee’s framework for research supervision, the goal was to understand how supervision and learning was achieved in, and shaped by, the properties of a social networking space. For this purpose, the discourse between supervisor and learners was analysed along with the structural properties afforded by the space. Using the empirical findings and further literature, a conceptual framework was developed that illustrates the ways in which functional supervision, enculturation, emancipation, critical thinking and relationship development are achieved and formed by the interplay of the technological, functional, multimodal and the wider sociocultural, political and sociolinguistic structures associated with social media space.