Lucie Byrne-Davis

Using mobile devices for teaching and learning in clinical medicine

The learning landscape has changed dramatically in the past decade and is undergoing a further seismic shift with the ubiquity of mobile internet-connected devices. Smartphones and tablets can now provide access to an almost unlimited amount of information that is accessible anytime and anyplace. Mobile devices have become commonplace for learning (and perhaps even the norm) in the classroom, higher education and the workplace. Early evaluation data from such projects have revealed heterogeneity in the adoption and acceptance of these devices among users. Whilst many see the undoubted benefits, issues including digital literacy and the need to integrate new ways of learning can be a barrier to uptake. With the increasing availability of highly intuitive devices and a generation of learners that access, and indeed process, information in a completely different way than the generations that preceded them, the issue is not whether we adopt these new technologies but whether we make the most of the opportunities they provide. The paediatric setting is a complex and demanding clinical learning environment. The provision of ready access to learning can be thought of in terms of supporting both explicit and tacit knowledge requirements. Clinicians are expected to apply the highest standards of practice according to local and national guidelines. Achieving this draws on their explicit knowledge, sourced from traditional references, a process that can, and will, be facilitated by connectivity. Perhaps for the first time patients, parents and relatives have almost unfettered access to the same resources and have consequently higher or differing expectations of patient care. In addition, it could be argued that the public are no longer willing to unquestioningly accept the opinion of a clinician. The instant access to high-quality reference resources will be crucial to doctors both for their own learning and their clinical practice. Doctors are also …

A feasible, acceptable and effective way to teach health care workers in low- and middle-income countries a method to manage acutely ill obstetric women

Maternal mortality is unacceptably high in Sub Saharan Africa, which accounts for 56% of all maternal deaths (WHO, 2012). Most maternal deaths are avoidable but with prompt recognition and timely intervention it is not inevitable that acute or critical maternal illness deteriorates to fatality (Firth and Ttendo, 2012). This paper discusses a project to provide multidisciplinary training in Maternal-Acute Illness Management (M-AIM) in a low resource setting in order to actively address the third delay to women accessing emergency obstetric care: prompt receipt of effective care on reaching a medical facility.

How we developed eForms: an electronic form and data capture tool to support assessment in mobile medical education

Abstract Mobile learning technologies are being introduced and adopted by an increasing number of medical schools. Following the implementation of these devices, institutions are tasked with the challenge of their integration into curriculum delivery and presented with the opportunity to facilitate data collection from large student cohorts. Since 2011, Manchester Medical School (MMS) has undertaken the largest deployment of iPads within UK Higher Education. Working towards the more efficient collation of students’ compulsory workplace-based assessment data led us to evaluate how existing information management software could replace previously paper-based systems. Following an evaluation of six, and a trial of one, commercially available packages, the existing software solutions were found to be inflexible and unfit for purpose. This resulted in the development of a new digital solution that addressed the limitations of the previous system. “University of Manchester (UoM) eForms” consists of an app and a web-based administration system that respectively permit high volume data collection and management. UoM eForms has now replaced the preceding paper-based and electronic systems within MMS for workplace-based assessment administration, due to the improved usability and dynamicity built into its interface and infrastructure. This new system has found many further useful applications, including research data collection, feedback, placement evaluations, quality assurance and interview marking.

Clinician Numeracy: The development of an assessment measure for doctors

Low numeracy in doctors poses serious risks to patient safety because inaccurate drug dose calculation may lead to under-treatment or overdose, while erroneous data interpretation affects medical decision making. Most research on numeracy in healthcare focuses on health numeracy in patients, while research on numeracy in doctors, “clinician numeracy”, is limited, partly due to the lack of a suitable assessment measure. We developed a new assessment, the Medical Interpretation and Numeracy Test (MINT), to assess clinician numeracy. The MINT tests computational, analytical and statistical constructs, using a combination of questions validated in other studies, and new test material specifically designed for doctors. We recruited 135 recently qualified doctors attending a teaching session on clinical decision making and risk communication to take our test. Psychometric analysis indicates that the MINT is a valid and reliable measure of clinician numeracy, with good internal-consistency reliability. Correlation with other numeracy/health numeracy tests varied greatly: this variation is understandable in view of the limited scope of many existing assessments that test only single constructs of numeracy/health numeracy. We conclude that the MINT provides a broad overview of clinician numeracy and can be a useful new assessment measure. Because of its important implications for patient safety, further research is needed to investigate clinician numeracy in doctors and other healthcare professionals, and to address and remediate deficiencies.

Efficacy and acceptability of an acute illness management course delivered to staff and students in Uganda by staff from the UK

BACKGROUND Recent reviews report that healthcare professionals have limited training in managing acutely ill patients and that significant gains could be made in low-income countries by focussing on care of the critically ill. We aimed to determine if a UK-developed acute illness management course (AIM) was acceptable to staff and students in a low-income country and if it improved their knowledge. METHODS A total of 188 students and staff attended one of 8 one-day courses teaching a systematic approach to the recognition, assessment and management of acutely ill patients. RESULTS A pre and post course test of knowledge was completed by 146/188 participants (77.7%) with a significant (p<0.001) increase in knowledge post course. Median increases in percentage scores by professional group ranged from 16-24%. A questionnaire about their experiences of the course and their intentions to use the AIM approach was completed by 81/188 participants (43.1%). The course was acceptable and participants indicated a high level of intention to use the approach. CONCLUSIONS A UK-developed acute illness management course was acceptable in a low-income country and delivered significant increases in knowledge and a high intention to change practice. Future research must focus on understanding the implementation of education into clinical practice.

The educational impact of experience overseas

Health care professionals are increasingly seeking overseas experience as part of their training. In the UK and Ireland, spending time overseas is becoming increasingly common during the first few years of training, with 10.8 per cent of Foundation Year‐2 (Postgraduate Year‐2) doctors working outside the UK in 2015. Although we know that doctors in training are increasingly seeking overseas experience, the reasons behind this are unknown. Many travel with the intention of returning after a period of time. With medical ‘gap years’ becoming common, there is a need to understand the reasons behind this phenomenon and what doctors take away from their overseas experience.

Medical students’ action plans are not specific

Action plans have been shown to be important in changing behaviour. In learners, action plans have been proposed as a mechanism by which feedback leads to an increase in expertise: feedback leads to action plans, which lead to changes in learning behaviours and finally to improvement. Little is known about the extent to which students are able to make specific actions plans that relate to the feedback they are given, however. We explored whether medical students created action plans after being given feedback, the quality of those plans and whether the action plans were related to the feedback given.

How behavioural science can contribute to health partnerships : the case of The Change Exchange

BackgroundHealth partnerships often use health professional training to change practice with the aim of improving quality of care. Interventions to change practice can learn from behavioural science and focus not only on improving the competence and capability of health professionals but also their opportunity and motivation to make changes in practice. We describe a project that used behavioural scientist volunteers to enable health partnerships to understand and use the theories, techniques and assessments of behavioural science.Case studiesThis paper outlines how The Change Exchange, a collective of volunteer behavioural scientists, worked with health partnerships to strengthen their projects by translating behavioural science in situ. We describe three case studies in which behavioural scientists, embedded in health partnerships in Uganda, Sierra Leone and Mozambique, explored the behaviour change techniques used by educators, supported knowledge and skill development in behaviour change, monitored the impact of projects on psychological determinants of behaviour and made recommendations for future project developments.DiscussionChallenges in the work included having time and space for behavioural science in already very busy health partnership schedules and the difficulties in using certain methods in other cultures. Future work could explore other modes of translation and further develop methods to make them more culturally applicable.ConclusionBehavioural scientists could translate behavioural science which was understood and used by the health partnerships to strengthen their project work.

Do Medical Students Assess the Credibility of Online or Downloadable Medical Reference Resources

This study was designed to elucidate how medical students assess the credibility of online resources and downloadable applications as well as describing trends in resource usage. Methods: 72 students participated in the study and completed an equestionnaire. This was based on a framework by Kapoun which summarises steps that users of online resources should take to ensure credibility using key domains; accuracy, authority, objectivity where the reader questions the provenance of the material, currency and coverage questioning appearance, reliability and accessibility of a document. Results: There were variations in the reported use of parameters of credibility with objectivity and currency being the most used widely used credibility measures. The study group were significantly influenced by the cost of resources using free resources if possible. Responses revealed that most of the study group were using open-access sites over commercially-based peer review resources. Conclusion: The widespread availability of mtechnology has increased the accessibility of online medical resources. Medical schools should review what information is provided to students and consider equipping students with the skills to successfully evaluate resource credibility as part of their core curricula.