Anupam KumarVanderbilt University School of Medicine

Class of 2014

A multi-stage trial of iPad utility at VUSM

Pilot issues

Small numbers of students Classroom focus Tech-savvy students Written content-focused

Rather than exploring the iPad as an ideal device for multimedia—videos, audio, books, etc.

Mobile computing at Vanderbilt Survey Fall 2012 219 students

Tablet owners

VMS 1 VMS 2 VMS 3 VMS 4 Total0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Types of tablets used

iPad83%

Android8%

Other9%

iPad note-taking frequency VMS 1/2

Never31%

Rarely11%

Occasionally20%

Often9%

Always29%

“Binders worth of information in a 1 lb. package”

-VMS 2

“No idea how I would do that ”

-VMS 2

VMS 3 tablet purchase timing

< 3 mo 3-6 mo 6-12 mo >1 yr0

0.1

0.2

0.3

0.4

0.5

0.6

VMS 4 tablet purchase timing

< 3 mo 3-6 mo 6-12 mo >1 yr0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

VMS 4 use of tablets for shelf study

Never 3%

Rarely22%

Occ19%

Often41%

Exclusive16%

Approaching the trial

Should we mandate How can we implement

Vanderbilt trial

Preclinical Gross anatomy lab

Clinical Clinical clerkships iTunes U course Access to the clinical workstation

phase 1Gross

Anatomy

phase 2Clinical

clerkships

Nov-Dec 2012

Jan-Mar 2013

Mary Van Meter and John Knowlton

12iPADs

60STUDENT

S

20DISSECTI

ONS

Gross anatomy laboratory

60 studentsNov-Dec 2012

Data Collection

Participation 60% (n=36)

iPad Use Cases

0%

20%

40%

60%

80%

All Owners Non-owners

iPad Application Features

0%

20%

40%

60%

80%

100%

All Owners Non-owners

Access to More iPad Resources

Internet (other) (12)

Class notes (6) Netter’s Atlas (5) Google (5) Wikipedia (5) Lecture slides (4)

Nova Skeleton Pro Langman's

Embryology YouTube KnowledgeMap

Resource Utilization

Before trial

Grant's Dissector Printed atlases “Lab Goals” slides Digital atlases Other materials Anatomy.tv

During trial

Grant's Dissector Printed atlases “Lab Goals” slidesiPad applicationsDigital atlases Other materials Anatomy.tv

MOST USED

LEAST USED

Improving Understanding

0%

20%

40%

60%

80%

All

Usefulness in Anatomy Lab

ALL OWNERS NON-OWNERS0%

20%

40%

60%

80%

Not useful at all Somewhat useful Very useful

Recommending Student Purchase

ALL OWNERS NON-OWNERS0%

10%

20%

30%

40%

No Not sure Maybe Definitely

Recommending Admin GA Lab Purchase

ALL OWNERS NON-OWNERS0%

10%

20%

30%

40%

50%

60%

No Not sure Maybe Definitely

Large Screen Mirroring

No Not sure Maybe Definitely0%

20%

40%

60%

80%

32 studentsJan-March 2013

Clinical clerkships

Clinical Workstation access

Access to EHR via Windows virtualization Restricted to resident and attending

physicians

iTunes U

iPad-based EKG teaching

What is the width of the QRS waveform?

Clerkship data

20 responses (63%)

Internal Medicine

44%

Peds/Ob33%

Psych/Neuro

6%

Surgery17%

Frequency of Use

Never Once/wk Once/d Multiple x/d0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8Before During

Common uses

Patient notes

CWS Net Email Ref. apps

Course reading

Practice ?s

Lecture notes

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Frequency of CWS use

Never Once/mo. Once/wk. Daily Mult. x/d0

0.1

0.2

0.3

0.4

0.5

0.6

Usefulness of CWS for clinical duties

Not at all Somewhat Very0

0.1

0.2

0.3

0.4

0.5

0.6

Difficulty using iTunes U

Not at all94%

Somewhat6%

Frequency of iTunes U access

Never Rarely Once/month

Weekly Daily0

0.1

0.2

0.3

0.4

0.5

0.6

iTunes U uses

Clerk

ship

mat

eria

ls

Dev

ice

set-up

Lear

ning

to u

se

Podca

sts

Recom

men

ded

apps

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Prefer iTunes U to current LMS

Yes74%

No26%

Students who watched vodcasts

Yes32%

No68%

Why not?

Lack

of a

war

enes

s

Tim

e co

nstrai

nt

Too

long

Not

use

ful

iPad

form

at0

0.1

0.2

0.3

0.4

0.5

0.6

Prefer podcasts for iPad instruction

Yes No0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

All Watchers

Prefer vodcasts for clerkship lectures

Yes No0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

All Watchers

Podcasts are a good method for delivering content to students

Yes89%

No11%

EKG comments

All students Very helpful Better than prior non-iPad sessions

iPad 75% students very helpful 1 student somewhat helpful

Frequency of use while rounding

Never Once/wk Once/d Mult x/d0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

Uses on rounds

Patient info Reference Email/nonpt.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Comfort using on rounds

Not at all50%

Somewhat28%

Very22%

Barriers to use while rounding

Non

e

Usage

diffi

culty

Carryi

ng d

evice

Usefu

lnes

s

Disco

urag

emen

t0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

How useful is the iPad for clinical duties?

Somewhat26%

Very74%

iPad contribution to clerkship learning

Very little Somewhat A great deal0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Trial contribution to improvement

None5%

Very little 5%

Some47%

Great42%

Conclusions

Utility Optimization Student role

Role of med student on clinical team

Data hunter-gatherer/data steward Role shared with residents Is already a primary role of the med school Data

Find Organize Interpret Apply

iPad allows expand through instant access to information Patient info, reference material Anywhere—rounds, at the bedside

Conclusions

Paradigm shift

Acknowledgements

Learning Technology Committee at VUSM Ryan Adams Scott Hagan Mitch Odom Jared Shenson

VUSM faculty Dean Kimberly

Lomis IT faculty

Ram Piyaket

VUSM students

Questions?