Medical institutions strive to provide each student with the best tools and training possible. These physicians in training are probably most commonly described as "mobile." To observe doctors, patients, and procedures, they move between classrooms, libraries, laboratories, hospitals, and clinics throughout the community. Their busy schedules make it next to impossible for medical schools to track each student's progress and accurately measure his or her experience. By taking advantage of this on-the-go lifestyle, however, the schools can supplement it with the appropriate technology. Such technology can enhance student education while offering the schools an important advantage in accreditation.
Right now, the healthcare industry at large is taking a closer look at how personal digital assistants (PDAs) can improve medicine and patient care (FIG. 1). Meanwhile, forward-looking medical schools are discovering that better access to information resources improves students' learning today. It also prepares them to practice medicine tomorrow. As stated by Dr. Bob Trelease, Associate Professor of Pathology and Laboratory Medicine at UCLA School of Medicine, "PDAs will be as common as the stethoscope."
Particularly as students move into their third and fourth years, mobility becomes an integral part of their education. The students spread out into community clerkships to gain firsthand experience with patients and medical procedures. Medical schools must therefore provide reliable information resources that fit their mobile lifestyle. Heavy textbooks and reference materials are no longer practical. Students increasingly "study" in a variety of locations and situations outside of the classroom. The reality is, however, that the learning tools have not kept pace.
Course management via paper-based reporting requires students to transcribe data on forms. The resulting feedback is rarely timely or accurate. As they struggle to track progress and ensure the observation of required procedures, the faculty finds it difficult to maintain the necessary level of communication with students. As those students spread out into the community and beyond, both the faculty and the administration lack an effective way to communicate with them. They also are hindered from evaluating each student's learning experience and making the necessary course adjustments.
Medical schools also are tasked with providing a well-rounded student experience for accreditation purposes. There is a growing trend toward quantifying experience through the monitoring and verification of student training and competency. This need also is being influenced by the increased credentialing requirements that face practitioners and post-graduate trainees. To meet accreditation standards, medical schools are attempting to add remote methods of monitoring student progress and faculty performance.
As they try to deal with these common pain points, the reality is that these institutions' budgets are tighter than ever. Medical schools have long found it challenging to manage information among such a dispersed population. They spent large sums of their budgets to institute paper-based processes that have now become inefficient. As a result, the evaluation of new solutions must take into account up-front costs, long-term costs, the anticipated return on investment (ROI), and any additional information-technology support or staffing that will be needed. Clearly, mobile technology answers the medical schools' need for a cost-effective solution.
For example, look at personal digital assistants. These devices are already changing the way that business is conducted and information is accessed and communicated. They fit easily into a mobile lifestyle to keep people connected. According to Harvard Medical School, between 70% to 75% of students entered medical school with a PDA. With those numbers growing, medical schools must consider how to leverage students' existing investments and add value. The PDAs can easily turn into an extension of their learning tools.
The medical schools are sandwiched between students' personal technology and the growing ubiquity of PDAs in healthcare. Physicians and hospitals use PDAs to track patient progress, facilitate rounds and data entry, dispense medication, and improve patient care (FIG. 2). A recent Harris Interactive Study1 predicted that by 2004, half of the physicians in practice will be using handheld devices. Meanwhile, hospitals are beginning to adopt PDAs as the information standard.
The impetus to put mobile applications in medical schools is being driven from both ends. Today's medical students need to be prepared for the mobile world. By familiarizing them with the tools that will be used in tomorrow's medical community, the schools can enrich the students' education and better prepare them for the future. Incorporating PDAs into education also can help schools establish a competitive edge. Medical schools must deliver compelling advantages that make students choose one institution over another.
The implementation of mobile technology also will help schools adjust to the standardization of accreditation. Mobile applications can streamline the data-collection process. That data can then be used by the student or the practitioner as well as educators, administrators, and credentialing bodies.
Mobility is even the answer for resource-constrained medical schools that require affordable, flexible, and easy-to-maintain solutions. The harnessing of mobility represents a cost-effective endeavor that benefits all parties. Mobile access to course textbooks, anatomy illustrations, and drug-interaction tables, for example, enhances the quality of education. These available, up-to-date information resources enable students to remain focused on learning.
For faculty, electronic course-evaluation forms could deliver timely and relevant feedback. The faculty could then tailor the education to individual student and/or class needs. In addition, they could monitor progress more closely and accurately as students move among hospitals and healthcare facilities.
The administrators also would benefit from the use of mobile solutions. Such solutions can effectively replace paper-based systems. Plus, electronic data capture and feedback would lead to more informed decision making and a better idea of student experience across the university population.
With the right mobile solutions, institutions will be able to integrate applications, leverage existing back-end computer data systems, and reduce operating costs. To see these best practices, look no further than the leading medical schools around the country. An example is Harvard Medical School (HMS). With close to 8000 faculty members and 17 affiliated facilities, Harvard Medical School is the largest of the school's graduate programs. Traditionally, it has been a trendsetter for many university-wide initiatives. With an estimated 70% of students already using PDAs, HMS sought a way to leverage mobile technology in education. The goal was to improve student and professor communications while accelerating access to information.
The result was the MyCourses mobile solution from Harvard Medical School. It is an innovative mobile information resource for both students and faculty. This solution extends the classroom to mobile devices by providing students and faculty with timely access to critical medical and course information on their PDAs. In the fall of 2001, more than half of the students headed back to school with a rich array of applications on their PDAs. Among these applications were class schedules, hospital-case-log notes, rotation details, lecture notes, anatomy illustrations with Flash technology, course evaluations, and exam calendars.
The MyCourses solution has provided administrators with higher-quality data and increased form-completion compliance. From the usual 20%, which were delivered up to six weeks after the completion of a course, the number of forms jumped to 80%. And they were delivered in near real time. In just six months, HMS eliminated $150,000 in costs. The school also realized a 50% ROI simply by replacing paper-based surveys with an automated, mobile solution.
Another real-world example is the University at Buffalo School of Medicine and BioMedical Sciences. After two years on campus, this school's students take assignments for clerkships in a variety of hospitals and clinics. Sometimes, these locations are up to an hour away from campus. Without a university hospital, the institution needed a way to deliver updated information, schedules, and a sense of community for its students. As it was, the students no longer saw much of the faculty or each other.
For the 2002-2003 academic year, the UB School of Medicine and BioMedical Sciences required all first-year students to have a PDA. It estimates that 80% of second-year students and 70% of third-year students also will be using a PDA. By the fall of 2003, the University of Buffalo plans to have the system entirely wireless. It will provide evaluation forms, schedules, instructor information, course syllabi, and other resources. At the same time, this system is providing students with a necessary "life connection." The school is now able to comprehend the breadth and depth of each student's exposure to patient cases and procedures.
Because it is anticipating the impact of this mobile system, the UB School of Medicine and BioMedical Sciences is now redesigning the third- and fourth-year curriculum around PDAs. It is tightening the curriculum and effectively changing the way that the faculty teaches. Beyond saving time, money, and other resources, UB says that the faculty and school derive the most value from training students to practice the medicine of the future.
The University of Cincinnati also is in the midst of deploying mobile technology. Its impetus was that health-professional education has increased its dependence on information resources. In addition, medical education is clearly spreading to diverse locations both within and outside of the academic health center. At the University of Cincinnati, there are four health-profession colleges: Medicine, Nursing, Pharmacy, and Allied Health. All of them are collaborating on a mobile initiative. Although it is still in the early stage, this project is connecting information and people and seeing results.
Previously, the University of Cincinnati's course evaluations comprised three-to-five-page documents. These evaluations were completed at the end of the academic quarter. The act of collating and analyzing the evaluations took both time and personnel. Often, such resources were not available to faculty until long after the course ended. Now, online-/PDA-based evaluations allow the faculty to get quick feedback. They also dramatically reduce paper usage and cost.
In addition, the College of Medicine has mobilized its Student Passport application. Formerly, it was a paper-based "passport" for gathering evidence about 40 clinical procedures. This passport was required of third- and fourth-year medical students. Now, students are able to monitor their own progress. Individual clerkship directors can tailor the curriculum to meet individual needs. Through these implementations, the college has gained a better understanding of the educational process beyond the campus.
For its next phase, the University of Cincinnati Academic Health Center is turning the campus into a wireless-Internet environment. It is wirelessly enabling the library, research, study areas, and classrooms. This project furthers a larger IT vision: to integrate all data across all four colleges in the health center. With "Students on the Move," everything will be accessible via PDAs. It will be live, interactive, and integrated.
The SUNY Downstate Medical Center is similar in that it also has four different colleges. Yet this center has a Level 1 Trauma Center and more than 80 specialty clinics as well. As such, the SUNY Downstate Medical Center emphasizes a multidisciplinary approach to medicine. Recently, the center decided that it wanted to improve the way that its residents learned from patient encounters. It also wanted to streamline the crucial accreditation process for residency programs. To these ends, SUNY implemented Portable Resource for Integrated Medical Education (PRIME) for the PDA.
This mobile and Web-based solution expedites learning. It allows the faculty to monitor residents' patient encounters and give them immediate feedback. For instance, say a faculty evaluator gives a below-average score for a patient encounter. The resources that are needed to enhance the student's skills or knowledge will then be automatically generated and sent back to the student's handheld. This system also contains a scheduling engine to track courses and rotations; an evaluation engine to dynamically create and score surveys; and a reporting engine to properly account for all of the procedures and diagnoses being performed.
Compared to the past two examples, the University of Southern California's (USC's) Keck School of Medicine is much more centralized. This school has only six basic science departments. It stands out, however, for its large student and faculty population. Founded in 1885, the Keck School of Medicine at USC now has more than 960 full-time faculty members. Its voluntary faculty numbers more than 3700 physicians. These individuals direct the studies of approximately 640 medical students and more than 200 students who are pursuing graduate degrees in one of the school's six departments. With such a vast population of students and faculty, USC could not find an effective way to stay connected to its students. It especially lost touch with their experiences as students entered their third- and fourth-year clerkships.
In 2001, the Keck School of Medicine began to explore mobile solutions as a means of closing the information loop. Specifically, these solutions would track patient encounters and student and faculty evaluations. As a result of this research, USC is now in the process of rolling out a new mobile application. Members of the third- and fourth-year medical student body will be the first to use this system as they visit patients and view procedures throughout the university's 14 affiliated hospitals and other ambulatory training sites. In addition, the Patient Encounter database will help busy students reference information and access feedback right at the point of care. The faculty will benefit from greater visibility and input into students' progress.
In the deployment at Keck, infrared (IR) ports are being installed on campus and in university-affiliated hospitals. As a result, providing feedback, accessing course schedules and content, and recording patient-encounter details will be fast and convenient for students and clerkship directors alike. The school also anticipates an increase in compliance rates, as it replaced paper-based evaluation forms with electronic forms. Scheduled reminders are now done via a personalized portal.
In these examples, it is clear that wireless is another area in which medical schools will compete. Because their primary differentiator is the quality of education, forward-thinking schools must set themselves apart through exemplary training. It is their job to provide the right tools and prepare students to practice medicine for the future. Mobility is very closely tied to the future of healthcare and improved patient care. Medical schools must embrace the responsibility for training their students—tomorrow's physicians, surgeons, and accomplished medical experts—in healthcare and wireless solutions. With the right technology and tools, these students can make an even bigger difference.