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Pharmacy students’ use and perceptions of Apple mobile devices incorporated into a basic health science laboratory
Currents in Pharmacy Teaching and Learning 9 (2017) 78–83
Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Experiences in Teaching and Learning
Pharmacy students’ use and perceptions of Apple mobile devices incorporated into a basic health science laboratory
cross
⁎
Jennifer E. Bryant, PhD , Craig A.H. Richard, PhD Department of Biopharmaceutical Sciences, Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, VA
A R T I C L E I N F O
ABSTRACT
Keywords: iPad Mobile devices Pharmacy education Technology Case studies
Objective: To describe pharmacy students’ use of mobile devices in a basic health science laboratory and to report the students’ perceptions on how solving cases with their mobile devices influenced their attitudes, abilities, and view on the use of mobile devices as tools for pharmacists. Methods: First-year pharmacy students utilized mobile devices to solve clinical case studies in a basic health sciences laboratory. A pre-survey and two post-surveys were administered to assess the students’ comfort, awareness, use, and perceptions on the use of their mobile devices and apps. Results: The pre-survey and first post-survey each had a response rate of 99%, and the second post-survey had a response rate of 100%. In comparing the pre-survey and first post-survey data, there was a statistically significant increase in the number of students that agreed or strongly agreed that they were more comfortable utilizing their mobile device (p = 0.025), they were more aware of apps for pharmacists (p < 0.005), and they have used more apps that can be useful for pharmacists (p < 0.005). The second post-survey demonstrated that over 78% of students agreed or strongly agreed that completing the case studies influenced them to be more comfortable with their mobile devices, to be more aware of apps that can be useful for pharmacists, and to be more agreeable with mobile device utilization by pharmacists in improving patient care. In addition, the second post-survey also demonstrated that 84% of students responded that using their mobile devices to solve the cases influenced them to either use their mobile device in a clinical setting for a clinical and/or pharmacy-related purpose for the first time or to use it more frequently for this purpose. Conclusions: The use of mobile devices to solve clinical cases in a first-year basic health science laboratory course was perceived as beneficial by students and influenced them to utilize their mobile device even more in a pharmacy practice setting.
Background and purpose Handheld computers, often referred to as mobile devices, are becoming increasingly incorporated into the assessment, management, and delivery of health care.1–3 These mobile devices allow for quick access to health care information and health carerelated mobile applications (apps) including disease information, drug information, laboratory references, medical calculators, medical news, and continuing education programs.4–7 In particular, the adoption of mobile technology into pharmacy practice is
⁎ Corresponding author: Jennifer E. Bryant, PhD, Department of Biopharmaceutical Sciences, Bernard J. Dunn School of Pharmacy, Shenandoah University, 1775 North Sector Court, Winchester, VA 22601. E-mail address: [email protected] (J.E. Bryant).
http://dx.doi.org/10.1016/j.cptl.2016.08.044
1877-1297/ © 2016 Elsevier Inc. All rights reserved.
Currents in Pharmacy Teaching and Learning 9 (2017) 78–83
J.E. Bryant, C.A.H. Richard
viewed as having a strong potential benefit to pharmacists and their patients.4,8,9 Some evidence confirms that the majority of pharmacists at various locations already use mobile devices and mobile apps in their practice and view these apps as having an increasingly positive impact on patient care.10,11 Pharmacists perceive them as useful for supporting health care education, consulting with patients, verifying orders in patient rounds, assessing experiential students, increasing productivity of practice responsibilities, and improving efficacy in patient care.11–13 In addition to the use in practice settings, mobile devices are also demonstrating increasing use, value, and support in clinical training settings. In a recent study, most hospital neurology residents utilized iPads and perceived them as useful in improving clinical care and were likely to continue using them in the future.14 The majority of residents and preceptors in a family medicine residency program reported that iPad use made the teaching and learning process more convenient, more engaging, and helpful to achieving learning or teaching goals.15 Distribution of iPads to medical residents of various specialties at the University of Virginia resulted in the majority reporting that the iPad improved coordination of care and they recommended the universal adoption of iPads among residents and fellows.16 The iPad mini, although smaller than the iPad, has also been reported to be helpful to clinicians in training by increasing the frequency with which residents in a physical medicine and rehabilitation program were able to complete tasks associated with their training.17 Almost every preceptor surveyed at a variety of pharmacy practice sites supported the education of pharmacy students on the use of mobile devices and relevant software.18 Incorporating mobile devices into the early didactic and experiential curriculum of health professions programs can be an important initial step to improving mobile device perceptions, use, expertise, and utility for future clinicians. The year-long use of iPads by medical students resulted in an increase in their use and expertise with mobile technology.19 Medical students have reported favorable responses to the incorporation of iPads into problem-based learning sessions and to the use of iPads for completing and submitting clerkship assignments.20,21 Nursing and midwifery students reported that iPads provided improved access to resources, improved time management, and improved their ability to provide patient education.22 Pharmacy students reported that iPads were appropriate for accessing clinical information and for using pharmacy-related apps.23,24 The use of iPads by pharmacy students during practice experiences resulted in the desire to have access to more mobile apps relevant to drug information and patient care.25 Academic institutions should identify ways to incorporate mobile devices into the early curricula of future clinicians, although this integration can have challenges.26 When asked about issues encountered when accessing medical resources on mobile devices, the majority of medical students, medical residents, and medical faculty reported that knowing which resources were available was a barrier.27 Another study showed that the incorporation of iPads into pharmacy courses for note taking and slide annotation was not positively received by the students.23,24 Although the incorporation of mobile devices into pharmacy curricula is strongly encouraged, there are few evidence-based publications about the incorporation of mobile devices into pharmacy education.28 In 2009, Shenandoah University began providing first-year pharmacy students with an Apple mobile device (the choice of an iPod Touch, iPhone, or iPad) in addition to an Apple MacBook Pro laptop. The same year, the authors of this paper initiated a pilot program to incorporate the Apple mobile devices into a first-year course they coordinated. The mobile devices were incorporated into the laboratory section of the Integrated Basic Health Sciences course taken by all first-year pharmacy students. The Integrated Basic Health Sciences course covers cell biology, genetics, anatomy, physiology, and pathophysiology. The weekly laboratory portion involves the traditional use of dissections, physiological experiments, microscopy, and anatomical models. The instructors aimed to incorporate the mobile devices the students received from the university in a way that highlighted the present and future clinical utility of these devices. A series of patient case studies directly related to the basic science material being taught were developed that the students would solve using only apps (such as Micromedex, Lexicomp, etc.) and websites (such as cdc.com, drugs.com., etc.) on their Apple mobile devices. The instructors termed this novel laboratory assignment the “iSolve Case Studies.” Further details of the creation, objectives, and implementation of the iSolve Case Studies—including a sample case study—can be found in the 2014 publication by Richard and Bryant.29 An assessment of student experiences and their perceptions with the iSolve Case Studies can also be found in the prior publication by Richard and Bryant.29 The authors administered a single survey to 88 pharmacy students in fall 2012 (Class of 2016) after the students completed several iSolve Case Studies. The results of the study demonstrated that the incorporation of clinical case studies solved with mobile devices was perceived as helpful to pharmacy students in a basic science laboratory to increase their understanding of basic science material and related clinical information. A limitation of this prior study was the lack of a pre-test to be able to know if students’ perception changed after completing iSolve Case Studies. An additional limitation was the absence of survey questions that asked if their comfort, awareness, use, and perceptions about the use of mobile apps and mobile devices for pharmacists were directly influenced by using mobile devices to solve the case studies. In this follow-up study, a pre-survey and two post-surveys were administered before and after the completion of several iSolve Case Studies, respectively. The objectives of this article are to describe pharmacy students’ use of mobile devices in a basic health science laboratory and to report the students’ perceptions on how solving cases with their mobile devices influenced their attitudes, abilities and view on the use of mobile devices as tools for pharmacists. Educational activity and setting Full approval through the university’s Institutional Review Board was obtained before the surveys were administered. This study included 68 first-year pharmacy students in the Class of 2017 enrolled in the Integrated Basic Health Sciences laboratory course in the fall of 2013 and spring of 2014. Half of these students participated in their Introductory Pharmacy Practice Experience (IPPE) in the Fall of 2013 and the other half of the students participated in their IPPE in the spring of 2014. Students selected an iPad or an 79
Currents in Pharmacy Teaching and Learning 9 (2017) 78–83
J.E. Bryant, C.A.H. Richard
iPad Mini as their university-distributed mobile device prior to the start of the course. This laboratory course was their first formal use of the mobile devices, and the only course during the first academic year to formally integrate their mobile devices into the curriculum. Three paper surveys were administered anonymously to each of the students in the laboratory course throughout the academic year of 2013–2014. Each survey contained a mix of Likert-scale questions and multiple choice questions. The first survey (presurvey) was administered on the first day of lab in fall 2013 and prior to the completion of any case studies. The outcomes measured in the first survey included the type of mobile device received from the university, other mobile devices owned, comfort with use of mobile device, awareness and use of apps relevant to pharmacists, usefulness of apps and mobile devices for pharmacists, and perception of best mobile device for a pharmacist. The first post-survey (post-survey 1) was administered at the end of fall 2013 after the completion of three case studies. The outcomes measured in post-survey 1 included comfort with mobile device, awareness and use of apps relevant to pharmacists, usefulness of apps and mobile devices for pharmacists, and perception of best mobile device for a pharmacist. The second post-survey (post-survey 2) was administered during spring 2014 after the completion of a total of five case studies. The outcomes measured in post-survey 2 included the influence of completing the case studies on the following: comfort with mobile device operating system, comfort with accessing resources on mobile device, awareness of apps for pharmacists, use of apps for pharmacists, and perception of the usefulness of apps and mobile devices for pharmacists. This survey also assessed the use of mobile devices in a clinical setting, influence of the case studies on use of mobile device in a clinical setting, and perception of the best mobile device for a pharmacist. Survey data collection, some descriptive analysis (count and percentage), and statistics were done with SPSS v23. Statistics were performed on the pre-survey and post-survey 1 comparison data found in Table 2. Strongly disagree, disagree, and neutral responses were combined into one group and agree and strongly agree responses were combined into another group. A Chi square test with a Yates correction was performed. Findings The pre-survey and post-survey 1 were completed by 67 out of 68 students for a response rate of 99%, and post-survey 2 was completed by all 68 students enrolled in the course for a response rate of 100%. The students consisted of 30 males and 38 females with an average age of 25 and an age range of 18–44. At the start of the year, the majority (67%) of students selected an iPad over an iPad Mini as their university-distributed mobile device (Table 1). Only 30% of students already owned an iPad and no students owned an iPad Mini prior to receiving their mobile device from the university. Table 2 compares the students’ mobile device use and perceptions before (pre-survey) and after (post-survey 1) completing three iSolve Case Studies. Prior to completing the iSolve Case Studies, 79% of students agreed or strongly agreed that they were comfortable utilizing most of the functions of the touchscreen operating system of their mobile device, compared to 94% of students after completing the case studies (p = 0.025). A total of 66% of students agreed or strongly agreed that they were aware of apps for mobile devices that can be useful for pharmacists before completion of the cases, whereas 95% of students agreed or strongly agreed with this after completion of the cases (p < 0.005). Prior to completing the cases, 52% of students agreed or strongly agreed that they had utilized apps for mobile devices that can be useful for pharmacists prior to completing the case studies, whereas 97% of students agreed or strongly agreed with this after completing the case studies (p < 0.005). The percentage of students who agreed or strongly agreed that apps for mobile devices can be useful for pharmacists prior to completing the case studies (97%) was similar to the percentage of students who agreed or strongly agreed with this following completion of the case studies (100%). A total of 93% of students agreed or strongly agreed before completing the case studies that mobile devices can improve patient health care if utilized by pharmacists, which was similar to the percentage of students (95%) that agreed or strongly agreed after completion of the case studies. Table 3 describes the influence of the iSolve Case Studies (completed using their iPad or iPad Mini) on mobile device use and perceptions following completion of five iSolve Case Studies (Post-survey 2). The majority of students agreed or strongly agreed that Table 1 Mobile devices received and owned by the studentsa Response, n (%), N = 67 Mobile devices
iPad iPad Mini iPhone iPod Touch Non-apple touchscreen smart phone Non-apple touchscreen tablet computer a b c
Receivedb
Ownedc
44 (67) 22 (33) N/A N/A N/A N/A
20 (30) 0 (0) 39 (58) 23 (34) 18 (27) 15 (22)
Data from pre-survey, prior to completion of any iSolve Case Studies. Devices selected and received by the students at the start of the pharmacy program. Devices owned by the students prior to starting the pharmacy program. May not add up to 100% because students could have more than one device.
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Currents in Pharmacy Teaching and Learning 9 (2017) 78–83
J.E. Bryant, C.A.H. Richard
Table 2 Comparison of student mobile device use and perceptionsa Response, n (%), N = 67 Strongly disagree/disagree/neutral
Agree/strongly agree
b
I am comfortable utilizing most of the functions of the touchscreen operating system of my SU mobile device Pre-survey 14 (21) Post-survey 1 4 (6)
53 (79) 62 (94)
I am aware of apps for mobile devices that can be useful for pharmacistsc Pre-survey Post-survey 1
23 (34) 3 (5)
44 (66) 63 (95)
I have utilized apps for mobile devices that can be useful for pharmacistsd Pre-survey Post-survey 1
32 (48) 2 (3)
35 (52) 64 (97)
I think apps for mobile devices can be useful for pharmacistse Pre-survey Post-survey 1
2 (3) 0 (0)
63 (97) 66 (100)
Mobile devices can improve patient health care if utilized by pharmacistsf Pre-survey Post-survey 1
5 (7) 3 (5)
62 (93) 63 (95)
SU, Shenandoah University. a Data from pre-survey, administered prior to initiation of iSolve Case Studies, and post-survey 1, administered after completion of three iSolve Case Studies. b Pre-survey and post-survey 1 data compared via Chi Squared with a Yates correction, p = 0.025. c Pre-survey and post-survey 1 data compared via Chi square with a Yates correction, p < 0.005. d Pre-survey and post-survey 1 data compared via Chi Square with a Yates correction, p < 0.005. e Pre-survey and post-survey 1 data compared via Chi Square with a Yates correction, no statistically significant difference. f Pre-survey and post-survey 1 data compared via Chi Square with a Yates correction, no statistically significant difference.
doing the iSolve Case Studies influenced them to be more comfortable utilizing most of the functions of the touchscreen operating system of their mobile device (78%), to be more comfortable accessing biomedical resources on their mobile device (90%), and to use more apps that can be helpful to pharmacists (90%). Solving the case studies with mobile devices also influenced students to be more aware of mobile apps that can be useful for pharmacists (94% agreed or strongly agreed), to think more so that mobile apps can be useful for pharmacists (83% agreed or strongly agreed), and to think more so that mobile devices can improve patient health care if utilized by pharmacists (87% agreed or strongly agreed). The frequency of student mobile device use and the influence of the iSolve Case Studies on mobile device use in a clinical setting were assessed following the completion of five iSolve Case Studies (post-survey 2). When asked how often they used any mobile device in a clinical setting for a clinical and/or pharmacy-related purpose during their P1 year so far, 42% of students responded never or rarely and 25% of students responded often or always. Totally, Thirty-five percent of students reported that the iSolve Cases influenced them to use their mobile device in a clinical setting for a clinical and/or pharmacy-related purpose for the first time, and 49% of students said they used their device more frequently for this purpose. No students felt that the iSolve cases influenced them to use their mobile device less frequently in a clinical setting for a clinical and/or pharmacy-related purpose or to stop using it all together. Examples of ways students utilized their mobile devices in a clinical setting include checking doses, interactions, or side effects of drugs. Table 3 Influence of iSolve Case Studies on mobile device use and perceptionsa Response, n (%), N = 68
Doing the iSolve Case Studies influenced me To be MORE comfortable utilizing most of the functions of the touchscreen operating system of my mobile device To be MORE comfortable accessing biomedical resources on my mobile device To be MORE aware of apps for mobile devices that can be useful for pharmacists To use MORE apps for mobile devices that can be useful for pharmacists To think MORE SO that apps for mobile devices can be useful for pharmacists To think MORE SO that mobile devices can improve patient health care if utilized by pharmacists a
Data from post-survey 2, administered after the completion of five iSolve Case Studies.
81
Strongly disagree/disagree/ neutral
Agree/strongly agree
15 (22)
53 (78)
7 (10) 4 (6) 7 (10) 12 (17) 9 (13)
61 64 61 56 59
(90) (94) (90) (83) (87)
Currents in Pharmacy Teaching and Learning 9 (2017) 78–83
J.E. Bryant, C.A.H. Richard
Table 4 Student preferences for type of Apple mobile device most useful for a pharmacista Response, n (%) Pre-survey N = 67
Post-survey 1 N = 67
Which of the following Apple mobile devices do you think is best for a pharmacist to use in a pharmacy setting? iPad 29 (45) 22 (33) iPad Mini 24 (37) 36 (55) iPhone 10 (15) 8 (12) iPod Touch 2 (3) 0 (0)
Post-survey 2 N = 68
22 (32) 38 (56) 8 (12) 0 (0)
a Data from pre-survey, administered prior to initiation of iSolve Case Studies, post survey 1, administered after the completion of three iSolve Case Studies, and post-survey 2, administered after the completion of five iSolve Case Studies.
Table 4 compares student perceptions taken from all three surveys regarding the type of Apple mobile device that would be best for use by a pharmacist. The students were asked, which mobile device they thought was best for a pharmacist to use in a pharmacy setting following completion of three case studies, and at this point the majority (55%) of students selected an iPad Mini as the best choice for a pharmacist in a pharmacy setting, 33% selected the iPad, 12% selected the iPhone, and no students selected the iPod Touch. The students’ preferences were different when compared to the responses prior to completing the case studies (45% chose the iPad, 37% chose the iPad Mini, 15% chose the iPhone, and 2% chose the iPod Touch). After completing a total of five iSolve Cases the students’ preferences for Apple mobile device for a pharmacist were similar when compared to the results after completing three case studies. Discussion The majority of students in this study utilized an iPad rather than an iPad Mini; however, after using the mobile devices to solve the case studies the majority of students responded that they would prefer an iPad Mini as the best device for a pharmacist to use in a pharmacy setting. One reason for this may be that students worked in groups to solve the cases and may have had to opportunity to utilize other students’ mobile devices. A preference for an iPad Mini was also reported in a previous study in which pharmacy students performed a side-by-side comparison of the iPad, iPad Mini, and iPhone, for the use of pharmacy-related tasks.30 The prior study and this current study seem to support the iPad Mini as a preferred Apple mobile device by pharmacy students. In a previously published study the authors reported that after completing the iSolve Case Studies, students agreed that mobile apps and devices can be useful for pharmacists and for improving patient health care. However, without pre-survey data, it was not possible to determine if their perceptions changed as a result of completing the cases. In the current study, the pre-survey results demonstrated that the students already had a very high perception of how useful mobile devices are for pharmacists and for the improvement of patient health care. Therefore, there was no significant increase in how the students perceived the usefulness of mobile devices for pharmacists and for the improvement of patient health care following the completion of the case studies. The new data suggest that prior to completion of the cases, students were already aware of the relevance and applicability of these mobile devices with regard to their future careers. The students’ awareness of the potential usefulness of mobile devices for pharmacists should be helpful when considering incorporation of activities involving mobile devices into pharmacy curricula. Because students already see the relevance of the mobile device, it may be easier to get them engaged in activities using mobile devices related to their coursework. The students’ increased comfort with their mobile devices may have been related to the use of their mobile devices in the course or to use outside the course. For example, the increased comfort reported at the end of the semester could have been exclusively due to use of their mobile devices at home, in other classes, and at experiential sites. Therefore, we directly asked the students if the iSolve Case Studies, which required use of their mobile devices, influenced their comfort, awareness, and use of their mobile devices. The majority of students agreed or strongly agreed that doing the iSolve Case Studies influenced them to be more comfortable using and accessing biomedical resources on their mobile device, to be more comfortable utilizing more apps that can be useful for pharmacists and to be more aware of apps that can be useful for pharmacists. This supports the idea that incorporation of activities involving mobile devices in courses may improve the students’ skills with their mobile devices, which may be helpful to them when they become pharmacists. Pharmacists using mobile devices perceive them as useful for supporting health care education, consulting with patients, verifying orders in patient rounds, assessing experiential students, increasing productivity of practice responsibilities, improving efficacy in patient care, and providing cost savings.11–13,31 One of the goals of the iSolve Case Studies was to highlight to the students the potential usefulness of mobile devices in pharmacy practice. The students agreed that solving the cases with their mobile devices influenced their opinions that mobile apps can be useful for pharmacists and to see that mobile devices can improve patient health care if utilized by pharmacists. This suggests that not only did the iSolve Case Studies improve the students’ skills with their mobile devices, it also directly and positively influenced their perception of the usefulness of mobile devices for pharmacists. The findings of our surveys indicate that the students’ use of their mobile devices in our course influenced them to use mobile devices outside of our course. The majority of students reported that the cases influenced them to use a mobile device in a clinical setting for the first time or more frequently. This demonstrates that having pharmacy students use mobile devices in a classroom 82
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setting can help motivate them to begin the use of or increase the use of mobile devices in a clinical setting. There were several limitations to the design of our survey. This study reported student perceptions but it did not directly measure mobile device proficiency or frequency of use in a clinical setting. In addition, our findings are specific to the students in the Class of 2017 at our school. Future assessments of the incorporation of mobile devices into this course could be improved by increasing sample size, including students from different professional years, incorporating students from other schools of pharmacy, providing funds to purchase commonly used apps, and directly measuring student use and proficiency with the mobile devices. Some challenges were encountered by the students while using mobile devices to solve the cases. These challenges included connecting to the wireless internet, encountering apps that were not free or required registration, viewing websites that are not optimized for a mobile device, and the variability of the amount of students’ prior experience using Apple mobile devices and their operating system. Other studies have reported access to and/or connectivity to wireless internet as a primary barrier in hospital or clinical settings.27,32,33 Additional challenges for the instructors included spending time becoming proficient with the mobile devices, determining the validity and usability of specific apps and websites, and learning the subtle differences between the various versions of the iPad and iPad Mini. These challenges for instructors could be addressed by additional training on the use of mobile devices. Summary Based on our results, implementing the use of mobile devices in the classroom aids in familiarizing the students with their mobile devices and becoming more aware of the ways they can be useful for a pharmacist. In addition, the vast majority of students indicated that solving the cases with their mobile device influenced them to use their mobile device in a clinical setting for the first time or more frequently. As more and more data is available electronically, the use of mobile devices will only increase and therefore we as pharmacy educators must teach our students how to properly and appropriately utilize this technology. References 1 Perera C. The evolution of E-health-mobile technology and mHealth. J Mob Technol Med. 2012;1(1):1–2. 2 Logan AG. Transforming hypertension management using mobile health technology for telemonitoring and self-care support. Can J Cardiol. 2013;29(5):579–585. 3 Paddock C. iPads in health and medicine: more than an information revolution?. Med News Today. 2012 〈http://www.medicalnewstoday.com/articles/242843.php〉 Accessed October 22, 2016. 4 Aungst TD. Medical applications for pharmacists using mobile devices. Ann Pharmacother. 2013;47(7–8):1088–1095. 5 DeBenedette V. Mobile apps for managing health. Drug Top. 2013;157(3):26–31. 6 Koehler N, Vujovic O, McMenamin C. Healthcare professionals’ use of mobile phones and the internet in clinical practice. J Mob Technol Med. 2013;2(1):3–13. 7 Mickan S, Tilson JK, Atherton H, Roberts NW, Heneghan C. Evidence of effectiveness of health care professionals using handheld computers: a scoping review of systematic reviews. J Med Internet Res. 2013;15(10):e212. 8 Clauson KA, Elrod S, Fox BI, Hajar Z, Dzenowagis JH. Opportunities for pharmacists in mobile health. Am J Health Syst Pharm. 2013;70(15):1348–1352. 9 Wolfe A., Moore R. mPharm: The Pharmacist as a Health Information Solution Provider. 〈http://www.pharmacytimes.com/publications/Directions-in-Pharmacy/2013/ December2013/mPharm-The-Pharmacist-as-a-Health-Information-Solution-Provider〉; 2013 Accessed October 22, 2016. 10 McCallum A, Sketris I, Rodrigues G, et al. Self-reported use of handheld computers: a survey of Nova Scotia pharmacists. JCHLA/JABSC. 2012;33(1):4–11. 11 Davies MJ, Collings M, Fletcher W, Mujtaba H. Pharmacy Apps: a new frontier on the digital landscape?. Pharmacy Pract. 2014;12(3):453. 12 Ray SM, Clark S, Jeter JW, Treadway SA. Assessing the impact of mobile technology on order verification during pharmacist participation in patient rounds. Am J Health Syst Pharm. 2013;70(7):633–636. 13 Divall MV, Zgarrick DP. Perceptions and use of iPad technology by pharmacy practice faculty members. Am J Pharm Educ. 2014;78(3) Article 52. 14 George P, Newey CR, Bhimraj A. The tablet device in hospital neurology and in neurology graduate medical education: a preliminary study. The Neurohospitalist. 2015;5(1):15–21. 15 Archibald D, Macdonald CJ, Plante J, Hogue RJ, Fiallos J. Residents’ and preceptors’ perceptions of the use of the iPad for clinical teaching in a family medicine residency program. BMC Med Educ. 2014;14:174. 16 Lobo MJ, Crandley EF, Rumph JS, et al. Pilot study of iPad incorporation into graduate medical education. J Grad Med Educ.. 2013;5(1):142–144. 17 Niehaus W, Boimbo S, Akuthota V. Resident use of iPad Mini mobile devices. Phys Med Rehabil. 2015;7(5):512–518. 18 Kostka-Rokosz MD, McCloskey WW. Survey of pharmacy preceptors’ use of hand-held devices. J Am Pharm Assoc. 2009;49(1):69–72. 19 Nuss MA, Hill JR, Cervero RM, Gaines JK, Middendorf BF. Real-time use of the iPad by third-year medical students for clinical decision support and learning: a mixed methods study. J Commun Hosp Intern Med Perspect. 2014;4(4):25184. 20 George P, Dumenco L, Dollase R, Taylor JS, Wald HS, Reis SP. Introducing technology into medical education: two pilot studies. Patient Educ Couns. 2013;93(3):522–524. 21 Lombardo NT, Honisett A. One tool for many tasks: integrating Ipads into the third-year learning experience. Med Ref Serv Q.. 2014;33(1):17–28. 22 Brown J, McCrorie P. The iPad: tablet technology to support nursing and midwifery student learning: an evaluation in practice. Comput Inform Nurs. 2015;33(3):93–98. 23 Spencer SD, Guo Y, Vansal S, et al. Integration of iPads into a pharmacy classroom. Am J Pharm Educ. 2013;77(5) Article 109. 24 Higdon-Topaz JA. Emerging pedagogies of student technologies (ePOST): do iPads offer benefits for learning and administrative activities?. Am J Pharm Educ. 2011;75(5) Article 105. 25 Bratberg JP, Charpentier MM. iPad use by student pharmacists on advanced and introductory pharmacy practice experiences. Am J Pharm Educ. 2013;77(5) Article 109. 26 Luanrattana R, Win KT, Fulcher J, Iverson D. Mobile technology use in medical education. J Med Syst. 2012;36(1):113–122. 27 Boruff JT, Storie D. Mobile devices in medicine: a survey of how medical students, residents, and faculty use smartphones and other mobile devices to find information. J Med Lib Assoc. 2014;102(1):22–30. 28 Aungst TD. Integrating mHealth and mobile technology education into the pharmacy curriculum. Am J Pharm Educ. 2014;78(1) Article 19. 29 Richard CAH, Bryant JE. Pharmacy student perceptions on the introduction of clinical case studies solved with Apple mobile devices into a basic health science laboratory. Curr Pharm Teach Learn. 2014;6(5):659–666. 30 Richard CAH, Hastings JF, Bryant JE. Pharmacy students’ preference for using mobile devices in a clinical setting for practice-related tasks. Am J Pharm Educ. 2014;79(2) Article 22. 31 Spires WH, Wesner A, Kidd RS. Development and evaluation of an iOS vancomycin clinical decision support software application. J Mob Technol Med. 2015;4(2):2–11. 32 Perez BA, von Isenburg MA, Yu M, et al. Exploring the impact of tablet computers on medical training at an academic medical center. J Med Lib Assoc. 2013;101(2):154–157. 33 Dana J, Wood K, Greene E, et al. Challenges and efficiencies of iPad 2 use to optimize ambulatory care pharmacy faculty practice. Am J Pharm Educ. 2012;76(5) Article 99.
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Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Experiences in Teaching and Learning
Pharmacy students’ use and perceptions of Apple mobile devices incorporated into a basic health science laboratory
cross
⁎
Jennifer E. Bryant, PhD , Craig A.H. Richard, PhD Department of Biopharmaceutical Sciences, Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, VA
A R T I C L E I N F O
ABSTRACT
Keywords: iPad Mobile devices Pharmacy education Technology Case studies
Objective: To describe pharmacy students’ use of mobile devices in a basic health science laboratory and to report the students’ perceptions on how solving cases with their mobile devices influenced their attitudes, abilities, and view on the use of mobile devices as tools for pharmacists. Methods: First-year pharmacy students utilized mobile devices to solve clinical case studies in a basic health sciences laboratory. A pre-survey and two post-surveys were administered to assess the students’ comfort, awareness, use, and perceptions on the use of their mobile devices and apps. Results: The pre-survey and first post-survey each had a response rate of 99%, and the second post-survey had a response rate of 100%. In comparing the pre-survey and first post-survey data, there was a statistically significant increase in the number of students that agreed or strongly agreed that they were more comfortable utilizing their mobile device (p = 0.025), they were more aware of apps for pharmacists (p < 0.005), and they have used more apps that can be useful for pharmacists (p < 0.005). The second post-survey demonstrated that over 78% of students agreed or strongly agreed that completing the case studies influenced them to be more comfortable with their mobile devices, to be more aware of apps that can be useful for pharmacists, and to be more agreeable with mobile device utilization by pharmacists in improving patient care. In addition, the second post-survey also demonstrated that 84% of students responded that using their mobile devices to solve the cases influenced them to either use their mobile device in a clinical setting for a clinical and/or pharmacy-related purpose for the first time or to use it more frequently for this purpose. Conclusions: The use of mobile devices to solve clinical cases in a first-year basic health science laboratory course was perceived as beneficial by students and influenced them to utilize their mobile device even more in a pharmacy practice setting.
Background and purpose Handheld computers, often referred to as mobile devices, are becoming increasingly incorporated into the assessment, management, and delivery of health care.1–3 These mobile devices allow for quick access to health care information and health carerelated mobile applications (apps) including disease information, drug information, laboratory references, medical calculators, medical news, and continuing education programs.4–7 In particular, the adoption of mobile technology into pharmacy practice is
⁎ Corresponding author: Jennifer E. Bryant, PhD, Department of Biopharmaceutical Sciences, Bernard J. Dunn School of Pharmacy, Shenandoah University, 1775 North Sector Court, Winchester, VA 22601. E-mail address: [email protected] (J.E. Bryant).
http://dx.doi.org/10.1016/j.cptl.2016.08.044
1877-1297/ © 2016 Elsevier Inc. All rights reserved.
Currents in Pharmacy Teaching and Learning 9 (2017) 78–83
J.E. Bryant, C.A.H. Richard
viewed as having a strong potential benefit to pharmacists and their patients.4,8,9 Some evidence confirms that the majority of pharmacists at various locations already use mobile devices and mobile apps in their practice and view these apps as having an increasingly positive impact on patient care.10,11 Pharmacists perceive them as useful for supporting health care education, consulting with patients, verifying orders in patient rounds, assessing experiential students, increasing productivity of practice responsibilities, and improving efficacy in patient care.11–13 In addition to the use in practice settings, mobile devices are also demonstrating increasing use, value, and support in clinical training settings. In a recent study, most hospital neurology residents utilized iPads and perceived them as useful in improving clinical care and were likely to continue using them in the future.14 The majority of residents and preceptors in a family medicine residency program reported that iPad use made the teaching and learning process more convenient, more engaging, and helpful to achieving learning or teaching goals.15 Distribution of iPads to medical residents of various specialties at the University of Virginia resulted in the majority reporting that the iPad improved coordination of care and they recommended the universal adoption of iPads among residents and fellows.16 The iPad mini, although smaller than the iPad, has also been reported to be helpful to clinicians in training by increasing the frequency with which residents in a physical medicine and rehabilitation program were able to complete tasks associated with their training.17 Almost every preceptor surveyed at a variety of pharmacy practice sites supported the education of pharmacy students on the use of mobile devices and relevant software.18 Incorporating mobile devices into the early didactic and experiential curriculum of health professions programs can be an important initial step to improving mobile device perceptions, use, expertise, and utility for future clinicians. The year-long use of iPads by medical students resulted in an increase in their use and expertise with mobile technology.19 Medical students have reported favorable responses to the incorporation of iPads into problem-based learning sessions and to the use of iPads for completing and submitting clerkship assignments.20,21 Nursing and midwifery students reported that iPads provided improved access to resources, improved time management, and improved their ability to provide patient education.22 Pharmacy students reported that iPads were appropriate for accessing clinical information and for using pharmacy-related apps.23,24 The use of iPads by pharmacy students during practice experiences resulted in the desire to have access to more mobile apps relevant to drug information and patient care.25 Academic institutions should identify ways to incorporate mobile devices into the early curricula of future clinicians, although this integration can have challenges.26 When asked about issues encountered when accessing medical resources on mobile devices, the majority of medical students, medical residents, and medical faculty reported that knowing which resources were available was a barrier.27 Another study showed that the incorporation of iPads into pharmacy courses for note taking and slide annotation was not positively received by the students.23,24 Although the incorporation of mobile devices into pharmacy curricula is strongly encouraged, there are few evidence-based publications about the incorporation of mobile devices into pharmacy education.28 In 2009, Shenandoah University began providing first-year pharmacy students with an Apple mobile device (the choice of an iPod Touch, iPhone, or iPad) in addition to an Apple MacBook Pro laptop. The same year, the authors of this paper initiated a pilot program to incorporate the Apple mobile devices into a first-year course they coordinated. The mobile devices were incorporated into the laboratory section of the Integrated Basic Health Sciences course taken by all first-year pharmacy students. The Integrated Basic Health Sciences course covers cell biology, genetics, anatomy, physiology, and pathophysiology. The weekly laboratory portion involves the traditional use of dissections, physiological experiments, microscopy, and anatomical models. The instructors aimed to incorporate the mobile devices the students received from the university in a way that highlighted the present and future clinical utility of these devices. A series of patient case studies directly related to the basic science material being taught were developed that the students would solve using only apps (such as Micromedex, Lexicomp, etc.) and websites (such as cdc.com, drugs.com., etc.) on their Apple mobile devices. The instructors termed this novel laboratory assignment the “iSolve Case Studies.” Further details of the creation, objectives, and implementation of the iSolve Case Studies—including a sample case study—can be found in the 2014 publication by Richard and Bryant.29 An assessment of student experiences and their perceptions with the iSolve Case Studies can also be found in the prior publication by Richard and Bryant.29 The authors administered a single survey to 88 pharmacy students in fall 2012 (Class of 2016) after the students completed several iSolve Case Studies. The results of the study demonstrated that the incorporation of clinical case studies solved with mobile devices was perceived as helpful to pharmacy students in a basic science laboratory to increase their understanding of basic science material and related clinical information. A limitation of this prior study was the lack of a pre-test to be able to know if students’ perception changed after completing iSolve Case Studies. An additional limitation was the absence of survey questions that asked if their comfort, awareness, use, and perceptions about the use of mobile apps and mobile devices for pharmacists were directly influenced by using mobile devices to solve the case studies. In this follow-up study, a pre-survey and two post-surveys were administered before and after the completion of several iSolve Case Studies, respectively. The objectives of this article are to describe pharmacy students’ use of mobile devices in a basic health science laboratory and to report the students’ perceptions on how solving cases with their mobile devices influenced their attitudes, abilities and view on the use of mobile devices as tools for pharmacists. Educational activity and setting Full approval through the university’s Institutional Review Board was obtained before the surveys were administered. This study included 68 first-year pharmacy students in the Class of 2017 enrolled in the Integrated Basic Health Sciences laboratory course in the fall of 2013 and spring of 2014. Half of these students participated in their Introductory Pharmacy Practice Experience (IPPE) in the Fall of 2013 and the other half of the students participated in their IPPE in the spring of 2014. Students selected an iPad or an 79
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iPad Mini as their university-distributed mobile device prior to the start of the course. This laboratory course was their first formal use of the mobile devices, and the only course during the first academic year to formally integrate their mobile devices into the curriculum. Three paper surveys were administered anonymously to each of the students in the laboratory course throughout the academic year of 2013–2014. Each survey contained a mix of Likert-scale questions and multiple choice questions. The first survey (presurvey) was administered on the first day of lab in fall 2013 and prior to the completion of any case studies. The outcomes measured in the first survey included the type of mobile device received from the university, other mobile devices owned, comfort with use of mobile device, awareness and use of apps relevant to pharmacists, usefulness of apps and mobile devices for pharmacists, and perception of best mobile device for a pharmacist. The first post-survey (post-survey 1) was administered at the end of fall 2013 after the completion of three case studies. The outcomes measured in post-survey 1 included comfort with mobile device, awareness and use of apps relevant to pharmacists, usefulness of apps and mobile devices for pharmacists, and perception of best mobile device for a pharmacist. The second post-survey (post-survey 2) was administered during spring 2014 after the completion of a total of five case studies. The outcomes measured in post-survey 2 included the influence of completing the case studies on the following: comfort with mobile device operating system, comfort with accessing resources on mobile device, awareness of apps for pharmacists, use of apps for pharmacists, and perception of the usefulness of apps and mobile devices for pharmacists. This survey also assessed the use of mobile devices in a clinical setting, influence of the case studies on use of mobile device in a clinical setting, and perception of the best mobile device for a pharmacist. Survey data collection, some descriptive analysis (count and percentage), and statistics were done with SPSS v23. Statistics were performed on the pre-survey and post-survey 1 comparison data found in Table 2. Strongly disagree, disagree, and neutral responses were combined into one group and agree and strongly agree responses were combined into another group. A Chi square test with a Yates correction was performed. Findings The pre-survey and post-survey 1 were completed by 67 out of 68 students for a response rate of 99%, and post-survey 2 was completed by all 68 students enrolled in the course for a response rate of 100%. The students consisted of 30 males and 38 females with an average age of 25 and an age range of 18–44. At the start of the year, the majority (67%) of students selected an iPad over an iPad Mini as their university-distributed mobile device (Table 1). Only 30% of students already owned an iPad and no students owned an iPad Mini prior to receiving their mobile device from the university. Table 2 compares the students’ mobile device use and perceptions before (pre-survey) and after (post-survey 1) completing three iSolve Case Studies. Prior to completing the iSolve Case Studies, 79% of students agreed or strongly agreed that they were comfortable utilizing most of the functions of the touchscreen operating system of their mobile device, compared to 94% of students after completing the case studies (p = 0.025). A total of 66% of students agreed or strongly agreed that they were aware of apps for mobile devices that can be useful for pharmacists before completion of the cases, whereas 95% of students agreed or strongly agreed with this after completion of the cases (p < 0.005). Prior to completing the cases, 52% of students agreed or strongly agreed that they had utilized apps for mobile devices that can be useful for pharmacists prior to completing the case studies, whereas 97% of students agreed or strongly agreed with this after completing the case studies (p < 0.005). The percentage of students who agreed or strongly agreed that apps for mobile devices can be useful for pharmacists prior to completing the case studies (97%) was similar to the percentage of students who agreed or strongly agreed with this following completion of the case studies (100%). A total of 93% of students agreed or strongly agreed before completing the case studies that mobile devices can improve patient health care if utilized by pharmacists, which was similar to the percentage of students (95%) that agreed or strongly agreed after completion of the case studies. Table 3 describes the influence of the iSolve Case Studies (completed using their iPad or iPad Mini) on mobile device use and perceptions following completion of five iSolve Case Studies (Post-survey 2). The majority of students agreed or strongly agreed that Table 1 Mobile devices received and owned by the studentsa Response, n (%), N = 67 Mobile devices
iPad iPad Mini iPhone iPod Touch Non-apple touchscreen smart phone Non-apple touchscreen tablet computer a b c
Receivedb
Ownedc
44 (67) 22 (33) N/A N/A N/A N/A
20 (30) 0 (0) 39 (58) 23 (34) 18 (27) 15 (22)
Data from pre-survey, prior to completion of any iSolve Case Studies. Devices selected and received by the students at the start of the pharmacy program. Devices owned by the students prior to starting the pharmacy program. May not add up to 100% because students could have more than one device.
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Table 2 Comparison of student mobile device use and perceptionsa Response, n (%), N = 67 Strongly disagree/disagree/neutral
Agree/strongly agree
b
I am comfortable utilizing most of the functions of the touchscreen operating system of my SU mobile device Pre-survey 14 (21) Post-survey 1 4 (6)
53 (79) 62 (94)
I am aware of apps for mobile devices that can be useful for pharmacistsc Pre-survey Post-survey 1
23 (34) 3 (5)
44 (66) 63 (95)
I have utilized apps for mobile devices that can be useful for pharmacistsd Pre-survey Post-survey 1
32 (48) 2 (3)
35 (52) 64 (97)
I think apps for mobile devices can be useful for pharmacistse Pre-survey Post-survey 1
2 (3) 0 (0)
63 (97) 66 (100)
Mobile devices can improve patient health care if utilized by pharmacistsf Pre-survey Post-survey 1
5 (7) 3 (5)
62 (93) 63 (95)
SU, Shenandoah University. a Data from pre-survey, administered prior to initiation of iSolve Case Studies, and post-survey 1, administered after completion of three iSolve Case Studies. b Pre-survey and post-survey 1 data compared via Chi Squared with a Yates correction, p = 0.025. c Pre-survey and post-survey 1 data compared via Chi square with a Yates correction, p < 0.005. d Pre-survey and post-survey 1 data compared via Chi Square with a Yates correction, p < 0.005. e Pre-survey and post-survey 1 data compared via Chi Square with a Yates correction, no statistically significant difference. f Pre-survey and post-survey 1 data compared via Chi Square with a Yates correction, no statistically significant difference.
doing the iSolve Case Studies influenced them to be more comfortable utilizing most of the functions of the touchscreen operating system of their mobile device (78%), to be more comfortable accessing biomedical resources on their mobile device (90%), and to use more apps that can be helpful to pharmacists (90%). Solving the case studies with mobile devices also influenced students to be more aware of mobile apps that can be useful for pharmacists (94% agreed or strongly agreed), to think more so that mobile apps can be useful for pharmacists (83% agreed or strongly agreed), and to think more so that mobile devices can improve patient health care if utilized by pharmacists (87% agreed or strongly agreed). The frequency of student mobile device use and the influence of the iSolve Case Studies on mobile device use in a clinical setting were assessed following the completion of five iSolve Case Studies (post-survey 2). When asked how often they used any mobile device in a clinical setting for a clinical and/or pharmacy-related purpose during their P1 year so far, 42% of students responded never or rarely and 25% of students responded often or always. Totally, Thirty-five percent of students reported that the iSolve Cases influenced them to use their mobile device in a clinical setting for a clinical and/or pharmacy-related purpose for the first time, and 49% of students said they used their device more frequently for this purpose. No students felt that the iSolve cases influenced them to use their mobile device less frequently in a clinical setting for a clinical and/or pharmacy-related purpose or to stop using it all together. Examples of ways students utilized their mobile devices in a clinical setting include checking doses, interactions, or side effects of drugs. Table 3 Influence of iSolve Case Studies on mobile device use and perceptionsa Response, n (%), N = 68
Doing the iSolve Case Studies influenced me To be MORE comfortable utilizing most of the functions of the touchscreen operating system of my mobile device To be MORE comfortable accessing biomedical resources on my mobile device To be MORE aware of apps for mobile devices that can be useful for pharmacists To use MORE apps for mobile devices that can be useful for pharmacists To think MORE SO that apps for mobile devices can be useful for pharmacists To think MORE SO that mobile devices can improve patient health care if utilized by pharmacists a
Data from post-survey 2, administered after the completion of five iSolve Case Studies.
81
Strongly disagree/disagree/ neutral
Agree/strongly agree
15 (22)
53 (78)
7 (10) 4 (6) 7 (10) 12 (17) 9 (13)
61 64 61 56 59
(90) (94) (90) (83) (87)
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Table 4 Student preferences for type of Apple mobile device most useful for a pharmacista Response, n (%) Pre-survey N = 67
Post-survey 1 N = 67
Which of the following Apple mobile devices do you think is best for a pharmacist to use in a pharmacy setting? iPad 29 (45) 22 (33) iPad Mini 24 (37) 36 (55) iPhone 10 (15) 8 (12) iPod Touch 2 (3) 0 (0)
Post-survey 2 N = 68
22 (32) 38 (56) 8 (12) 0 (0)
a Data from pre-survey, administered prior to initiation of iSolve Case Studies, post survey 1, administered after the completion of three iSolve Case Studies, and post-survey 2, administered after the completion of five iSolve Case Studies.
Table 4 compares student perceptions taken from all three surveys regarding the type of Apple mobile device that would be best for use by a pharmacist. The students were asked, which mobile device they thought was best for a pharmacist to use in a pharmacy setting following completion of three case studies, and at this point the majority (55%) of students selected an iPad Mini as the best choice for a pharmacist in a pharmacy setting, 33% selected the iPad, 12% selected the iPhone, and no students selected the iPod Touch. The students’ preferences were different when compared to the responses prior to completing the case studies (45% chose the iPad, 37% chose the iPad Mini, 15% chose the iPhone, and 2% chose the iPod Touch). After completing a total of five iSolve Cases the students’ preferences for Apple mobile device for a pharmacist were similar when compared to the results after completing three case studies. Discussion The majority of students in this study utilized an iPad rather than an iPad Mini; however, after using the mobile devices to solve the case studies the majority of students responded that they would prefer an iPad Mini as the best device for a pharmacist to use in a pharmacy setting. One reason for this may be that students worked in groups to solve the cases and may have had to opportunity to utilize other students’ mobile devices. A preference for an iPad Mini was also reported in a previous study in which pharmacy students performed a side-by-side comparison of the iPad, iPad Mini, and iPhone, for the use of pharmacy-related tasks.30 The prior study and this current study seem to support the iPad Mini as a preferred Apple mobile device by pharmacy students. In a previously published study the authors reported that after completing the iSolve Case Studies, students agreed that mobile apps and devices can be useful for pharmacists and for improving patient health care. However, without pre-survey data, it was not possible to determine if their perceptions changed as a result of completing the cases. In the current study, the pre-survey results demonstrated that the students already had a very high perception of how useful mobile devices are for pharmacists and for the improvement of patient health care. Therefore, there was no significant increase in how the students perceived the usefulness of mobile devices for pharmacists and for the improvement of patient health care following the completion of the case studies. The new data suggest that prior to completion of the cases, students were already aware of the relevance and applicability of these mobile devices with regard to their future careers. The students’ awareness of the potential usefulness of mobile devices for pharmacists should be helpful when considering incorporation of activities involving mobile devices into pharmacy curricula. Because students already see the relevance of the mobile device, it may be easier to get them engaged in activities using mobile devices related to their coursework. The students’ increased comfort with their mobile devices may have been related to the use of their mobile devices in the course or to use outside the course. For example, the increased comfort reported at the end of the semester could have been exclusively due to use of their mobile devices at home, in other classes, and at experiential sites. Therefore, we directly asked the students if the iSolve Case Studies, which required use of their mobile devices, influenced their comfort, awareness, and use of their mobile devices. The majority of students agreed or strongly agreed that doing the iSolve Case Studies influenced them to be more comfortable using and accessing biomedical resources on their mobile device, to be more comfortable utilizing more apps that can be useful for pharmacists and to be more aware of apps that can be useful for pharmacists. This supports the idea that incorporation of activities involving mobile devices in courses may improve the students’ skills with their mobile devices, which may be helpful to them when they become pharmacists. Pharmacists using mobile devices perceive them as useful for supporting health care education, consulting with patients, verifying orders in patient rounds, assessing experiential students, increasing productivity of practice responsibilities, improving efficacy in patient care, and providing cost savings.11–13,31 One of the goals of the iSolve Case Studies was to highlight to the students the potential usefulness of mobile devices in pharmacy practice. The students agreed that solving the cases with their mobile devices influenced their opinions that mobile apps can be useful for pharmacists and to see that mobile devices can improve patient health care if utilized by pharmacists. This suggests that not only did the iSolve Case Studies improve the students’ skills with their mobile devices, it also directly and positively influenced their perception of the usefulness of mobile devices for pharmacists. The findings of our surveys indicate that the students’ use of their mobile devices in our course influenced them to use mobile devices outside of our course. The majority of students reported that the cases influenced them to use a mobile device in a clinical setting for the first time or more frequently. This demonstrates that having pharmacy students use mobile devices in a classroom 82
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setting can help motivate them to begin the use of or increase the use of mobile devices in a clinical setting. There were several limitations to the design of our survey. This study reported student perceptions but it did not directly measure mobile device proficiency or frequency of use in a clinical setting. In addition, our findings are specific to the students in the Class of 2017 at our school. Future assessments of the incorporation of mobile devices into this course could be improved by increasing sample size, including students from different professional years, incorporating students from other schools of pharmacy, providing funds to purchase commonly used apps, and directly measuring student use and proficiency with the mobile devices. Some challenges were encountered by the students while using mobile devices to solve the cases. These challenges included connecting to the wireless internet, encountering apps that were not free or required registration, viewing websites that are not optimized for a mobile device, and the variability of the amount of students’ prior experience using Apple mobile devices and their operating system. Other studies have reported access to and/or connectivity to wireless internet as a primary barrier in hospital or clinical settings.27,32,33 Additional challenges for the instructors included spending time becoming proficient with the mobile devices, determining the validity and usability of specific apps and websites, and learning the subtle differences between the various versions of the iPad and iPad Mini. These challenges for instructors could be addressed by additional training on the use of mobile devices. Summary Based on our results, implementing the use of mobile devices in the classroom aids in familiarizing the students with their mobile devices and becoming more aware of the ways they can be useful for a pharmacist. In addition, the vast majority of students indicated that solving the cases with their mobile device influenced them to use their mobile device in a clinical setting for the first time or more frequently. As more and more data is available electronically, the use of mobile devices will only increase and therefore we as pharmacy educators must teach our students how to properly and appropriately utilize this technology. References 1 Perera C. The evolution of E-health-mobile technology and mHealth. J Mob Technol Med. 2012;1(1):1–2. 2 Logan AG. Transforming hypertension management using mobile health technology for telemonitoring and self-care support. Can J Cardiol. 2013;29(5):579–585. 3 Paddock C. iPads in health and medicine: more than an information revolution?. 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