As 80 Georgia medical students carry iPads into hospitals this fall, their actions could dictate whether hospitals in more than 21 states will soon deploy handheld devices in patient rooms.
“The troubling thing is trying to figure out how to measure quality of care being delivered, and there’s no way to do that,” said Michelle Nuss, associate dean at the Georgia Regents University-University of Georgia Medical Partnership. “When it comes to point-of-care and looking up clinical questions at the patients’ bedside, we know that happens. But we don’t know whether that affects outcomes.”
Instead, the research team focused on education and communication. Nuss and Julie Gaines, the GRU-UGA librarian, recruited Janette Hill and Ronald Cervero, UGA adult education and instructional technology professors, to conduct weekly interviews, ask the students to fill out usage logs, and observe iPad integration during the internal medicine rotation at St. Mary’s Hospital in Athens, Ga.
When the group publishes findings from the two-year study in early 2014, CHE Trinity Health, the healthcare system that bought controlling interest St. Mary’s, will decide whether to deploy iPads in its 82 hospitals across 21 states, Nuss said.
The University of California at Irvine, Stanford University and Yale University shipped iPads into medical school classrooms in 2010 and 2011, and recent reports suggest that test scores went up. Medical schools in Florida, Minnesota and Pennsylvania have since jumped on board. But few schools have studied the technology in both the classroom and clinical settings, particularly in Georgia.
“I’ve observed doctors and students discussing what apps are the most helpful, which is fun to watch,” Hill said. “I’ve also seen doctors tell students to look up information while working through a case or while helping patients to make a particular decision.”
Though the students vary in how often they use the iPad, most have taken to it quickly for patient questions. Some students — who Gaines dubs “superusers” — constantly check reviews for new apps and tell others what to download.
“I found ways to streamline and make my work more efficient, and I can’t think of a better way to carry around and look at patient information,” said Dylan Lovin, a fourth-year “superuser” student. “Is there an app out there for this question or situation? Probably.”
But the hospitalists — nine St. Mary’s Hospital doctors who signed up to participate in the research — haven’t adapted as quickly. Not only is the technology a new distraction on top of a heavy workload, but the doctors are also new to the teaching realm.
“For the students, it’s never out of their sight. They’re often eating and studying at the same time,” Gaines said. “But on rounds, I’ve seen the doctors rely on the students to get their iPads rolling to look up information or access records.”
Lightening the load
As a first-year GRU-UGA medical student in 2010, Travis Smith took advantage of the free printing privileges offered by the school. With three lectures per day, some containing more than 120 slides, Smith amassed nearly 100 pages of printed paper per week. By the end of first year, several reams of paper lined his bookshelf.
By second year, printing was no longer free. Smith paid his way for notetaking on lecture slides and began adding up the costs. With color prints running between a quarter and 50 cents per page — and a personal printer, ink, and paper totatling about the same — the year would cost him $450.
He then realized $50 more would get him an iPad — and save the hassle of carrying pens, notebooks and folders.
Don’t forget the required textbooks the students lugged to campus. Robbins & Cotran Pathologic Basis of Disease, a 1,400-page behemoth that weighs 8 pounds and costs $95, was just one of the heavy burdens. When Smith discovered most of the texts, or their equivalents, were available online for free through the school’s library, he didn’t hesitate to invest in the technology.
“It’s impossible to keep the information you need in textbooks anymore, which are 5-10 years behind the latest research,” said Smith, now a fourth-year student. “You can’t walk around with every textbook you need. The knowledge is so vast.”
When Nuss and Gaines saw Smith and his roommate use the iPads in class, they decided to team with St. Mary’s to provide devices for the rest of the class and research the effects. Now the students regularly discuss apps for textbooks, medication values and patient vitals in class.
“I like taking preset drawings of the heart and stents and showing people where their problems are and how we’re going to fix them,” said Smith, who used the iPad frequently during his cardiology and vascular surgery rotations. “Putting a picture and face on the problem that’s causing patients pain gives them an extra ability to deal with it, it seems.
At the end of the day, Smith pulls up textbooks and reviews his daily cases. He hopes the consistent review will help him during the next round of patients.
“The prevailing wind in health care is, ‘Nobody has time for me,’ so sitting down and taking extra time with a patient really helps,” he said. “It’s unreal what we’re capable of doing with these machines.”
And medical professionals are paying attention. After the research team presented preliminary observations at a local conference this fall, several doctors across Northeast Georgia asked advice about what apps to download and how to incorporate mobile technology into their offices.
With more than 300 interviews to transcribe and code throughout December, the UGA group will present their findings in April at the American Educational Research Association conference, where more than 10,000 researchers gather annually.
As part of that, the research team will share findings and recommendations with Trinity Health as a whole. By late January, Gaines and Nuss will help St. Mary’s to infuse the iPad technology into the hospital’s new residency program as well.
“Our work is part of that bigger picture, and our data will be shared across the whole organization,” Nuss said. “From our standpoint, it’s win-win-win.”
For Smith and the other fourth-year students, though, there’s one loss — the third-years received new iPad minis this fall.
“The biggest problem is carrying the iPad around and not being able to put it in your pocket when gowned and gloved or moving between patient rooms,” Smith said. “The biggest complaint so far is just mechanical, and now the third-years don’t have to worry about that.”