Exploring E-Readers to Support Clinical Medical Education: Two Case Studies*[dagger] EC

Article excerpt

Question: Can e-readers loaded with medical textbooks and other relevant material benefit medical students, residents, and preceptors in clinical settings?

Settings: The settings are North Carolina community clinics served by Duke University Medical Center and St. Joseph's Hospital in Bryan, Texas, and Scott and White Memorial Hospital in Temple, Texas.

Methods: Duke University: Twenty second-year medical students and fourteen family medicine clerkship preceptors used Kindle e-readers in clinics during eight months of rotations. Students and preceptors provided feedback through an anonymous online survey. Texas A&M University: Nine fourth-year medical students in an elective compared medical textbooks in print, online, and on a Kindle. Six residents at a local hospital completed an anonymous online survey after a three-week loan of a Kindle loaded with medical textbooks.

Results: The e-reader's major advantages in clinical settings are portability and searchability. The selected e-reader's limitations include connection speed, navigation, and display. User preferences varied, but online resources were preferred. Participants suggested additional uses for Kindles in medical education.

Conclusions: The selected e-reader's limitations may be resolved with further development of the device. Investigation of other e-readers is needed. Criteria for evaluating e-readers in clinical settings should include portability, searchability, speed, navigation, and display. Research comparing e-readers and mobile devices in clinical education is also warranted.

INTRODUCTION

Patient care encounters often generate questions, either directly from the patient or from gaps in the clinician's knowledge or experience. A 2007 review of the literature indicated that physicians generate somewhere between 0.16 and 1.27 clinical questions per patient encounter [I]. Another study demonstrated that family medicine residents generate 1.3 questions per patient [2]. Medical students on clinical rotations likely have a similar, if not higher, rate of questions, given their relative lack of experience.

Multiple obstacles can impede the efficient and seamless acquisition of information in the clinical setting, such as resources that are physically distant, poorly organized, or not clinically oriented [3]. To facilitate better information usage, medical libraries offer electronic books and other resources that are accessible on laptop or desktop computers. Some resources are also available on mobile devices. The recent prominence of electronic book readers offers a potential solution for a portable and searchable electronic library in clinical settings.

The authors were unable to find any studies testing e-book readers in medical education. Several academic libraries have piloted circulation or classroom projects with e-readers [4, 5] or have tested multiple e-reader devices for evaluative purposes [6-8]. While not testing an e-book reader specifically, a study exploring nursing students' use of e-books on portable digital assistants (PDAs) indicated that handheld devices loaded with e-books were recommended for students and nursing staff for use in clinical care [9].

A search of the literature revealed numerous other studies exploring the role of handheld computers in medical education and clinical care and demonstrated the utility of these devices for accessing information for medical reference. One systematic review focused on hospital physicians' use of handheld computers and demonstrated that mobile handheld technology can improve access to information for physicians [1O]. A recent systematic review of 67 studies testing handheld computers in medical education found that 60%-70% of students and residents used handhelds for educational purposes or clinical care and that electronic textbooks ranked highly among the most useful and most commonly accessed applications [H].

Electronic book sales, use, and acceptance are expected to climb dramatically in the next five years [12]. …