Chaired Panel 6 Jill Taylor

Evaluating the impact of mobile technologies on the student learning experience in health practice placements Jill Taylor, Catherine Coates, Sara Eastburn, and Ieuan Ellis Leeds Metropolitan University, [email protected]

ABSTRACT Practice education is a core element of all health care professional education programmes and an essential component for registration to practice. Assessment and Learning in Practice Settings (ALPS), a Centre for Excellence in Teaching & Learning (CETL), is a collaborative project between 5 Higher Education Institutions committed to delivering excellent assessment, learning and teaching (ALT) opportunities across health and social care professions. As an ALPS partner site, Leeds Met undertook a pilot project, involving preregistration dietetic and physiotherapy students, to deploy mobile technologies into placement settings and to develop appropriate pedagogic approaches that exploit the technology to deliver an enhanced student learning experience. MediaBoard was used to set up web-based multimedia message boards. Students and tutors contributed to the message boards by sending SMS (text), MMS (text, picture, audio), from O2 XDA 2 mobile PDA/phones. This allowed recording of immediate “real time” experiences within the placements setting and exploited the features available on the mobile devices to record this information in multimedia formats. The students collected information as part of a multimedia blog including information about observations and learning experiences, especially pivotal incidents that support critical analysis of learning that underpins reflection. The approach also gave them the opportunity to work collaboratively to support and enhance inter-professional learning. Although the emphasis was on supporting formative activities the data collected could be used as evidence in summative assessment of some of the practice placement learning outcomes. Key findings from the project evaluation are discussed such as learner and tutor experiences, benefits to ALT, and issues associated with implementation such as usability, connectivity, and the ethical and cultural change issues that arise. We will suggest ways in which this technology could be utilised and embedded more effectively in ALT strategy.

KEYWORDS Practice education, Reflective practice, Mo-blogging, PDAs

INTRODUCTION The potential of personal digital assistants (PDAs) for learning and assessment is of increasing interest to Health and Social Care Professions (Sauders and Pellow, 2006) and the wider H.E. community (Smith, 2003; Anderson and Blackwood, 2004). The use of handheld computers to facilitate practice assessment is one of the key strategic aims of the ALPS CETL. Mobile technologies are mainly being used for clinical rather than learning applications. Previous studies in health settings have been undertaken mainly in the USA and Australia and have focused on nurses (Miller, 2006), paramedics (Norman, 2005) and doctors (Scheck McAlearney, 2004). These studies investigated the use of PDAs to provide access to information and assessed the usability of the devices for Health Care Professionals. Walton et al (2005) explored the perceptions of health care students regarding the use of PDAs in the community. The students showed a low level of awareness of the technology but placed great importance on being able to access learning resources from the community. They have been found to be an effective resource for students, especially for reference materials (Miller et al, 2005). There are very few studies that have assessed the effectiveness of PDAs for practice assessment and these have mainly involved self assessment activities with medics (Engum, 2003; Bent et al, 2002) and nurses (Kneebone et al, 2003). This study used physiotherapy and dietetics students and aimed to evaluate the barriers and benefits of introducing PDAs for reflective learning and for the collection of learning artifacts to support constructionist pedagogies.

METHODS Twenty pre-registration M.Sc Physiotherapy students and twelve B.Sc hons Dietetics students were issued with O2 XDA mini-s PDAs to support reflective learning experiences during assessed placement taking place in a wide range of practice placement settings within NHS Trusts in Yorkshire. University tutors and link tutors were also provided with PDAs to facilitate communication with the students. MediaBoard is a flexible, web based tool which enables the creation of interactive learning tasks and projects. It has been previously used successfully to deliver a wide variety of educational

mobile pilots in a variety of educational settings (Savill-Smith, 2006). It was used to set up Internet based multimedia message boards. A Mediaboard starts with a central image which can be marked up into zones. Students are able to send in comments, which can be text, audio, pictures or emails to a specific zone. Unlike most traditional Internet message boards they can add their comments by sending SMS (text) or MMS (picture, text and audio) from a mobile device. A variety of mediaBoards were set up including the “Sites” board (Fig 1) which provided the opportunity for interprofessional learning and collaborative working to support reflective practice. Individual and tutor boards were employed to log pivotal incidents and encourage reflective practice. Learning artifacts posted by students were used for formative and summative assessment in practice modules and contributed to the students practice portfolios. The project was underpinned by hands on training sessions for staff and students on the use of the PDA and mediaBoard. These were complimented with online WebCT support materials and a IT helpdesk. Ethical clearance was obtained from the Faculty ethics committee for the pilot and each participating student completed an ethics proforma to ensure that no images were taken of active clinical environments to preserve patient confidentiality. A number of evaluation instruments were used to assess the experience of the learners and practitioners including pre and post WebCT surveys, focus groups, semi-structured interviews of staff, and mediaBoard staff and student issues blogs.

RESULTS Students posted a variety of artifacts to their individual boards, for example, images taken of procedures, X-rays and clinical resources (Fig. 2) and in addition posted comments and reflections to tutors via the tutor boards. Most students preferred entering text data using the slide out keyboard in preference to handwriting recognition or the on screen keyboard.

Benefits for students The main perceived benefits for students were improved tutor and peer support and better access to information and resources along with the ability to record and reflect on their clinical experiences in real time. Students felt they were learning a useful skill that could be transferred and used in future innovations (Fig. 3). Students commented that: “It’s useful as we had projects to do together so we used it a lot for that” “Useful for contacting visiting

tutor at university whilst on placement”. “Being able to take pictures during in-services (x-ray for example) acts as a useful trigger for recalling information”. “Good for recording data and evaluating and reflecting upon clinical experiences” Issues for students The issues encountered with using the technology in the practice placement settings were ethical and cultural acceptance, finding time within hectic practice placements to interact with the technology, and the technical problems that arose. Students commented that: “Obviously I had explained it to my supervisor but all the other staff, like psychologists or occupational therapists were all looking at me as if to say “What’s she doing on her mobile phone?”…..” “Sometimes when I was getting shown something on a patient, then that would have been useful but you can’t do it”. “I think the mediaBoard could be very useful although I didn’t have time to use it” “A bit bulky to carry around whilst in uniform” “Couldn’t send video”. The majority of students agreed they would be more motivated to post to the mediaBoard if it counted towards the assessment. Evaluation from tutors Initial evaluation from tutors indicates that the PDAs and mediaBoard facilitates communication however the tutors found the use of the PDAs challenging and would have liked greater support and better training. The resistance to change affected their engagement with the technology. However some acknowledged the future potential of this approach for enhancing practice education. Tutors commented that: “A big cultural change but very interesting and potentially useful to support learning”. “I can see that with more time and commitment I would use this more in the future”. “Personally I am not against them but I would need much more support/time to learn how to use them”.

“Great way to access and support students directly when on placement”. “Felt we are just at the start when the pilot ended. Would welcome development for portfolios, reflective practice, web logs etc. Opportunities extended for peer support and learning in practice setting”.

CONCLUSION AND RECOMMENDATIONS This initial pilot begins to address the benefits and issues involved in introducing mobile technology to the practice environment and its ability to facilitate pedagogical practices congruent with a constructionist educational philosophy as proposed by Sotillo (2003). Our findings suggest that the impact of m-learning would be facilitated if the technology is introduced early in the student life cycle to encourage familiarity and develop cultural acceptance. A lesson we learned was that we should be more directive with the task definition and embed the learning activities firmly in the assessment strategy. In addition we would redesign the training for students, tutors and practice educators to encourage more experimentation to encourage acceptance and familiarity. A future challenge will be to gain recognition from NHS Trusts, practice educators, and service users of the PDA as the “modern notebook “for undertaking assessments and recording clinical experiences in multimedia formats.

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