Perception of medical students for utility of mobile technology use in medical education

Introduction: Mobile technology is changing the way we live, and it is beginning to change the way we learn. Current literature reviews have shown that research on mobile technology in medical education primarily focused on efficacy, of mobile devices as an educational tool and resource, infrastructure to support m-learning, benefits, challenges, and appropriate use. Objectives: To assess the perception of medical student for the utility of mobile technology in their learning experience and to find out different barriers in the application of mobile phone in medical education. Materials and Methods: The study was designed as a descriptive study to assess emerging patterns of mobile technology use by medical students across the academic year 2013–2014. Interview and focus group discussion was a method of data collection. Results: Mean age ± standard deviation of the current mobile was 3.45 ± 1.45 years. Mobile users were 302 (96.79%) and Smartphone users were 261 (83.61%). In the present study, 176 (56.41%) used for the academic purpose and 65 (20.83%) of the students preferred the same for an entertainment purpose. Gender-wise significant difference was observed in regards to Smartphone availability and daily Internet use for education purpose by female was more than male. Conclusion: The lessons learned from this study are-majority of the students use Smartphone mainly for communication, learning, and entertainment purpose. With increasing use of portable devices by students, it is logical to expect the next step to incorporate these devices in the learning environment and should, therefore, be appropriately considered for curriculum.


INTRODUCTION
Mobile technology is changing the way we live, and it is beginning to change the way we learn. [1]Recent study indicated the frequent use of mobile devices as reference and information management tools in clinical practice and medical training among faculty, students, and residents, with a trend toward higher use among newer professionals and trainees. [2]M-learning or mobile learning is defined as "learning across multiple contexts, through social and content interactions, using personal electronic devices." [3]A form of e-learning distance education, m-learners can use mobile device for educational technology in many locations at their time convenience. [4]Several studies have indicated that mobile, wireless device technology supports teaching and learning. [5,6]An increasing number of physicians, residents, and medical students currently use mobile devices such as Smartphones, iPads, and Tablets for education and use in clinical environments. [7,8]Medical students need to assimilate considerable new information during their studies especially with the need for evidence-based practice, and they must develop skills for lifelong learning, keeping their knowledge updated. [9]Lifelong learning, particularly in medicine, requires motivation and problem identification and solving skills relevant to the clinical situation. [10]nternational Journal of Medicine and Public Health | Oct-Dec 2015 | Vol 5 | Issue 4 ][13][14][15] In our set up, the situation may be same or different in terms of accessibility and application of M-technology for learning at undergraduate level.The majority of students belongs to diverse socioeconomic status; variability in perception about the use of mobile and in Government Institution M-technology accessibility may find different barriers for the use of mobile in learning process.
With this background, the present study was carried out to assess the perception of medical student for the utility of mobile technology in their learning experience and to find out different barriers in the application of mobile phone in medical education.It was also planned to identify common mobile applications and extent of used by medical undergraduate students.

MATERIALS AND METHODS
In the present cross-sectional study, a representative sample of 450 medical students was selected which comprised of first (n = 150), second (n = 100), and third (n = 200) year students at the Indira Gandhi Government Medical College (IGGMC), Nagpur.Before conducting the study, ethical approval for the study was given by the Institutional Ethics Committee of IGGMC.The students were invited to participate in the study and informed about objectives and anonymity of the study information at one of the lectures in different subjects.All participants were provided with written information about the study and consent for participation before start of the study.They were informed that this study was completely voluntary, and they can withdraw from the study or stop participating at any time.

Sample size and study design
The minimum sample size was calculated to be 300, taking into consideration that 40% of the student population of a previous study had self-reported an addiction to mobile phones Subba et al., [16] with an allowable error of 10% and a 95% confidence level.
The study was designed as a descriptive study to assess emerging patterns of mobile technology use by medical students across the academic year 2013-2014.The questionnaire used for this study was designed and pretested before its use in the present study.For this purpose, piloting was done on 10 subjects, so that validity and reliability of each item were ensured.Entire process of validation was done by three independent experts in questionnaire research and descriptive study.After necessary changes in the study tool, final draft was approved and adopted for the present study.
It was a baseline survey to seek reliable information on medical undergraduates' behaviors, preference, and constraints with mobile technology in medical education learning processes.This survey consisted with 20 questions and final open-ended general question.
The adopted short survey used in this study was distributed to approximately 70-80 first, second, and final year medical students of study institution during the months of August to October of 2014.The 20-item survey questionnaire covered three main topics: Student use of mobile devices, student interest in mobile technologies as they apply to education, and technology issues related to implementing the mobile application in education.

Data collection and analysis
A direct quantitative survey was used to gather data.The survey included several closed-ended question and last open-ended sections that were further analyzed by Microsoft Excel software to illustrate discussions of the quantitative data.Descriptive statistics was used to determine mean and percentages.Continuous data were analyzed by ANOVA to derive significance.Categorical data were analyzed by use of Chi-square test.Response to open-ended question was qualitatively analyzed.This data were collected to learn more about the emerging patterns in mobile education as reported by students.Author independently identified themes to the responses, and the most common threads were reported.

RESULTS
During 2010-2013, 450 students were enrolled for the MBBS course.There were 150 students in first and 100 in 2 nd years.However; in the final year, there were 200 students.More than 356 students of similar proportions from each year voluntarily participated in the study.Hence, the response rate was 79.1%.Forty-four students failed to complete study questionnaire hence were excluded from the final analysis.Survey data of 312 subjects provided information on sociodemographic characteristics, current status of mobile, applications of mobile technology, barriers, and student interest in mobile technologies as they apply to education.
Table 1 shows that of 312 students; 138 (44.33%) and 174 (55.77%) were male and female, respectively.It also reveals that mean age ± standard deviation (SD) of the student participants was 20.5 ± 1.73 years.
In Table 2, data analysis indicated that almost all students of first, second, and final MBBS had any one of the type of mobile.The data also showed that 89 (100%) 1 st year students had a Smartphone or similar device.However, 78 (95.12%) and 99 (70.21%) of second and final MBBS students, respectively, owned a Smartphone or similar device.Mean age ± SD of the current mobile was 3.45 ± 1.45 years.Of 312 students; Smartphone users were 261 (86.42%).Preference for the use of information technology in courses: Overall, participants indicated their preference for incorporating informational technology in education.Students' primary uses of mobile devices were assessed by self-reporting.In the present study, approximately 239 (76.60%) of students preferred the use of mobile technology extensively for social purpose, 176 (56.41%) use for academic purpose/the courses, and 65 (20.83%) of the student preferred for an entertainment.The majority of students 180 (58%) reported that they were not currently using their mobile devices to access medical resource applications.However, when asked if they would use their devices to see more use of social networking websites in their mobile-related to MBBS course, over 141 (45.19%) of students reported that they would use their mobile devices as a study device.Table 2 shows that majority, 294 (94.87%) students used internet on their own or others mobile.Frequency of internet use was 175 (56.09%) daily, weekly 88 (28.20%), and monthly 31 (9.93%).
Table 3 shows barriers to using mobile technology in education: Students identified certain technology issues concerning the use of mobile technology in education that should be addressed to make smaller mobile devices popular for educational use.Table 3 shows that the majority 181 (58%) of students indicated that they would prefer to have larger displays, which provide for better readability and viewing of learning materials.In addition, the time constraint was also a major (44.87%) barrier in proportionately higher study subjects.The other factors that students identified as barriers for successful implementation of mobile technology in education were connectivity 67 (21.47%), price of application 57 (18.27%), and ignorance 19 (6.09%).
Majority 178 (57.05%) of the students use some restriction and 73 (23.40%) use lot of restriction while accessing Internet.Table 4 shows that; when asked about collaboration or working with other students using any of the following web-based tools for the educational purpose, majority of the students used video-sharing websites 153 (49.04%), social networking websites 139 (44.55%),Wikis (Wikipedia, course wiki, etc.) 108 (34.61%), and web-based   word processor, spreadsheet, and presentation (GoogleDocs, iWork, Microsoft Office, Live Workspace, etc.) 94 (30.13%).
Qualitative analysis of comments about open-ended question suggested that the majority of students perceived the use of mobile technology in medical education as a feasible application.Comments highlighted three common themes: 1.The current use of mobile technology in the academics, social communication, and entertainment.2. Accessibility to learning materials.3. Constraints while using mobile technology."I am using mobile for academic activity like presentation sharing, learning any topic in depth, but this is a supplementary because most of the things are being told during lecture or available in the textbooks" (2 nd year student).
I find mobile device more useful for downloading and understanding diagram, videos, and different clinical conditions, so it is very helpful in the learning process" (final year student).
However, a small percentage of students perceived that mobile technology is best used "in the room or after the teaching schedule."However; implementation of mobile technology in education may not be cost-effective, particularly for students due to the expense of network connection and monthly charges and no institutional support.
"Most of us have advanced mobile device, but hardly we use it for academic purpose due to small screen, no knowledge about applications, lack of culture, but found very effective in communication and partly for entertainment" (first year student).
"Majority of the student expressed that very useful, helpful, and good for academic purpose" (final year student).

DISCUSSION
In the present study, students' perception indicated that all students of first, 95% of second, and 70.20% students of final M.B.B.S. had smart/android mobile phone.Overall mean age (± SD) of mobile was 3.44 (±1.45) years.However; final year students mean age (± SD) of mobile was 3.96 (±1.45) years.Lower proportion of Smartphone by final year students could be because of the higher mean age of mobile.Smartphone technology is newer technology and at the time of introduction cost was also high hence final year student had lower proportion of Smartphone.As technology becomes older, the cost decreases and demands of new application increases hence almost 1 st and 2 nd year students had Smartphone.In the present study, 10 (3.21%) of the student did not use mobile.In an earlier study, it was reported that mobile was not used by 0.68%  of the medical students. [13]Mobile device ownership reported in the present survey was consistent with previously reported trends in mobile ownership. [12,14]While the previous study has also explored a single institution, [15] a limited user group-residents or medical students and junior doctors [12] data on mobile device use in medicine.
Students' primary uses of mobile devices were assessed by selfreporting.In spite of relatively new mobile technology; in the present study, approximately three-fourth of students preferred the use of mobile technology extensively for social communication, and more than 50% used for academic purpose.
In earlier study, students responses indicated that mobile devices were potential avenues for reviewing instructional materials, an invaluable resource for immediate feedback, and other educational purposes. [17]Recent study reveals that physicians and medical students make decisions about using their Smartphones according to some combination of three considerations: Degree of relevance to patient care, the appropriateness of the behavior in front of patients, and the issue of how disruptive that behavior may be. [18]ere is a perceived risk that portable devices may distract from the provision of patient or client care if used by health professionals or students during employment. [19]e present study mobile technology was extensively used for social communication.As regards to the people with whom the students communicated the most with their mobiles, a majority of them were found to do so with their parents.The reason for this in our study could be that 30% of the students in study institution were from other parts of the states and equal proportions were from different parts of Maharashtra.Their parents found it easier to keep in contact with their wards through mobile phones.This was similar to the findings of a study which was done among Malaysian college students, where 51% of the students said that they talked most often to either parent. [20] the present study, majority of the students used educational video-sharing websites 153 (49.04%) and social networking websites.Nearly, one-half 139 (44.55%) of the students used Wikis, and onethird of the students used a web-based word processor, spreadsheet, and presentation.
More than 50% students were using internet mobile on daily, onefourth used weekly, and one tenth occasionally.Burff et al. [12] reported that 59.1% of medical students in their clinical clerkship (3 rd -or 4 thyear undergraduates) used them more than once a day, while 94.6% used them at least several times per week or more.E-learning in healthcare professional education still seems like it is a new innovation, but the reality is that e-learning has been around for as long as the internet has been around.In a recent study, it has been mentioned that e-learning will also become more adaptive in the future, and so will deliver educational content based on learners' exact needs. [21]Availability and accessibility of mobile technology perceived very positively by medical students as an educational tool.No doubt, it requires some more inputs in the form trained facilitators, other resources like connectivity and administrative support from the institution.

Barriers
The majority 181 (58%) of students indicated that they would prefer to have larger displays, which provide for better readability and viewing of learning materials.In addition, the time constraint was also a major (44.87%) barrier in proportionately higher study subjects.The other factors that students identified as barriers for successful implementation of mobile technology in education were connectivity 67 (21.47%), and ignorance 19 (6.09%).However; the financial barrier was expressed by 57 (18.27%), the major concern expressed by study participants.Financial constraint was a major concern have also been reported by Zhang et al. [22] In spite of this, it was reported that a cumulative total of 51.7% perceived that the mobile app to augment undergraduate education is helpful.
In the present study, one-fifth of the study subjects were using mobile as a media for entertainment.In an earlier study, [23] the vast majority of young people now carry devices on which they play games, listen to music, and in many cases, connect to the Internet and watch videos. [23] the present study, majority of the students expressed inability to use mobile as an educational tool.It also reveal that lack of institutional support like no Wi-Fi facility in the campus, financial constraints, and lack of time were the major barriers in the application of mobile in medical education.Moreover, results from this present study reflected prior needs assessment reports with regard to two separate issues: Student availability of mobile technology and inclination of a medical student to use this technology in medical education.Mobile application and technology issues should be addressed by each institution in order to successfully incorporate mobile technology in education, particularly with regard to resources in terms of computer technology, institutional technology infrastructure, faculty awareness of efficient application of mobile devices for content delivery, and student accessibility. [19]Literature also suggests that availability and accessibility of technology is one issue and another important issue is that faculty is integrated with the process.They have the training and resources to feel properly supported and that they understand this is where education is going. [24]bile technology in medical education has to make sure that faculty is integrated into the process that they understand this is where education is going, and that they have the training and resources to feel properly supported. [17]Nevertheless, students are using mobile technology such as Smartphone/android because they provide on demand accessibility to information regardless of whether faculty will incorporate such technology in their teaching.

Limitation of the study
This study is limited by the personal reporting of voluntary respondents.A possible inherent issue in their responses is bias related to prior experiences with technology.Findings of the study cannot be generalized to entire medical student population as data were generated from the single institution.Extent of use of mobile technology was not quantified in this study.

CONCLUSION AND RECOMMENDATIONS
The lessons learned from this study are majority of the student uses Smartphone for communication, learning, and entertainment.Positive inclination and perception is a good sign for m-learning in medical education.Availability and acceptability of mobile in the learning process is a great asset.Most important barriers for not use of technology were lack of time, knowledge, etc., which need to be addressed in proper perspectives.Understanding the opportunities and challenges of using mobile devices in the academic medical environment can help to determine the inclination and perceptions of their Smartphone use.Undergraduate medical students are well versed with the use of You Tube and word processor document sharing used for learning.It also concludes that significantly more female students use Smartphone and internet facility as compared to boys.The strength of this study is that the medical undergraduate's student participants are from one institution.Hence, uniformity is ensured.With increasing use of portable devices by students, it is logical to expect the next step to incorporate these devices in the learning environment and should be consider for curriculum.
International Journal of Medicine and Public Health | Oct-Dec 2015 | Vol 5 | Issue 4

Table 2 : Characteristics of mobile and related use by study subjects
#Multiple responses

Table 5 : Gender-wise difference with some sociodemographics of study subjects and their mobile use
#Chi-square test, £ ANOVA, P < 0.05 considered as significant.SD = Standard deviation