Bedside Planners

As hospitals become test beds for enhanced wireless networks and nurses become seasoned users of various wireless devices, mobile technology is helping transform the way the next generation of physicians is being educated. (See Mesh to the Bedside.)

At Brown University Medical School in Providence, Rhode Island, first- and second-year students in the required, two-year "Doctoring" course, focusing on professional development and patient-centered care, are required to carry Zire handheld devices made by Palm Inc. to record their clinical experiences, which are then uploaded into a central database. The collected information is analyzed and fed back to students and their physician mentors to ensure that each student gets clear and useful feedback on their patient encounters and their development.

"The students upload their experiences on a monthly basis and we review that information," says Dr. Art Frazzano, Brown's associate dean of medicine. "And from that we can say, 'Gee, y'know, student 362 is not getting enough physical diagnoses,' or whatever it might be, and we can talk to the student to make arrangements either individually or with their mentor to make sure they're able to do more physical diagnoses or whatever."

The Zire devices come into play again in the third and fourth years of med school, when students do a six-week clinical rotation in family medicine, again under the eye of physician mentors or "preceptors." In groups of seven to fifteen students, the future doctors keep electronic patient logs that record each one of their patient encounters in clinical. As with the Doctoring course, the student information, collected in a customized database application from created using HanDbase, is fed back to the students in reviews that come at three weeks into the rotation and at the end of the clerkship.

"The main benefit is in the mid-clerkship review, they get both interim and cumulative reports based on the information collected," says Julie Taylor, the director of pre-doctoral education and family medicine for Brown Medical School. "It gives them a context for their own clinical experience, and helps keep them on task. We're able to monitor the clinical experience for the students and monitor the preceptors as well."

The goal: better doctors. The use of the Zire handhelds, which has been going on at Brown since 2002, coincides with the broader movement in medical education toward giving students more real-world, hands-on experience in med school, as opposed to stuffing them full of facts. In that sense, today's mobile technology is helping students gain a more rounded education experience that hearkens back to the 19th century.

"Prior to about 1910 all med students worked very little to learn science, they spent most of their time in apprenticeships with doctors in the community," points out Frazzano. "After 1910 med schools had to standardize, they became academic centers, students were trained in hospitals, and they began to lose sight of what most of them were going to be doing, which was treating individual patients."

The mentoring relationships formed in the Doctoring class and the third/fourth-year clerkship are meant to help alleviate that trend, giving students a better idea of what a physician does every day. And the Zire devices, which carry a quick and easily completed series of forms to fill out for each patient, play a critical role in expanding and optimizing those relationships.

"There's no other way to collect this information except having the students write down each of their encounters, then manually sort through all of those written accounts," explains Frazzano. "It'd be outrageous."

At the same time, handheld devices are playing an increasingly prominent role in actual patient care at the bedside, as the amount of relevant and timely information on diseases, diagnoses, and medications explodes beyond any physicians' ability to remain current. Programs like Epocrates, which includes up-to-date information on interactions between prescription medicines, have become increasingly prevalent over the last half-decade or so. With a mobile device like a Zire, the physician can check instantly on diagnosis and prognosis, without leaving the patient's room.

"These sorts of resources were certainly not part of my training in the late 1990s," says Taylor. "They've brought immediate access to up-to-date information into the examination room that you previously had to go look up in a textbook that was out of date anyway. So it's of real benefit to the patients as well as the learners."

"The wireless aspect of being able to get timely information at the bedside is just incredibly important," adds Frazzano. "It's really hard to overstate."

Finally, the use of mobile technology in clinical education settings is having the collateral benefit of helping to bridge the digital divide between today's tech-savvy med students and their physician mentors, less comfortable with computers and wireless devices.

"Students learn how to use these programs and they take that knowledge back to their attending physicians," says Taylor, "so they're educating that previous generation that did not train with this sort of tool in their education. It's helping to narrow that divide in terms of use of electronics."

And maybe the med students can help their mentors program the MDs' iPods while they're at it.

— Richard Martin, Senior Editor, Unstrung

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