Anju Relan and Susan Baillie:

Handheld computing is now at the forefront of medical education, with its promise of a truly mobile learning environment.  While robust uses of the technology have been widely noted among residents and practicing clinicians, relatively few applications have been examined in the context of medical education.  Can handheld technologies nurture the process of becoming an expert clinician? Can students' clinical experiences be strengthened via handheld computing? Can students increasingly rely on such technologies for self assessment leading to becoming efficient, independent learners?  In this paper, we describe a set of applications created at a leading medical school which are explicitly designed to assist clinical faculty in diagnosing and prescribing appropriate patient encounters for students, in assisting students with self monitoring of their clinical encounters, and contributing to an overall improvement in their clinical clerkship experiences.

The need to monitor students' clinical apprenticeship effectively has been documented copiously in the medical education literature. Typically, the last two years of the medical school (of a total of four, in the USA) are spent in acquiring clinical expertise via "clerkships" in a variety of specialties. However, in spite of inventive efforts to standardize this experience for all students, successful attainment has been moderate. Students see patient problems that vary considerably in the nature of illness, seasonal variations, geographical location.  The type of feedback received by students in the same location itself may vary given the variety of clinical faculty they may encounter.  This variability has an impact of how clerkships are structured, monitored and evaluated as well as on student learning.  Given the nature of clinical apprenticeship, it is not surprising that medical students are left to make their own decisions, seek additional, relevant information and refine their clinical reasoning process independent of faculty modeling.

UCLA PDA Patient Log is suite of applications designed to address issues described above.  The objectives of the application are as follows:

• permit students to document all patients seen during clerkships on their handheld devices
• allow students to view their patient entries via a web portal
• allow students to annotate their own patient data in a variety of ways
• allow students to communicate more effectively with faculty
• allow faculty to view individual students’ data
• allow faculty to view aggregate clerkship data in tables as well as dynamic graphs
• permit students and faculty to search data according to predetermined fields
• permit students and faculty to generate printable reports

The application consists of three components:  the PDA client which can be downloaded and allows data entry.  This is a form based application containing pull down menus for patient demographics (in accordance with honoring patient privacy), patient problems, radiological findings and a blank field for additional notes.  While such logs have been used to document clinical experiences via the web in other medical schools, the unique feature of this patient log are the customized versions for different specialties.  Thus there is no single common log, but versions which are endemic to six specialties: Surgery, Pediatrics. Obstetrics and Gynecology, Family Medicine, Psychiatry and Neurology.  An AvantGo server (http://www.AvantGo.com) serves as the mediating technology between the web based database where all he patient data resides and the students' PDA's.  This is the second, commercially available component of the application.  Finally, a web based interface allows the database entries to be searched and manipulated by students and faculty.  The entire application is created using web and database programming environments such as html, javascript, Cold Fusion and proprietary AvantGo platform. An SQL database is utilized for data storage and retrieval.  The entire model of development and implementation will be discussed via graphical illustrations and flowcharts.  Data will be presented on the extent and quality of faculty and student usage.

What is the impact of customized PDA applications on improving the clinical education of students?  Do faculty find such data useful?  What kinds of changes to clerkships are being implemented after evaluating patient data?  These questions will frame the discussion focusing on the effectiveness of interactive handheld applications in medical education.