When first-year medical students at Rush Medical College sat down to take their cell and molecular biology block exam this past September, they were not handed stacks of stapled paper. Rather, the students received a single sheet of paper with instructions on taking the exam on their iPads.
This change, however, did not catch any student off guard. At the beginning of this academic year, Rush Medical College joined the ranks of other medical schools in the frontier of integrating tablet technology into the medical education curriculum. During orientation, first-year medical students were given the newest edition of the iPad. While the college made it clear that students were not required to use iPads to study, the college no longer provides paper course guides or study materials, and all exams are administered on the iPads.
Prior to this block exam, students had the opportunity to take practice exams using SofTest, an iPad application developed by ExamSoft Worldwide. With a few taps and swipes to disable internet access and enter a password given by the proctor, students are able to quickly log in and begin the exam.
So far, students’ reactions to the heavy reliance on iPads have been mixed. While the majority of students do use iPads to take notes in lecture, many have realized that paper and highlighters worked best for them and began using printed condensed notes to study. Similarly, some have gone back to the more familiar method of using laptops, and a couple of students have been printing entire course guides.
“It took people much longer to take the exam on iPads than paper, partly because we could only see and answer one question at a time and with every question, we had to check to see if there was anything left out of the screen,” noted Elizabeth Aguila, a first-year medical student. “I do like the portability of iPads and being able to draw on the lecture notes.”
In addition to taking notes and exams, the students use iPads in other parts of the curriculum. The anatomy department has made the theme dissector available on Bookshelf, an application on the iPad. First-year medical students are able to bring their iPads, protected by zip lock bags, to the anatomy lab and follow the instructions and videos as they dissect. Recordings of simulated patient interviews are done with iPads and are made instantly available to students for self-evaluation. Students can also listen to lecture recordings at various speeds.
Cost implications played a major role in the movement towards iPads in the classroom. According to Bill Fleming, the manager of Medical Student Systems at Rush University, Rush Medical College’s quest of integrating iPads began in the fall of 2012 when the university was evaluating the budget plan for the 2013-2014 academic year. The implementation of paperless education was deemed more environmentally friendly and cost effective than printing over 800 pages of education material per week per student.
“It costs the school up to 10,000 dollars to print all education materials for first- and second-year medical students every year,” Fleming said. “After the AAMC conference in November, we took other medical schools as examples and formed a committee of staff from many departments to develop a system to allow medical students using iPads.”
Although not listed on the tuition statement, the cost of iPads is presumably included in the tuition and is technically paid by the students. In addition, students who prefer paper method have to spend extra money on printing that would have been included as part of their tuition in previous years.
When asked why Rush Medical College decided to use iPads and not other tablets, many of which are cheaper, Fleming explained, “The other medical schools that use tablets all use iPads, and so they provide a good model and support system where we can seek advice.”
Other medical schools, including Stanford University, University of Pennsylvania and most notably University of California Irvine (UCI), have also successfully embraced tablet-based medical education.
In 2010, UCI launched the iMedEd initiative and became the first medical school to fully utilize iPads in medical education and training. As a component of the iMedEd program, the school offers comprehensive IT, faculty and student support with lists of recommended applications and tutorials.
Earlier this year, UCI released a report stating that, holding grades and MCAT scores constant, this year’s USMLE score was 23% higher than previous years when iPads were not used in classrooms. This data seems to suggest that using iPads can promote students’ ability to learn and make it easier to take tests electronically, such as the USMLE Step 1. Exactly to what extent the students used their iPads throughout their medical education, however, is difficult to measure. Nonetheless, this data is promising to other medical schools in the process of transitioning to a paperless education.
“We recognize the limitations and difficulties of using iPads,” Fleming said. “We are trying to build a support system where the students can ask for help about their iPads, because right now, other than the six second-year medical students who were in the pilot group last year, first-year medical students are kind of on their own to figure out what works.”
“Our hope is to eventually transition current medical students to use iPads during their rotations,” Fleming continued. “But our current focus is first two years.”
In the age of laparoscopic surgery, da Vinci surgical robots and mind-controlled prosthetics, using tablets in medical education seems only appropriate. The new generations of medical students will be increasingly comfortable learning with technology, and so it is farsighted that medical schools and hospitals transition to a paperless education. With the implementation of electronic health record mandate and the mere practicality and portability, tablets will take hold of a new home—medicine.