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322 Open Medicine Journal, 2016, 3, (Suppl-3, M6) 322-327

Open Medicine Journal

Content list available at: www.benthamopen.com/MEDJ/

DOI: 10.2174/1874220301603010322

RESEARCH ARTICLE
The Use of Smartphone Applications in Medical Education
E. Snashall and S. Hindocha*
Department of Plastic Surgery, Whiston Hospital, Merseyside, L35 5DR, UK

Received: July 12, 2015 Revised: September 17, 2016 Accepted: September 17, 2016
Abstract:
Introduction:
With the rise of computer technology, there has seen a shift in the delivery of medical education towards e-learning. Specifically,
there has been increased use smartphone technology and applications (app) use.
Aim:
The aim of this article is to assess the use of medical apps amongst medical students.
Results:
89% of respondents owned a smart device. Of these, 98% used Apps. Medical applications were used in 82% of the “App user”
population. Apps were used for medical learning purposes in 85% of this population, of which 93% found them useful. If a more
comprehensive medical learning application were to be available, 97% of responders would consider using it.
Conclusion:
The use of smart devices and medical apps is prevalent amongst medical students and will continue to rise in the future. Medical apps
may be a very important adjunct in medical education however the evidence remains limited. To keep up with technological
advances and meet the learning needs of medical students both now and in the future, more research is required to assess and address
these needs.
Keywords: App, E-learning, Medical student, Technology.

INTRODUCTION
Undergraduate medical education has historically been lecture based. With the rise in accessibility of computer
technology, this has seen a shift in the delivery of medical education and has resulted in the development of electronic
learning (e-learning). Some medical schools have recognised this growing trend and initiated the introduction of e-
learning in the undergraduate curricula [1]. As e-learning developed, some universities began offering distance learning
degrees. The number of these distance learning degrees is increasing year on year [2].
As technology and the internet has advanced, social media has become a powerful teaching tool. The use of social
media is increasing, especially amongst students. Websites such as Facebook and other social media are being
frequently used as an adjunct in the learning process of medical students and doctors [3]. This has increased further with
advances in technology that have seen a shift in use from personal computers towards portable electronic hardware
devices.
Smart phones and tablet devices [4], or “smart devices” are mobile hardware that have been developed to be used
whilst on the move. The devices have a simple design making them easy to use and are becoming increasingly popular.
In 2012, nearly 500 million smart phones were bought, which totaled more than the number of personal computers sold
[4]. Their popularity is seemingly attributed to the applications (“Apps”) that they contain. Apps are independent
* Address correspondence to this author at the Department of Plastic Surgery, Whiston Hospital, Liverpool, L35 5DR UK; Tel: + 44(0)1244366265;
Fax: +44(0)1244366265; E-mail: hindocha2001@yahoo.com

1874-2203/16 2016 Bentham Open

The use of Smartphone Applications Open Medicine Journal, 2016, Volume 3 323

software applications. They can be downloaded onto smart devices and can serve multiple functions. Apps
are used for advertising and marketing, recreational purposes, by news corporations, for social media and for
communication purposes in addition to education.
Apps encompass a multimedia approach including videos, texts, illustrations and podcasts, and their popularity is
increasing. Apple’s App Store alone has over one billion downloads a month [5]. In 2011, $718 million was spent on
healthcare Apps, a seven fold increase on 2010 [6]. The increase in popularity of medical apps is in part due to the
immediate access to electronic medical text and portability of the device to enable use anywhere. There is also evidence
to show that medical apps have demonstrated an improvement in patient care [7]. Apps facilitate lifelong learning, an
essential component not only of undergraduate education but required to continue in a medical career[8]. Handheld
computers in medical education are already recognised by professional bodies such as the General Medical Council [8]
and some medical schools are already supplying medical students with smart devices [9]. There is a substantial variety
of medical apps available for download onto smart devices. As evidence to the increasing availability and diversity of
medical apps, websites have emerged that are dedicated to their review [10].
With the continued rise of smart devices and e-learning, medical Apps are likely to become an increasingly
important aspect of future medical education.

TEACHING AND LEARNING MODELS

Honey [11] categorize four broad learning styles; activists, pragmatists, theorists and reflectors. This emphasises the
importance of understanding different learning needs in order to provide effective teaching. Medical apps can be
tailored to target these individual needs and therefore appreciate different learning styles.
Nonaka [12] proposed a theory for the creation of knowledge. This follows that “explicit” knowledge i.e. core
knowledge base is obtained prior to becoming “tacit” knowledge. Tacit knowledge is created through experience and
practice. Smartphone apps provide a portal to obtain explicit knowledge quickly for example in a clinical situation. This
can then be converted into tacit knowledge through application to the clinical scenario. This is important for medical
education as effective learning necessitates a balance between the two.
Sfard [13] described two models of learning, the acquisition model and the participation model. The acquisition
model puts emphasis upon the individual and their learning needs in contrast to the participation model which focuses
upon becoming part of a social community and participating in the learning process. For effective learning, a balance
needs to be achieved between these models. Learning requires obtaining knowledge in addition to social participation.
Apps provide a channel for the acquisition of knowledge in a clinical setting, which allows practical participation to
enhance the learning process. This can be seen in apps which simulate for instance heart sounds or bowel noises.
Another model of learning is illustrated by Lave [14] who describes the concept of situated learning. This puts
emphasis on the need for contextualisation of knowledge. The portability of the smartphone device allows information
to be readily accessed and applied in a clinical context.
Davies [15] formulated a model of learning facilitated by smartphone devices. A trigger leads to the recognition of
an educational need. This may be insufficient knowledge of a disease process during a patient encounter. Following
this, the smartphone is used to gain knowledge in this area. The knowledge can then be contextualised into the relevant
clinical scenario. Repeated application of the acquired knowledge allows consolidation. Through this, and through
reflection, smartphones facilitate learning.
Despite the prevalence of smartphone app use in medical education, there is a distinct lack of objective evidence
assessing this.

AIM
The aim of this article is to assess the use of medical applications amongst medical students. In addition to this we
aim to ask how these are currently being utilized, and to what benefit, by medical students. We also review current
literature on this increasing technology use.

METHODS
A survey was sent to all undergraduates of the University of Liverpool (approximately 1800 student). This was
completed anonymously either by hand or by email. The survey was distributed by email to all current medical students
324 Open Medicine Journal, 2016, Volume 3 Snashall and Hindocha

through the University medical school email database. The questionnaire asked questions in relation to the use of
smartphones, apps and specifically medical apps. We also asked in regard to their feelings towards the future use of
apps in both their training and future careers. The survey can be found as Appendix 1.

RESULTS
123 students returned the survey (approximately 7% return rate).
Table 1. Results of medical app survey.

Number of Own a smart Use apps Use apps in a Use medical apps Found medical apps Believe in need for
respondents device medical context for learning for learning useful further medical apps
Medical 123 109 (89%) 107 (98%) 88 (82%) 91 (85%) 100 (93%) 104 (97%)
students

Eighty nine percent of respondents owned a smart device. Of these, 98% used Apps. Medical applications were used
in 82% of the “App user” population (Fig. 1). Apps were used for medical learning purposes in 85% of this population,
of which 93% found them useful. However, if a more comprehensive medical learning application were to be available,
97% of responders would consider using it (Table 1). Applications that were most popular amongst these students
included “Almost a Doctor”, “Oxford Handbook” series and “Pastest”.

100

95

90
%

85

80

75
Own a smart device Use apps Use medical apps for
learning purposes

Fig. (1). Use of smart devices, apps and medical apps.

These results, in regard to application use, are comparable to the results of other studies in the literature [17]. The
usage of medical applications however, appears to be slightly higher in this cohort than that found in the literature. This
may be due to selection bias in that questionnaires were more likely to be filled in by those with an interest in smart
devices. Another contributing factor will be the major technological advances and increasing popularity in smart
devices in the past year.

DISCUSSION
It is clear that medical apps are widely used by medical students. Medical apps can provide instant, readily available
information that can be accessed in a clinical setting such as a ward or clinic. This acquired knowledge can then be put
into context and incorporated into clinical practice in order to improve learning. Hardyman [18] demonstrated that the
quick and timely acquisition of knowledge from a smart device can provide better patient care and more efficiency in
the work place. Another advantage of some medical apps is that they can be used in an “offline” mode, hence they do
not require internet connectivity and will therefore not interfere with medical equipment.
There is strong evidence that medical apps facilitate the concept of situational learning. It is documented by both
The use of Smartphone Applications Open Medicine Journal, 2016, Volume 3 325

Sfard [13] and Lave [14] that learning is more effective when in context and when knowledge is combined with
practical application. This model of learning is evidenced by Hardyman [14] in a case report series. One report states
that a smartphone facilitated anatomy teaching before a theatre session through the use of visual aids and allowed the
information being delivered to be put into context and enhance the learning experience [15]. This has a role in
impromptu teaching scenarios where learning material has not been pre-prepared. The accessibility and portability of
medical apps means that they can be used at times when learning would otherwise be impractical. Examples include
whilst stood at a bus stop or between patients in clinic. This reduction in [16] “time wasting” is also evidenced in the
literature by Davies [17].
Although the usefulness of medical apps has been well documented, this approach to learning should be
supplementary and not be used alone. Apps should be used as an adjunct to traditional teaching methods. This fits in
with current learning strategies in that a learning environment should encompass a variety of learning media to
maximise the learning process [18].
The above survey reports that 97% of the population would use a comprehensive medical app for learning purposes
if available. Franko [19] found that the continued inclination for the development of further apps demonstrates that
currently available apps do not meet the current educational needs of medical students and doctors. Greater involvement
from universities, postgraduate education programmes and the Royal Colleges, could result in the development of
appropriate apps that address the educational needs of this population.
Multiple respondents from the study survey reported concerns regarding the reliability and lack of regulation of
medical apps. Franko [19] reported that there is no formal regulation regarding the content of medical apps. This could
indicate another potential role for governing bodies to undertake in the future.
Some studies have reported on the affordability of smart devices and apps. Payne [20] reported that some medical
students found that smart devices were too expensive for a student budget and therefore the use of medical applications
is limited to a certain cohort. Surprisingly, this same study found that more students owned a smart device and used
apps than doctors. This was despite the cost of these devices and demonstrates the rise in popularity of smart devices
amongst the student population. This might also be explained by the fact that medical students are on average of a
higher socioeconomic class compared to the general population and are more likely to have financial help from their
parents. Franko [19] found an inverse correlation between seniority of doctor and app use. This is likely to be a result of
greater use and understanding of smart devices and technology among the younger population, and could contribute to
the higher prevalence of smart devices amongst students. This suggests that the future use of smartphones and apps will
increase as the younger and more technologically-familiar students and doctors become older.
The acceptability of smart devices in the hospital setting is another hurdle that needs to be overcome. A case report
by Payne stated that some observers found it rude when a smart device was used in a clinical environment. Looking at a
phone on the ward could be misinterpreted and risk the health professional looking disinterested. This could adversely
affect the patient-doctor relationship. With increasing use and awareness of smart devices, this obstacle may gradually
be overcome.
With continued technological advances and increasing popularity of smart devices, app use will increase in the
future. In order to meet educational needs, and keep up with the technological advances, medical apps need to be made
available to all medical students and doctors. To meet educational needs and demand, more money needs to be invested
by Universities, hospital trusts and Royal Colleges into the development of medical apps for learning purposes. This
also requires regulation of medical apps by professional bodies. There is a lack of objective data on the use of
smartphones and apps in the literature. Further research is required to assess educational needs in relation to medical
apps.

CONCLUSION
Smart devices and the use of medical apps is prevalent amongst medical students. This will continue to rise in the
future amongst both medical students and doctors. Educational needs can be supplemented by the use of medical apps
and are particularly important in contextual learning. Evidence for the use of apps in medical education however,
remains limited. To keep up with technological advances and meet the learning needs of medical students both now and
in the future, more research is required to assess and address these needs.
326 Open Medicine Journal, 2016, Volume 3 Snashall and Hindocha

Appendix 1: App Survey

PLEASE DELETE ANSWERS AS APPROPRIATE

What is your grade?
Medical student ______ which year? ______ F1/SHO ______ SpR/Consultant ______ Other ______
Do you use a smart phone/tablet device?
Yes ______ No ______
Do you use Apps?
Yes ______ No ______
Have you used Apps in a medical context?
Yes ______ No ______
Do you know of colleagues using Apps to in a medical context?
Yes ______ No ______
Have you used medical Apps for referencing medical information/pathways?
Yes ______ No ______
If so, have you found them useful?
Yes ______ No ______
If available, would you use a medical Apps to reference medical information/pathways?
Yes ______ No ______
Have you used medical Apps for learning purposes?
Yes ______ No ______
If so, have you found them useful?
Yes ______ No ______
If a comprehensive medical app for learning purposes were available, would you consider using it?
Yes ______ No ______
If you have any specific comments/experience please elaborate below
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

CONFLICT OF INTEREST
The authors confirm that this article content has no conflict of interest.

ACKNOWLEDGEMENTS
Declared none.
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