Use of personal digital assistants (PDAs) in reflection on learning and practice

Original Research

Use of Personal Digital Assistants (PDAs)in Reflection on Learning and Practice

SONYA L. RANSON, PHD; JOHN BOOTHBY, MSW; PAUL E. MAZMANIAN, PHD; ANIKA ALVANZO, MD

Introduction: As the use of personal digital assistants (PDAs) grows, the value of reflection of learning andpractice draws increased attention from policymakers and evaluators. To learn more about the use of PDAs inpractice and learning, the present study describes use of (1) PDAs in patient care and (2) a PDA version of theVirginia Board of Medicine Continuing Competency and Assessment Form (CCAF), a learning portfolio intendedto encourage documentation of reflection on practice and medical education.

Methods: A purposive sample of 10 practicing physicians (6 male, 7 primary care) was recruited from geographicregions throughout Virginia. Five participants were previous users of a PDA. Three sources of data were analyzed:(1) a questionnaire describing PDA usage, (2) transcripts from telephone interviews, and (3) CCAF written com-ments. A study team member installed the PDA system and conducted individualized training on the basis of cur-rent equipment, software, and skills of the learner. Telephone interviews were completed 4–6 months after training.

Results: All physicians accessed the system after training. Use of the PDA was associated with the value ofinformation for making clinical decisions. Information accessed by PDA was used not only for clinical decisionsbut also for patient education and for teaching medical students. Use of the CCAF prompted physicians to reflecton changes in clinical practice.

Discussion: Training on the handheld equipment and applications should include assessment of systems con-nectivity and integration, access authority, existing skills, and previous use. Proponents of PDA use for clinicaldecisions should assure access to information that is useful to physicians for reflection on learning and practice.

Key Words: personal digital assistant, reflection, learning, clinical practice, continuing medical education, port-folio, decision support

Introduction

Since their introduction in the mid-1990s handheld comput-ers or personal digital assistants ~PDAs! have become com-mon and are now used by multiple disciplines. Health careis no exception: several reviews show that PDAs are beingintegrated increasingly into clinical practice and medical

education.1–6 A 2006 systematic review of PDA use by healthcare providers found that the adoption rate for professionaluse ranges between 45% and 85%, depending on the pop-ulation surveyed, up from 10%–15% in 1996.6

Information Retrieval and Decision Support

Although physicians have access to numerous sources ofdata via textbooks, journals, the Internet, and so on, fre-quently the information is not immediately accessible. PDAsallow physicians to access medical information remotely,often at the point of care. Such use of PDAs includes theability to access drug reference software, electronic text-books and differential diagnosis software, medical compu-tation programs, and clinical practice guidelines.7–11 Severalstudies indicate that physicians most frequently use PDAsfor accessing drug reference applications.6,12–16 One studyof 108 attending physicians and physicians in training fromteaching hospitals in five U.S. states found that 67% of par-ticipants reported PDA use had influenced their clinical de-cision making, with more than half reporting that PDA useaided in changing a patient’s treatment.13 Most were re-lated to selection of drug choice or dosage.

Dr. Sonya L. Ranson: Manager, Simulation Center, Carilion Clinic,Roanoke, VA; Mr. John Boothby: Virginia Commonwealth UniversitySchool of Medicine, Continuing Professional Development and Evalua-tion Studies, Richmond, VA; Dr. Paul Mazmanian: Virginia Common-wealth University School of Medicine, Continuing ProfessionalDevelopment and Evaluation Studies, Richmond, VA; Dr. Anika Alvanzo:Virginia Commonwealth University School of Medicine, Internal Medi-cine, Division of Quality Healthcare, Richmond, VA.

This research was conducted while Dr. Ranson served as Research Coor-dinator, Office of Continuing Professional Development and EvaluationStudies, Virginia Commonwealth University.

Correspondence: Dr. Sonya L. Ranson, Carilion Clinic, Medical Educa-tion, Simulation Center Manager, PO Box 13367, 1906 Bellview Ave.,Roanoke, VA 24014; e-mail: [email protected].

© 2007 Wiley Periodicals, Inc. • Published online in Wiley InterScience~www.interscience.wiley.com!. DOI: 10.10020chp.142

JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, 27(4):227–233, 2007

Much less is known about the use of PDAs in the adop-tion of clinical practice guidelines. Two pilot studies, con-ducted with Canadian family physicians, found that PDAswere successful in increasing appropriate referrals for car-diac stress testing in patients with suspected angina17 andin improving adherence to four of five preventive medicineguidelines.18 However, as these were pilot studies the sam-ple size was too small to show statistically significant dif-ferences. Jones and Curry were able to show that PDA usesignificantly increased the number of diabetic patients whoreceived annual foot exams ~odds ratio 4.8, p � .0001! andeye ~odds ratio 5.4, p � .0001! exams but showed no dif-ference in outcomes of care such as hemoglobin A1C, low-density lipoprotein ~LDL! cholesterol, weight, or bloodpressure.19 Similarly, Shiffman and colleagues found thatuse of PDAs increased pediatricians’ adherence to asthmaguidelines but had no effect on patient outcomes such assubsequent emergency department visits, hospitalizations,or days missed from school.20 Notably, this study also hadthe unintended effects of significantly longer office visitsand increased charges for patients whose physician was inthe intervention arm.

Patient Tracking Software

Though less frequently used than medical reference soft-ware, patient tracking software is another common use ofPDAs4,5,12,13,21–23 but can be limited by the effort neededto enter patient data on the small PDA screen.24 Accord-ing to one review,5 several studies showed that integra-tion of PDA software with hospital information systemsallowed medical trainees to save time by avoiding man-ual data retrieval.5 A 2001 qualitative study conducted ina Canadian intensive care unit ~ICU! found that attendingphysicians appreciated the usefulness of a PDA patient data-base, specifically when they were taking over the care ofpatients.12 It was believed that use of PDAs improved theteam’s knowledge of patients, particularly for those pa-tients whose conditions were more complex and who hadhad long hospital stays.12 A study of residents rotating ina neonatal intensive care unit ~NICU! found that a PDA-based patient record and charting system decreased docu-mentation discrepancies of patient weights in written dailynotes but had no effect on discrepancies of medicationsor vascular lines.21

PDA Use in Medical Education and Training

PDAs are being increasingly used in undergraduate and grad-uate medical education, and many of the aforementionedstudies included medical students and resident physicians.A 2000 survey of family medicine residency programs foundthat 67% of the programs who responded reported that PDAswere being used in their practices, with an additional 14%reporting plans to implement PDA use within the 24 months

after the survey. Of those reporting use, 45% reported thatuse of PDA applications was routinely required.25

While the aforementioned uses of PDAs appear to bethe most commonly employed in medical student and resi-dent education, other uses have been reported. PDAs havebeen used to track procedure documentation, which is re-quired by Residency Review Committees and necessary foracquisition of hospital privileges.26,27 One study found thatPDAs significantly increased emergency medicine residentdocumentation on 3 of 20 procedures, when compared tohistorical controls of handwritten documentation. It alsofound that residents preferred PDA documentation and that100% of the PDA entries were complete, compared to 91%of the handwritten entries.27 Two other studies found thatPDAs are useful in tracking medical students’ 28 and resi-dents’ 29 clinical experiences. Both reported that PDAs im-proved data collection and were useful in identifyinggaps, defined by recorded patient encounters, in trainees’education.

PDAs also found widespread use in evaluation. Twostudies report that using PDA-based checklists to assessthe learner’s performance during objective structured clin-ical examinations ~OSCEs! resulted in improved efficiencyand was rated highly by examiners.30,31 A 2002 report fromHarvard Medical School estimated an annual saving of$150,000 in clerical labor after converting from paper-based course evaluation surveys to a PDA-based format.32

Torre and colleagues described the use of PDAs to assessthird-year medical students’ perceptions of high-qualityteaching experiences33 and to track direct observation ofthe students’ cardiac auscultation skills.33,34

Two studies looked at the effect of PDAs on evidence-based medicine ~EBM! knowledge.35,36 One studied fourth-year medical students in Hong Kong. Most students thoughtthe decision support software helped to identify learningneeds and enhanced learning; however, use of the softwarewas low and barriers included faculty attitudes and limita-tions of the software with respect to student learning needs.36

The second study35 compared two groups of family prac-tice residents. All 57 residents received PDAs with proce-dure tracking and drug prescribing software and were trainedin the use of the software. Residents in the intervention armalso received an EBM course and an additional clinical de-cision support PDA software tool. At the end of 8 months,there was no significant difference in change scores for thetwo groups.

Learning and Continuing Medical Education

Attending physicians are included in many of the afore-mentioned studies documenting the use of PDAs in theclinical setting and at the point of care. Yet little is knownabout the use of PDAs in the evaluation and documenta-tion of continuing medical education ~CME!. Our reviewfound only one study, of 20 primary care physicians whoattended a series of 1-day CME activities, which found

Use of Personal Digital Assistants

228 JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS—27(4), 2007DOI: 10.1002/chp

that physicians reported use of a PDA supported both theirclinical decision making and their continuing medicaleducation.37

Access to information is important, but it is not a pre-dictor of change.38 Reflection, as a form of mental pro-cessing,39 allows physicians to make information andknowledge more meaningful.40 Several studies have dem-onstrated that diaries ~computerized or paper-and-pencil!assist physicians in recording and reflecting on their learn-ing activities.41–43

Effective January 2002, the Virginia Board of Medicinerequired by law that physicians complete 60 hours of con-tinuing medical education every 2 years, with 30 hours be-ing reported as type 1 credit.44 Credit must be offered byan accredited sponsor or organization that is sanctionedby the profession and provides documentation of hours tothe practitioner ~for example: American Medical Associa-tion PRA category 1, American Osteopathic Association cat-egory 1, American Academy of Family Physicians Prescribedcredit; American Academy of Pediatrics credit hours to-ward the Pediatrics Review and Education Program ~PREP!educational award!. Fifteen of the 30 hours must be com-pleted on a face-to-face, interactive basis. To meet medicalrelicensure requirements, physicians must submit a recordof their continuing medical education on a Virginia Boardof Medicine Continued Competency and Assessment Form~CCAF!. This form provides physicians with an opportu-nity to reflect upon their practice and educational activities.The Medical Society of Virginia revised its Virginia Physi-cian’s Recognition Award to align with the new state re-quirements and the CCAF of the Board of Medicine.

The present study ~1! develops an understanding of how10 volunteer physicians in Virginia use the PDA in theirclinical practice and ~2! describes how physicians use thePDA version of the CCAF to reflect upon their practice andmedical education. Descriptors of successful use of the PDAand deficiencies in the user interface involving the CCAFWeb-based reporting system are discussed.

Methods

In November 2006 a literature search using MEDLINE,CINAHL, Dissertation Abstracts, PsychINFO, and the Re-search and Development Resource Base ~maintained by theSociety for Academic Continuing Medical Education! wasconducted. Search terms used were personal digital assis-tant, reflection on learning, continuing medical education,physicians, medical education, and patient tracking soft-ware. Several studies describe the use of paper diaries anddesktop computers as tools for creating portfolios of phy-sicians’ continuing medical education activities.41–43

The present study used case study methods. Yin45 de-fines case study research as an “empirical inquiry that in-vestigates a contemporary phenomenon within its real-lifecontext; when the boundaries between phenomenon andcontext are not clearly evident” ~p. 23!. Case study re-

search typically answers one or more questions that beginwith how or why and a key strength of this method in-volves using multiple sources and techniques in the datagathering process.46

The case in this study involved 10 physicians in Virginiaselected by using a stratified purposeful sampling tech-nique. These physicians were chosen on the basis of rec-ommendations from the Virginia Board of Medicine ~three!,the Intrastate CME Accreditation Committee of Medical So-ciety of Virginia ~three!, and the Virginia CommonwealthUniversity ~VCU! Office of Continuing Professional De-velopment and Evaluation Studies ~four! contingent on phy-sicians’ willingness to use a PDA in the clinical setting, andtheir ability to participate in one conference call interviewand a PDA training session. PDA users and nonusers com-posed the study group.

Without charge, participants received a Dell Axim 30Pocket PC that included the following technical specifica-tions: ~1! pocket personal computer ~PC! operating system,~2! MS Office Suite compatibility, ~3! 256-MB additionmemory card, and ~4! WiFi and Bluetooth capabilities. APDA version of the CCAF was preloaded on each unit ~FIG-URES 1 and 2!, along with selected clinical guidelines,

FIGURE 1. Activity entry on CCAF.

Ranson et al.

JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS—27(4), 2007 229DOI: 10.1002/chp

access to online CME, and other software generating ac-cess to medical information resources ~e.g., InfoRetriever,5-Minute Clinical Consult, EBM Calculator!. Three levelsof data security were implemented: ~1! PDA unit registra-tion, ~2! user password system, and ~3! auto log-off.

All physicians were trained in the use of the programs andthe PDAs. Actual time each physician spent in training wasindividualized and ranged from 1.5 to 4 hours. A study in-vestigator ~JB! installed the PDA system and conducted train-ing on the basis of current equipment, software, and skillsof the learner. The training sessions included ~1! descrip-tion of project background and research consent process,~2! baseline demographic and PDA use data collection,~3! demonstration of PDA use to include CCAF and Info-Retriever, ~4! practice time, and ~5! review of projectexpectations.

Participants were contacted during the study period toprovide support to overcome barriers of PDA use withoutdirecting their performance. After approximately 4– 6months, the research team conducted a conference call in-terview with each of the 10 physicians. The following areexamples of research questions used as a guide for datacollection:

• How often do physicians use the PDA to record informa-tion on their Continued Competency and Assessment Form~CCAF!?

• What barriers prevent or obstruct maximum use of the PDAversion of the CCAF?

• What types of responses are recorded on the PDA CCAF?• Is there a difference in number of times physicians access

the PDA to record information on their CCAF between usersand nonusers?

• Do physicians find the CCAF accessed through the PDAuseful in their clinical practice?

• What barriers prevent physicians from PDA access to edu-cational information they need to improve practice?

• What types of information ~e.g., 5-Minute Clinical Consult,EBM Calculator, InfoPOEMs! are the 10 physicians ordi-narily accessing with PDAs?

There was some flexibility in that additional questionswere asked to clarify the meaning of responses and to elab-orate on topics the participants mentioned.

Three members ~SL, JB, PM! of the research team wroteobserver comments on initial review of the interview text.Transcripts were loaded into ATLAS.ti computer soft-ware for coding by the study investigators. Inductive dataanalysis was accomplished using the constant comparativetechnique.47 Initially, topics began to develop while the re-searchers reviewed the transcribed interviews. Investigatortriangulation was applied to help assure valid interpretationof data. A physician respondent reviewed the codes and par-ticipated in data analysis. The transcripts were reviewed onthree separate occasions and codes and subcodes were cre-ated from the data. The coded data were then clustered intocategories and patterns ~themes0concepts!. Written reflec-tions collected from the PDA version of the CCAF werereviewed for themes.

The three sources of data—PDA usage survey, interviewtranscripts, and CCAF written comments—were combinedfor each physician to get an overall picture of how he orshe used the PDA in clinical practice and perceived the use-fulness of the CCAF in the PDA format.

The final analytic step included presentation of the con-clusions to the physicians interviewed so they could check~1! accuracy of the data and ~2! validity of the findings.Participants received written results by e-mail and gave feed-back to investigators by e-mail reply or conference call. Thisprocedure was a crucial step to establish validity and trust-worthiness of the findings. Revisions based on physicians’comments were included in the final study analysis, tostrengthen the conclusions. Confidentially was maintainedby using pseudonyms in the report of findings. Descriptivestatistics using SPSS 14.0 also were generated.

Results

Upon completion of training, all physicians were able~1! to turn on the PDA and access major functions such asthe calendar, notes, contacts, and Internet; ~2! to perform

FIGURE 2. Reflection entry on CCAF.



the “syncing” process successfully; ~3! to access infoRe-triever ~InfoPoems! and 5-Minute Consult; ~4! to accessVCU Library PDA resources; and ~5! to enter a sample en-try into the CCAF using HanDBase. Characteristics of studyparticipants and a detailed discussion of how these physi-cians used the PDA and the CCAF are described in thefollowing.

Study Participants

Our sample included 10 physicians practicing in regionsacross Virginia ~three central, three southwest, two north-ern, two eastern!: six males and seven primary care physi-cians and four specialists ~nephrology, cardiology, emergencymedicine, and endocrinology!. Years out of medical schoolrange from 5 to 35 years. Of the five participants whohad previously used a PDA, three used a Dell, one used aSony, and the other used a Palm brand. Only one physi-cian had wireless Internet capability. Four of the five statedthey had used their PDA for at least 3 years and all hadused it for work-related clinical activities. All of these phy-sicians had used the scheduling0calendar ~five! and druginformation applications ~five!, and some had used the med-ical calculators ~four!, evidence for clinical decisions ~two!,and documentation0billing ~two! applications.

Those who had not used the PDA perceived it might beuseful for clinical information, drug dosages, patient infor-mation, calendar, and scheduling and as a task reminder.Reasons given for not using it were “money,” and “I haven’tgotten to the point that I thought it would improve my per-sonal or professional life enough to warrant spending themoney on something that will be less expensive and moreversatile shortly after purchasing. I guess that means I amgetting older.”

Value of Information in Clinical Decisions

Although there are apparent barriers to using the PDA in aclinical environment that are related to the usefulness ofavailable resources available in a PDA format, findings in-dicate that the PDA is a useful data-gathering tool for se-lect physician participants.

• An experienced electronic medical record user: “I am al-ready very connected, I use an electronic medical recordwhich has Internet access on it.” “So I rarely used the PDAin the clinical setting.” “I use our own portal called FirstConsult.”

• A new PDA user: “The InfoRetriever helped. For example,patients with DKA come in and there are lots of decisionsto be made. What’s nice about this is it tells you exactlyfluid therapy and it tells you what level the patient’s in.”

• An experienced PDA user: “I use it to quickly look up druginformation, side effects, drug interactions, contraindica-tions, etc.”

The perceived barriers and uses of the PDA in thesephysicians’ clinical practice vary and are summarized inTABLE 1.

Use of Information for Patient Education andTeaching

Information accessed by the PDA was used not only forclinical decisions but also for patient education and for teach-ing medical students.

• “I almost always use it when I need to calculate a specificcontinuous IV infusion that I don’t use all the time.”

• “I pulled up the picture, which was nice to show the patientthat hers was really pretty similar to what other people’slesions look like.”

• “We @physicians and student# would go to the office to-gether, so I would look up something on my PDA and showit to her . . . going back to the basics.”

Use of CCAF Prompts Reflection

Use of the CCAF prompted physicians to reflect on changesin clinical practice.

• “It helps with self-examination; it makes you pick up whatyou get out of meetings and CME.”

• “I think it challenges me by making me think one moretime you have to address how I’m going to implement thisnew information.”

• “Does it make me different; I don’t know. I think it’sbeneficial.”

TABLE 1. Uses and Perceived Barriers of the PDA ~n � 10!

Uses

Aid to make clinical decisions ~treatment, diagnosis!

Point of care ~patient education, decision aid!

Drug information ~dosage, type!

Clinical guidelines

Teaching medical students

Barriers

No perceived need for PDA functions ~already have a system that works!

Challenge for older physician

Clinical information not available or relevant to practice ~pediatricspecialty practice, drug IDs!

Difficult to maneuver through the PDA system quickly because oftechnical challenges to use

Information not current ~other reference material more timely!

Lack of confidence in accuracy of PDA information

Lost PDA

Limited memory of the PDA

Inconvenient to carry

Ranson et al.


Utilization of the CCAF on the PDA was influenced bydifferent barriers perhaps unique to the practice setting inVirginia; for example, we found a lack of familiarity withthe CCAF and its purpose among physicians across the boardin the study. Without reminders CCAF use diminished andparticipants stated it was cumbersome to use.

• “I think on the laptop it’s printed out easier; you can alterinformation easier for typing in things. As far as the PDAit’s tedious to enter information.”

• “I have so much to do during my day that entering in theinformation seemed too cumbersome.”

• “I just didn’t think to use it. It’s not something that wouldautomatically pop up on my screen.”

The amount of text required to record reflection or ac-complish tasks can diminish the utility of the PDA as atool.23,48 Other technological platforms ~e.g., Web-based!may provide greater functionality and ease of use for phy-sicians completing CCAFs.

Discussion

Training on handheld equipment and applications should in-clude assessment of systems connectivity and integration,access authority, existing skills, and previous use. Propo-nents of PDA use for clinical decision support, patient ed-ucation, and medical student education should assure accessto information that is useful to physicians for reflection onlearning and practice.

Our results regarding barriers to use of the PDA tend tosupport the results of previous studies. Physicians in thisstudy described accessing drug information and clinicalguidelines and using this information to make clinical deci-sions. They also described using it with medical students andpatients at the point of care. These findings are similar tothe results of previous studies.7,8,10–12,14,15,22 Several barri-ers to use ~e.g., no perceived need, lack of confidence inaccuracy of PDA information, lost, limited memory, and in-convenient to carry! also were consistent with the litera-ture.8,10,14,23 However, a few of these physicians indicatedthat select clinical information such as pediatric referencematerial and drug identifications appeared unavailable orotherwise irrelevant to their specific specialty practice, andsome information was seen as less current than other refer-ence materials physicians used. Finally, barriers to use ofthe CCAF ~e.g., lack of familiarity with the CCAF and itspurpose, need for reminders, and cumbersomeness! suggestthat legally required completion of a form does not guaran-tee its best use. Many physicians were unfamiliar with theCCAF in paper and electronic versions. Further research isneeded to explore the value of required report forms thatmay serve as learning portfolios and the use of PDAs as tools.

Each PDA installation and training was unique with re-spect to type of hardware0software platforms and levels ofparticipant ancillary technical support, confirming the chal-lenges of “heterogeneity of @user# requirements” reportedby others ~p. 114!.48 Challenges to setup and training were

~1! availability of the participant’s time, ~2! trainer time,~3! travel distances, and ~4! administrator access to the net-work to allow the installation. Because most participantswere unaware of the CCAF, background was required onits purpose and use. Finally, a glitch in the PDA version ofthe CCAF form application forced follow-up visits and0ortelephone consultation to assist participants in file updates.

This study is limited to 10 physicians in Virginia. Theresults do not apply to all physicians. The purpose of theresearch was to develop an understanding of how physi-cians use the PDA and the PDA version of the Virginia Boardof Medicine’s CCAF in reflecting upon their practice andmedical education. The potential for observer bias was min-imized by verbatim taped records of participant responses,precise and detailed descriptions of the interview session,and setting aside of assumptions while focusing on listen-ing and clarifying participant’s verbal messages. Finally,investigator triangulation helped to assure accurate interpre-tation of results described by physicians as their experi-ences during the study.

Planning for the use of reflection in continuing medicaleducation and for improving the quality of education andregulation involves understanding what physicians need toknow or do to remain competent. This project was designedto inform educational designers and regulatory agencies, asthey plan for improved policy, instruction, and evaluation.This study has generated information that will inform deci-sions about the interface of the PDA and physician utiliza-tion. The Virginia Board of Medicine and other regulatoryagencies interested in ongoing physician competency and as-sessment may use these findings to help improve policy in-volving the continued competency of licensed physicians.

Acknowledgments

We wish to acknowledge a discount provided by InfoRe-triever. We thank the Virginia Board of Medicine and theMedical Society of Virginia Intrastate CME AccreditationCommittee for their consultation during study design, andwe thank Chris Stephens for developing the HanDBase ver-sion of the CCAF. This project was funded, in part, by the

Lessons for Practice

• Use of the PDA was associated with thevalue of information in clinical decisions ofthe individual user.

• Information accessed by PDA was used forclinical decision support, patient education,and teaching medical students.

• Use of the CCAF prompted physicians toreflect on changes in clinical practice.



Society for Academic Continuing Medical Education Re-search Endowment and the Theresa Thomas Foundation.

References

1. Fischer S, Stewart TE, Mehta S, Wax R, Lapinsky SE. Handheld com-puting in medicine. J Am Med Inform Assoc. 2003;10:139–149.

2. Kho A, Henderson LE, Dressler DD, Kripalani S. Use of handheldcomputers in medical education. J Gen Intern Med. 2006;21:531–537.

3. Torre DM, Wright SM. Clinical and educational uses of handheld com-puters. South Med J. 2003;96:996–999.

4. Baumgart DC. Personal digital assistants in health care: Experiencedclinicians in your hand? Lancet. 2005;366:1210–1222.

5. Kuziemsky CE, Laul F, Leung RC. A review on diffusion of personaldigital assistants in healthcare. J Med Syst. 2005;29:335–342.

6. Garritty C, El Emam K. Who’s using PDAs? Estimates of PDA use byhealth care providers: A systematic review of surveys. J Med InternetRes. 2006;8~2!:e7.

7. Carroll AE, Christakis DA. Pediatricians’ use and attitudes about per-sonal digital assistants. Pediatrics. 2004;113:238–242.

8. Lu Y-C, Lee JK, Xiao Y, Sears A, Jacko JA, Charters K. Why don’tphysicians use their personal digital assistants? AMIA 2003 Sympo-sium Proceedings. 2003:405–409.

9. McLeod TG, Ebbert JO, Lymp JF. Survey assessment of personal dig-ital assistant use among trainees and attending physicians. J Am MedInform Assoc. 2003;10:605–607.

10. McAlearney AS, Schweikhart SB, Medow MA. Doctor’s experiencewith handheld computers in clinical practice: Qualitative study. Br MedJ. 2004;328:1–5.

11. Luo J. Portable computing in psychiatry. Can J Psychiatry. 2004;49~1!:24–30.

12. Lapinsky SE, Weshler J, Mehta S, Varkul M, Hallet D, Stewart TE.Handheld computers in critical care. Crit Care Med. 2001;5~4!:227–231.

13. Dee CR, Tolis M, Todd AD. Physician’s use of the personal digitalassistant ~PDA! in clinical decision making. J Med Libr Assoc. 2005;93~4!:480–486.

14. Barrett JR, Strayer SM, Schubart JR. Assessing medical residents’ usageand perceived needs for personal digital assistants. Int J Med Inform.2004;73~1!:25–34.

15. McCord G, Smucker WD, Selius BA, et al. Answering questions atthe point of care: Do residents practice EMB or manage informationsources? Acad Med. 2007;82~3!:298–303.

16. Rothschild JM, Lee TH, Bae T, Bates DW. Clinical use of a Palmtopdrug reference guide. J Am Med Inform Assoc. 2002;9~3!:223–229.

17. Griever M, Drummond N, White D, Weshler J, Moineddin R. Anginaon the Palm: Randomized controlled pilot trial of Palm PDA softwarefor referrals for cardiac testing. Can Fam Physician. 2005;51:382–383.

18. Price M. Can hand-held computers improve adherence to guidelines?Can Fam Physician. 2005;51:1506–1507.

19. Jones D, Curry W. Impact of a PDA-based diabetes electronic man-agement system in a primary care office. Am J Med Qual. 2006;21~6!:401–407.

20. Shiffman RN, Freudigman KA, Brandt CA, Liaw Y, Navedo DD. Aguideline implementation system using handheld computers for officemanagement of asthma: Effects on adherence and patient outcomes.Pediatrics. 2000;105~4!:767–773.

21. Carroll AE, Tarczy-Hornoch P, O’Reilly E, Christakis DA. The effectof point-of-care personal digital assistant use on resident documenta-tion discrepancies. Pediatrics. 2004;113~3!:450–454.

22. Eastes L. Use of the personal digital assistant for point-of-care traumadocumentation. J Emerg Nurs. 2001;27~5!:516–518.

23. Kiel JM, Goldblum OM. Using personal digital assistants to enhanceoutcomes. J Healthc Inform Manage. 2001;15~3!:237–250.

24. Adatia F, Bedard P. “Palm reading”: 2. Handheld software for physi-cians. Can Med Assoc J. 2003;167~7!:775–780.

25. Criswell DF, Parchman ML. Handheld computer use in U.S. familypractice residency programs. J Am Med Inform Assoc. 2002;9~1!:80–86.

26. Bird SB, Zarum RS, Renzi FP. Emergency medicine resident patientcare documentation using a hand-held computerized device. AcadEmerg Med. 2001;8~12!:1200–1203.

27. Bird SB, Lane DR. House officer procedure documentation using apersonal digital assistant: A longitudinal study. BMC Med InformaticsDecis Making. 2006;6~5!:1–6.

28. Alderson, O. Clinical experience of medical students in primary care:Use of an electronic log in monitoring experience and in guiding ed-ucation in the Cambridge Community Based Clinical Course. MedEduc. 1999;33~6!:429–433.

29. Malan TK, Haffner WHJ, Armstrong AY, Satin AJ. Hand-held com-puter operating system program for collection of resident experiencedata. Obstet Gynecol. 2000;96~5, pt 1!:792–794.

30. Schmidts MB. OSCE logistics—handheld computers replace check-lists and provide automated feedback. Med Educ. 2000;34~11!:957–958.

31. Treadwell I. The usability of personal digital assistants ~PDAs! forassessment of practical performance. Med Educ. 2006;40:855–861.

32. Briggs B. Pushing data out to PDAs. Health Data Manage. 2002;10:28.33. Torre DM, Simpson D, Sebastian JL, Elnicki DM. Learning0feedback

activities and high-quality teaching: Perceptions of third-year medicalstudents during an inpatient rotation. Acad Med. 2005;80~10!:950–954.

34. Torre DM, Sebastian JL, Simpson DE. A PDA-based instructional toolto monitor students’ cardiac auscultation during a medicine clerkship.Med Teacher. 2005;27~6!:559–566.

35. Grad RM, Meng Y, Bartlett G, et al. Effect of a PDA-assisted evidence-based medicine course on knowledge of common clinical problems.Fam Med. 2005;37~10!:734–740.

36. Johnston JM, Leung GM, Tin KYK, Ho L-M, Lam W, Fielding R.Evaluation of a handheld clinical decision support tool for evidence-based learning and practice in medical undergraduates. Med Educ.2004;38:628–637.

37. Pennington F. Technology Support for Point of Care Learning andClinical Decision Support. Austin, Tex: The Society of Academic Con-tinuing Medical Education; 2005.

38. Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physi-cian performance: A systematic review of the effect of continuing med-ical education strategies. JAMA. 1995;274:700–705.

39. Moon J. Learning Journals: A Handbook for Academics, Students andProfessional Development. London: Kogan Page; 1999.

40. Lockyer J, Gondocz S, Thivierge R. Knowledge translation: The roleand place of practice reflection. J Contin Educ Health Prof. 2004;24~1!:50–56.

41. Campbell C, Parboosingh J, Gondocz T, Babitskaya G, Pham B. Studyof the factors influencing the stimulus to learning recorded by physi-cians keeping a learning portfolio. J Contin Educ Health Prof.2001;19:16–24.

42. Campbell C, Parboosingh J, Gondocz T, et al. Self-education for pro-fessionals. Acad Med. 1996;71~10!:S49–S51.

43. Campbell C, Parboosingh J, Gondocz T, Babitskaya G, Pham B. Astudy of the factors that influence physicians’ commitments to changetheir practices using learning diaries. Acad Med. 1999;74S~suppl10!:S34–S36.

44. Virginia Board of Medicine Continued Competency Activity and As-sessment Form. Accessed May 2, 2006, at http:00www.dhp.virginia.gov0forms0medicine0ContinuingComp0CEInstructions_and_forms.doc.

45. Yin R. Case Study Research: Design and Methods. Newbury Park,Calif: Sage Publications; 1984.

46. Creswell J. Qualitative Inquiry and Research Design: Choosing AmongFive Traditions. Thousand Oaks, Calif: Sage Publications; 1998.

47. Glaser B, Strauss A. The Discovery of Grounded Theory: Strategiesfor Qualitative Research. New York: Aldine Publishing Company; 1967.

48. Carroll A, Saluja S, Tarczy-Hornoch P. The implementation of a per-sonal digital assistant ~PDA! based patient record and charting sys-tem: Lessons learned. Paper presented at: AMIA Annual symposium,2002; San Antonio, Tex.

Ranson et al.


Documents

Use of personal digital assistants (PDAs) in reflection on learning and practice