BackgroundMobile technology is increasingly being used by clinicians to access up-to-date information for patient care. These offer learning opportunities in the clinical setting for medical students but the underlying pedagogic theories are not clear. A conceptual framework is needed to understand these further. Our initial questions were how the medical students used the technology, how it enabled them to learn and what theoretical underpinning supported the learning.Methods387 medical students were provided with a personal digital assistant (PDA) loaded with medical resources for the duration of their clinical studies. Outcomes were assessed by a mixed-methods triangulation approach using qualitative and quantitative analysis of surveys, focus groups and usage tracking data.ResultsLearning occurred in context with timely access to key facts and through consolidation of knowledge via repetition. The PDA was an important addition to the learning ecology rather than a replacement. Contextual factors impacted on use both positively and negatively. Barriers included concerns of interrupting the clinical interaction and of negative responses from teachers and patients. Students preferred a future involving smartphone platforms.ConclusionsThis is the first study to describe the learning ecology and pedagogic basis behind the use of mobile learning technologies in a large cohort of undergraduate medical students in the clinical environment. We have developed a model for mobile learning in the clinical setting that shows how different theories contribute to its use taking into account positive and negative contextual factors.The lessons from this study are transferable internationally, to other health care professions and to the development of similar initiatives with newer technology such as smartphones or tablet computers.

Objective-To examine whether the association between expected symptoms of acute myocardial infarction and actual symptoms predicted delay in reaching hospital and help seeking behaviour. Design-During hospital convalescence, participants completed a structured interview designed to measure symptom experience and help seeking behaviour following the onset of symptoms of acute myocardial infarction. Patients-88 patients admitted to hospital with their first myocardial infarction Main outcome measures-Delay in reaching hospital from onset of worst symptoms, obtained from ambulance and hospital records. Results-The most common symptoms expected by patients with myocardial infarction were central chest pain (76%), radiating arm or shoulder pain (34%), and collapse (26%). The most common symptoms experienced were sweats or feeling feverish (78%), chest pain (64%), and arm, shoulder, or radiating pain (66%). A mismatch between symptoms experienced and those expected occurred in 58% of patients, and was associated with delay. Patients who experienced a mismatch between expectation and actual symptoms also were more likely to have a third party decide to call for help. Conclusions-The experience and interpretation of symptoms is an important source of delay and help seeking following onset of myocardial infarction symptoms. (Heart 2000;83:388-393)

Numerous studies have been undertaken demonstrating that online learning is an effective teaching tool, working best when combined with more conventional teaching methods. There is a paucity of data both examining the longitudinal blending of an e-module with more conventional modes of curriculum delivery and also relating to the time and financial costs involved in successful delivery of such a module. The study reported in this article was performed over an academic year in a cohort of 101 year 5 medical students. It demonstrates that there are significant set-up costs involved in designing and implementing an online module, although these costs will diminish following initial set-up. Surveys performed throughout the year demonstrated consistently high levels of student satisfaction, with appreciation of the educational benefits provided by e-learning. Successful clinician engagement and effective IT support are essential ingredients to success. Future research is likely to focus on outcome evaluations of e-learning and how it may affect learner knowledge, skills or attitudes.

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