tablets for medical education (t4me) in rwanda: usage patterns & outcomes over three years...
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Tablets for Medical Education (T4ME) in Rwanda: Usage Patterns & Outcomes Over Three Years
Distance Teaching & Learning Conference, Madison, WIAug 13, 2015
Adam Papendieck MPHProgram Director, Tulane University School of Law, Payson Graduate Program in Global
DevelopmentDoctoral Student, University of Texas at Austin, C&I - Learning Technologies
Nancy Mock DrPHAssistant Professor, Tulane University, School of Public Health and Tropical Medicine
Patrick Kyamanywa MDAssociate Professor, University of Rwanda, School of Medicine
Tablets for Medical Education (T4ME)
• In fall 2012, 91 third year medical students were given 7-inch Samsung Galaxy tabs with a case, keyboard, storage, sim card (2 months data)
• Preloaded with a variety of apps, e.g.:• Epocrates• Medscape• DropBox• Kindle• Annotation• Skype
• Support• Training• Facebook User Groups• Email support
Goals1. Increase access to internet
and (digital) resources
2. Network a community of practice: improve connectivity, communication and collaboration
3. Enhance new literacies and digital participation (Jenkins et al., 2006)
4. Improve learning outcomes
Photo source: The New Times / JP Bucyensenge
Outcomes: Internet and Device Usage
Baseline 3 Months 12 Month 33 Month0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Use computer daily for studyUse tablet daily for studyUse of internet daily for study
N=91 n=86 n=82 n=21
Outcomes: Centrality of Web
Baseline 3 Months 12 Month 33 Month0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Online resources are important for studyOnline resources are easy to access
N=91 n=86 n=82 n=21
Outcomes: Resource Access
Baseline 3 Months 12 Month 33 Month0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Easy to access assigned readingsEasy to access high quality resources
N=91 n=86 n=82 n=21
2012 Test Cohort vs. 2011 (Control)
HAEMIMMUNO
CVS
RESPIRATORY
GENETICS
MUSCULOPER
INFECTIOUS
GIT
OVERALL
-20.0 -15.0 -10.0 -5.0 0.0 5.0 10.0 15.0
Performance difference (%) on summative exams*
Performance difference (%)
*all differences were significant at p<.000 (86 out of 91 responding)
The Angry Birds Hypothesis
Type of usage and exam scores
• No significant association between overall scores and usage patterns
• A few significant negative associations with individual exam scores, for example:– daily internet access (MUSCULO-PER, p<.004)– daily use of the computer (MUSCULO-PER, p<.010)– daily use of tablet for social networking (MUSCULO-PER, p<.025)– daily use of tablet for web conferencing (MUSCULO-PER, p<.028) – gaming more than once per day (INFECTIO, p<.04)
• One significant positive association– daily usage of the tablet’s phone (HAEMIMMU, p<.032)
Students reported tablets as important academically, professionally and personally
% n
Tablets were important for academic work 95.2 21
Tablets were important for life outside of the university 100 21
Tablet ownership influenced peers to procure a computing device
95.0 21
*33 months post intervention
*
Outcomes and Impact
Portable access to resources“It helped me during my ward rounds and bedside learning and in preparation of my presentations using android apps for medicine like medscape, skyscape and others”
“I have some medicals apps that I do use which increase my performance [because I check in the] field what I don’t know.”
“I have been able to know…different medical issues and discoveries in medicine.”
“Academically I am able to access online materials”
Outcomes and Impact
Key literacy development
“I [now] read often per day.”
“As far as it is easier to carry it [everywhere] it indirectly increase[s] my study reading.”
“The tablet has improved my skills on electronic devices”
“…improving skills [on] other computing devices and in communication.”
Outcomes and Impact
Community networking and communication
“I have been able to access my emails without going to internet cafes.”
“The tablet helps me in communication either by sms, phone or by social networks.”
It has also impacted the way I use social networks.
…communication with my colleagues has also become easy.
…helps me to socialize with the world, interact with my friends.
Main Problems Reported
• Issues of “isolation” and “dependence” • Limited internet access• Device malfunction (crashes)
Support wishes
• Free, high-bandwidth connectivity• Access to protected sites and resources (e.g. Hinari)• App and online resource orientation• Training on very specific apps (e.g. UpToDate) or
tasks (presentation creation)
Lessons
• Digital literacy and self-efficacy may be positively impact with tablets in Rwanda, while decreasing overall usage of computers
• Learner agency, resource access and sense of community may be positively impacted with tablets in Rwanda, but internet access is limiting
Lessons• In context, summative semester exam scores are probably not a
satisfactory measure of impact (on their own)– Exams may change semester to semester– Exams may not measure what we actually want to know
• In general, it is helpful to measure usage and impact broadly in technologically marginalized contexts– We may miss key issues by focusing on narrow measures, or by not
measuring.– There is evidence that extremely constructionist interventions which use
technology may sometimes disrupt technologically marginalized learners• See Warschauer and Ames (2010) look at the impact of OLPC• See Reardon (2011) and Baily & Dynarsky (2011) about the widening education
and achievement gaps in the US
LessonsLightweight, mixed methods monitoring and evaluation strategies which are adaptable and active over longer periods of are helpful and feasible:
• Monitor small indicator sets over time for implementation guidance– SMS: Textit (textit.in) RapidPro (rapidpro.io)– Email/web: surveymonkey, polleverywhere
• Qualitative open-ended questions and focus groups – Barriers/solutions/support gaps, – Relevant resources– Innovative user strategies in context– Development of CoP and participation– Wikisurveys: allourideas.org
• Mobile device management (MDM), Web and Learning Analytics
Health Systems Transformation
Faculty development
Educational Programs
Applied Research: policy, operations and
evaluation
Administrative Systems
Faculty and student extension/outreach
Higher Ed. Partnerships Health systems change
Improved program policies, program design and implementation
Sustainable production of health workforce needs in country
Systems Change
Student graduation growth in Rwanda
Source: Rwanda Higher Education Council (2011)
Research Context
• Extremely constructionist tech interventions might further disrupt technologically marginalized– See Warschauer and Ames (2010) look at the
impact of OLPC– See Reardon (2011) and Baily & Dynarsky (2011)
about the widening education and achievement gaps in the US
