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Apple Watch: Med School's flipped classroom

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Dr Colin Lumsden is a paediatrician and the academic lead for eLearning at the Manchester Medical School - after an iPad pilot project, the result was a full roll-out of iPads to Medical Students at the University of Manchester who are in their clinical years (Years 3, 4 and 5). Colin is a full-time practitioner who also teaches part time; born in Kuala Lumpur, he grew up in Aberdeen, Scotland.

Colin was recently running workshops and seminars for the Australian University Consortium on the practical aspects of deploying technology in government hospital systems - including related security considerations - and the opportunities technology presents to clinical practitioners and educators. I talked to him by phone before his Melbourne talk.

I mentioned that these sorts of discussions about iPads being used in institutions inevitably result in the question 'why Apple?' and Colin immediately stated "I am not beholden to Apple in any way. I'm quite happy to talk about the deficiency of Apple. But when we started, there pretty much only was the iPad." The iPad came out April 2010, and Colin started seriously evaluating the iPad as a learning tool in January 2011.

At that time there was only the first iPad, and a Samsung 7-inch tablet. "I'm very glad we didn't go to the 7-inch Galaxy tab at that time. I guess our choice was influenced by Apple being a premium product, it had a lot of apps already available, and it really was - and still is - the best place to get medical certificate applications. So it came with a whole lot of resource already built and expanding rapidly.

"Samsung weren't really very interested in talking to us. They didn't talk to us. Microsoft were very interested in talking to us - but didn't have any product. So yes - it would be a more difficult conversation, I think, to have now, but at that time, it wasn't difficult.

"As we've moved through the project, Apple is very hard to work with. They usually say no. To anything. [Laughs.] And I know developers don't particularly like Apple because of its closed, restrictive nature, but it actually works for us very well. We don't have to worry about any malware.

We know the apps are quality controlled through the App Store. We've produced applications and there is a very rigid, quite strict quality control of applications. And I guess one of the big things is we have to take these things out into critical placement - and they are extremely sensitive about security." The IT departments had to be happy to have the iPad, "So that kind of restrictive, very security conscious nature, while it makes making developing things quite difficult, is perfect for us." The iPads have to be on, and use, government networks and web services securely.

"We ended up building one app really because we couldn't find an alternative, but we'd use 20 or 30 different apps because there is always something out there that is free or extremely cheap. So when we are presented with an issue or a development that somebody wants to do, the first thing you do is hop on the App Store, have a look at a few systems, look at online reviews and then try some of them out. Because they're so cheap, then very often we'll go for the cheapest, or the freest option. We just try them, and if they work, great, and if they don't, we stop using them."

Previously, medical institutions bought very expensive institutional access to software. "Once you've paid for it you basically have to use it - you're not going to dump it very quickly. So we've moved that to a much more responsive model. That has been a good positive, definitely."

I asked whether he had noticed a change in how people learn, with the switch to iPads, as when Colin started teaching everything was still fairly traditional. Colin qualified as a paediatrician in 2005, having graduated from medicine in 1995.

He worked in post-graduate medicine directing various aspects of training, and worked at the Royal College of Paediatrics. In 2009 he began teaching at the medical school in Manchester. "At that time eLearning was fairly rudimentary. We'd perhaps put some content up. You must click through it, read it and there might be some multiple-choice questions at the end. And we still have all that kind of thing, but now I think the big shift is that access to resources is very student-centred. You go and get what you want. It's not necessarily the institution telling you."

The iPad is an aggregator of information. As Colin puts it, it's "A single point where they can curate all the resources they have gathered over the course of time, and they all reside in one place. All their texts are on there, all their assignments are on there, we do a lot of their assessments on there. And it all pulls it together into one place." Students in first and second years don't have iPads. Staff have noticed they spend a lot of time on the institutionalised Learning Management System looking at content - traditional eLearning.

"They come out onto iPads [in Year 3] and then they spend hardly any time on the Learning Management System." The school has done research on what the iPads are being used for, which has found the iPads become very individually tailored to what students want to do with them. "If you want to use our textbooks, great. If you don't want to use our textbooks, fine." This suits the different learning styles people naturally have.

Assessment is on what has been learnt, not how it was learnt. "This is augmenting teaching. People still want to be taught by someone. I think a big thing in learning at the moment is so-called 'flipped classrooms', the idea that you put the content out, you ask people to read it, assimilate that, and then you come to a face-to-face session where you see if they've understood it, and clarify their understanding, and that now is very easy, with this technology."

That said, Colin takes a position you might not expect."I always say to people 'forget about the technology'! People call me a techy and I'm not a techy. I don't care what it does, and I don't know how it does it, either. I just want it to work for me. And that's been a big thing with the user interface. Nobody needs any training. You kind of get on with it. And in terms of a device, [the iPad is] incredibly reliable. It's very robust. We really don't have any IT support. I mean, we have it, but it's not used. They either work or they don't work - there's nothing much in between."

In the first year with 500 iPads out, two were stolen. Now 1500 are out "And we have about one per cent attrition rate." That's a few stolen, and a few people dropping them on their corners and cracking the screens.

In the clinical environment, mobile devices have become almost ubiquitous. "Clinicians can see the benefit - there's an app for almost any specialty going." The big centres of excellence and medical colleges all have their own apps. "It's a computer you can wander around with." Colin laughs about his first cohort going out into the workplace - usually the National Health Service. "They're finding it utterly infuriating. They still have these great big 300 lb trolleys they wheel around to gain access to results. It's not integrated, the user interface is horrible ... everything is moving towards iPad patient records but the problem is: how do you get the data in? And these are the solution - but it takes time."

Colin has found a lot of his first cohort have set up their own companies, producing apps, producing revision notes for other students etcetera.

People are wondering what the next big thing is. "Wearable? You can't take notes on wearable." He concedes that sensor technology is going to be really exciting in medicine, and thinks Google Glass has amazing potential for teachers. "But the problem for us, in the NHS, is patient confidentiality. The flip-side is that patients can now record us. Without our permission. That's legal. You can't do it the other way round."

I mention that the last time I spent any time in hospital (2010, visiting stricken family members) we weren't even allowed to have our cellphones turned on. Those days are gone, at least in the UK. "Yeah, everyone's got their cellphones on - to the point where some patents pick up their phones and answer them while I'm speaking to them. Which drives me nuts, to be honest ... and doctors do it. I mean I think if you picked up your phone in the middle of Intensive Care, nobody would be particularly pleased! It wasn't that long ago that we all had pagers, and nobody has pagers any more. It's all mobile phones."

Smartphones have just taken over. "I don't know any doctor that doesn't have a smartphone." The universities in England are having to embrace mobile learning. "What I say is, if you're not doing mobile learning, you're deluding yourself, because your students are doing it. They've all got smartphones and they're doing it whether you like it or not.

"My kids have grown up with touchscreens. I don't think they know any different." As for his own device, Colin has the original iPad mini, and doesn't think it replaces a laptop yet. For that he has an 11-inch MacBook Air. "The iPad mini is better for the clinical environment. It's a lot lighter."

And it fits in a labcoat pocket.

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