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Student e-Learning Technology
Implementing a Personal Digital Assistant (PDA) Program in a Veterinary College Curriculum David G. Bristol Dan McWhorter g
INTRODUCTION Technological advances have and will continue to alter the way we live, both professionally and personally. Even clothing design has changed to accommodate cell phones, personal digital assistants (PDAs), MP3 players, CD players, and other devices. One company, Technology Enabled Clothing, has incorporated solar chargers into their ScotteVest to allow daylight charging of electronic devices.1 They have also incorporated hidden electronic conduits in their clothing designs so that devices can be connected, creating a Personal Area Network. Sensors are becoming both more accurate and smaller. Smart Dust,2, 3 tiny wireless electromechanical sensors that can create their own network for sharing information, are under development and hold tremendous potential for changing manufacturing, military, medical, and other practices. The goal is to create sensors that are less than 1 mm thin and either have their own battery power or are able to scavenge energy from light, heat, vibrations, or other sources. The potential applications in veterinary medicine are enormous! Technological advances affect how we practice veterinary medicine. Numerous imaging modalities are available, and telemedicine is providing review of locally generated images by specialists at distant sites (teleradiology, teleCT, tele MRI, etc.). Microchips are routinely used for permanent pet animal identification. The mission of veterinary colleges is to graduate students who are medically competent. Veterinary students spend enormous amounts of time in classrooms being exposed to material considered essential for them to become good practitioners. Problem- and case-based learning is used in many institutions both to aid students in accumulating knowledge and to help them learn how to think ‘‘like a clinician.’’ Students need to learn what the best tools are to help them reach a diagnosis and treat their patient’s disorders. To do this for the twenty-first century, they must learn how to maximally utilize information technology in their veterinary practice. Critical to the provision of high-quality veterinary health care is access to current, accurate information. The knowledge base in veterinary medicine, as in other sciences, is continually increasing at a rate that makes it impossible for any individual to know of all advancements made on a daily basis. However, through advances in the development of information resources and wireless technology, information can be retrieved at almost any location. At some time in the future, veterinarians who fail to make use of readily available electronically based information resources to provide the best possible medical care will be as guilty of malpractice as those who fail to review textbooks and JVME 32(1) ß 2005 AAVMC
journal articles are today. Society’s general acceptance of information technology will raise the expectations of our students’ future clients that these graduates can use technology’s tools to improve the treatment of veterinary patients. Because of the increasing impact of information technology on society in general, and its probable impact on the future of veterinary medicine, the College of Veterinary Medicine at North Carolina State University CNCSU recently started a personal digital assistant (PDA) program, with the first distribution of PDAs to junior students in 2002. This article reviews the chronology of the program and its current status.
WHY PDAS? One can justifiably question why PDAs might be selected as the tool to introduce students to some of the benefits of using information technology. Many veterinary schools have laptop programs, and tablet PCs now offer advantages similar to those of laptop computers with greater convenience.4 Both are much more powerful than PDAs and can store more information. However, they can also be impractical in a large hospital environment. While PDAs lack the memory storage of larger devices, they can easily be carried in a lab coat or coverall pocket. Some of the memory limitations can be addressed through wireless connectivity to the Internet, as information can be stored on the network rather than on the device itself. Web-based applications can be designed so that demanding calculations take place on the server, rather than on the local device. The higher-level computational capabilities of computers are not necessary for most veterinary functions.
TECHNICAL CONSIDERATIONS The two major platforms for handheld computing are Palm OS and Windows CE. At the time of institution of our PDA program, devices using the Palm OS had the largest market share and the largest number of general software programs available. In addition, most of the available veterinary applications were based on the Palm operating system. We chose the Palm OS so that student users would be most familiar with the dominant operating system in the marketplace. A color display was deemed critical because of the highly visual nature of veterinary diagnostics. Images of ophthalmologic or dermatologic disorders are very difficult to evaluate using a grayscale image. The selected device also had to have the capability for wireless connectivity. The 802.11b wireless standard provides for approximately 300 feet of coverage from the access points that send and 117
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receive information. At the time this project was initiated, this connectivity for PDAs had to be established with a plug-in module. The device that best met these needs was a Handspring Visor Prism PDAa with a Xircom wireless module. In order to provide wireless coverage of the areas within the college where students spend most of their time (classrooms, cafeteria, library, teaching hospital), 17 wireless WiFi (802.11b) access points were installed and connected to the college’s network. This was an outgrowth of an earlier initiative to provide wireless laptop access to the hospital’s paperless patient record system that began in the late 1990s. Extensive signal strength testing was completed to determine optimum placement of the access points throughout the facility. Consideration was also given to the location of the hard-wired computer network and power so that the wireless access points could easily be tied into the existing system. As a facility-wide cable television system was being installed at this time, co-location of the access points helped defray installation costs. Lucent Technology access pointsb were recommended by the university’s IT unit to integrate with NCSU’s Nomadic computing architecture. Under this arrangement the access points serve as nodes on a virtual local area network (VLAN), limiting access to authorized users only. The system requires each user to authenticate using universitywide Unity network credentials through a Web browser to gain access to the network. This approach was taken to ensure compliance with university specifications to keep the network as secure as possible.
EARLY COMPLICATIONS WITH THE WIRELESS NETWORK The 802.11b wireless standard operates at 2.4 GHz. This is the same frequency that was used by some cordless phones in the Veterinary Teaching Hospital. The 2.4-GHz phones interfered with the wireless activity of the PDAs and would bump them from the wireless network. To address this problem, the 2.4-GHz phones were replaced with phones that use the same 802.11b wireless standard and the Voice over Internet Protocol (VoIP). VoIP phones are popular with faculty and staff in the Teaching Hospital because they provide a much greater range of coverage than the 2.4-GHz phones. The VoIP phones can operate wherever there are 802.11b access points to the Internet. Another complication was radio frequency interference cause by the imaging equipment in radiology; this was successfully addressed by shielding the equipment areas.
was sold to Intel. The technical support for both the wireless modules and the PDAs was relatively poor. As is typical in technology sectors, product availability changes rapidly: within two years of the PDA program’s inception, the model we had selected was discontinued.
CONTENT DEVELOPMENT A basic philosophy for developing electronically based information for NCSU-CVM’s PDA program is that it be platform independent. There are strong arguments in favor of this approach. First, as is obvious from the short lifespan of the first products selected, hardware changes occur quickly because of rapid technologics advances. Programs or databases designed for a specific format can rapidly become obsolete. While attempting to remain platform independent, product design does need to be optimized for the platform currently in use. This concern applies primarily to consideration of screen size in developing graphical content. Large files, such as highly detailed images, can take a long time to download in a wireless environment. Another consideration in developing content is whether the material needs to be available at all times, and must therefore reside in the device’s memory, or whether it is needed only while within range of the wireless network. Memory-resident applications are easier and faster for users to access and should be considered for those applications that will be useful in an ambulatory, nonhospital setting; an example is a drug formulary that should be available at all times. Web-based applications are useful for programs or databases that would exceed the available memory of the unit, applications that involve compiling information from a number of sources, or applications that distribute information to other users. An example of a current Web-based application is a teacher evaluation program that collects information from a large number of students and compiles it for departmental evaluation. A shortcoming of Web-based applications in our program is that they are limited to the availability of an 802.11b network. While these networks are commonly available in airports and in some coffee houses and fast-food restaurants, they are by no means universal.
CURRENT STATUS OF THE PROGRAM With the demise of the Handspring Visor Prism, another search for an optimal device for the college’s environment was undertaken. Again, a Palm OS was selected for market reasons. The Palm Tungsten C unit was chosen because it combined additional memory, faster processing speed, and better screen resolution than the initial product (Table 1).
THE EARLY YEARS Students in the graduating classes of 2003 and 2004 received the Handspring Visor Prisms and Xircom wireless Springportc expansion modules. Faculty and staff who expressed interest in the program received the same equipment. A total of 201 combined units were distributed. While the program made progress in development of tools for use in the educational process, several problems became apparent. The wireless capabilities of the devices were unreliable, resulting in units occasionally losing connections to the network. This was obviously a source of frustration. Xircom, the company that produced the wireless modules, 118
CURRENT APPLICATIONS Current applications include both memory-resident and Web-based applications. A relational database program is used as the backbone for a number of databases related to veterinary medicine, including a veterinary drug formulary, normal values for our clinical pathology laboratory, common bacterial isolates from specific sites in different domestic animals, antibiotic efficacies based on past isolates from patients in the veterinary teaching hospital, a veterinary virology database, and a medical JVME 32(1) ß 2005 AAVMC
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Spanish–English dictionary.d The Spanish–English dictionary is a free download from the Internet and was included in the databases because of the increasing Hispanic population in North Carolina. Text-based information is also available, including the hospital’s policy and procedures manual. A number of medical calculators are also included. The multimedia capabilities of the unit have been utilized for videotapes of normal auscultation techniques and a narrated demonstration of common surgical knot-tying procedures. The wireless capabilities allow user access to e-mail and other Internet-based applications. An instructional tool has been developed to allow faculty members to poll students in class. This program, Instant Polling, allows a faculty member to prepare multiple-choice or true/false questions either prior to class or during the classroom presentation.
Table 1: PDA product comparison Product
Handspring Visor Prism
Palm Tungsten C
Memory
8 MB RAM
64 MB RAM
Screen resolution
160 160
320 320
Processor speed
33 MHz
440 MHz
Wireless capabilities
Springport add-on
Built in
Memory expansion
Proprietary Springport format
Open Secure Digital Standard
The question is then presented to the students, who use their PDAs’ wireless Internet access to respond. The program compiles the responses and provides a graphical representation of the student responses (see Figure 1). This gives the faculty member immediate understanding of the students’ comprehension of the topic in question. If it is apparent that the students have not understood the topic, the faculty member can immediately review it. This tool keeps large classes interactive to a much greater degree than simply asking the class a question. In the latter situation, the faculty member really does not know whether anyone other than the responding student understands the concepts being discussed. The data collection capabilities of Web-based programs have also been used to gather information on teaching effectiveness in the veterinary teaching hospital. Traditionally, instructors were evaluated by students at the end of each course (years 1 through 3) or hospital rotation (year 4). Poor response rates were typical of evaluation of hospital instruction. In part this was due to the difficulty of making the necessary forms available at the end of rotations in a busy hospital environment. Now that the evaluation process uses a Web-based mechanism, the evaluation ‘‘forms’’ are always available to students, who can complete them using any networked computer or via their PDAs.
FACULTY PROGRAM DEVELOPMENT Training sessions are held for students, faculty, and staff on basic use of the PDAs. To encourage development of programs and databases related to the veterinary profession, teaching innovation grants have been awarded
Figure 1: Instant polling graphical presentation of results (on the PDA this is presented in color). Note that F is the correct response. JVME 32(1) ß 2005 AAVMC
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to faculty interested in developing these materials. Faculty members submit proposals to the Faculty Committee on Curriculum and Course Evaluation for evaluation and ranking. Ongoing training and guidance are provided to faculty in determining the best use for the mobile technology, based on ongoing research in development and presentation tools. Whenever possible, faculty are encouraged to leverage existing skills such as Hypertext Markup Language (HTML) to bring content to the PDAs as quickly and effectively as possible.
important to their future ability to practice effectively in our technologically evolving world.
NOTES a
HandSpring acquired by PalmOne, Milpitas, CA .
b
Lucent Technology, Murray Hill, NJ .
c
Xircom acquired by Intel, Santa Clara, CA .
d
Medical Spanish Dictionary, Michael Dansie, Wellington, FL .
e
AvantGo, Dublin, CA .
FUTURE APPLICATIONS At present, several applications are under development or consideration for future rollout. To facilitate access to resources for students and faculty in clinical rotations, a server-side Web application is under construction that will pull together course scheduling, class rosters, course content, faculty contact information, and faculty evaluation in a mobile format design for PDA displays. This databasedriven application works equally as well on wireless laptop and traditional desktop systems. As the Web server handles database integration, any standard Web browser can serve as the user interface; no additional software is needed on users’ systems. Mobile access is also under consideration for the hospital’s Universal Veterinary Information System (UVIS), a medical record system. To eliminate the need for full-time wireless connectivity to that system, an asynchronous method of data transfer using the AvantGo solutione is being explored. This solution provides a means for asynchronous forms processing that will allow downloading of data to the PDA prior to seeing the patient, updating of the record during the visit, and uploading those data back to the back-end servers at a later time.
REFERENCES 1 Technology Enabled Clothing . Accessed 03/19/04. 2 Pister K, Kahn J, Boser B. SMART DUST: Autonomous sensing and communication in a cubic millimeter . Accessed 03/19/04. 3 Johnson RC. Companies test prototype wireless sensor net. EE times, January 2003 . Accessed 03/19/04. 4 Eurell JC, Diamond NA, Buie B, Grant D, Pijanowski GJ. Tablet computers in the veterinary curriculum. J Vet Med Educ 32:113–116, 2005 (current issue).
AUTHOR INFORMATION CONCLUSIONS The PDA program is relatively new and has not yet been critically assessed. The current plan is to survey the class that will graduate in 2005 late in their senior year to assess the usefulness of the PDAs in both the pre-clinical and the clinical training programs. This class is the first to receive the Palm Tungsten C units with integrated wireless capabilities and larger memory capacities. Regardless of the outcome of the survey, integration of information technology into the training of veterinary students is
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David G. Bristol, DVM, Dipl. ABVP, Dipl. ACVS, currently serves as the Associate Dean and Director of Academic Affairs, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606 USA. E-mail:
[email protected]. Dan McWhorter, MA, is the Director of Web-Based Instruction and oversees the Mobile Computing Initiative at the College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606 USA. E-mail:
[email protected].
JVME 32(1) ß 2005 AAVMC
