Apr 19, 2012 - These free text comments are reproduced below. ... iphone or ipad or mobile computing devices? ... Information Management subsection.
PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (see an example) and are provided with free text boxes to elaborate on their assessment. These free text comments are reproduced below. Some articles will have been accepted based in part or entirely on reviews undertaken for other BMJ Group journals. These will be reproduced where possible. ARTICLE DETAILS TITLE (PROVISIONAL) AUTHORS
―It‘s on my iPhone‖: attitudes to the use of mobile computing devices in medical education, a mixed-methods study. Wallace, Sean ; Clark, Marcia; White, Jonathan VERSION 1 - REVIEW
REVIEWER
I do not have any conflict of interest, whether financial or other.
REVIEW RETURNED
Alireza Jalali MD, LMCC, DESMS Assistant Professor, Division d'anatomie clinique et fonctionnelle Director of Practical Exams, UGME Pre-Clerkship Units Faculté de médecine, uOttawa 451 Smyth Road, 2164 Ottawa (Ontario) K1H 8M5 03-May-2012
GENERAL COMMENTS
This is an important and timely article. mLearning is on the rise and this article‘s evaluation of use of mobile devices in medical education is interesting. Two strengths of this article are the Mix Method Evaluation and having participants from 3 groups: Students, Residents and Faculty (Life Long Learning). It‘s Well written and provides worthy details. It could be a guide for other medical schools planning to do such evaluations in mLearning. To maximize the benefit of this article I have a few suggestions: Abstract: • The ―Mobile Computing Device‖ should be clearly defined at the beginning. Is it only smart phones and tablets or it included Laptops also? etc. • You use the phrase ―Such as iPhone/iPad‖ often to give an example of Mobile device, smartphone, etc. This seems like "Apple advertising". I would remove them except if absolutely necessary. Introduction: • P5: 1st paragraph: Need reference for ―Mobile ... have been adapted by many countries‖ • P5: 3rd Para: You mention iP & BB but then just mention how iP is used. It would be good to have Refs on BB and Android also. Methods • Great to have the 3 groups: S/R/F (Life Long Learning!) • You could bring ―Ethical Approval‖ part up to be clear you got it before starting the project. Results • P7: 3 major domains: I would number them as 1,2,3 . Just to clearly separate them from ―Patterns of Usage ― & ―Advantages‖ • P7: (Consistency) At the end of the page, the 2 last stats (Journals & News) are not defined (S/R/F)
• P8: 2nd Para: The ―Apps‖ you mention may need R or TM beside their name. • P8: Communication: Only 10% use it for Images. Any idea WHY? • P9: You need a small intro before Advantages to conclude the 3 domains and introduce Adv/Challenges • P10: Last Para: ―57% agreed to …‖ not sure if this % is right as you have (S54/R31/F57) • P12: Last Para: (Consistency) 47% is spelled out. • P12- 13- "Policy" & "Future" are mentioned as the aims of your study (P5), but the section devoted them is short and could be enriched. Discussion: • P14: 1st Para: ―Many Authors have …‖ needs more refs than one (6). • 2nd para: Well explained the limits Any "future plans for" OR "changes resulting from" this study at your university? All the best AJ
REVIEWER
REVIEW RETURNED
THE STUDY
Vivian Lo Centre for Innovation in Complex Care University Health Network Toronto, Canada I have no conflicts of interest to report 03-May-2012
Overall There is a need to be clearer and explicit about the focus of the study by standardizing the terms used. Is the focus of the study specifically on iphones/ ipads usage or mobile computing devices in general? These terms were used interchangeably throughout the paper and in the quotes. If the focus is on the former, citing statistics on the percentage of iphones users among the participants (interviewees and survey respondents) would be useful. If latter, an environmental scan on the different types of devices used by participants would be insightful. I recognized that statistics were highlighted under the ―Patterns of usage‖ in the Results section (Page 7, Lines 18-27) but would like to see those numbers made more explicit. Also, it is not clear in the quotes/verbatim listed in Page 10, Lines 127 made by R07, S10 etc, what is ―it‖ referring to? Is ―it‖ referring to iphone or ipad or mobile computing devices? Methods Surveys More description is required on the data collection surrounding the online survey. • How many questionnaire items were on the survey? • Were the responses provided on a Likert scale or dichotomous? (e.g., Yes or No?) • Was the survey validated prior to data collection?
• What sampling methods were used to recruit the respondents? • What type of statistical analyses was conducted on the data?
RESULTS & CONCLUSIONS
Interviews Further description and details on the sample characteristics of the interviewees would be useful. E.g., How many of the interviewees were smartphone users or not? How and what methods were employed in the selection of the participants? It would be useful to explain the reason why only 1 faculty member was enrolled in the study. Results While citing the statistics from the survey responses in the Results section is useful, it is harder to keep track on the numbers. I would recommend having a table or bar graph and present the statistics on the respondents‘ level of agreement for each theme. I would also suggest listing out what major specialties were represented by the participants in Page 7 Line 7. Information Management subsection A major portion of the data from the ―Advantages‖ findings seems to overlap with the data in other parts of the Results section. I would recommend merging or combining the data from the Advantages subsection with the earlier subsections such as ―Information Management‖. For example, the verbatim of R05 (page 9 Lines 3132) in Advantage subsection could fit with the survey data found in (page 7, Line 41) which can further strengthen your paper as a mixed method study. Communication subsection Some description on the communication issues and challenges in the existing medical and clinical settings (such as the limitations of numeric paging; the inherent nature of mobile clinicians working in different temporal spaces) would be insightful. It would help the reader understand why clinicians would perceive email or telephone or text messages as the more efficient means to bridge these gaps. The verbatim by S02 is interesting (page 8, Lines 49-50). It would be insightful to further explore the implications for those who are not early adopters or users of mobile computing devices. How does that affect their medical learning and/or team relations and communications? Are there any data to support or suggest what some of these implications were? Time Management subsection Similar to the above comment, further analyses exploring the impacts of time management could be insightful. E.g., what are the impacts from sharing calenders between residents? Did that improve their communication and team dynamics with one another? Verbatim from S07 found in Advantages and Challenges subsection (Page 9 lines 45-46 versus Page 10 lines 45-46) appear to be very similar but seems to support two different arguments. I would recommend keeping the verbatim to either one of the section only. Challenges There are a number of themes listed in this section which could further tighten up. I would recommend for clarity of reading, to categorize the findings into major themes with its associated
subthemes. For example, some of the findings could be categorized as the ―Blurring of professional and personal boundaries‖ as a major theme with ―personal distractions such as facebook checking during clinical rounds‖ and ―discussion of patient data on personal devices‖ as subthemes. You may want to include subheadings for this section as well.
GENERAL COMMENTS
Discussions The discussion section is cohesive and well-written. Including a short paragraph describing directions for the future research and studies would be recommended. General Comments This is an interesting and pertinent study examining the attitudes and perceptions surrounding the use of iphone and related devices on medical learning and training. The themes in the paper are well supported by the interview and survey data and provided useful insights into the utilities and unintended consequences of mobile technology. Findings of this study can help readers devise the appropriate strategies and considerations of how to adopt smartphone technology effectively in their educational and clinical settings. Below are the comments and suggestions on how to further strengthen the paper and sections. Overall There is a need to be clearer and explicit about the focus of the study by standardizing the terms used. Is the focus of the study specifically on iphones/ ipads usage or mobile computing devices in general? These terms were used interchangeably throughout the paper and in the quotes. If the focus is on the former, citing statistics on the percentage of iphones users among the participants (interviewees and survey respondents) would be useful. If latter, an environmental scan on the different types of devices used by participants would be insightful. I recognized that statistics were highlighted under the ―Patterns of usage‖ in the Results section (Page 7, Lines 18-27) but would like to see those numbers made more explicit. Also, it is not clear in the quotes/verbatim listed in Page 10, Lines 127 made by R07, S10 etc, what is ―it‖ referring to? Is ―it‖ referring to iphone or ipad or mobile computing devices? Methods Surveys More description is required on the data collection surrounding the online survey. How many questionnaire items were on the survey? Were the responses provided on a Likert scale or dichotomous? (e.g., Yes or No?) Was the survey validated prior to data collection? What sampling methods were used to recruit the respondents? What type of statistical analyses was conducted on the data? Interviews Further description and details on the sample characteristics of the interviewees would be useful. E.g., How many of the interviewees were smartphone users or not?
How and what methods were employed in the selection of the participants? It would be useful to explain the reason why only 1 faculty member was enrolled in the study. Results While citing the statistics from the survey responses in the Results section is useful, it is harder to keep track on the numbers. I would recommend having a table or bar graph and present the statistics on the respondents‘ level of agreement for each theme. I would also suggest listing out what major specialties were represented by the participants in Page 7 Line 7. REVIEWER
REVIEW RETURNED
THE STUDY
Dr Anna Jones Teaching fellow Brighton and Sussex Medical School Brighton UK 12-May-2012
Thank you for inviting me to review this paper which aimed to examine how medical teachers and learners are using mobile devices such as Smartphones to assist with their learning in a large medical school in Canada. My suggestions are as follows: In the abstract, the objective was stated as examining how they are using such devices in medical education; however the data presented looked more widely at how they are being used for learning but also in clinical practice and I think this needs to be amended. I agree that this methodology is appropriate for this type of study and that there are advantages afforded by the mixed methodology of quantitative and qualitative methods. However, whilst the authors acknowledge in the limitations section of the paper (in the discussion) that it is not possible to generalize these findings and that the participants in the study may not be representative of all of the study population, it would be helpful if the methodology could be expanded in order to explore this further. The issue of identifying why certain people are early adopters of new technology and others are resistant has been widely reported on. It is crucial in developing policy for ensuring that the advantages of such technology (which the authors clearly outline and highlight in this paper) is available as widely as possible and it is therefore important to identify who is not participating in this and why. It may be that the group that did not participate in the study have similar use of the technology and have similar characteristics but it would be useful to know this. I would therefore suggest that more focus on how representative the study participants were in comparison to the whole school population would help. It would be useful to know in terms of the methodology: 1. Inclusion / exclusion criteria for participants 2. How do the study participants compare with the study population in terms of gender, academic attainment, age etc? 3. It‘s not always clear to (this!) reader in the results whether the
data is from the survey participants or the interviewees. Also was there any overlap between these 2 groups ie did some people take part in the survey as well as the interviews? 4. Recruitment strategy for interviewing – was this convenience or purposive? 5. It would be useful to see the question / topic guide for the semistructured interviews and the questionnaire for the online survey. Was the survey data anonymous / confidential? How was consent obtained for the interviews? Future use of technology: – one of the objectives of the study is to examine how the use of such technology will change in the future and I was not convinced from the data that was presented that this has been demonstrated – rather the evidence is from other literature. I agree that it is likely that it will continue to expand but that is based on other literature and experience rather than from the data that you have presented.
GENERAL COMMENTS
Barriers to use: It was helpful to see the issue of cost being discussed as this can certainly act as a barrier. I felt that more detail and exploration could be given to the issue of use (and how to determine whether this is appropriate or inappropriate) of these devices within the clinical setting and in particular the use of mobile devices for sharing clinical information as this is a major concern. The finding that 10% of students and only 5% of faculty members admitted to doing this was interesting too. Your suggestion of developing guidance for professional etiquette could be expanded on based on your findings. Further to my review, I would also like to recommend that you refer to a recent opinion piece, ‗Using mobile phones on the job‘, Authors: Patricia Mechael, Ada Kwan, Sarah Struble Publication date: 19 Apr 2012 http://careers.bmj.com/careers/advice/viewarticle.html?id=20007122#, on using Smartphone technology. This piece, along with the resources referenced, may provide further information to strengthen your manuscript. It cites a paper (Davies BS, Rafique J, Vincent TR, Fairclough J, Packer MH, Vincent R, et al. Mobile Medical Education (MoMEd)— how mobile information resources contribute to learning for undergraduate clinical students—a mixed methods study. BMC Medical Education 2012; 12.) that was authored by colleagues of mine here at Brighton and Sussex Medical School. I hope that these resources are helpful – Anna Jones VERSION 1 – AUTHOR RESPONSE
Thanks for the further comments on our revised manuscript, and thank you for recommending publication. We enjoyed reading the reviewers‘ comments and have laid out our changes and responses below. We have resubmitted the manuscript in the following files:
‗iPhone Further Track Changes‘ with all of the changes noted ‗iPhone Further Changes Accepted‘ with all of the changes accepted We hope that the changes we have made will meet with your approval and we look forward to hearing from you. Best wishes
Sean Wallace Dr Marcia Clark Dr Jonathan White
VERSION 2 – REVIEW REVIEWER
REVIEW RETURNED
THE STUDY
RESULTS & CONCLUSIONS
Vivian Lo Centre for Innovation in Complex Care University Health Network Toronto, Ontario Canada Competing interests: None declared 07-Jun-2012
1. Discrepancies over the definition of constructs In the Introduction section, the adopted definition of ―mobile computing device‖ in this study excludes tablets (Page 5, Lines 3536). However, the Apple iPad is reviewed and discussed in this section (Page 5, Lines 41-42) and others (e.g., Results-Advantages: Page 7, Lines 49-50). The authors need to consider if they want to include tablets as part of this study or revised a new definition on what constitutes as a mobile computing device. 2. Discrepancies in the Data Collection Methods In the Method section, it was noted that interviews ―were up to 30mins in length‖ (Page 6, Line 9). However, it was mentioned in the latter part of same section that ―interviews lasted 30-45mins‖ (Page 6, Line 20). Please be clear and consistent on the length of the interviews. In the Results section, it was noted that 213 participants responded to the survey (Page 7, Line7). However, statistics of the different groups only add up to 182 respondents (Page 7, Line 8). Please check that the numbers are corrected. 3. Further information required and Clarity of phrases and sentences A. Methods Section On Page 6, Lines 16-17, it was noted that all medical students, residents and faculty were invited to the study. Please indicate the statistics on the overall population size from each group invited to participate to the survey. B. Results Section b1. In the Results Section, it is not clear what the label ―multiple 1‖ (Page 7, Line 31) means. Does it mean multiple devices? In the
REPORTING & ETHICS
same line (Page 7, Line 31), please also include the statistic for nonsmartphones users. It would be useful for readers to know how many smartphone and non-smartphone users participated in the survey. b2. It is unclear what this sentence meant—―More information was obtained about how participants used mobile computing devices to ‗look stuff up‘ (Page 8, Lines 5-6). What and how was this ‗More information‘ obtained? Does it mean further follow up questions were asked in the survey or interviews? Please clarify. b3. The first paragraph on Information Management theme centered on different information sources. It is unclear how note taking fits in as an information source. See sentence ―Note taking was a commonly described use‖ (Page 8, Line 49). Is note taking an information source, an application, a Smartphone functionality or simply a recording exercise adopted by users/participants? 4. Discrepancies between Results Findings and Discussion Write Up. In the Communication theme (Page 9, Lines 31-32), it was noted that ―many participants described texting as a more efficient way than meeting in person‖. This contradicts with the paragraph in the Discussion Section where ―co-workers preferred communication in person to texting..‖ (Page 15, Line 27). It weakens the earlier argument and statement in the paragraph that ―The findings of this study support Wu et al‖ (Page 15, Line 19). Thus, please be concise and precise in your sentences and arguments to avoid confusion. 5. Conclusions made from the Results Findings a. In Page 10 Line 14, the phrase ‗a number of participants described... ‗ does not seems to go in line with the low proportion and statistics of 27% respondents. b. Under the Challenges theme, only interviews sources were mentioned in the first sentence (Page 10, Line 27). It appeared, however, that survey data were also used to illuminate these challenges as shown in the subtheme of Trusting Information Sources. Please revise the sentence to be clearer. c. Under the Blurring of Personal/Professional Boundaries subtheme, it is argued in the last paragraph that ―many participants suggested that some policy may be required to streamline use across different systems...‖ (Page 13, Line 6). However, given that less than half of the majority (i.e. only 47%) agreed with the survey statement, it is not accurate to depict this 47% as ―many participants....‖. Perhaps ―Some participants‖ would be a more accurate phrase. 6. Restructuring the paragraphs in the Discussion Section To improve the flow and coherency of the Discussion section, here are some considerations and suggestions: A. Place the second paragraph starting with ―This study supports the findings of Davies et al..‖ at the end of the fourth paragraph that discussed how the current study supported Wu et al‘s study. B. Place the third paragraph centering on the study limitation starting with the sentence ―Our study was limited‖ as the 3rd last paragraph before the paragraph and line ―This study has encouraged a debate among students and faculty...‖ Minor Issue: Grammatical Corrections and Edits 1. Introduction a. Removed the word ―the‖ from the sentence to ―We believe that mobile access...‖ (Page 5, Line 10) 2. Methods a. Revised the sentence in Page 6, Lines 12-13 to ―The interviews were conducted in person (with the exception of one phone
interview) at a private office space located in our medical school.‖ 3. Results a. Insert ―(― in Page 12 Line 8 after the word ―patient‖ b. Insert ― to the quote in Page 12 Line 34 before the word ―One‖ c. Spaces between the quotes under the Anticipated Future Uses theme 4. Discussion a. Removed and Replaced the word ―to‖ from the sentence to ―It seems unlikely that using ‗The Cloud‘ will ever completely replace the need..‖ (Page 15, Lines 48-49) b. Replaced the word ‗may‘ with ‗and‘ in the sentence ―...from giving full attention to tasks at hand and distract users from the normal activities..‖ (Page 15, Line 8) c. Recommend the authors revise the sentence ―....end-users of these devices are running ahead of leaders, policy-makers and educators‖ (Page 16, Lines 16-17) to be clearer. GENERAL COMMENTS
Overall, substantial improvements have been made in this second revision of the manuscript from the earlier version. Below are the comments and suggestions on the major and minor issues for this revised manuscript. Major Concerns/Issues 1. Discrepancies over the definition of constructs In the Introduction section, the adopted definition of ―mobile computing device‖ in this study excludes tablets (Page 5, Lines 35‐36). However, the Apple iPad is reviewed and discussed in this section (Page 5, Lines 41‐42) and others (e.g., Results‐Advantages: Page 7, Lines 49‐50). The authors need to consider if they want to include tablets as part of this study or revised a new definition on what constitutes as a mobile computing device. 2. Discrepancies in the Data Collection Methods In the Method section, it was noted that interviews ―were up to 30mins in length‖ (Page 6, Line 9). However, it was mentioned in the latter part of same section that ―interviews lasted 30‐45mins‖ (Page 6, Line 20). Please be clear and consistent on the length of the interviews. In the Results section, it was noted that 213 participants responded to the survey (Page 7, Line7). However, statistics of the different groups only add up to 182 respondents (Page 7, Line 8). Please check that the numbers are corrected. 3. Further information required and Clarity of phrases and sentences A. Methods Section On Page 6, Lines 16‐17, it was noted that all medical students, residents and faculty were invited to the study. Please indicate the statistics on the overall population size from each group invited to participate to the survey. B. Results Section b1. In the Results Section, it is not clear what the label ―multiple 1‖ (Page 7, Line 31) means. Does it mean multiple devices? In the same line (Page 7, Line 31), please also include the statistic for nonsmartphones users. It would be useful for readers to know how many smartphone and non‐smartphone users participated in the survey.
b2. It is unclear what this sentence meant—―More information was obtained about how participants used mobile computing devices to ‗look stuff up‘ (Page 8, Lines 5‐6). What and how was this ‗More information‘ obtained? Does it mean further follow up questions were asked in the survey or interviews? Please clarify. b3. The first paragraph on Information Management theme centered on different information sources. It is unclear how note taking fits in as an information source. See sentence ―Note taking was a commonly described use‖ (Page 8, Line 49). Is note taking an information source, an application, a Smartphone functionality or simply a recording exercise adopted by users/participants? 4. Discrepancies between Results Findings and Discussion Write Up. In the Communication theme (Page 9, Lines 31‐32), it was noted that ―many participants described texting as a more efficient way than meeting in person‖. This contradicts with the paragraph in the Discussion Section where ―co‐workers preferred communication in person to texting..‖ (Page 15, Line 27). It weakens the earlier argument and statement in the paragraph that ―The findings of this study support Wu et al‖ (Page 15, Line 19). Thus, please be concise and precise in your sentences and arguments to avoid confusion. 5. Conclusions made from the Results Findings a. In Page 10 Line 14, the phrase ‗a number of participants described... ‗ does not seems to go in line with the low proportion and statistics of 27% respondents. b. Under the Challenges theme, only interviews sources were mentioned in the first sentence (Page 10, Line 27). It appeared, however, that survey data were also used to illuminate these challenges as shown in the subtheme of Trusting Information Sources. Please revise the sentence to be clearer. c. Under the Blurring of Personal/Professional Boundaries subtheme, it is argued in the last paragraph that ―many participants suggested that some policy may be required to streamline use across different systems...‖ (Page 13, Line 6). However, given that less than half of the majority (i.e. only 47%) agreed with the survey statement, it is not accurate to depict this 47% as ―many participants....‖. Perhaps ―Some participants‖ would be a more accurate phrase. 6. Restructuring the paragraphs in the Discussion Section To improve the flow and coherency of the Discussion section, here are some considerations and suggestions: A. Place the second paragraph starting with ―This study supports the findings of Davies et al..‖ at the end of the fourth paragraph that discussed how the current study supported Wu et al‘s study. B. Place the third paragraph centering on the study limitation starting with the sentence ―Our study was limited‖ as the 3rd last paragraph before the paragraph and line ―This study has encouraged a debate among students and faculty...‖
Minor Issue: Grammatical Corrections and Edits 1. Introduction a. Removed the word ―the‖ from the sentence to ―We believe that mobile access...‖ (Page 5, Line 10) 2. Methods a. Revised the sentence in Page 6, Lines 12‐13 to ―The interviews were conducted in person (with the exception of one phone interview) at a private office space located in our medical school.‖ 3. Results a. Insert ―(― in Page 12 Line 8 after the word ―patient‖ b. Insert “ to the quote in Page 12 Line 34 before the word ―One‖ c. Spaces between the quotes under the Anticipated Future Uses theme 4. Discussion a. Removed and Replaced the word ―to‖ from the sentence to ―It seems unlikely that using ‗The Cloud‘ will ever completely replace the need..‖ (Page 15, Lines 48‐49) b. Replaced the word ‗may‘ with ‗and‘ in the sentence ―...from giving full attention to tasks at hand and distract users from the normal activities..‖ (Page 15, Line 8) c. Recommend the authors revise the sentence ―....end‐users of these devices are running ahead of leaders, policy‐makers and educators‖ (Page 16, Lines 16‐17) to be clearer. VERSION 2 – AUTHOR RESPONSE
Reviewer: Vivian Lo Centre for Innovation in Complex Care University Health Network Toronto, Ontario Canada Competing interests: None declared 1. Discrepancies over the definition of constructs In the Introduction section, the adopted definition of ―mobile computing device‖ in this study excludes tablets (Page 5, Lines 35-36). However, the Apple iPad is reviewed and discussed in this section (Page 5, Lines 41-42) and others (e.g., Results-Advantages: Page 7, Lines 49-50). The authors need to consider if they want to include tablets as part of this study or revised a new definition on what constitutes as a mobile computing device.
Amended to: This definition includes all manner of “smartphones” such as the iPhone™ and the Blackberry™ and devices such as the iPad but excludes desktops, netbooks and laptop computers.
2. Discrepancies in the Data Collection Methods In the Method section, it was noted that interviews ―were up to 30mins in length‖ (Page 6, Line 9). However, it was mentioned in the latter part of same section that ―interviews lasted 30-45mins‖ (Page 6, Line 20). Please be clear and consistent on the length of the interviews.
So amended
In the Results section, it was noted that 213 participants responded to the survey (Page 7, Line7). However, statistics of the different groups only add up to 182 respondents (Page 7, Line 8). Please check that the numbers are corrected.
Apologies for this oversight, the correct figures are: 93 medical students, 72 residents and 48 faculty members.
3. Further information required and Clarity of phrases and sentences A. Methods Section On Page 6, Lines 16-17, it was noted that all medical students, residents and faculty were invited to the study. Please indicate the statistics on the overall population size from each group invited to participate to the survey.
Approximate numbers have been provided
B. Results Section b1. In the Results Section, it is not clear what the label ―multiple 1‖ (Page 7, Line 31) means. Does it mean multiple devices?
So amended.
In the same line (Page 7, Line 31), please also include the statistic for non-smartphones users. It would be useful for readers to know how many smartphone and non-smartphone users participated in the survey.
Amended to: Almost 90% of participants reported current use of a mobile computing device (overall: 87%, students 85%, residents 90%, faculty 85%),
b2. It is unclear what this sentence meant—―More information was obtained about how participants used mobile computing devices to ‗look stuff up‘ (Page 8, Lines 5-6). What and how was this ‗More information‘ obtained? Does it mean further follow up questions were asked in the survey or interviews? Please clarify.
Amended to: Participants provided further information on how they used mobile computing devices to “look stuff up”.
b3. The first paragraph on Information Management theme centered on different information sources. It is unclear how note taking fits in as an information source. See sentence ―Note taking was a
commonly described use‖ (Page 8, Line 49). Is note taking an information source, an application, a Smartphone functionality or simply a recording exercise adopted by users/participants?
In this paragraph on Information Management, we first mention information sources, and then discuss how participants managed information by taking notes and defining unfamiliar terms.
4. Discrepancies between Results Findings and Discussion Write Up. In the Communication theme (Page 9, Lines 31-32), it was noted that ―many participants described texting as a more efficient way than meeting in person‖. This contradicts with the paragraph in the Discussion Section where ―co-workers preferred communication in person to texting..‖ (Page 15, Line 27). It weakens the earlier argument and statement in the paragraph that ―The findings of this study support Wu et al‖ (Page 15, Line 19). Thus, please be concise and precise in your sentences and arguments to avoid confusion.
We believe that our findings do in general support those of We et al, even if they are not exactly congruent. Our findings suggest that medical students, residents and faculty may prefer texting to in-person communication; Wu et al suggest that other members of the healthcare team may prefer in-person communication.
5. Conclusions made from the Results Findings a. In Page 10 Line 14, the phrase ‗a number of participants described... ‗ does not seems to go in line with the low proportion and statistics of 27% respondents.
We believe it is reasonable to report the views of a minority of participants, and have made it clear that the proportion expressing this view was 27%.
b. Under the Challenges theme, only interviews sources were mentioned in the first sentence (Page 10, Line 27). It appeared, however, that survey data were also used to illuminate these challenges as shown in the subtheme of Trusting Information Sources. Please revise the sentence to be clearer.
Amended to: Participants identified a number of potential challenges to the use of mobile computing devices in medical education
c. Under the Blurring of Personal/Professional Boundaries subtheme, it is argued in the last paragraph that ―many participants suggested that some policy may be required to streamline use across different systems...‖ (Page 13, Line 6). However, given that less than half of the majority (i.e. only 47%) agreed with the survey statement, it is not accurate to depict this 47% as ―many participants....‖. Perhaps ―Some participants‖ would be a more accurate phrase.
Amended to: Participants suggested that some policy may be required…
6. Restructuring the paragraphs in the Discussion Section To improve the flow and coherency of the Discussion section, here are some considerations and suggestions:
A. Place the second paragraph starting with ―This study supports the findings of Davies et al..‖ at the end of the fourth paragraph that discussed how the current study supported Wu et al‘s study.
So amended.
B. Place the third paragraph centering on the study limitation starting with the sentence ―Our study was limited‖ as the 3rd last paragraph before the paragraph and line ―This study has encouraged a debate among students and faculty...‖
So amended.
Minor Issue: Grammatical Corrections and Edits 1. Introduction a. Removed the word ―the‖ from the sentence to ―We believe that mobile access...‖ (Page 5, Line 10)
So amended.
2. Methods a. Revised the sentence in Page 6, Lines 12-13 to ―The interviews were conducted in person (with the exception of one phone interview) at a private office space located in our medical school.‖
So amended.
3. Results a. Insert ―(― in Page 12 Line 8 after the word ―patient‖
So amended.
b. Insert ― to the quote in Page 12 Line 34 before the word ―One‖
So amended.
c. Spaces between the quotes under the Anticipated Future Uses theme
So amended.
4. Discussion a. Removed and Replaced the word ―to‖ from the sentence to ―It seems unlikely that using ‗The Cloud‘ will ever completely replace the need..‖ (Page 15, Lines 48-49)
So amended.
b. Replaced the word ‗may‘ with ‗and‘ in the sentence ―...from giving full attention to tasks at hand and distract users from the normal activities..‖ (Page 15, Line 8)
So amended: and may distract users from the normal activities
c. Recommend the authors revise the sentence ―....end-users of these devices are running ahead of leaders, policy-makers and educators‖ (Page 16, Lines 16-17) to be clearer.
Amended to: users of mobile computing devices appear to be running ahead of leaders, polic
