The iPad goes third-year

By Mike Miliard
11:13 AM

Lots of medical schools use iPad textbooks in the classroom. Now some are moving them into clinical settings.

IRVINE, CA – This past fall, as the academic year got under way, medical schools across the country, from Brown to Stanford, were tossing out heavy and expensive textbooks in favor of fully-loaded and interactive iPads. Now that spring is here, it's time for the iPad to graduate: moving out of the classroom and into the clinical setting.

Warren Wiechmann, MD, faculty director for instructional technologies at UC Irvine School of Medicine saw the device's potential early on. "When we launched our program in August of 2010, the iPad was only a few months old," he said last fall. But he saw right away that it "was the only device that could hold all the books and content necessary for medical school and provided a platform that was scalable for other apps and technologies to help augment the curriculum."

As medicine evolves apace – becoming "more and more connected and mobile," he says, "new issues and problems arise that we need to be prepared for: the ePatient, social media and medicine, virtual practices and even topics as simple as how do you curate the web for our patients. All of these things are starting to be addressed within our curriculum at UC Irvine. In this instance, the iPad becomes the 'conversation starter' that gets our students and faculty thinking about these issues in medicine."

Beyond those capabilities, however, it's clear the iPad is beginning to find a foothold in clinical settings. More and more vendors are developing EHRs for the tablets. Five times as many doctors own iPads than the population at large. So UC Irvine, along with other schools such as Yale, is moving the device into third-year internships.

Not everyone has quite come around on the idea. Writing on the Student Doctor Network Forums (, one med student – not at UC Irvine – wondered about the propriety of bringing an iPad on his shadowing rounds."

"Rule number one. Don't be that guy," wrote one fellow student. "Would just look weird and probably be a pain to carry," wrote another. "Very useful for providing the residents with new comic relief," joked a third.

But Wiechmann says the 110 third-year students about to start carrying iPads in a hospital setting will soon see the value.

"The hospital has decided to embrace the iPad as their main mobile strategy for healthcare," he says. Other pilots have shown iPhones and iPod touches are great for communication and barcode scanning and medication reconciliation," but only the iPad offers the "real estate" to look at lots of patients and look at trends, "to go through and look at labs and put in orders and pull up radiology. The iPad is the ideal format to do that."

Portability is a plus, of course: "Instead of taking one of those workplaces on wheels," students "can have an iPad in their pocket when they go to a patient's bedside," says Wiechmann. "Moreover, it's good for doctor-patient interaction: "It makes people more attuned. It's not as daunting as when you open up an EMR on a desktop computer."

But one of the chief benefits of the UC Irvine program is how it sets the stage for collaboration, and puts the student at the center of care. "Only one or two students on every care team will have an iPad linked to EMRs," he says. That means "the students will be forced into the centerpiece of the team now, since the iPad gives them a new place and function that they didn't really have before."

Other schools are also moving iPads into clinical internships. Writing on physician Kevin Pho's blog, Alex Chamessian a student at Duke University Medical Center, says the iPad has been "exceedingly useful and versatile." Simply put, he writes, "I have an entire medical library in my pocket. With the touch of a button I can pull up essential texts such as Harrison’s Principles of Internal Medicine or William’s Endocrinology. … Several times a day, I use these sources to look things up that I encounter in the patient-care setting."

At Yale, iPads have added "vibrant new dimension" to the experience of third- and fourth-year students, Michael Schwartz, assistant dean for curriculum at Yale School of Medicine, told the Yale News recently. The tablets are encrypted to safely handle real-world personal health information.

Indeed, says Wiechmann, "our healthcare institution does not allow – or is very restrictive of – Android devices on the network because they can't guarantee the security of the device, and they can't be provisioned the way the iPad can to have an extra layer of security."

Ultimately, he sees big dividends in the program – and expects to see it grow. He predicts students who will "finish their third year with a higher technical skill set than some physicians have who have been out for 10 or 20 years. We're really creating a new generation of physicians who are not just familiar with the technology, but are really savvy and can really interact. They may go to another institution after med school with another EMR, and they'll have an expectation of a mobile platform, and of being able to remotely monitor their patient in the ICU when they're in another part of the hospital. These are the directions people want healthcare to move."