Nathan Skelley, MD

Many orthopaedic residency programs used to have educational curricula based around textbooks, photocopied pages, and handwritten notes. Today, programs are commonly replacing printed educational materials with mobile tablets and smartphones. Most residents own and rely on these devices as an orthopaedic library.

Multiple resources can be electronically carried in applications such as the AAOS eBooks app, and numerous note-taking programs are available for mobile devices. My own residency program provides tablets to incoming resident physicians to enhance their educational opportunities.

Mobile technologies have become a significant part of the day-to-day activities of many Americans. This has both positive and negative impacts. For example, this year’s AAOS public service advertising campaign—the “Digital Deadwalkers”—highlights what can happen when people are focused on their mobile devices instead of paying attention to their surroundings. This great campaign clearly depicts some of the negative aspects of technology diffusion in our culture.

However, the resident or student using their smartphone or tablet during a lecture or case presentation is not necessarily the equivalent “Digital Deadsitter.” Mobile technologies, used at the appropriate time, have the ability to greatly enhance orthopaedic resident education.

In 2013, Chad A. Krueger, MD, described the downsides of mobile technology. In his AAOS Now article, he noted that mobile technology can detract from the education of a resident-in-training. Although I agree that the potential to distract is present, I would also argue that mobile technologies can greatly enhance and support resident education.

As Dr. Krueger noted, “Technology never regresses; it will continue to grow rapidly and we will continue to find new and ‘better’ ways to use it to improve our own education and patient care.” The power of mobile technologies to enhance education is indisputable, when they are used respectfully to accomplish that goal.

As a follow-up to that article, I propose the following three steps that can be taken to use mobile technologies in a positive manner for resident education.

1. Faculty should appreciate that the tools for education have changed from when they were in training.
2. Residents must appreciate that there is an appropriate time and place for using these technologies.
3. Educators and publishers should continue to develop and incorporate programs that facilitate resident education with mobile technology.

Instructors in all educational fields have had to adapt their teaching styles in light of advances in mobile technology. Today’s undergraduate and medical school classrooms and lecture halls are filled with students using laptops and tablets. Some may be on social media, watching an irrelevant video, checking email, or playing a game, but that is an abuse of technology in the classroom. Most, however, may be using an online image, virtual textbook, or note-taking program to enhance their understanding of the instructor’s lecture.

I believe educators are slowly adapting to this change in their classrooms. Instructors of orthopaedic surgery will also eventually adapt. I also believe the onus is on the residents to use mobile technology in a positive manner, especially if their learning style is enhanced by this interaction.

Educators should not be intimidated or frustrated when residents use smartphones, tablets, or laptops during a lecture. The use of these devices by most residents is not meant to be disrespectful. In fact, using these devices contributes to a more active form of learning that improves retention compared to the passive “sit-and-listen” format of many lectures.

Actively involving residents in their education improves concept retention. Furthermore, notes in a mobile device have the benefits of portability, sharing with co-residents, utility across multiple platforms, and easy referencing in the future.

The AAOS and other educational publishers appreciate this change in the education model. Many textbooks, online review resources, and technique videos are easily available on mobile devices. Journals, such as the Journal of the AAOS and The Bone & Joint Journal (formerly the Journal of Bone & Joint Surgery, British edition), are becoming increasingly available to residents in mobile formats. This enables publishers to immediately update and release information directly to consumers. It also enables residents to access these educational materials anytime, anywhere. I anticipate that more text and print resources will soon shift to mobile devices in the future.

Mobile technology is one of the great inventions of the modern age. As with any new technology, however, the changes may be perceived by some to be positive and by others as negative. Orthopaedic residents who use these devices respectfully and appropriately can enhance both their own and their colleagues’ education. Instructors should strive to be open-minded about the use of these devices to actively engage and improve resident education. Embracing new applications and programs designed to facilitate resident education can help improve medical care in the future.

Nathan Skelley, MD, is a PGY-4 resident at Washington University, St. Louis, and a member of the AAOS Resident Assembly Executive Committee.

Additional Information:

• Krueger C: The Downside of Smartphones, Tablets, and Computers. AAOS Now, June 2013.
• Franko OI, Tirrell TF: Smartphone app use among medical providers in ACGME training programs. J Med Syst 2012;36(5):3135–3139.