When the Stanford School of Medicine decided to incorporate mobile technology into the curriculum while reducing the use of paper in the classroom, students were issued iPads to access electronic versions of their course materials. Within a semester there was a general revolt, and paper was reinstated as the primary teaching tool.

When the Yale School of Medicine sought to use iPads to eliminate paper, after a botched experiment with flash drives, the goal was to take a big risk in order to have a big impact. The bold strategy paid off. With 84% of first year medical students saying that the iPad was their primary classroom tool, and 90% of students reporting that it was their primary tool for reading, adoption rates were better than the implementation team had expected. Now, not only has the program been recognized as a success, but the Yale Medical School is also now regularly contacted by other departments and programs, as well as other universities, for information on how to successfully deploy iPads in teaching. Joining us on Tuesday to talk about the history, implementation, and success of the program were Michael Scwartz, Gary Leydon, Judy Spark, and Mark Gentry, all from the team at the Yale School of Medicine responsible for the success of the iPad program.

As Assistant Dean of Curriculum, Michael Schwartz began the presentation by explaining not only the problems other schools had encountered while teaching with iPads, but also the steps that Yale knew it needed to take to make the program unique and successful. Several elements stood out. First, education on the use of the iPad was mandatory. Second, they used a pilot program to determine student needs, and adapted the program to anticipate and avoid simple problems that might otherwise have been easily overlooked. Third, there was significant cooperation between departments, and, finally, a mobile support network of mobile-friendly sites and a new CMS compatible with the iPad  were deployed at the same time as students received the tablets. Finally, the implementation group decided to focus on near perfect functionality of core components rather than trying to support all features, resulting in the cutting of printing support and non-HTML5 movies to focus on encryption, reading, and note-taking. The cumulative result was an environment where students could focus on learning course content rather than learning how to use the device.

Although adoption was made as easy as possible for students, creating this transparency was an exceptional challenge for support staff. Starting with the news that the program had been expanded overnight to cover all 518 current medical school students instead of only 200 first years, the implementation team was faced with the challenge of preparing 518 devices that each required being physically plugged into a computer to turn on for the first time – before being individually configured with internal encryption to meet stringent healthcare confidentiality requirements for electronic protected health information (ePHI) in the clinical environment.

The initial group of 9 committed students in the pilot program had emphasized the importance of ease of use of supporting systems as well as the device itself. Frequently accessed websites and the learning management system had to be optimized for use on the tablet – including not only a redesign of the mobile version of the sites, but also the ability to quickly access classroom resources through bulk download and rapid content update. With screen constraints, course sites and resources needed to be completely uniform to avoid confusion while accessing content, and students wanted to be able to interact with that content not only through touch and drawing, but also with a keyboard.

Thus, the implementation team faced a dual challenge. First they had to configure over 500 devices to be secure and useful tools to access both course material and confidential health information. The second, greater, challenge was the need to develop the support infrastructure to make these devices useful.

The restructuring of learning infrastructure to improve the iPad experience involved three main components. First, the learning management system, where all course materials reside, needed to be linked to the iPads in a form that allowed students to update materials in seconds before lecture if a professor has made a last minute change to his presentation. The second support system was a modification of Medical School Websites in general to make them more mobile friendly, and to create portals through which students could access the most commonly needed content, including course podcasts, faculty produced teaching applications, and pages with tips and instructions. The final step is providing technical and software support beyond the basic applications included with the iPad. In the YSM program, this function is filled by the library, which evaluates medical software and resources, acquires site licenses, and consults with students about how their technical needs might be better suited by new tools. The library also helps students integrate their portable computers, mobile phones, and tablet computers to improve productivity while maintaining compliance with ePHI regulation.

In order to perform all of the changes needed for back end support of the iPads, the implementation team had to bring together many departments to work cooperatively. While the library worked on promoting mobile friendly interfaces and testing software, ITS and the curriculum development group worked on the LMS. Settling on a system called “BlueDogs,” an implementation of the licensed LCMS+ system for medical schools,  a script could be used that every 55 minutes looks through content, finds new material, indexes text, produces PDF copies of everything, and then pushes the content to a WebDav server which hosts content that can be pulled, either one file at a time or a semester at a time, to iPads on demand (push sync has not yet been tested). Once on the iPad, most students choose to use GoodReader to read and annotate materials.

In order to minimize technical problems, educational support staff kept complete control over the content on the LMS. This included renaming all files to match a standard convention over the course of six months and sorting the items into folders – the same folders that would appear on the iPad. Although the sheer number of changes implemented at once made some staff members nervous, ultimately all of the back end changes worked well, and in the coming year faculty will probably get direct access to their own course sites.

With the back end services ready to go, the challenge of physically preparing and issuing the iPads came next. As mentioned earlier, each iOS4 unit had to be manually plugged into a computer and configured, but since each device would have to be registered to the wireless network using netID, and encryption passwords would all be private, the setup that could perform in advance was limited. Nonetheless, staff purchased  a 10 port USB hub (the 20 port physically burned out) and initialized every device. In the process they installed a web clip (like a shortcut) that linked to the YSM’s setup guide for iPads, and also iBooks, so students would have to set up an apple account, but could do so without a credit card. Serial numbers for all devices were retained and tied to students’ names.

In the opening week of classes, students were obligated to go to an orientation class to get their iPads where they were broken into groups of 25 to 40 people for training on setting up curriculum, email, and security systems. Students also received either an Apple Bluetooth keyboard or a $69 Amazon giftcard to purchase their own keyboard, 2 years of AppleCare warranty coverage, and a Goodreader activation code. Students were fast learners. While the older students took about an hour to set up the iPads, first years usually finished the entire process in 15 minutes.

Adoption rates have been very high, and while the BlueDogs system is completely compatible with laptops and other devices, most students will still use their iPads to obtain and read course materials. The program has also been successful in mostly eliminating the use of paper in teaching. Before the iPad program, over $1000 worth of copies were made for every student. Students are still given the option of purchasing the paper form of course information, but not a single student chose to. The program also promises to bring more creative learning opportunities to the Medical School. Some professors have already begun the process of writing applications to go along with their courses, including interactive maps of body systems. iPads will also be integrated with the information systems of Yale New Haven Hospital, allowing students to use the same device for both learning and clinical practice. With outstanding rates of adoption, and increased integration with new teaching tools and the clinical setting, the Yale School of Medicine’s iPad program is a model for the deployment of tablet computing in education.

For full coverage of this session, please click the video below
(note a slight delay upon initial playback):