Mobile learning (m-learning)

One proposed technological solution to the problems of time, space, place and teacher is via the use of mobile technology. The average Briton spent 41 hours engaging with their mobile phone in December 2013 (128), with around 97% of the population owning one. Mobile phones have successfully been used to deliver educational material to healthcare workers (129) and to enhance communication between healthcare professionals in the hospital setting (130). They allow learners to engage with virtual environments in a variety of ways

unconstrained by space or time thus allowing for new forms of learning taking place at times when a trainer is not present (131). The recent national mobile health worker project (132) commissioned by the NHS, although not strictly employing pedagogical evaluation, also shows that mobile technology could improve the efficiency of health services.

Mobile learning, often referred to as m-learning, is characterised by its ubiquity and by “learning on the move (133). It is not just a case of giving students mobile phones or delivering teaching material through them, it is more a case of learners taking advantage of the learning opportunities afforded by mobile technologies (134). As mobile phones have become more common and the technology available to students through them has grown exponentially, it is not surprising that educators have started to research the possibilities afforded by these technologies. However both research and practice in mobile learning are in their infancy (135). There is some debate over whether educational theory needs to catch up with the technology (131). Research in m-learning currently appears to be active in two areas, firstly by augmenting curriculum centred classroom learning and secondly for learning on the move (135).

Most research into m-learning concentrates on progress reports and case studies. They elicit information about successes and obstacles they have encountered as well as participants reviews of the technology. The introduction of mobile learning devices into the classroom has

37

led to increases in motivation to study (136). Case studies also report on the successful use of mobile technologies for distance learning and in resource limited settings (129). M-learning initiatives in the field of healthcare education include quiz based games (137), information based applications; and information gathering systems (138,139) which allow epidemiological information to be gathered at a central location in real time.

Traxler (140) argues that there is more need to construct the concept of m-learning based on learners’ experiences rather than focusing on technology. Most m-learning initiatives have focused on changing classrooms or lecture theatres from teacher-focused pedagogies to social constructivist theories rooted in those of Laurillard (141), Wenger (70) and Vygotsky (142). Cochrane (143) speaks of the pedagogy, andragogy, heutagogy development process as a judgment of whether or not a m-learning initiative has been successful. He defines heutagogy as where students take control of their own learning objectives and propose innovative solutions to these objectives. His work builds on that of O’Malley et al (144) who developed some initial guidelines for mobile learning. A key competency for any healthcare professional is to be able to identify their own learning needs and to then take self-directed action to address those needs. Problem-based learning has been employed in undergraduate schools to develop student capability in this area. Given that many m-learning studies also wish for self- directed learning as an output i.e. developing heutagogy, it would be useful to evaluate whether or not m-learning is an effective tool for healthcare education. The educational success of an intervention could possibly be defined as a conversion of learning from a pedagogical to a heutgogical form. However for an intervention to be deemed successful in healthcare education, there should be an increase in knowledge that will ultimately benefit patient care.

Games- based learning GBL sometimes referred to as “edutainment , is another area where mobile technology has been used to facilitate healthcare education (145,146). GBL has been

38

shown to be successful by putting ‘fun’ into learning (146,147). Educational games have involved simulating domiciliary visits where students were expected to identify risks by interacting with and exploring the living quarters of a virtual patient. This allowed for equity of experience amongst learners as not all students were able to experience this on placement.

It has been argued that educational games and m-learning facilitate heutagogy, a learning process driven by the student rather than the teacher, whereby the student chooses what, when and how to learn (148). The usefulness of heutagogy in healthcare education is

questionable as educators need some degree of control about what students learn. Providing a framework within which students learn can be argued to be pedagogy as educators are still proscribing what a student must learn, just allowing license to explore the concepts as they see fit.

M-learning has been proposed as a useful tool in teacher education as teachers are naturally itinerant (149). The same could be said about qualified healthcare professionals; they are often multi-tasking whilst working in extremely stressful situations. As such, their time for learning, although proscribed by professional bodies (GMC, NMC, GPhC) is limited. M-learning allows for flexibility for the learner as they can access material from home, in the workplace and whilst travelling. Also practitioners can engage with virtual environments and

communicate with fellow learners, who they otherwise would have no network with due to the constraints of space. In the UK, doctors, pharmacists and nurses must undergo

revalidation in order to remain on their professional registers. Mobile learning would allow professionals to learn on the move, giving them a framework to bypass the more proscribed forms of experiential learning favoured by Kolb in favour of allowing a reflection-in-action model championed by Cochrane (143), Wiestra and de Jong (150), and Cornelius and Marston (151). This has benefits for the practitioner both in terms of time saved and patients in terms of increasing engagement with professional developments.

39

Thus mobile technology may create an opportunity to negate one of the most difficult tasks involved in developing IPE; that of timetabling. Combining the principles of GBL and

healthcare simulation, a virtual patient (VP) may be designed to utilise mobile technology and allow healthcare professionals to learn with, from and about each other, whilst caring for a patient in a ‘safe’ environment.

40