Personal digital assistant use in Florida obstetrics and gynecology residency programs.
Objectives: Improvements in electronic technologies have resulted in affordable, smaller computers that operate at faster speeds. The personal digital assistant (PDA (Personal Digital Assistant) A handheld computer for managing contacts, appointments and tasks. It typically includes a name and address database, calendar, to-do list and note taker, which are the functions in a personal information manager (see PIM). ) is a tool that has the potential to enhance residency A duration of stay required by state and local laws that entitles a person to the legal protection and benefits provided by applicable statutes.
States have required state residency for a variety of rights, including the right to vote, the right to run for public office, the education by allowing residents immediate access to an abundance of information. This article assesses the current use of this tool at obstetrics and gynecology obstetrics and gynecology
Medical and surgical specialty concerned with the management of pregnancy and childbirth and with the health of the female reproductive system. residency programs in the state of Florida.
Methods: The authors conducted a statewide survey addressing the general question: is the PDA useful in an obstetrics and gynecology residency training program? Specifically, the authors asked residents how much time was perceived to be saved weekly with the use of this tool, and in what aspect of their training use of this tool was most helpful.
Results: At the survey's close, five of seven programs had returned the survey for evaluation. These five institutions included both university- and community-based residency programs. Forty percent of obstetrics and gynecology residents at these programs responded to this questionnaire. Resident responses to the survey revealed that most of the perceived benefit was in maintaining procedural statistics logs, pharmacology pharmacology, study of the changes produced in living animals by chemical substances, especially the actions of drugs, substances used to treat disease. Systematic investigation of the effects of drugs based on animal experimentation and the use of isolated and reference manuals, and personal clinical protocols. Most responses revealed that only minimal time savings (<2 h/wk) were gained with using this tool. However, many residents felt they were not using this tool to its maximum potential. Nearly 90% of those who responded felt that the PDA should be available at residency programs and anticipated using it after completing residency.
Conclusions: This study posed the question of PDA usefulness at obstetric ob·stet·ric or ob·stet·ri·cal
Of or relating to the profession of obstetrics or the care of women during and after pregnancy.
pertaining to or emanating from obstetrics. and gynecology residency programs in the state of Florida. Although not all programs provided their residents with a PDA, 95% of the respondents revealed that they owned one of these tools. Experience at the authors' institution revealed high expectations for the potential uses of a PDA. Although many residents were not using this tool to its full potential, a PDA tutorial session could educate residents on the many applications available for PDAs, including applications to maintain on-call schedules and sign-out lists, statistics and procedure logs for credentialing and board certification board certification
The process by which a person is tested and approved to practice in a specialty field, especially medicine, after successfully completing the requirements of a board of specialists in that field. , electronic billing Electronic billing is the electronic delivery and presentation of financial statements, bills, invoices, and related information sent by a company to its customers. Electronic billing is also referred to as the following:
Key Words: obstetrics and gynecology, personal digital assistant, residency training
Clinical medicine in the 21st century demands that the physician become more efficient yet maintain thoroughness. One approach to meeting these demands is better use of available technologies. Although the computer revolution continues to impact all professions, the medical profession remains reactive rather than proactive. For example, only 1 to 2% of a typical health care operating budget Noun 1. operating budget - a budget for current expenses as distinct from financial transactions or permanent improvements
budget items, operating cost, operating expense, overhead - the expense of maintaining property (e.g. is spent on information technology, as opposed to 4 to 10% in other industries. (1) Trends in medical applications that have only slowly elicited a reaction include electronic medical records and the paperless office Long predicted, the paperless office is still a myth. Although paper usage has been reduced in some organizations, it has increased in others. Today's PCs make it easy to churn out documents.
As one technology eliminates paper, another comes along to increase usage. . Other industries, such as banking and the service sectors, have welcomed this revolution.
The most recent addition to this arena is the personal digital assistant (PDA), also known as a handheld computer A computing device that can be easily held in one hand while the other hand is used to operate it. The Palm devices are a popular example. See Palm, smartphone and palmtop. . The advantages of a PDA include mobility and instant availability of data. (2) Physicians need a mobile instrument that can provide access to evidence-based medicine evidence-based medicine Decision-making 'The use of scientific data to confirm that proposed diagnostic or therapeutic procedures are appropriate in light of their high probability of producing the best and most favorable outcome'. See Meta-analysis. and other clinical data resources at the point of care. (3) Malan et al (4) found handheld computers increasingly useful in the daily practice of clinical and academic medicine. However, a 2002 survey reveals that only 28% of Canadian physicians are currently using the PDA in clinical practice. (5)
Our institutional experience (6) gave us mixed findings as to the residents' satisfaction in using these PDAs. This article samples a larger population representing both university- and community-based residency programs in the state of Florida, and specifically addresses whether a PDA is helpful in an obstetrics and gynecology residency training program.
Materials and Methods
In Florida, there are four university-based obstetrics and gynecology residency programs (located in Gainesville, Jacksonville, Miami, and Tampa) and three community-based residency programs (located in Orlando, Pensacola, and St. Petersburg). A survey (Fig. 1) was sent to the chairs of each of the Florida obstetrics and gynecology residency programs, and their assistance in disseminating the surveys to their residents was requested. On completion of the surveys, all responses were to be returned to the program coordinator at the University of Florida University of Florida is the third-largest university in the United States, with 50,912 students (as of Fall 2006) and has the eighth-largest budget (nearly $1.9 billion per year). UF is home to 16 colleges and more than 150 research centers and institutes. Health Science Center, Jacksonville. All queries maintained residents' anonymity, with the only identifying questions asking for residency institution and postgraduate year (PGY PGY Post Graduate Year
PGY Planar Generalized Yee (algorithm) ) level. Statistical analysis was performed using StatView for Windows (SAS Institute SAS Institute Inc., headquartered in Cary, North Carolina, USA, has been a major producer of software since it was founded in 1976 by Anthony Barr, James Goodnight, John Sall and Jane Helwig. Inc., Cary, NC). A Student t test was used to compare dichotomous di·chot·o·mous
1. Divided or dividing into two parts or classifications.
2. Characterized by dichotomy.
The survey included several quantitative components (Fig. 1), combined to assign a daily value to having a PDA. These measures included resident perception of usefulness of the PDA for clinical practice protocols, sign-out sheets while on call, drug reference manuals, personal organizer, procedure log, and so forth. A numeric score ranging from 1 (PDA not useful at all) to 5 (very useful) was then assigned to resident responses. If no response was given, a score of 0 was assigned. The respondent's score could thus range from 0 to 50. The mean for each PGY level was compared. Additional evaluation included comparing university- to community-based residency programs.
[FIGURE 1 OMITTED]
Additional questions included whether residents would recommend PDA use at other residency programs, and whether respondents anticipated using PDAs on completion of residency (ie, in private practice or fellowship). A final evaluation was of the time respondents perceived they saved weekly by using the PDA: less than 2 hours, 2 to 5 hours, 5 to 9 hours, or greater than 9 hours.
Five of the seven obstetrics and gynecology residency programs that received the survey had returned it at the time of our study's close. Although there are 140 obstetrics and gynecology residents in Florida programs, nearly 70% are at university-based programs. There were 54 responses (16 of 40 from community programs and 38 of 100 from university programs), for a nearly 40% response rate. Of those institutions that returned the surveys, the response rate varied from 25 to 92% of residents at each institution. The percentage of nonresponders was nearly equal.
When comparing the mean response score for each PGY level, the only statistically significant result was for the PGY-1 class compared with the PGY-3 class (mean difference = -7.09, t value = -2.59, P = 0.03). When comparing other PGY levels (PGY-1 versus PGY-2, PGY-1 versus PGY-4. etc.), none of the mean differences were statistically significant. Table 1 lists the mean score and standard error for each PGY level.
When comparing a summation summation n. the final argument of an attorney at the close of a trial in which he/she attempts to convince the judge and/or jury of the virtues of the client's case. (See: closing argument) of the resident scores at university-based programs to those at community-based programs, a statistically significant difference favoring community-based programs was noted (mean difference = 4.75, t value = 2.22, P = 0.04). Table 1 lists the mean score and standard error for community- versus university-based programs. However, when comparing each residency program to the other programs individually, no statistically significant differences were noted.
Sixty percent of respondents had used their PDA for more than 12 months, 12% for 6 to 12 months, and 28% for less than 2 months. With regard to time saved by using this tool, in 64% of responses, the residents felt that less than 2 hours were being saved by having the PDA. In an additional 32% of responses, the residents felt they saved or could save 2 to 5 hours weekly. The remaining 4% felt that they could save more than 5 hours a week using the PDA.
Comments from residents as to their satisfaction with the PDA related to maintaining on-call schedules and pharmacologic pharmacologic /phar·ma·co·log·ic/ (-kah-loj´ik) pertaining to pharmacology or to the properties and reactions of drugs.
pertaining to pharmacology. reference manuals, keeping procedural statistics, decreasing the number of books kept in the laboratory coat, and improving organization with to-do and contact lists. Complaints from respondents included difficulty using the PDA, difficulty transcribing data into the PDA, and insufficient time to learn software applications.
Our institutional experience (6) has shown that resident expectations are high when PDAs are made available. However, residency requirements for obstetrics and gynecology are very time intensive, and the necessary investment of time makes learning how to use a new tool a daunting daunt
tr.v. daunt·ed, daunt·ing, daunts
To abate the courage of; discourage. See Synonyms at dismay.
[Middle English daunten, from Old French danter, from Latin task for the resident, especially in a voluntary setting. As a result, the introduction of new technologies can be associated with a degree of resistance. (7) Therefore, resident comments such as "have not used the PDA in 4 months" and "not taken the time to learn how to use it but plan to learn" are not surprising.
One of the limitations of this study is selection bias. We limited our survey to obstetrics and gynecology residents within Florida programs. In addition, we relied on program directors and their staff to distribute and collect the survey. We suspect that this method of survey dissemination dissemination Medtalk The spread of a pernicious process–eg, CA, acute infection Oncology Metastasis, see there contributed to our nonresponder bias. In nearly 95% of responses, the respondents stated they owned or had access to a PDA. We suspect that our findings might have been different had all residents responded. Those residents who either did not own a PDA or had a negative opinion of the PDA may not have taken the time to complete the survey.
In addition, in an effort to maintain anonymity, identifiers of gender, race, and age were omitted from the survey. We recognize that these identifiers are independent variables that may have helped in distinguishing nonresponders from responders, but maintaining simplicity was a key component of this survey. Furthermore, regarding accessibility to software applications, we did not explicitly ask, but relied on respondents to provide such information.
We do not suspect a bias in our comparison of university- to community-based training programs; however, statistically, there was a greater perceived usefulness at community programs. Of the two programs for which survey responses were not available, one program was university-based and the other community-based. Therefore, there was a balance of responding programs, and the number of responses from community programs was 16 (40% of all potential responses) compared with 38 (38% of all potential responses) at the university programs.
The generalizability of our findings must be confirmed with larger studies, due to the limited number of residents that were evaluated in this survey. One hundred forty obstetrics and gynecology residents were available to asses the experience of using a PDA within Florida residency programs. We could increase the sample size by obtaining a higher response rate from the current programs or sampling additional programs throughout the country. An increase in the sample size could impact the initial findings of our study.
The 2002 Canadian Medical Association The Canadian Medical Association (CMA), with more than 65,000 members, is the largest association of doctors in Canada and works to represent their interests nationally. It formed in 1867, three months after Confederation. Physician Resource Questionnaire revealed that there has been a 47% increase in PDA use since 2001. (5) This increased PDA use by clinicians complements our finding in that nearly 90% of our responders recommended the PDA to other residency programs and for use after residency. This can be interpreted as indicating that residents recognize the potential value of this tool and continue to anticipate time-saving rewards in the future.
Our survey has demonstrated that just providing the tools is inadequate. Given the demands of residency training, an additional tool can be considered an extra burden to the resident. Although most residents feel that this tool will be useful in their future, the initial time necessary to learn the PDA alphabetic character recognition system and additional applications is a drawback DRAWBACK, com. law. An allowance made by the government to merchants on the reexportation of certain imported goods liable to duties, which, in some cases, consists of the whole; in others, of a part of the duties which had been paid upon the importation. . Only those who are motivated or interested in this new technology will use these tools unless there are imposed requirements from the department or national accreditation committees. Constant technical support and problem solving problem solving
Process involved in finding a solution to a problem. Many animals routinely solve problems of locomotion, food finding, and shelter through trial and error. will be necessary to optimize user acceptance. (7)
There are immediate and future rewards to the obstetrics and gynecology resident who becomes proficient pro·fi·cient
Having or marked by an advanced degree of competence, as in an art, vocation, profession, or branch of learning.
An expert; an adept. with these technologically advanced tools. For example, resident procedure tracking is an onerous task required for residency accreditation and for future hospital privilege applications by the resident. With the PDA and a patient-data tracking application, not only can residents have access to their procedural statistics, they can also use them for the case list submitted for the oral examination for licensure licensure
(lī´snsh . Furthermore, it is now possible to achieve wireless entry and retrieval of data using a PDA, with potential advantages being the collection and entry of data at the same time, easy entry of data from multiple sites, and retrieval of data at the patient's bedside. (8)
In future practice, the obstetrics and gynecology resident could do billing on the PDA using a data capture program, whereby the billing would be more accurate, and there would be no hard copy to misplace mis·place
tr.v. mis·placed, mis·plac·ing, mis·plac·es
a. To put into a wrong place: misplace punctuation in a sentence.
b. , forget, or have incorrectly prepared by billing personnel. Some charge-capture programs automatically generate codes based on Medicare guidelines, and the clinician clinician /cli·ni·cian/ (kli-nish´in) an expert clinical physician and teacher.
n. can earn an extra 5% per year while seeing the same number of patients. (8) In addition, in today's highly litigious litigious adj. referring to a person who constantly brings or prolongs legal actions, particularly when the legal maneuvers are unnecessary or unfounded. Such persons often enjoy legal battles, controversy, the courtroom, the spotlight, use the courts to punish environment, with national attention focused on medical errors, complications, and deaths, the objective measure of a physician's skills will become important in licensing, hiring, privileging, and promotion processes. (9) Using an electronic prescribing application has the potential to improve work flow, reduce prescription fraud, provide formulary formulary /for·mu·lary/ (for´mu-lar?e) a collection of recipes, formulas, and prescriptions.
National Formulary see under N.
n. and copay co·pay
A copayment. information, and reduce medication errors medication error Malpractice An error in the type of medication administered or dosage. See Adverse effect, Error. . (10, 11) Prescriptions can be electronically transmitted to the pharmacy by means of fax or a hard copy provided to the patient.
In the near future, many doctors will find their PDA to be an essential medical instrument, as indispensable as their stethoscope stethoscope (stĕth`əskōp') [Gr.,=chest viewer], instrument that enables the physican to hear the sounds made by the heart, the lungs, and various other organs. The earliest stethoscope, devised by the French physician R. T. H. . (3) We suggest implementing information technology tutorial sessions into the didactic di·dac·tic
Of or relating to medical teaching by lectures or textbooks as distinguished from clinical demonstration with patients. sessions for all residency programs. Our institution incorporated a PDA tutorial, and found residents receptive to this educational program. This tutorial not only introduced, but also encouraged the use of clinical applications for the PDA. Consequently, we anticipate that providing both opportunity and education will motivate residents to integrate the infinite computer resources available through the World Wide Web and the mobility of the PDA into their clinical practice.
Table 1. Resident survey response scores at different intervals (a,b) PDA usefulness No. of score respondents All PGY-1 31.7 [+ or -] 2.04 11 All PGY-2 31.9 [+ or -] 2.38 14 All PGY-3 38.5 [+ or -] 1.93 16 All PGY-4 33.4 [+ or -] 2.52 13 University-based programs 33.7 [+ or -] 1.39 38 Community-based programs 35.3 [+ or -] 2.11 16 (a) PDA, personal digital assistant; PGY, postgraduate year resident. (b) Score reported as mean [+ or -] standard error. Score: minimum = 0, maximum = 50. Two respondents, who did not own a PDA, did not provide a usefulness score.
Accepted December 8, 2003.
Copyright [c] 2004 by The Southern Medical Association
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portable computer - a personal computer that can easily be carried by hand operating system operating system (OS)
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German chemist known for his research on the components of blood. He won a 1930 Nobel Prize for his work on the synthesis of hemin. , Lapinsky SE, Weshler J, et al. Surgical procedure logging with use of a hand-held computer. Can J Surg 2002;45:345-350.
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RELATED ARTICLE: Key Points
* Many residents felt they were not using the personal digital assistant (PDA) to its maximum potential.
* Nearly 90% of those who responded felt that the PDA should be available at residency programs.
* Nearly 90% anticipated using the PDA after completing residency.
Saju Joy, MD, and Guy Benrubi, MD
From the Department of Obstetrics and Gynecology, University of Florida Health Science Center Jacksonville, Jacksonville, FL.
Reprint reprint An individually bound copy of an article in a journal or science communication requests to Saju Joy, MD, Department Obstetrics and Gynecology, 561 Means Hall, 1654 Upham Drive, Columbus, OH 43210. Email: firstname.lastname@example.org