Implementation of a Smartphone application in medical education: a randomised trial (iSTART)

Background: Smartphones are popular technologies that combine telephone communications and informatics in portable devices. Limited evidence exists regarding their effectiveness in improving academic performance among medical students. This study aims to assess whether a smartphone application could improve academic performance in multiple-choice tests. Methods: A double-masked randomised trial was held among interns at the School of Medicine of the Universidad de Valparaiso. Participants were randomised to receive an application designed to review key concepts in Internal Medicine and its subspecialties using clinical vignettes. Contents were selected and provided in a format akin to a mandatory national examination required for practising medicine in Chile. Analyses were undertaken under the intention to treat principle and missing data were handled using multiple imputation techniques. Results: Eighty interns volunteered to participate in this trial, most were female (48 students, 60%) and had a mean age of 25.3 +/- 2.2 years. Participants showed significant experience with smartphones, with a median use of 4 years (IQR 3-6 years) and 67 (83.7%) reporting routine use in clinical practice. Intention-to-treat analyses showed significant improvements in performance amongst students allocated to the smartphone application (mean increase of 14.5 +/- 8.9 vs 9.4 +/- 11.6points, p = 0.03). A reduction in total time and mean time per question was also found, which was significant in complete-case analyses (p = 0.04). Discussion: Smartphones were popular among medical trainees. Academic performance was significantly improved by the use of our application, although the overall effect was smaller than expected from previous trials. This study provides evidence that smartphone-based interventions can assist in teaching internal medicine.