In our first year of implementing an innovative educational technology, we found that adoption and use varied by campus and educational pathway and among individual students. Our experience and evaluation data are providing useful guidance for optimizing implementation of the new platform at LECOM and may be useful to others seeking to innovate with their own medical students.
New technologies hold legitimate promise for revolutionizing learning,
7 and institutions are increasingly purchasing these resources for students. However, faculty often overestimate the extent to which students will adopt and use new technologies,
8 and there is little research-based evidence to guide effective implementation.
9 To our knowledge, only 2 studies have explicitly evaluated adoption of educational applications among undergraduate medical students. One study
10 evaluated the use of an application that provided mobile access to a digital family medicine textbook, finding higher use among female students, students who expected benefit, and those who used smartphones. The second study,
9 which included 6787 Osmosis users from 2014 to 2015, found that persistent use of the platform was associated with paying for a subscription, being part of an online group, and using a mobile device. At LECOM, although more individuals signed up for an account when it was provided for free, we also found higher use among students who paid for a subscription. The study by Menon et al
9 could not determine why paid subscribers would use the technology more, but they suggested that subscribing could be a marker for behavioral intent, an important feature of technology adoption models.
11 We found that many high-intensity users were second-year medical students using the platform to prepare for board examinations, indicating that this specific intention may have encouraged their use of the application.
Analyzing data across LECOM's campuses afforded unique comparisons. For example, most new accounts were created among students at the Erie campus, and these students also provided the most responses to our evaluation surveys. We believe this difference occurred primarily owing to the presence of faculty champions at this campus and support that was lacking at the Greensburg and Bradenton campuses. Previous studies of technology adoption have pointed to the importance of “facilitating conditions,” defined as the “consumers’ perceptions of the resources and support available to perform a behavior.”
12 In medical education, faculty champions may encourage this perception among students. Future studies may be able to tailor existing technology adoption frameworks to medical education settings.
In contrast to simple flashcard or quizzing software, the Osmosis platform captures a variety of behaviors, demonstrating that individual students in different settings study in different ways. We found that some students gravitated to answering questions, some to generating content, and others to taking notes. Some students even became “superusers,” answering or creating thousands of items. Cognitive sciences research consistently shows that formative assessments enhance learning, whereas passive learning behaviors, such as rereading materials, provides the illusion of learning without fostering knowledge acquisition and retention.
6 Medical education studies corroborate this research, consistently showing that scores on high-stakes board examinations are correlated with the number of formative assessment items completed in preparation.
13-16 Additional studies examining why students used different features of the platform would help encourage student engagement and behaviors likely to enhance learning.
The most consistent barrier to adoption and use of the platform reported by students was lack of time to learn how to use the application. Surprisingly little is known about how medical students adapt to medical school academic environments. This may be a legacy of the traditional curricular model, in which the first 2 years of medical school were largely classroom and laboratory based and may have resembled the college learning experience. However, today's first-year medical school learning environments are likely to differ considerably from college environments, because nearly all curricula include early clinical experience, and many include activities intended to promote self-regulated learning skills. Moreover, students are now offered a bewildering array of supplementary resources to choose from. In this context, it is not surprising that students reported having little time to learn new study habits, and they likely have less time and energy to devote to creating and sharing formative assessment items. Investing in resources that introduce new study techniques and simplifying students’ choices of study resources may be promising ways to improve their learning habits, and this approach is consistent with the osteopathic principle of caring for mind, body, and spirit.
Finally, although our focus was on implementing the Osmosis platform to benefit students, we discovered an unintended consequence of faculty engagement with the product's team. Our impression before this experience, perhaps influenced by published reports,
17,18 was that representatives of the medical education “industry” might not make good partners, leading to strained relationships. However, in working with the platform's team, we found that our goals of improving medical student education were aligned and that our relationship was symbiotic. Osmosis team members helped us obtain grants that funded initial implementation and scholarship at LECOM, and they connected us with faculty at another institution, with whom we successfully applied for another competitive research grant. Faculty members at LECOM and other institutions using the same platform have begun working together as a community of innovators in medical education, looking ahead to additional fruitful collaborations. The Osmosis team has benefited as well by receiving regular feedback that makes its platform more beneficial for other medical student users.