Sailas Nyareza*, American International Health Alliance, Pretoria, South Africa John Capati, American International Health Alliance, Pretoria, South Africa Frank Peters, University of Pretoria, Pretoria, South Africa Track: Practice Presentation Topic: Web 2.0-based medical education and learning Presentation Type: Oral presentation Submission Type: Single Presentation Building: Joseph B. Martin Conference Center at Harvard Medical School Room: C-Rotunda Room Date: 2012-09-16 11:45 AM – 12:30 PM Last modified: 2012-09-16

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Background
In 2008, South Africa’s National Department of Health launched the Clinical Associates Program at three medical schools to increase numbers of medical professionals, particularly in rural areas. Similar to US physician assistants, Clinical Associates provide care in district hospitals, allowing physicians to focus on more complex cases. Approximately 70-90% of the training in this 3-year post-secondary school program occurs in district hospitals versus university classroom settings. Clinical Associate students and faculty need improved access to learning materials and evidence-based information resources while training at clinical sites. Many clinical sites lack internet access and space to house learning facilities. Portable hand-held devices like tablets allow access to medical applications (apps) and clinical reference material accessible from device memory when connectivity is unavailable.

Methods
With support from PEPFAR, HRSA, and CDC/South Africa, AIHA is introducing tablet devices to improve access to medical information resources for Clinical Associate students training in district hospitals. AIHA preloads the Android tablets with free and low-cost applications, providing access to databases, textbooks, and reference materials that can be accessed on tablet memory when wireless or mobile connection is not available. In April and May 2012, the devices will be rotated among second and third year students from the University of Pretoria training at Tembisa Hospital, with only half of them having access to the tablets for each specific assignment. A quantitative study will compare the scores on assignments by students using the tablets versus the same assignments submitted by students without tablet access. Student scores will also be analyzed to determine if the use of the tablet affected individual performance.

Results
Tablets will enable Clinical Associate students to more quickly and easily access the latest evidence and information while training in district hospitals, which should improve the quality of assignments submitted. Compared to laptop and desktop computers, tablets start more quickly, have longer battery life, are easier to use with the touch-screen, have better virus protection, and are more portable. Bedside learning will be supported as students can access resources during ward rounds instead of going to a static resource room. By accessing information at point-of-care while training, students will become more effective practitioners after graduation. The tablets will foster more effective team learning among students at the same facility, as they access information quickly and share what they learned. The results of the pilot at Tembisa Hospital will inform the rollout of tablet devices to other teaching hospitals training Clinical Associates in South Africa, as well as the introduction of tablets to support other training programs in at least six other African countries.

Conclusions
If incorporated into the program and managed effectively, tablets should improve the quality of learning by Clinical Associate students at clinical sites and could be utilized in training of other health worker cadres. Internet or mobile connectivity is not required, but only needed occasionally to update resources and applications. Students will gain practical experience in applying evidence based medicine by accessing resources to inform their learning and practice, and team learning will be enhanced.