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Smartphones are becoming ubiquitous in health care settings. The increased adoption of mobile technology such as smartphones may be attributed to their use as a point-of-care information source and to perceived improvements in clinical communication and efficiency. However, little is known about medical students’ use of personal smartphones for clinical work.
The intent of the study was to examine final-year medical students’ experience with and attitudes toward using personal mobile technology in the clinical environment, with respect to the perceived impact on patient confidentiality and provider professionalism.
Cross-sectional surveys were completed by final-year medical students at the University of Toronto. Respondents were asked about the type of personal mobile phone they use, security features on their personal phone, experiences using their personal phone during clinical rotations, and attitudes about using their personal phone for clinical work purposes.
The overall response rate was 45.4% (99/218). Smartphone ownership was prevalent (98%, 97/99) with the majority (86%, 85/99) of participants using their personal phones for patient-related communication during clinical rotations. A total of 26% (26/99) of participants reported not having any type of security feature on their personal phone, 94% (90/96) of participants agreed that using their personal phone for clinical work makes them more efficient, and 86% (82/95) agreed that their personal phone allows them to provide better patient care. Although 68% (65/95) of participants believe that the use of personal phones for patient-related communication with colleagues poses a risk to the privacy and confidentiality of patient health information, 22% (21/96) of participants still use their personal phone to text or email identifiable patient data to colleagues.
Our findings suggest that the use of personal smartphones for clinical work by medical students is prevalent. There is a need to more fully address the threat to patient confidentiality posed by the use of unsecured communication devices such as smartphones.
Smartphones are becoming ubiquitous in the health care setting. The rise in mobile technology such as smartphones may be attributed to perceived improvements in clinical communication, efficiency, and clinical skills [
Smartphones are also being recognized for their use in medical education and training. With smartphones being described as a “learn anywhere” resource [
Although some studies have shown multiple benefits associated with increased connectivity from smartphone use, negative consequences of its use have also been described. Distracted doctoring due to frequent smartphone interruptions can result in adverse events such as medical errors [
This study explores the uses of personal smartphones by medical students during their clinical rotations and describes the perceived impact on the confidentiality of personal health information and professionalism.
Participants were fourth-year medical students from the Faculty of Medicine at the University of Toronto. Participants would have been exposed to all of their clinical rotations in the various medical specialties.
We developed the survey through an iterative process using standard survey methodology [
In February 2013, medical students from the University of Toronto were surveyed during their final year of the medical school curriculum. Each student was provided with a paper survey at the beginning of his/her Transition to Residency course (all fourth-year medical students are required to take the course). A project manager for the Undergraduate Medical Education program distributed surveys at the beginning of class and completed surveys were collected during a class break. Students were informed that participation was voluntary and responses were anonymous and confidential. The study was approved by The University of Toronto Research Ethics Board. Descriptive statistics were generated from the survey results using Microsoft Excel.
The overall response rate was 45.4% (99/218). Nearly all (98%, 97/99) of the respondents currently owned a personal smartphone and the majority (79%, 78/99) of participants owned iPhones (
Medical students reported using their personal smartphones for multiple purposes during their clinical rotations. The majority of students used their personal phone to communicate with medical team members about patient-related matters (86%, 85/99) and non−patient-related matters (93%, 92/99). Although 71% (70/99) of students had password protection on their phone, the survey revealed that 26% (26/99) of students’ phones lacked any type of security feature.
The type, uses, and security features on medical students’ personal mobile phones (n=99).
Question | Answer options | n (%) |
1. What type of personal mobile phone do you currently use?a | iPhone | 78 (79) |
BlackBerry | 6 (6) | |
Windows Phone | 0 (0) | |
Android | 14 (14) | |
Cellular phone (non-smartphone) | 2 (2) | |
Other: Nokia smartphone | 1 (1) | |
2. How do you use your personal mobile phone during clinical rotations? | Communication with patients | 3 (3) |
Communication with other medical team members (patient-related) | 85 (86) | |
Communication with other medical team members (not patient-related) | 92 (93) | |
Medical references, resources, and applications | 92 (93) | |
View patient information | 6 (6) | |
Personal purposes (not work-related) | 89 (90) | |
3. What type of security features do you have on your personal mobile phone? | Password protection | 70 (71) |
Encryption | 5 (5) | |
I don’t know | 6 (6) | |
None | 26 (26) |
aTwo participants reported using two types of personal mobile phones.
A total of 46% (45/97) of medical students stated that they had answered/made a call, texted, or emailed on their personal phone during patient encounters (
Participants’ experiences using personal mobile technology during clinical rotations (n=99)a.
Question | Never, |
Rarely |
Occasionally |
Frequently |
Always |
Q1. I have answered/made a call, texted, or emailed on my personal mobile phone while I was with a patient. | 52 (54) | 35 (36) | 10 (10) | 0 (0) | 0 (0) |
Q2. My senior resident or attending physician has interrupted a patient meeting to answer/make a call, text, or email. | 7 (7) | 38 (40) | 41 (43) | 10 (10) | 0 (0) |
Q3. I have answered/made a call, texted, or emailed on my personal mobile phone while I was in an educational session (eg, teaching rounds, bullet rounds, etc) | 6 (6) | 24 (25) | 32 (33) | 30 (31) | 5 (5) |
Q4. My senior resident or attending physician has interrupted an educational session to answer/make a call, text, or email. | 3 (3) | 41 (43) | 34 (35) | 18 (19) | 0 (0) |
Q5. I used my personal mobile phone for personal matters (eg, personal texts, calls, etc) during clinical rotations. | 2 (2) | 7 (7) | 25 (26) | 49 (52) | 12 (13) |
Q6. I used my personal mobile phone to text or email identifiable patient data (eg, patient last name, OHIP number, medical record number, etc) to colleagues. | 75 (78) | 17 (18) | 3 (3) | 1 (1) | 0 (0) |
Q7. My senior resident or attending physician has texted or emailed identifiable patient data to colleagues. | 40 (44) | 38 (42) | 9 (10) | 4 (4) | 0 (0) |
aA total of 99 surveys were returned but some participants did not answer every question.
In total, 78% (75/96) of students reported that they had never used their personal phone to text or email identifiable patient information to colleagues (
Participants’ attitudes about using personal mobile technologies for clinical work purposes (n=99)a.
Question | Strongly disagree, |
Disagree, |
Neutral, |
Agree, |
Strongly agree, |
Q8. The medical school curriculum has educated me on appropriate and inappropriate ways to use my personal mobile phone for communicating patient information. | 3 (3) | 18 (19) | 18 (19) | 48 (51) | 8 (8) |
Q9. My senior resident or attending physician has given me feedback on appropriate and inappropriate ways to use my personal mobile phone for communicating patient information. | 22 (23) | 36 (37) | 16 (17) | 19 (20) | 3 (3) |
Q10. The medical school curriculum has educated me on appropriate and inappropriate ways to conduct myself professionally with mobile technology. | 5 (5) | 23 (24) | 27 (28) | 36 (38) | 5 (5) |
Q11. My senior resident or attending physician has given me feedback on appropriate and inappropriate ways to conduct myself professionally with mobile technology. | 19 (20) | 42 (44) | 26 (27) | 9 (9) | 0 (0) |
Q12. The use of personal mobile phones for patient-related communication with colleagues poses a risk to the privacy and confidentiality of patient health information. | 2 (2) | 7 (7) | 21 (22) | 38 (40) | 27 (28) |
Q13. My personal mobile phone is distracting during clinical work. | 17 (18) | 40 (42) | 20 (21) | 19 (20) | 0 (0) |
Q14. Using my personal mobile phone for clinical work makes me more efficient. | 0 (0) | 1 (1) | 5 (5) | 54 (56) | 36 (38) |
Q15. The efficiency of communicating with colleagues through text and email using my personal mobile phone outweighs the risk to the privacy and confidentiality of patient health information. | 5 (5) | 12 (13) | 24 (25) | 46 (48) | 9 (9) |
Q16. Using my personal mobile phone for clinical work allows me to provide better patient care. | 0 (0) | 0 (0) | 13 (14) | 59 (62) | 23 (24) |
aA total of 99 surveys were returned but some participants did not answer every question.
A total of 59% (56/95) of students agreed or strongly agreed that their medical school curriculum had educated them on appropriate and inappropriate ways to use their personal mobile phone for communicating patient information (
Personal smartphone use among medical students has become ubiquitous in health care settings. Our results provide a description of how and why medical students are using their personal smartphones. In addition, we describe the possible issues that could arise relating to medical students’ level of preparedness on the appropriate and inappropriate use of their smartphones in the clinical environment. Students are using their personal smartphones for work-related functions such as communicating with medical team members about patient-related and non−patient-related matters and using medical references, resources, and applications. They perceive that smartphone use increases their efficiency. While they communicate patient-related information using their personal phones, most medical students did not report communicating patient identifiable personal health information (PHI) in texts or emails. However, the majority (56%) of students reported that their senior residents and attending physicians had communicated patient identifiable PHI. In terms of preparedness, approximately half of students perceived they were educated on appropriate uses of their personal smartphones.
The personal smartphones of most participants lacked the necessary security features to protect the sensitive information that they may be sharing. As required by the Personal Health Information Protection Act (PHIPA), smartphones must be configured to operate in a secure manner when used to transmit or store personal health information [
Despite security concerns over using personal smartphones for clinical work purposes, medical students perceive that their devices make them more efficient and allow them to provide better patient care. The majority believe that the benefits of perceived better care outweigh the possible harms of unsecure communication. However, this increased connectivity may have a negative impact on professionalism such as “distracted doctoring”, which may disrupt patient care and education.
Although a vast majority of medical students are using their personal smartphones in the clinical environment, many students do not feel that the medical school curriculum or role modeling has educated them on appropriate and inappropriate ways to use their personal smartphone for clinical work. There is increasing recognition that smartphone use by clinicians can be perceived to be unprofessional [
Our findings raise concerns over the security of personal health information. The use of personal smartphones for clinical work may increase efficiency, but there is concern about privacy breaches through unsecure sharing of confidential information. While individual clinicians including medical students, residents, and staff physicians need to understand the importance of keeping personal health information secure, it is the responsibility of the institutions to provide an effective, secure communication infrastructure for clinicians. Otherwise, we can expect ongoing privacy breaches.
This study has several limitations. The study only included medical students from a single university in Canada and our response rate was only 45.4%. We may also have a biased selection of medical students who own smartphones. However, the university is affiliated with five academic teaching hospitals. With a total of 99 responses, we believe that these results are likely to be generalizable to medical teaching institutions in Canada and the United States. The study also examined self-reported experiences. Participant responses were, therefore, subject to both recall bias and response bias. In addition, due to the sensitive nature of PHI, communication of PHI may be under-reported. Our findings show that students perceived their senior residents or attending physicians to communicate PHI more often than they reported for themselves. However, it is unclear whether the devices their senior residents or attending physicians were using to communicate PHI were personal phones or institutional devices.
Some of our findings are consistent with the literature reporting high use of smartphones by clinicians for work purposes. Consistent with previous literature, smartphones are being used for clinical and educational purposes and perceived improvements in efficiency have been reported [
The use of personal smartphones in the clinical environment is an established reality. It is evident that medical students prefer to use their personal smartphones for clinical work as they perceive that these devices make them more efficient and allow them to provide better patient care. With the popularity of personal smartphones, it is critical that more attention be focused on educating medical professionals on how to appropriately use their personal devices for clinical work as well as adopting secure means for clinical communication.
Smartphone survey.
personal health information
None declared.