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A Tendency Of App Learning

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‘App learning’ is the new language spoken by the e-learners, particularly among medical students, and more specifically among those who own Smartphones. A new term to label this learners cohort is proposed as opposed to the conventional general term: ‘online’ learning.

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The need for more Smartphone applications in clinical education is crucial. This paper examine some of the guidelines considered when designing an e-learning tool as suggested by the AMEE e-learning guide (Masters & Ellaway, 2008) then apply them to the designing of a Smartphone application. Moreover, it offer a link between these guidelines and the affordances of information and communication technologies as explained by Conole and Dyke. It also addresses the lack of research in this filed and make an open invitation to fill this shortage. It also describes some other suggested features to keep in mind when designing an app, according to a short survey conducted on some clinical educators.


Smartphone applications are vastly used. There is an app for almost everything nowadays. From apps to manage your phone calls to apps to process your emails, online banking, gaming, calculating, maps…etc. There is just over

1,200,000 apps solely on the apple store and more than 75 billion apps downloads up to date, since the launch of Apple applications store in 2008. (Wikipedia, 2014).

Figure 1 Smartphone

Figure 2 Smartphone Applications

Apps are more than a “smaller” portable web based application —it is a fundamental change in how people interact in life. Mobile device ubiquities, combined with the openness of the Web, have sparked the imaginations of both users and inventors. This has motivated e-learning investors to explore this revolution, and use it for the benefit of medical student teaching and learning, to tackle the deficient aspect of a gigantic growing mobile app world.

Clinical educators cannot ignore the potential benefits in the learning process by using Smartphone applications. The digital era surrounding us implies some sort of e-literacy, on both users and potential developers or designers equally. I believe any user in this information age should have a degree of common understanding (e-literacy) of the online technology. This basic understanding could aid in the transition from being a digital immigrant or tourist to the ultimate destination, in my view, a digital native. The available e-resources or reusable learning objects offered by different professional bodies may augment this process (Morris &Mckimm, 2009).

Pedagogically, there has been a steady growth in online learning environment and resources to aid students’ learning (Conole & Dyke, 2004), yet little research been conducted to justify such claims (Mehanna 2004). Nevertheless, e-learning has been widely utilized in medical education and become part of its mainstream (Cook & McDonald, 2008). Perhaps the fast advancing technologies has influenced this.

The e-learning in medical education AMEE Guide 32 in its second part by Masters and Ellaway ; (technology , management and design) published in the medical teacher 2008, provides some guidelines to consider when designing e- learning medium in order to create a more robust and sustainable e-learning tool. The guidelines offered as a number of questions to account for when designing any e-learning module. Theses guidelines are of ultimate value when considered in designing a Smartphone application, regardless if it was transforming a website or a new creation. On the other hand, Conole and Dyke provided some affordances of information and communication technology (ICT) that could be linked to these guidelines ‘questions’.

In this paper, I will apply some of these design guidelines of the AMEE e-learning guide, and use that for the advantage of designing an app. I will attempt to map this with the possible design-related affordances of ICT offered by Conole and Dyke , in order to show the superiority of Smartphone applications as a tool to mediate e-learning both to clinical educators and to medical students. I will describe some suggested other app’ feataures and support that by discussing a short survey results. I will conclude by predicting what the future might hide in the world of apps.

Designing Smartphone applications between Guidelines and Affordances:

Students born to an era of an information age, they are used to laptops, Smartphones, game consoles from an early age(Morris & McKimm, 2009). They speak a language of their own, they constantly exploring new online methods to learn, and on constant peruse of new apps that relate to their learning. Clinical educators required to speak this language, in order to facilitate learning with minimum interruption possible. This information age has penetrated health care providers and forced them to adopted a digital approach to various levels of patient care such as electronic records, online prescribing, viewing and ordering test results. This is a practical proof on why clinical educators need to evolve and adopt some this fast advancing technologies including the app technology, not only as users but as a potential designers with many guidelines to consider such as:

Is there an appropriate interaction? How students will be assessed?

An app that would be a set of pages to flick through, would not be an effective learning tool as to an app that contains variety of quizzes, self-assessments and more crucially an opportunity to interact with other users (Masters & Ellaway, 2008). E-learning students will be dealing with the final product of the app design. The overall layout of an app must be as intuitive and simple to understand and to use as mush as possible. Students want to get on and learn, discuss and share thoughts. The affordances for this guideline derived form the potential for learning by engagement with the ‘other’ (Conole & Dyke , 2004) opened up the possibilities to share notions and communicate with other users, perhaps by push notifications or signing up to a mailing list or engaging in bigger diverse learner community, among those who will be using the apps. This is highlighted in the survey conducted on a group of educators; ease of use, user friendly layout and interactivity were among the top selected features of a potential app (appendix 1).

Are learners’ learning styles and needs accommodated?

Planning a design for an app should take into consideration the balance between self-paced and self-directed learning, acknowledging that this is still a new field for most students and to some still require handholding in that matter. However, the app should make it possible to personalise the learning activity to meet students ‘personal’ needs (Masters& Ellaway, 2008). Exposure to different ‘the other’ learning experience within the app community. Sharing own experiences will connect students learning to own’ life experience (Conole & Dyke, 2004). This highlights the diversity as an affordance in e- learning.

Will the app use multimedia?

Where Animations, video clips and podcasts can significantly increase the effectiveness of e-learning. It could be excluding to others due to disability (Masters & Ellaway, 2008). Videos clips as a learning medium, from the designing point of view; Videos should be easily played, paused, repeated as many times as the leaner wishes, in order to gain the skill or competency required. A multimedia library (videos in this instance) within the app could include a variety of categories, and a carefully constructed step-by-step approach to a given skills. A practical example could be physical examination of various parts of the human systems, like physical examination of the abdominal system, the cardiovascular system, the central nervous system, and many more. This range of diverse learning experiences (Conole & Dyke, 2004) is another affordance that is linked to another app designing guideline.

‘‘Although the physical requirement of healthcare practice limits the profundity of disability healthcare educators need to accommodate (Roberts , 2002), making materials and services broadly accessible helps all users and concentrate the mind on how the teacher indented things to be.’’(Masters & Ellaway, 2008). Ensuring that all app contents have a consideration for learners with disability is vital. To illustrate this, images including buttons should have a voice over option. This practical way allows all users to benefit from the app. It is important not to deprive learners with disability form using the full content of the app, crucial information should not be missing form videos or podcasts, or be only be available somewhere else on the app and missing from the multimedia library.

May participants skip sections? Temporarily exit, or return later?

This highlights the flexibility of apps, as some learners may prefer to skip some of the contents for various reasons, which could rely in their learning style or as planned preparation for that particular concept. Leaving the app and the ability to return to the exit point seamlessly would help students to be in charge of their learning process (Masters & Ellaway, 2008). It will make the app an easily accessible e-learning tool. This flexibility affordance implies that the challenge doest not rely in accessing information but in knowing how to use what is available (Conole & Dyke, 2004).

Is the app multimodal and non- linear?

The online environment that provides tools that can be used simultaneously through hypertext and the powerful search abilities dictates this; which allows the student to adopt a more personalised strategies and pathways. This behaviourist approach is one of under-utilised affordances as most of the online tools lack the multimodal approach (Conole & Dyke, 2004)

What is the evaluation method?

This could be in a form of a questionnaire via the app, or by the use of self-assessment or quizzes as mentioned earlier. Another valuable method is reflection (Conole & Dyke, 2004), whish is considered as an important gain in app designs. This ‘interactive’ technology stimulates engaging in discussions and in critical debates; this could be horizontally between peers, or vertically, between tutor and students. It can also allow for a longer time frame for reflection to take place, in comparison to a more shorter, almost immediate on traditional websites.

Other considerations

Objectives, time required, and guidance available: Designer should use the cycle of the students’ curriculum to advantage: define intended learning outcomes, set out the teaching and learning activities, measure the learning outcomes via assessments, and evaluate achievement of outcomes and alignment of stages.

Immediacy: the speed by which information is exchanged between e-learners’ devices would be always governed by the available bandwidth (Masters &Ellaway, 2008). Current e-learning opportunities expand to fill the available bandwidth. Such opportunities, ‘e-learning’ in general and ‘app learning’ in particular, will have to grow to face the constantly expanding bandwidth.

Speed of change: has caused a shift in the balance from accessing information to selecting the information (Conole & Dyke, 2004). This is apparent, not only with the learning contents of the app, but also with the technicality surrounding the design and function of the app, on that particular Smartphone. The modernity of the devices highlights the fragility and the possible risk of the inability to access the material simply because the server is down (Conole & Dyke, 2004), or the device software update has not released yet which render the app functionless.

In addition to the above discussed guidelines and affordances, there is other proposed features of an app to keep in mind, to obtain the ‘perfect’ app. This is not by anyway an exclusive feathers just few suggestions. Some of these features explored via conducting a short survey among a group of eighteen candidates enrolled in a masters program in clinical pedagogy at King’s College London. Candidates were a group of educators in clinical and non-clinical fields. Thirteen out of the eighteen educators (8 females and 5 male) has responded to the survey. Almost all the educators used some sort of electronic device to augment learning, more than two-thirds preferred using Smartphone and its applications to other online methods such as laptops, tablets and MP3 players. On the other hand, only few have suggested apps to their students as a supplements material to learning. Candidates were asked if they prefer certain features that should be included in the proposed app and the count for each feature is plotted in Figure 3 (where the ‘y’ access represents the number of responses for that feature). Additionally, candidates were queried their technical preferences and results were shown in Figure 4.

Figure 3: Suggested featured of an App

Figure 4: Other technical features

Low cost, ease of access, user-friendly layout, and interaction properties of apps, where the most chosen determining features for a ‘perfect’ app.

The result of this short survey is found to be in high agreement with the guidelines and affordances discussed earlier.

A research by Payne et al (Payne et al, 2012), on use of medical related apps among medical students and junior doctors, found a high level of Smartphone ownership and usage, with an average owned between one and five medical related apps. The research demonstrated that over 24hours apps were used for between 1–30 minutes for students and 1–20 minutes for doctors, students used disease diagnosis/management and drug reference apps, with doctors favouring clinical score/calculator apps. Both groups endorse the development of more apps to support their education and clinical practice. This actually shows the fundamental need for more apps.

‘App learning’ as opposed to ‘online learning’ is a suitable term that could be reserved to the process of e-learning via Smartphone applications. ‘App learning’ if to be used, will refer to a sub cohort of the online learner. The term will be exclusive to people who utilize the potential of the Smartphone for learning activity. This subcategory could be defining, perhaps, a unique generation due to the prevalence of Smartphone ownership among e-learners.

To comply with future requirement of present generation, there is a constant urge for developing more customised apps that meet the expectations and needs of both clinical educators and e-learners.


App technology with its apparent simplicity, yet sophisticated underneath, contributed for the use of Smartphone applications among e-learners and clinical educators to evolve.

There are certain guidelines to consider when attempting designing an e-learning tool. Some of these guidelines drawn form the AMEE e-learning guide (Masters & Ellaway, 2008), could be applied when designing an app.

‘App learning’ is a ‘term’ to describe the cohort of e-learners who use Smartphone application as a learning environment, whom in turn is a part of the bigger cohort ‘online’ learners.

The starting point could be transforming a traditional website to an app. The conducted survey highlighted some of the extra features to consider when designing an app. The future will offer more challenges for clinical educators in planning and designing apps to be suitable and meet the required affordances of the current fast evolving ICT. The shortage of research in this field provokes the need for exploring the process further, particularly in the field of designing apps for the medical students, in an attempt to fill this gap.

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