clinical mobile technology

Article: Recommendations For Implementing a Longitudinal Study Using Wearable and Environmental Sensors in a Health Care Organization

This study gives examples for implementing technology-facilitated approaches and provides the following recommendations for conducting such longitudinal, sensor-based research, with both environmental and wearable sensors in a health care setting: pilot test sensors and software early and often; build trust with key stakeholders and with potential participants who may be wary of sensor-based data collection and concerned about privacy; generate excitement for novel, new technology during recruitment; monitor incoming sensor data to troubleshoot sensor issues; and consider the logistical constraints of sensor-based research.

L’Hommedieu M, L’Hommedieu J, Begay C, Schenone A, Dimitropoulou L, Margolin G, Falk T, Ferrara E, Lerman K, Narayanan S. (2019). Lessons Learned: Recommendations For Implementing a Longitudinal Study Using Wearable and Environmental Sensors in a Health Care Organization. JMIR Mhealth Uhealth, 7(12):e13305.

We’re going to be seeing more and more of this type of research in healthcare organisations, which I think is a good thing, given the following caveats (I’m sure that there are many more):

  • We still need to be critical about how sensors record data, what kind of data they record, and what kinds of questions are prioritised with this type of research.
  • Knowing more about how bodies work at the physiological level doesn’t say anything about the social, political, ethical, etc. factors that are responsible for the bigger health issues of our time e.g. chronic diseases of life.
  • Behaviour can be tracked but the underlying beliefs that drive behaviour are still opaque. We need to be careful not to confuse behaviour with reasons for that behaviour.

Using sensors for data collection allows us to overcome the limitations of traditional data collection tools, such as surveys, as sensor data are considered to be more objective and accurate.

The reason I think that sensor-based research is, in general, a good thing is because the questions that you’re likely to ask in these kinds of studies are the same questions that we currently use observation and participant self-report to answer. We know that these forms of data collection are inherently unreliable so it’s interesting to see people trying to address this.

However, even assuming that sensor-based studies are more reliable (and we would first need to ask, reliable against what outcomes?), having more reliable data says little about whether the questions and corresponding data are valid. In other words, we need to be careful that that date being collected is appropriate for answering the types questions we’re asking.

Finally, it stands to reason that once we have the data on the behaviour (the easy part) we still need to do the hard research that gets at the underlying reasons for why people behave in the way that they do. Simply knowing that people tend to do X is only the first step. Understanding why they do X and not Y is another step (possibly determined by interviews for FGDs), and then presumably trying to get them to change their behaviour may be the hardest part of all.

mobile technology writing

Pitches for The Conversation: Africa


I’ve been wanting to contribute to The Conversation: Africa for ages and have only recently been able to put together a few pitches for the articles I’d like to write. If you’ve never heard of The Conversation, it’s a wonderful attempt to get academics to write thought-pieces that are more accessible to the general public and those outside the field. All content is also published under Creative Commons licenses, meaning that what you write is freely accessible and can be distributed in any number of ways. Here are a few points that resonate with me from The Conversation: 10 ways we are different page:

  1. In a world of misinformation and spin, The Conversation contributes to healthy democratic discourse by injecting facts and evidence into the public arena.
  2. All our content is sourced from university scholars and researchers who have deep expertise in their subject.
  3. We are transparent, with every author disclosing their expertise, funding, and conflicts of interest.
  4. All our content is free to read and republish under Creative Commons while the rest of the media charges for re-publication.
  5. We believe in the free flow of information. We disseminate our content to more than 12,000 sites worldwide. That gives our content a global reach of 23 million readers a month, and growing.
  6. To avoid commercial conflict we don’t carry advertising pop-ups or annoying autoplay.
  7. We are a not-for-profit organisation serving the public good.

It’s a bit more formal than a blog because you have to submit ideas to the editors who then review the pitch and provide you with guidelines and deadlines. I’ve drafted the outlines for three articles on the use of technology in higher education and sent the following three pitches to the editors.

Pitch 1: The future is here, it’s just not evenly distributed
It has become a truism that when we talk about the integration of technology in the context of teaching and learning in higher education, we must avoid making assumptions about the level of physical and epistemological access that our students have when it comes to using that technology. However, while I acknowledge this important point, I do worry that too much emphasis on it leads to a conservative approach to the introduction of technology into the classroom, and that this conservatism will lead to our students having a significant disadvantage upon graduation. The world is not going to wait for our students to catch up and the deep integration of technology into every other aspect of life continues unabated, at an accelerating rate of change. So, how do we prepare our students for a world that we cannot predict? Is it by adding more content to the curriculum? Or is it by teaching students how to adapt to change, through the aggressive incorporation of digital technologies into teaching and learning practices through intentional pedagogical design?

Pitch 2: Dominant design and the future of technology in higher education
The power of technology in education is in it’s potential to bring about transformative forms of teaching and learning that fundamentally change the people who use it. And yet, when we look at how technology is used in higher education we see it predominantly used to encourage ways of thinking and learning that reinforce outdated pedagogical practices. Dominant design is a management concept suggesting that, once a design has taken hold and become dominant, future innovation in the field is directed towards improving that design rather than challenging it and creating new paradigms. This is exactly what we see when we consider the Learning Management System (LMS) which, for many, represents the cutting edge of technology-integrated teaching and learning. And yet, what does the LMS offer besides a cost-effective content-distribution system and an efficient way to manage students? In order to truly use technology to bring about transformative approaches to teaching and learning, we must establish the following beyond any doubt:

  1. The technology does matter; but pedagogy matters more.
  2. The integration of technology should solve more problems than it introduces.
  3. The technology must be accompanied with a concomitant change in practice.

Pitch 3: Why an emphasis on content in higher education is untenable in a digital society
There are important pedagogical reasons for why a focus on “covering the content” is flawed when it comes to higher education, not least of which is the idea that a higher education must be about more than the accumulation of facts and the ability to recall information on cue. The value of a university is not that its academics control access to specialised knowledge but that there is a need in society for spaces that encourage a deep and critical investigation into the nature of the world. By focusing purely on discipline-specific content, we do nothing to advance the academic project and instead reduce our roles as academics to filters, making decisions about what content is important to cover. But what happens when machines are able to outperform us as content filters? What happens when we can “outsource” information recall to our constantly connected devices? What do we do when our students are able to challenge us on every point we make? Do we retreat into the relative safety of an enforced disconnected classroom, or do we embrace the use of connected devices and work collaboratively with students to create deeper and more critical inquiries into the world?


mobile technology

Using a Chromebook for academic work

I’ve been thinking about getting a Chromebook as a cheaper laptop alternative, especially since I use Google apps and services extensively. While I was initially sceptical about a browser-based operating system (i.e. ChromeOS), I’ve heard good things about Chromebooks and so I was pretty excited to be offered a demo model from Google Education to try it out. The machine I got was a C730, which is a low end device and so is quite inexpensive compared to a regular laptop. I’ve been using it almost exclusively for the past week and thought Id share my experience as an academic using a Chromebook for work.

This post should be read with the following caveats. Firstly, this is not a technical review of Chromebooks. There are many other sites devoted to reviewing the hardware, all of which do a better job than I could (see this review of the best devices for 2015). I’m going to review the Chromebook from the point of view of an academic interested in a low cost secondary mobile device that could be used to accomplish most of what I do in my daily work.

The second point to note is that I am not an average user. I use multiple devices that run multiple operating systems, including a Windows machine at work and Xubuntu on my desktop at home. I have a laptop running the latest version of Ubuntu, a Nexus 7 running a custom ROM (Cyanogenmod), and an iPad. All of these devices need to fit into my workflow, which means that (almost) everything I use is cross-platform or, at the very least, web-based. My point is that the way that I think about – and use – technology is probably quite different to most academics. So with that in mind, here are my thoughts after using a Chromebook for a week.


I’m not going to harp on about this (see previous comment regarding reviews sites) but I thought I should briefly mention the device itself. I was worried that the Chromebook would feel cheap considering how much it retails for, but it doesn’t. The keyboard is solid and feels good to type on. The i3 processor, even though it is relatively slow compared to regular laptops, does a good job, which is not unexpected since the operating systems is basically just a browser. Battery life is also very good, allowing me to work on it for a full day without needing to charge.

Setting up

If you’re already invested in the Chrome ecosystem with regards Google services and Chrome apps, setting up the device is simple. You login, go make a cup of coffee and – assuming you have a decent internet connection – all of your usual apps will be up and running by the time you get back. The other thing that is quite nice is that multiple accounts are managed very well, making this quite a nice device for sharing with others – maybe a departmental computer, or having a few that you pass in around in class for groupwork.


The thing that is probably going to be the initial barrier for most people is the fact that the file browser is actually an alternative front-end to Google Drive, with another folder called Downloads. Downloads is the only folder that automatically keeps files for offline browsing so if you’re offline you don’t have access to anything unless you’ve already saved it for offline use, or have previously saved it into Downloads. If you’re already using Drive and get how it works this wont be a big deal. It seems that there are different options available for offline access on various devices, depending on what OS you’re running. Strangely it appears that if you use Drive on a regular computer, you can set it up so that – by default – all of your files are synced for offline use. I thought it was odd that I couldn’t enable offline access on the Chromebook but maybe the assumption is that this device is really meant to be used with an internet connection. Or I just couldn’t find the right setting.

I Having said that, I was impressed with the file browser. It’s clean and simple and works very well if you’re online. I didn’t spent much time trying to rearrange the folder structure (it just pulls down my file system from Drive) even though how I use Drive is not quite the same way that I use my local file system. Where Files really shines is its integration with the Google ecosystem (Gmail, Docs, Sheets, etc.). Obviously.

Screenshot 2015-05-12 at 10.54.20


If you’re an academic, you live in your email client so this was obviously something that needed to work very well. For me, this wasn’t going to be a problem, since I route my work email through a Google Apps account, which means I’ve been using Gmail for work for years. if your institution uses Google Apps for your email, or if you send your work email to a Gmail account, email is going to just work. You sign into the device with your Google Account, open Gmail and you’re up and running. However, if your institution uses something like Groupwise, you are going to be able to access your email via the browser but you may end up running into issues with things like attaching files. However, I didn’t test this so I may be wrong.


Another thing that I need it do a lot of is scheduling. Since I use Google Calendar via Sunrise, this was also not a problem. After signing into the device, all of my Chrome apps began installing automatically and after a few minutes I could open Sunrise and see all of my appointments. Sunrise also runs offline.

Screenshot 2015-05-12 at 10.47.30


On my desktop and laptop, I use LibreOffice as my word processor, along with Google Docs (and Sheets and Slides) for collaborative work, Evernote and Keep for note taking, and a plain text editor for early drafts. Since academic work involves a lot of writing, getting a good sense of what writing apps are available for the Chromebook is a good idea. In addition to what I’ve listed above, there are many other apps that also work well. For me, these ones are the most useful since they have brower-based user interfaces, as well as mobile apps that are cross-platform.

Google Docs / Sheets / Slides: I use Google Docs, Sheets and Forms extensively – as do our students – both for our undergraduate curriculum and for collaborating with colleagues. This is important to note because if you, your colleagues and your students are not already using Google Drive, the ability to integrate within an institutional ecosystem is going to be a challenge. Its not impossible but I don’t think it will be easy. Since many of my students submit work on Docs, I already use Google services for that work, which means that the Chromebook is a natural fit for my situation. Even when not working collaboratively many of our students prefer using Docs and submit their work that way. If you’re starting to move your department towards cloud-based services, then a Chromebook could definitely be considered but even then, you would probably need a few months to let things stabilise before committing.

Evernote: I use Evernote for taking notes in meetings, collecting resources for papers, and writing outlines for proposals and articles. You can either use Evernote in the browser if you’re online, or as a standalone Android app (see below), which has offline access. Since the text is quite small in the app, I suggest only using this version when you don’t have access, otherwise the web interface is better.

Screenshot 2015-05-12 at 13.34.43

Text editor: As part of this experiment I also looked for a simple text editor. Over the past couple of years I’ve been using plain text editors for my early stage drafting. I use Markdown for basic structure, which allows me to focus on getting ideas onto the page without getting distracted by formatting. While not necessary, I had a look for a  text editor that would run offline on ChromeOS and very quickly found Minimalist Markdown Editor. The app loads quickly and is very fast to work in, so for a low-powered device like this Chromebook, I would almost go so far as to recommend using something like this instead of Google Docs. It supports keyboard shortcuts (e.g. Ctrl-S for Save), multiple tabs and can be set to show a preview alongside the plain text (see below). Files are saved either as plain text (.txt) or Markdown (.md) in the Downloads folder in Files.

Screenshot 2015-05-12 at 11.11.44

Keep: I use Evernote for work-related notes and for saving webpages, images, links, etc. that are relevant for long-term projects, and use Keep for short-term, ephemeral notes that I’m not going to keep for very long. This might be a short tick list, or something that I need to remember for a meeting. There’s no reason that I can’t use Evernote for the same thing but it works for me to keep them separate. Being a Google app means that Keep works well on the Chromebook. It also works offline.


Since most of my work is synchronised across devices via Dropbox, I was hoping that the integration of Dropbox into ChromeOS would be seamless. I was disappointed. While I can use the browser to find and view files in Dropbox (see below), there is no easy way to edit them. I also can’t browse Dropbox as if it was part of the file system. The Files app seems like it could easily include a Dropbox folder into the left-hand navigation panel and, if I’m signed in to Dropbox, should allow me to navigate the folders as part of the file system. I should then be able to open Word documents in Google Docs, and to save those files back up to Dropbox. This would also be useful for attaching files in Dropbox to Gmail. For example, in the Gmail app on Android, I can browse through my Dropbox folder and attach files to emails directly, so I thought that it would be similar on the Chromebook.

Screenshot 2015-05-12 at 10.44.10

I’m not sure that there’s any technical reason why this isn’t possible and was really disappointed that the only way for me to access files in Dropbox was to find it with the browser, download it into Files / Drive and then open it with Docs. I suppose this wouldn’t be a problem if I migrated everything from Dropbox to Drive but this obviously isn’t something that I would do for this test. Google does offer 1TB of cloud storage to Chromebook users for free, for 2 years but this doesn’t seem like a good deal for most people (if you have 1TB of content that you’re working with, a Chromebook is probably not the best option for you). If you do decide to commit to a Chromebook, then a full migration to Drive from Dropbox (or whatever cloud-based storage service you use) would resolve this issue.


For any academic, a PDF management app like Mendeley (or some alternative) is absolutely essential for your workflow. I’ll focus on Mendeley because that’s what I use. Mendeley is cross-platform and has a really nice web interface that is quite usable on a Chromebook. However, if you want to do serious work with your articles then it you might find the web UI a bit cumbersome. It’s not impossible, but it is slow and unwieldy. If you just need to find a specific paper and read it, its fine. But if you want to work with multiple papers and make notes on them, it becomes more difficult to manage. However, the nice thing about web-based platforms is that updates can be rolled out quite quickly and who knows, the ability to keep files locally and access them through the browser might be in the pipeline. It’s not technically impossible. So, the article manager is available but not great.

Screenshot 2015-05-12 at 10.52.00


Printing was problematic. Within an hour of setting up at work, I had a student come to see me asking for a letter of reference. Creating the letter in Docs was obviously no problem but setting up Googles Cloud Print wasn’t trivial. You need to set it up via another computer first, which I suppose isn’t a big deal but more than I felt like dealing with at the time. I never did get around to setting up cloud printing on the Chromebook because honestly, it’s not something that I need to do often. And, since that’s the kind of thing you only need to do once, it’s not going to be a deal breaker for anyone.

Final thoughts

After using the Chromebook at work for a week, here are my final thoughts:

  • Even with the underpowered i3 chip on this Chromebook, ChromeOS is fast. Overall, I was impressed with the performance of the device.
  • If you, your students and your colleagues already use Google services extensively, you wont have too many issues integrating with that ecosystem at work.
  • Related to this, signing in and getting your apps up and running automatically works seamlessly.
  • The integration of Google’s services on the device works really well. If you route your work email through Gmail and combine this with Drive, then this alone would mean that you could probably do about 70% of your work with a Chromebook. If your students also use Drive, I think you could do almost all of your work.
  • If you already use Chrome apps via the browser for some of your work (e.g. Keep,, Sunrise), you’re not going to find any problems moving to a Chromebook. However, if you’ve only ever used Chrome as a browser and are not comfortable with installing apps you may find the laptop limited while you find your feet.
  • I didn’t really look into any of the special offers that come with the purchase of a Chromebook, but I’m assuming that some of those might also influence your decision.

If you’re an academic and are thinking about buying a Chromebook that you’re going to use for work, I suggest that you really commit to cloud-based services, preferably Google’s. The main problem I would have is a migration from Dropbox to Google Drive. Dropbox is (barely) usable via the browser, whereas Drive is integrated into ChromeOS. You have a few storage options with Drive: If you just use this for work, the the free 15GB will be fine. I can’t imagine you would use more than that with Word documents, slideshows and PDFs. If you need more space, you can pay $2 a month for 100GB. No academic is likely to need the 1TB that Google offers free for 2 years, especially if this is a secondary device that you intend using for work alone. If you already use web-based services like Gmail, Calendar (or Sunrise), Drive, Evernote, and Keep (I also use and Pocket extensively – both are browser-based with mobile apps), then switching to a Chromebook will involve a bit of restructuring and management but after that will most likely be fine.

Thank you to Karen Walstra (Twitter, Google+) at Google for Education, who very kindly offered me the use of a demo Chromebook for this experiment.



New article published to Clinical Teacher mobile app

I’ve just published a new article on Objective Structured Clinical Exams (OSCEs) to my Clinical Teacher mobile app. An early draft of the article is available here. Here are some screenshots from the app.

You can download the app for iOS or for Android.


Update on the Clinical Teacher mobile app

I’ve just finished a full draft of the first article I’ve written for the Clinical Teacher in more than a year. It’s been a busy 12 months and I’ve been involved in a host of other projects but now I’m ready to get back into writing for the mobile app. This next article is on the Objective Structured Clinical Exam and I’m really proud of how it’s turned out. I’ll publish the first draft here tomorrow and am hoping to have a final release by the end of the month.

In the meantime, I thought I’d mention that while I’ve been busy with other things, Snapplify has continued updating the app (iOS, Android and web versions) and I’m really excited with where it’s going. The web interface is especially elegant (see below).


I’m also working on another article on Informed Consent, which will hopefully be ready before the end of the year. It’s already about 80% done but we’re also trying to figure out the new design for the articles, so that’s taking up quite a bit of time as well. I’m really looking forward to putting out some new content for the Clinical Teacher app in the next few months, and hope to make up for lost time.

mobile technology

Clinical Teacher app upgrade

The Clinical Teacher mobile app has just been upgraded. The most noticeable features include:

  • Push Notifications so that you’ll always find out immediately when new content is available
  • A new default white theme that looks fresh and clean
  • Compatible with iOS7

Thanks to Snapplify for getting this done so quickly.

Note: also trying Google+ embeds, which seem to work quite nicely.

mobile teaching

Effective lectures

This is the first draft of an article that was eventually published in the Clinical Teacher mobile app.


“The successful teacher is no longer on a height, pumping knowledge at high pressures into passive receptacles. He is a senior student anxious to help his juniors” (William Osler, 1849-1919)

In medical education, the word “lecture” is fast becoming a term of derision. Advances in our understanding of how people learn have demonstrated that passive approaches to teaching and learning is ineffective in developing advanced cognitive skills. However, traditional lectures where students are expected to sit and listen are still one of the most common methods of teaching in health sciences education (Graffam, 2007; Sandhu et al., 2012). When interactive lectures are used instead of didactic lectures, we know that student satisfaction, learning outcomes, and knowledge retention is better. However, rather than suggest that the lecture is dead, as many would have you believe, this article presents a range of methods that clinical teachers can use to enhance lectures by making them more interactive.

What is a lecture?

“…a great lecture is not a rote mechanical reading of notes, but a kind of dance, in which lecturer and listeners watch, respond to, and draw energy and inspiration from each other. One of the greatest pleasures of lecturing occurs when learners pose insightful questions that the lecturer did not — perhaps even could not — foresee..” (Gunderman, 2013)

A good lecture tells a story, as simple as that. It poses problems that are eventually resolved, and it keeps learners in suspense, waiting to see how the problem can be worked out. Great lecturers find ways to share the responsibility for solving these problems with learners, working with them to find a solution. In these kinds of classrooms, students are not merely sitting and listening. Instead, they are challenged and engaged, actively thinking and imagining along with the lecturer as both struggle toward new insights (Gunderman, 2013).

Lectures are often thought of as a mechanism for sharing facts, rather than for sharing personal experiences and insights. When thought of in this way, a lecture can be used to give a human face to a topic, or to paint a bigger picture for a course. They can stimulate interest, explain concepts, provide core knowledge and direct learning (Cantillon, 2003). Outlines of lectures can provide a structure where they can be seen in the context of the whole programme, with concepts shown in relation to each other. In this respect, it is clear that the purpose of a lecture need not be primarily to transmit information, since other techniques like assigning a reading or distributing an electronic copy of the notes, can be equally effective. Lectures should therefore not be used simply as a method of spoon feeding students with predigested facts (Harden & Dent, 2005).

“The real purpose of a lecture is to show the mind and heart of the lecturer at work, and to engage the minds and hearts of learners” (Gunderman, 2013)

It is important to note that lectures in themselves are not bad but that they, like any teaching method, can be used badly. A good lecturer tells a story that inspires and motivates students, so we should use caution when speaking poorly of lectures. When the lecture fails as a teaching medium, it is often the lecturer who is at fault.

Content vs Learning

One of the key challenges faced by lecturers is the tension between covering a range of discipline-specific content and ensuring that deep and meaningful learning happens. This tension is often exacerbated by the limited time in the curriculum allocated to each section of work. The movement of facts from lecturer to the class is pretty much how most people think of learning. However, knowing what to do with facts should rightfully be the centre of the learning process. That doesn’t mean that we shouldn’t stand in front of students and speak, but that our “speech should be to evangelise, to inspire, and to demonstrate”, rather than simply being a mechanism to impart knowledge (Chester, 2013).

“A great lecture is not a rote mechanical reading of notes, but a kind of dance, in which lecturer and listeners watch, respond to, and draw energy and inspiration from each other.” (Gunderman, 2013)

One of the enormous challenges with lectures is the attempt to incorporate students into the process, as part of an interactive exchange. The problem is that one-way lectures are difficult to make interactive because students are generally presented with answers rather than having to find answers for themselves (Dalsgaard & Godsk, 2007). However, a problem-based approach to teaching and learning that is supported by social constructivist principles (Vygotsky, 1978) is not feasible with a lecture. It requires a different approach to learning than what is available in the traditional lecture format, which is why lectures should not be thought of as an effective means of developing skills, higher order thinking, or changing attitudes (Cantillon, 2003). It is therefore worthwhile to consider that multiple teaching approaches have value, and that no single method can be used to cover the range of learning that much happen during clinical education.

“In the world of Google, facts can be accessed quickly and efficiently at any time, from any place, and with any device – so rote mastery of facts is no longer the core of learning” (Chester, 2013)

Types of lecture

Before you begin creating a lecture, it is useful to spend some time thinking about what kind of lecture you’re going to present. Or, to put it another way, what is the overall objective of the lecture? What will it be used for, in the context of the programme? Consider the following different types of lecture (Dent & Harden, 2005):

  • Overview – an overview of the module as an introduction to establish the context, before beginning with other teaching and learning methods.
  • Core – a series of lectures that presents the major concepts of a module.
  • Non-core – using lectures occasionally to elaborate on complex ideas, or to present aspects of the topic that are peripheral to the core curriculum.
  • Assessment material – demonstration of worked examples of assessment methods in the module.
  • Patient presentations – using a lecture to “walk students through” a case study, which can be more interactive than the one-way transmission of facts
  • Shared lectures – when several lecturers provide multiple points of view or perspectives on the same topic e.g. a physician and nurse provide different approaches to the management of the same patient (see also “Team teaching”).

Structuring a lecture

Most lectures are able to follow the simple outline of a beginning, a middle and an end. “Tell them what you are going to tell them, tell them, then tell them what you told them.”


The introduction to the lecture is used to attract the attention of the students and set the mood for the session. One was to “captivate” students from the start is to use an exciting or controversial proposition, question or statement (Sandhu et al., 2012). It can be used to inspire them to concentrate, or to establish pre-existing knowledge. During this early part of the session, make sure you establish context by explaining how this lecture fits into the broader picture. Identify the usefulness of the content, identifying it’s perceived value for the students and thereby giving them a sense of place and direction (Cantillon, 2003). The Introduction should also be used to set the aims and objectives for the lecture. If the lecture is part of a series, it is always useful to use the Introduction to briefly review what was presented during the previous lecture. If this is the first lecture with a new group, this would be a good time to go over the “ground rules” e.g turning off cell phones, late arrivals, questioning periods, etc.

Main body

The main part of the lecture can be structured in a variety of ways:

  • Sections: Lecture is divided into sections, which is easy to plan and for students to make notes, but can be perceived as boring. This approach may be more useful for topics that are naturally categorised in hierarchies e.g. health or body systems, or classifications of injuries or disease.
  • Problems: State a problem and then produce arguments and counterarguments for solutions to the problem. This approach can help students develop critical thinking around clinical problems.
  • Sequence: A series of linked statements, each leading logically from one to the other, towards a conclusion. This approach could be used to take students through a patient examination process.

In order to prevent students’ minds from wandering, the Body of the lecture should be broken up into shorter sections, either by alternating the presentation format or by having students engage in relevant activities (Sandhu et al., 2012). After presenting the content, lecturers can have students work individually, in pairs or in small groups. You could even ask them to present short summaries of the key points of the lecture, during the end of the session.


The lecture should finish with a review of the objectives and key points that were covered. The lecturer might highlight ways in which students could extend the lecture by presenting routes for self-study and further independent learning. The Conclusion should avoid the introduction of new ideas.


Keep the time that students are sitting passively to a minimum. Thirty to forty minutes can be considered a maximum period of time without a proper break, since this is about the longest that people can concentrate. This time period can be broken up into ten or twenty minute sections, during which lecturers can have students engage in activities. For example, present them with a new idea or high-level concept (10 minutes), have them engage with the idea by discussing with a neighbour (2-5 minutes), clarify the idea with further examples (10 minutes), before finally moving on to the next idea. After that, give the students a 5-10 minute break before continuing.

The lecturer as a performer

“There are good lectures and bad lectures, just as there are good lecturers and bad lecturers. Rather than disposing entirely of the lecture as a means of learning, we should attempt to understand better the features that distinguish effective, engaging lectures from those that leave learners limp. Good lecturing is an art, and like other arts such as painting, musicianship, and writing, it takes real dedication and many hours of practice to excel at. Some may be more gifted at lecturing than others, but through study and practice, nearly everyone can improve” (Gunderman, 2013).

While it can be useful to think of the lecturer as a performer, they are not entertainers. The lecturer should aim to inspire and captivate students, but not to entertain them. There are a range of verbal and nonverbal skills that can be employed to keep the students captivated and engaged. These include using direct eye contact, changes in body language, gesturing, changing volume and tone for emphasis and exaggeration, projecting a sense of enthusiasm and excitement, and having a sense of humour (Sandhu et al., 2012). Digressions in the form of a personal story or contemporary reference can alter the tone and style of the lecture and can recapture flagging student attention. Students are almost always excited to hear about clinical experiences, especially those that demonstrate that the lecturer is human and fallible.

Maintain eye contact with students, moving your attention around the room. Focus on individuals when making a relevant point, as if you are speaking directly to that person. While this is a good way of maintaining a connection with them, avoid focusing on the same person too often, as this may make them feel targeted. Speak clearly and fluently. You may need to practice enunciating your words if you’re not comfortable speaking to groups. Make sure that you adjust your pace of delivery if you expect students to take notes, and adjust your tone of voice to avoid a monotonous session. Whether you prefer to lecture while seated, standing still or walking around the room, make sure that wherever you are, you are visible and audible to everyone in the room.

The last lecture is a good example of the lecturer as a performer.

It is worth noting that the lecturer may need to change their personal perspective of their role in the classroom, moving from being a “fount of knowledge” towards becoming a more experienced peer, a guide who knows the terrain and who can help students learn how to navigate it independently. If the lecturer sees themselves as the source of the “correct” information, students will also have that perception, which gives them little incentive to actively work through the course (Dalsgaard & Godsk, 2007).

Slideshow presentations

Many lecturers use slideshow presentations as a way of highlighting the major points of the session but many more use presentations in ways that end up distracting students while adding little to the lecture. For example, fancy animated transitions between slides add nothing to what students should learn, and comes across as cheap and gimmicky. In the same way, multimedia integration as part of a slideshow can add significant value to what you want students to learn but can also distract from the main point of lecture. Therefore, avoid adding images and video simply for the sake of it. Try to decide how adding different media will add to the presentation, rather than simply take attention away from the main concepts you’re trying to convey.

When developing a slideshow presentation, lecturers often focus on the bullet points that convey the facts, and pay attention to little else. But slideshow design is important. There’s nothing worse than trying to make sense of too much cramped text forced onto a single slide, or to feel like you’ve been slapped in the face by an ugly presentation. Even if you don’t believe that you can design anything good looking, then a simple black font on a white background is perfectly adequate. Better that than cheap clip art and flashing animated transitions.

For those who are a bit more adventurous and would like to learn more, Presentation Zen is a great site for learning about good design principles for presentations. Here are some example posts from the site that I enjoyed:

Presentation tools

If you’re considering (or are already using) slideshows as part of your lectures, you should familiarise yourself with the following tools:

Using images in a slideshow

There’s nothing more boring than reading a long list of bullet points. Consider using pictures embedded in the slide that will help you to make a point more strongly, or that add the kind of detail that is difficult to illustrate with text. Presentation Zen is an amazing resource that has many examples of how images can make or break a presentation.

Always try to find high quality images, preferably from sources that use open licenses (see the section on “Copyright” later). The quality of a digital image is determined chiefly by its resolution. The higher the resolution, the better the quality of the image. However, note that as resolution increases so does the file size, which may be a problem if you need to keep your presentations small. The table below presents examples of an image at different resolutions.

Normal resolution

Low resolution


Also, make sure that you maintain the correct aspect ratio when using images in your lecture slides. It’s jarring for the viewer to see images that are stretched or compressed into areas that they were not designed to fill.

Correct aspect ratio

Incorrect aspect ratio


Another common problem is when lecturers take a small image and expand it to take up more screen space. When this happens, the image on display looks pixelated. You can avoid this by using images at their actual size, rather than enlarging them. Note that you can take a large image and make it smaller with no discernable problems. The issue arises when you try to make a small image larger.

Using video

Video can be a great way to appeal to students on an emotional level, since it often brings out the human element of a story. However, if you do include a video as part of your lecture, make sure that it’s short, since passively watching a video is no different to passively watching a lecturer. If you do include video, it should go beyond simply telling the students something that you could tell them yourself. If all it does is convey more facts, then it would be better to have them learn those facts in another way. Also, after watching the video, the lecturer should set aside time for the students to engage with the ideas that were presented. If you’d like for students to watch a long video because it’s an essential aspect of the module, rather have them watch it at home, make notes, create questions, and then bring those questions to class for discussion.

It is possible to record lectures in a way that the lecture can be made available for students to watch later. The benefits of this include being able to pause, rewind and re-listen more complex sections of work. In addition, some software programmes allow a slideshow presentation (if one was used) to be synchronised and shown alongside the video of the lecturer. Recorded lectures can be made available on the university intranet along with additional resources, copies of the presentation slides, handouts, etc. for students to access after the lecture. Note however, that watching videos of lectures is not a replacement for attending lectures, especially if the lecturer has created space and time in the lecture for interaction.


A lesson plan is always useful as a guide for students to situate themselves within the context of the lecture, and can be made available to them in print or online. The can be created in advance and given to students either before the lecture to help them prepare, or afterwards as a summary.

The point of a handout is to scaffold students’ independent exploration of a topic, not to provide them with the content of the lecture. Use the handout to identify the aims and objectives of the session, to make connections to other lectures or subjects, summarise the main concepts, provide self-assessment questions for independent study and direct them to additional reading and resources.

More comprehensive handouts avoid the need for students to take extensive notes but this may also encourage them to stop concentrating during the lecture. Notes that provide less detail may encourage students to pay more attention and to engage with the topic independently, since the handouts in themselves do not provide everything that is necessary to know. For this reason, handouts should provide a scaffold for students to build a better understanding of a topic by summarising the major themes of the lecture, while at the same time avoiding exhaustive coverage. They should aim to inform self-directed learning, and should therefore include exercises and questions with reading lists (Cantillon, 2003).

Let students know if they are expected to take notes during the lecture or if the handouts will provide everything they need. Note-taking is a form of engagement during the lecture but can also help students to structure their thoughts during follow up homework. You can teach them how to effectively take notes during class, for example by using the Cornell method (see below for a guide on using this method, from the Cornell Learning Strategies Center).

Facilitating interaction

While most students have had several years of experience attending lectures by the time they reach you, almost all of them view lectures as an opportunity to sit back and soak up the learning, or as one student told me, to “sit back and switch off”. It’s important for students to understand that actively engaging with the lecture will help them to derive maximum benefit from it.

One of the easiest ways to encourage interaction during a lecture is “Think. Pair. Share”. The lecturer presents an idea, then gives the students a short period of time to think about it individually, possibly giving them a question as a stimulus or asking them to write something down. Then, they pair up with the person sitting next to them and discuss the ideas and questions that each of them just came up with. Finally, some of the pairs are asked to share what they discussed with the larger group, with the lecturer providing input at various stages in the form of clarification, reinforcement and challenges.

Another useful option is to get the students to ask the lecturer questions during the session. However, instead of asking them to do it as individuals, try having them work on a question in small groups of two or three. This way they can avoid the perceived embarrassment of asking a “silly” question and will gain confidence to ask questions in public. Then, instead of the lecturer answering the question, give other groups the opportunity to try first. This will not only hold everyones attention but will also give the lecturer a few different ideas to work with during the discussion.

Having students work in small groups is an effective way for them to engage with the content of the lecture. By discussing the concept with others, they not only remain focused during the lecture, but they have an opportunity to reinforce it in their own minds. In this way misunderstanding can be identified early on, with students having the opportunity to ask clarifying questions. In addition, seeing different answers to the same question can demonstrate to students the different ways of understanding something.

Students can also be given short, formative assessments after a significant piece of work has been covered. They can be informed in advance that the assessment will happen at the end of the lecture, thereby prompting them to pay more attention than they would usually. By making it a formative assessment there is less pressure on them to worry about passing, and more attention can be paid to identifying areas of their misunderstanding. The timing of the assessment is important, since doing one at the beginning of the lecture would be more appropriate to determine prior learning, while one at the end would be better for evaluating the work just covered. Having students assess each other’s work using a rubric prepared in advance will not only relieve the lecturer from marking the work but will introduce students to evaluating the work of others. Completing the assessment before the end of the lecture period also allows time for students to ask questions to clarify their misunderstanding.

Questions of copyright

This is a common challenge that lecturers often face. What content you can use and what you can use it for is determined by copyright. How much text can you photocopy and give to students? What pictures can you include in my slides? Are YouTube videos off limits? These are just a few questions that arise when considering the issue of intellectual property and which pieces of content you can include. Note that even if you’re properly referencing the content, it doesn’t matter. This is a problem of how much content you can distribute without paying for it.

It’s always a good idea to try and find content that is licensed with Creative Commons licenses. This is a way of knowing exactly what the content creator will allow you to do. When someone creates a piece of content, even if there is no copyright notice, by default they own all rights to use that content exclusively. This has implications for when lecturers use content they did not create, and share it with students without paying the author. Most university libraries have intellectual property policies and agreements, and specify exactly how much content lecturers can share with students.

Getting feedback

It is always useful to get feedback after a lecture as this will allow you to make changes to future lectures based on the students’ experiences. The feedback should not only aim to identify areas that could be improved but should also provide constructive advice on how the lecturer can actually improve. Sources of feedback can include:

  • Students, whose opinions are possibly the most valuable
  • Colleagues, as part of a more formal peer review
  • Personal reflection, as part of developing a teaching portfolio

If mini-assessments are conducted at the end of the lecture they also be kept as part of an informal evaluation of teaching practice, since student performance is a useful indicator of teaching efficacy. In addition, students’ notes can also be reviewed (with their permission) in order for the lecturer to see if the session was clear to them (Cantillon, 2003).

A simple form can be used for either peer or student review of a lecture:

The lecturer was:

Strongly agree

Slightly agree

Slightly disagree

Strongly disagree




Clear and concise


Lecturers will often need to deal with several challenges that may arise during the lecture, including:

  • Students arriving late
  • Questions that aim to distract
  • Cell phones ringing
  • Students falling asleep
  • Students talking to each other
  • Technical failures

While these challenges are outside of the direct control of the lecturer, being well-prepared and engaging the students’ attention will help prevent many of these problems arising. In addition, ensuring that students know the rules of the classroom may also address some of these issues.


Lectures can be an incredible effective, powerful form of communicating important and difficult concepts and ideas to students. Lectures can be used to present core material and to provide an overview of the course. It should be structured, have clearly defined objectives and a lesson plan. Lecturers should pay attention to their own presentation skills and to the preparation of their handouts and other materials. Lectures can be made more effective by capturing and maintaining the attention of students, requiring them to be active participants in the session, leading them in questioning and discussion. In addition, formative assessment with immediate feedback can also be used to enhance traditional lectures.


Legal stuff

To the best of my knowledge, all sources used in the creation of this work are freely available and not encumbered by licensing issues. The image in the article header was taken from the Wikipedia page on Meerkats.

mobile technology

Clinical Teacher development progress

It’s been a long time since I’ve written about my Clinical Teacher mobile app, so I thought I’d write a short post to highlight the progress that has been made over the past few months. Thanks a ton to the amazing team at Snapplify, who are making this project possible.

First up, after a long time of being iOS-only, the app is now available on any Android device through Google’s Play store, as well as through the browser. This effectively means that you can now access the Clinical Teacher content on any internet-enabled device. Once the content has been downloaded to the mobile app, it will be available offline.

The Clinical Teacher available through Google's Play Store.
The Clinical Teacher available through Google’s Play Store.

The app has also recently been updated to include bug fixes and minor UI improvements. However, we are due for another update in the next few weeks that will mean that content bought on any platform will be available on any other platform. So, if you’ve bought content in the iOS app, then it’ll be available online in the browser, or on Android. Right now, if you purchase content in the browser you won’t be able to sync it to the app until after the upcoming update.

An index of the content available through the browser-based version of the app.
An index of the content available through the browser-based version of the app.

There’s also some new content, including Effective lectures, Case-based learning and How to write Systematic Reviews. I’m going to begin working on a few more articles, which I hope to have finished in the next few months.

So, as you can see, development on the app is moving along nicely, the content is being developed and published and . If you’d like to write something for the Clinical Teacher, let me know about your idea so that we can get you started.

assessment mobile technology

Adding complexity for its own sake

saraceno15I was discussing a PhD project with a colleague at the HELTASA conference a few weeks ago and she was describing her plan to me. She’s interested in the possibilities that mobile technology brings to higher learning, specifically in nursing education. I gathered that she was talking about mobile as a combination of hardware and software as a means of accessing content, although we didn’t really get into how she was defining mobile for her study.

What I found most interesting was that she was starting from the point that she would be using mobile, and then looking for a problem that she could use it to solve. This seems to be the wrong way around.

We often find people wanting to add complexity (e.g. using mobile devices in the clinical context) without really thinking about whether that added complexity brings with it any benefits. And then asking if the cost of the added complexity brings about a greater benefit. Before adding anything to the curriculum we need to ask ourselves, “What are we going to get in return?”

My colleague wanted to use mobile devices to figure out students’ prior knowledge i.e. she began from the premise that she would be using mobile devices. When I asked her why she didn’t just use pen and paper, she was confused. She said that she couldn’t use pen and paper because she would be using mobile devices. And therein lies the problem. She didn’t say that she wanted students to collaboratively come up with a dataset of “prior knowledge”, or that she wanted all students to see each others’ work, or any other reason that digital or mobile would have an advantage. Her sole reason for wanting to use mobile is that she wanted to use mobile.

By adding complexity to the curriculum without conducting a cost/benefit analysis, you will most likely include a set of unintended consequences, like increasing the actual financial cost of the course, increasing the workload of teachers, or confusing students. Without having a definite objective in mind, which would be enhanced or otherwise facilitated through the addition of the new feature, it’s difficult to argue convincingly for its inclusion.

mobile social media

Social media and professional identity: Part 1 (Introduction)

As I mentioned a few days ago, I’m getting another article ready for the Clinical Teacher mobile app; Social media and Professional Identity. I’ve been working on it sporadically over the past few months and have finally sent it to the designer for laying it out and getting it ready for the app. I’ve been making the content of The Clinical Teacher articles available for free on my blog. This one is quite long so I’m going to break it up into shorter sections and post it here as a series on the use of social media to create and develop an online professional identity. I’ve included the “Abstract” below, which really just serves as the article description in the Clinical Teacher app, and actually isn’t a part of the article.

Here is the lineup for the series on social media and professional identity:

  • Part 1 (the rest of this post): Introduction to the internet and social media
  • Part 2: Social media, online identity and engagement (blogs and microblogs)
  • Part 3: Academic social networks (Mendeley)
  • Part 4: Academic social networks (ResearchGate)
  • Part 5: Academic social networks (
  • Part 6: Getting started with social media
  • Part 7: Privacy and sharing: social media policies in healthcare


In an increasingly connected and digital world, it often seems that too much happening, too quickly. Every week another online service, app or device is competing for your time and it can be overwhelming to decide where to focus your attention. At the same time, there’s social pressure to participate in this connected world. Whether it’s an email telling you that an old highschool friend has Liked a post you made on Facebook, or asking you to respond to an @reply on Twitter, or a nagging feeling of guilt that you still haven’t shared that photo album on Flickr. In addition, there is the constant “fomo” (fear of missing out) when people you know start talking about the next big thing.

Even in our professional lives as clinicians or academics, there is an increasing sense that “being” online is important, even if we don’t know exactly “how” to be, or “where” to be. There is a move towards the sharing of clinical experiences and resources that can add value to your professional life, if the available services and tools are used effectively. You may feel that you have something important to say, even if it is “just” the sharing of your experience. The clinical context is so dynamic, complex and challenging that we owe it to ourselves, our colleagues and our professions to share what we know.

This guide is an introduction to the online services and tools that I’ve found useful in the development of my own professional online identity. It is not an “academic” text as much as it is a personal perspective on establishing and developing a professional presence in online spaces.

An introduction to “the tubes

Before we begin talking about using the internet and social media, I thought it might be useful to establish some context and background. An absolute date is hard to pin down but the general consensus is that the thing we call the internet dates back to research conducted in the 1960s, and was developed as a decentralised communications network that could withstand a nuclear attack on major American cities. What most people refer to as “the internet” is actually the World Wide Web (WWW), a system of hyperlinked documents (webpages) that “sits on top of” the internet, and was created in 1990. In addition to the web (http), the internet supports a range of other protocols, including email (smtp), file transfer (ftp), and voice over internet protocol (VoIP).

In the early days, the web consisted of pages of content that were connected to each other using hyperlinks, and were generally controlled by companies and media organisations who could afford to host content and hire web developers. Webpages had to be hand-coded in HTML, which made it difficult for ordinary people to create online content. This is what people refer to as the first “version” of the web. Content was static and did not change much over time, and websites looked the same every time you visited them. A series of incremental changes in the languages used to create websites (for example, moving from HTML to XML, Javascript, and PHP) led to the development of dynamic websites, which allowed developers to change how people interacted with the web and with each other. This led to what people began calling Web 2.0. Care should be taken with when talking about Web 2.0 because it implies that there was an upgrade to the system that moved it to a second iteration. Rather, the web evolved (and continues to evolve), adding features as it did so.

Whatever you decide to call it, these changes allowed ordinary people to create web-based content that was dynamic and interactive, without needing an in-depth understanding of how the web works. It became possible for the average person to create online content that they could publish themselves and that their readers could interact with. For the first time in history, ordinary people could publish whatever they wanted directly into a global communication system and compete with massive media companies for the attention of readers. This change in the underlying web platform is what ushered in the rise of user-generated content, which is where we find ourselves today.

What do we mean when we say “social media”?

Social media is an umbrella term for a range of online services that facilitate the creation, curation and sharing of user-generated content. It is increasingly being tied in to mobile devices (i.e. smartphones and tablets) that make it easy to share most aspects of our personal lives, especially when it comes to photos and short text-based messages. Some examples of the types of technologies that come under this term are: blogs (e.g. apophenia), microblogs (e.g. Twitter), wikis (e.g. Wikipedia, Physiopedia), podcasts (e.g. IT conversations: Health & Medicine), discussion forums, virtual social worlds (e.g. Second Life), gaming worlds (e.g. World of Warcraft) and social networks (e.g. Google+ and Facebook). As you can see, the term “social media” covers a lot of ground, which is why it’s sometimes difficult to figure out what exactly someone means when they talk mention it.

Social media services can be said to be based on the following broad pillars: identity, conversation, sharing, presence, relationships, reputation, and groups. Not all of these services need to include all of these aspects, although they are useful concepts to explore the notion of engagement and interaction, which is what makes social media “social”.

In the following section (Part 2: Social media, online identity and engagement) I will briefly discuss two of the more common forms of social media, and explain how you could use them as part of establishing an online professional identity and presence.