gms | German Medical Science

Mobile devices that allow accessing the internet – smartphones – are widely-used and their market share increases constantly [http://www.w3schools.com/browsers/browsers_mobile.asp]. An increase of traffic by 15 and a triplication of the devices within the next five years is forcasted for Germany [1]. Apple’s presentation of the revolutionary iPhone in 2007 contributed largely to this as it combined a simple handling with a huge variety of function for the first time and has been awarded therefore many times [http://www.jdpower.com/consumer-ratings/electronics/ratings/909201396/2012-Wireless+Consumer+Smartphone+Customer+Satisfaction+Study/index.htm]. Apple shares the market leadership in the smartphone market with Samsung and Nokia [2], [3].

The increasing market share of smartphones and the ability to access websites mobile easily change the requirements of the users. Up until today websites have been displayed on laptops and desktops only and optimisation focused on those two formats. Recent upgrowth of smartphones demand a change with respect to the optimisation of content for much smaller display sizes – this is often referred to as „responsive webdesign“ [https://en.wikipedia.org/wiki/Responsive_Web_Design]. The changes begin with reshuffling of single elements to improve the legibility (e.g. alternative navigation), can be enhanced by images with smaller file size to reduce traffic and ultimately can be as neat as a complete simulation of a native application (applications that have been developed using the manufacturer’s developing kit (SDK)) which integrates into the operating system intuitively (see figure 1 [Fig. 1]).

Especially young people seem to be fascinated by smartphones [4]. Davies and his colleagues investigated the learning and study habits of students and questioned how smartphones are used [5]. They found out that smartphones are mostly used to answer a question right on the spot („timely access to key facts – learning in context“) and that students would use smartphones to repeat learned topics.

Due to the author’s interest in smartphones as a learning platform and his fascination for the development of own applications a prototype was designed to find out if a smartphone can be more than a reference book. The leading question was whether and how the application can be realised and if there are any limitations? An questionnaire was designed to get an insight into the student’s thoughts about mobile learning.

Hangman [https://de.wikipedia.org/wiki/Galgenm%C3%A4nnchen] is a classical game for two or more players in which one player thinks of a word and the other tries to guess it by suggesting letters. The game is over if the player needs more guesses than allowed. The idea of this game has been adapted within the project „Mediman“ so that medical terms must be guessed. At the end of each game the term is defined and explained to produce a benfit for the student (see figure 2 [Fig. 2]).

Before starting the actual development of the application a decision regarding the programming language had to be reached. The author decided to program a native HTML website in combination with the JavaScript framework jQuery mobile [http://jquerymobile.com/] as it can be used to build native looking applications on one hand but also supports many mobile devices out of the box [http://jquerymobile.com/]. This ensures a quick development and reduces errors on the different devices. jQuery mobile is widely spread, possible alternatives with similar features are jQTouch and Sencha Touch.

Mediman uses a MySQL database to store the data and AJAX („Asynchronus JavaScript and XML“) to increase usability, e.g. no page reload is necessary to start a new game round as data is loaded in the background.

During the development simulation programs where used that emulate the smartphones on the development PC. The benefit is that the developer does not actually has to own all the devices to run tests with them.

To start the application the user needs to type in the internet adress (URL) – no installation is required. If the website is additionally added to the home screen a defined icon appears and the difference between a native application and a web site simulating it vanishes even more (see figure 1 [Fig. 1] and figure 2 [Fig. 2]).

Subsequent to the development process a questionnaire with nine items was desigend. If not declared otherwise a Likert scalling was used. Test users (n=20) were asked to submit the online forms between June and Juliy 2012 after they received an invitation via e-mail. All test users are students (third year or above) attending Faculty of Medicine of the University of Munich and took part voluntarily. The data analysis was performed with Microsoft Excel.

Eleven test users (55%) completed the survey completely. They aged 25 years in average and most of them were male (63,6%). The majority of the users used products of the Apple iPhone family, followed by devices by Samsung. One user used a Nokia N8, an other a Apple iPod touch 2G (category „other“). Nobody used a smartphone that runs Windows Phone (see figure 3 [Fig. 3]).

When it comes to usage frequency of the devices for learning the majority of the users stated that they use it more than once a week or at least at times (<5/month). Only three of the test users use it rarely (<1/month) or never (see figure 4 [Fig. 4]).

Figure 5 [Fig. 5] indicates that only few test users think that many learning applications for smartphones exist. In contrast most of the users stated that smartphones are an ideal plattform – they are modern, widely spread and easy to use (see figure 6 [Fig. 6] and table 1 [Tab. 1]).

The evaluation of the developed application is dominated by the impression that the idea is interesting and well realised. Usabilty feels comfortable, a learning progress is not distinctive (see table 1 [Tab. 1]).

Regarding the requirements a learning application should have the test users were allowed to submit free text. Buzzwords were „fast, easy“, „easy usability“ („One should not need to write or type in too much – that won’t work for smartphones very well“) and „Aim must be to reach goal with a few clicks“.

Smartphones are widely spread devices with plenty of possible applications due to their connection to the internet. The Faculty of Medicine of the University of Stanford for example picked up this trend and equip every new medical student with an Apple iPad since 2010 [6]. Parallel to the introduction the faculty established a portal with learning material (presentations, videos, manuals and more) which can be accessed by the students for free using a app [7]. This allows the students to access the needed material when they want and how often they want.

So far, available e-learning programs, e.g. CASUS, work within a desktop environment – and they do their job mostly fine. Those programs are therefore designed and optimised for desktop computers (with internet browsers), big screens and a computer mouse for interaction. The e-learning programs can be used with modern smartphones aswell but they are always suboptimal with respect to usability and legibility. The growing role smartphones play in our daily life due to their increasing market share demands an adaptation to the changed needs of the users. The analysis of the questionnaire showes that the test users think that smartphones are an ideal learning environment because most of them carry one with them all the time. This is comprehensible as for the first time ever more smartphones than desktop computers have been sold last year [http://www.canalys.com/newsroom/smart-phones-overtake-client-pcs-2011]. The survey showed aswell that not enough learning applications specially designed for smartphones exist (see figure 2 [Fig. 2]), the desire for them though is high (see table 2 [Tab. 2]).

In our opinion the results however do not allow the conclusion that existing learning applications should simply be optimised for the smaller display sizes. The demands of the users seem to be more differentiated as they seem to look for short sessions explicitly. A test user submited the free text item covering the needs of the users with the comment that he or she would like to start sessions while travelling betwen two university locations or even when sitting in the train. Short texts and optimised cases for the repetition of knowledge seem the be more important than continuous text.

Applications – generally speaking – can be produced as native applications for a chosen manufacturer or operating system (e.g. Apple iOS, Android) and can then advertised and sold through the manufacturer’s online store. The manufacturers support the developers by providing developmental environments and content (SDK). Apple, for example, will check each version before deploying it to the online store and can even refuse to publish it.

Mediman uses a different way. Instead of developing the application for the various operating systems individually the author used programming languages that are normally used to program websites (HTML, CSS, Javascript) in combination with a JavaScript framework called jQuery mobile. This framework simulates a native application optically and because the necessary skills already existed no further longsome familiarisation with SDKs was necessary. This ensured a short development time, the list of supported devices of the framework is long and checks by the manufacturers prior to the aproval of an application to their online store does not exist. As a sort of hybrid technique Phonegap (http://phonegap.com) must be mentioned (web sites will be transformed and compiled into native apps) but was not chosen for the development of Mediman as it would have required training. Offering applications through the online stores means automatic avertising but web applications allow faster publication due to no certivication process.

The results of the survey show that learning applications designed as a web site with an ideal integration into the smartphone – simulating a native application – seems to work for the test users. The users liked the adaptation of the game Hangman into a medical learning program. The used JavaScript framework ensured fast developing and publishing. We did not find any relevant limitations using web site programming languages as no device specific function, e.g. motion sensor, was used. Those functions can normally only be used if the SDK is used. Uncertainty exists insofar as the analysis of the submited data of the test users did not show a clear trend if an active internet connection may be a requirement for running the learning application (see table 2 [Tab. 2]). The anxiety that this is explicitly a problem of the used programming languages used in the example project Mediman can be qualified as version 5 of HTML supports storing data locally [http://diveintohtml5.info/storage.html]. Apart from the technical aspect the author thinks that mobile plans with unlimited traffic are common.

The importance of smartphones increases in learning environments. Today, only few learning applications designed to work seamlessly on smartphones exist – this is reflected in the usage frequency. It does not seem to be the one and only solution to adapt existing e-learning programs to fit into the small screen sizes because the needs of users is different. The survey showed that dealing with learning applications for smartphones will be an important topic in the future.

Mediman, the example project that was used mainly to demonstrate the potential and feasibility of the realisation of a small and simple learning application for smartphones was rated well within the questionnaire. As this was one of the main aims the project succeeded in our opinion and further devlopments should be considered. Due to the small number of participants we should not draw a general conclusion out of the given data but as a high relevance can be derived further research on this topic must be seeked.

The author declares that he has no competing interests.