iBece.org

This article will be the first in a series on PDAs, and their use to medical students and junior doctors. I will cover some basics, try to dispel some myths and share some of what I’ve learnt in my search for a PDA. Future articles will focus on specific uses and software that I believe may be of use to medical students.

To those in the dark, PDA is an acronym for a “Personal Digital Assistant” and ever since the introduction of the PalmPilot in 1996, these handheld computers have been pushing their way into the lives of doctors around the world. Because of the contiuing and exponential increase in medical knowledge, our profession is perfectly suited to what PDAs have to offer - vast information in your pocket, wherever you may be. For a medical student, nothing beats reading up on your last patient’s disease while en route to a ward round with that scary consultant. Not only does it win you brownie points, but it’s a great way to learn your craft. Did someone mention an drug name that you probably should know? No worries - inconspicuously flip open your PDA and in seconds you’re up to speed.

What can a PDA give me?

PDAs started life as little more than fancy organisers. At a time when anything IT was “in”, they allowed executives to store contact details, appointments, to-do lists and memos. When you buy a shiny new PDA, this is still essentially what you get. If this were the limit of these machines however, they wouldn’t offer much to most of us than a free drug-company notepad and pen couldn’t. Thankfully, the power of PDAs comes from their expandability. Just like a brand new computer isn’t much fun until you load your favourite software, PDAs only begin to shine when you begin adding new programs. Because of their immense popularity with the medical community, there are almost more medical programs for PDAs available than for any other single profession. What this means to you is that the possibilities are virtually endless.

Organiser features aside, at its core, a PDA commonly satisfies two purposes: a mobile reference library and a clinical assistant:

• Library. Many medical students love their Oxford Handbook of Clinical Medicine. For those that don’t know, it’s a pocket-sized bedside companion that covers much of what a student and intern needs while on the wards. It doesn’t cover all medical specialties or surgery, and its drug information is fairly cursory - but all round it’s a great reference. A PDA can potentially offer everything the OHCM does, plus fill every conceivable gap in its scope, at a fraction of the weight and size. For fans of the Handbook, you can even install a verbatim copy of the book on your device, as well as a miriad of other popular medical references - Harrison’s, Griffith’s 5 Minute Consult, Dorland’s, you name it. For Aussies, MIMS offers a PDA version of their handbook, so you’re only a few clicks away from any drug available in Australia. Once you develop an library of a few choice texts on your PDA, you may even find you seldom open a real book anymore. Can your Oxford do that?

• Clinical Assistant. Admittedly this is a smaller, and arguably less-useful, category of medical software. As well as textbooks, your PDA can have any number of “calculators” to help you with everyday situations. Calculating infusion rates, biometric parameters, drug dosages, or any other clinical scenario can be done easily with the available programs, many free! Can’t remember the Cockcroft-Gault equation? With the help of a medical calculator, you can have that GFR sorted in seconds.

One criticism some sceptics present is that with all of this knowledge sitting in your pocket, there is less drive to actually learn anything. While the pocket-brain certainly makes a less-knowledgable student/doctor manage the wards, it also provides instant learning in the context of a clinical problem. Studies (that I can’t quote, but know exist) have shown that adults learn best in a problem-based setting. When a clinical need arises, and it is filled almost instatly by library in your pocket, your chances of retention are much greater.

What PDA should I get?

Once you decide that a PDA would be beneficial to your studies and future career, you are presented with a dilemma - what to buy? Many people have false preconceptions about the high cost of one of these units, and a number of people I’d spoken to believed they were upwards of $AUD1000. While this was certainly true in their infancy, PDAs are now going for significantly less than your average mobile phone. The cheapest Palms can be had for less than $180, and $500-600 will get you a very competent unit. Top-of-the-line PDAs will still approach $1K but often these have features that are not necessary for our purposes.

Once you have decided on a budget, there are two important decisions that need to be made:

• Palm or Windows Mobile? There are two flavours of PDA on the market, one based on the PalmOS operating system, while the other runs Windows Mobile. An analogy is Windows XP and MacOS X on desktop computers. Unlike desktops however, where Windows has a virtual monopoly, the PDA market is more evenly balanced. Palms were the first PDAs and try as it might, Microsoft couldn’t crack the market succesfully. This all began to change after 2003 when Windows PDAs began to compare to the ease of use and stability of Palm. Just to make a point clear, the Windows that runs on PDAs is not the same Windows that runs on your desktop - the similarities are rather superficial.There is a feeling these days that Palm is on its way out. Although it still holds more than 50% of the market, new PDA sales are tipped in Microsoft’s favour. One reason for this is that buyers are familiar with the Windows trademark, and chose to stick to what they know. Another is the competition. While only a limitted number of companies produce Palm PDAs, most large computer manufacturers have their flavour of Windows PDA. This choice keeps prices low and floods the market with Windows devices. The final, oft-cited advantage of Windows PDAs are their “power”. Many Windows Mobile devices have processors that outperform (in theory) their Palm counterparts. This argument is less true than the preceding two, because Windows Mobile is also a much more complex operating system than PalmOS, and requires more grunt to run at comparable speeds. For medical purposes, there is little real difference between the two operating systems. Some will say Palm is easier to use, although in reality neither is overly complicated. Traditionally more medical programs have been offered for PalmOS because of the profession’s early adoption of the technology. Palm certainly has been the doctors’ choice in the past, although with Windows Mobile’s increasing popularity, even this is beginning to balance out. As such, your decision should be based on price and hardware features, rather than operating system. I will look at a few current options and discuss their relative pros and cons in a future article.

• Standalone or phone-PDA? The other big decision to make is whether to buy a dedicated PDA, or a device that combines a PDA and a mobile phone in one. It is undeniable that “convergence” is the buzz-word of the 21st century. It seems that we’re headed towards a future where your every need is satisfied by a single device - be that organiser, music player, camera, textbook, or anything your mind imagines. Just like mobile phones have begun incorporating cameras and MP3 players, so have they started encroaching on PDA’s turf.While some “smartphones” are still more phone than PDA, other devices such as the O2 Mini are clearly a fully fledged PDA with a built-in phone.The obvious advantage is the saving in pocket-space - carrying one device instead of two. It may also mean that all of your contacts are in one place, and with the increasing connectivity of mobile phones, you can talk to coleagues, surf the web and look up medical references all from the one device. Disadvantages are initial cost (although a hibrid will often cost less than two separate devices) and, paradoxically size. While it may be small enough to carry around the wards, a PDA-phone, being bigger than your standard phone, may be just a little too big for a night on the town. Some newer models, such as the abovementioned O2 Mini, and the new O2 Atom address this issue by shrinking the PDA to almost phone-sized proportions. While this solves the pocketability problem, the reduction in screen size makes using your PDA phone for study a strain on the eyes.

It is worth mentioning here to consider the cost of medical software when surveying PDAs. While it may be tempting to stretch your budget to include every feature the salesman tries to convince you you need, don’t underestimate the costs involved in the programs. As I mentioned earlier, the PDA itself is just the beginning - and on its own is pretty unexciting. Electronic books are cheaper than the printed variety, but paying $US50 or more is not unusual. In my opinion, the single most-important feature of any PDA is the screen quality, anything else is optional.

In the next article in this series, I will explore in more detail the process of selecting a PDA and what specifically to look for. I will also give a brief review of what I believe are top contenders for medical students on a budget.

Summary

A PDA can be a valuable addition to a medical student’s and junior doctor’s armoury of tricks on the road to becoming a competent practitioner. As well as helping you manage the mountain of medical knowledge, it can be an invaluable study tool.

The decision on which PDA to purchase should be based primarily on budget, and secondarily on screen quality. Operating system and fancy features will not make a big difference to a medical user’s experience. The cost of reference texts should be considered when making a decision.

Continue reading: PDAs in Medicine: Choosing the One