Methods:An electronic survey was di

Methods:

An electronic survey was distributed by medical librarians at four Canadian universities to medical students, residents, and faculty members via departmental email discussion lists, personal contacts, and relevant websites. It investigated the types of information sought, facilitators to mobile device use in medical information seeking, barriers to access, support needs, familiarity with institutionally licensed resources, and most frequently used resources.

Results:

The survey of 1,210 respondents indicated widespread use of smartphones and tablets in clinical settings in 4 Canadian universities. Third- and fourth-year undergraduate students (i.e., those in their clinical clerkships) and medical residents, compared to other graduate students and faculty, used their mobile devices more often, used them for a broader range of activities, and purchased more resources for their devices.

Conclusions:

Technological and intellectual barriers do not seem to prevent medical trainees and faculty from regularly using mobile devices for their medical information searches; however, barriers to access and lack of awareness might keep them from using reliable, library-licensed resources.

Implications:

Libraries should focus on providing access to a smaller number of highly used mobile resources instead of a huge collection until library-licensed mobile resources have streamlined authentication processes.

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INTRODUCTION
Since the advent of personal digital assistants (PDAs), mobile devices (PDAs, smartphones, and tablet computers) have been widely adopted by medical professionals 1–3. These devices are quickly becoming one of the main tools for accessing clinical information, especially for younger health professionals and trainees 4–6. Many medical resources of varying quality are available for these devices. Some are free and others are supported by advertising or have been developed by relatively unknown publishers, raising concerns about the quality of information 7,8 and the influence of pharmaceutical companies on the content 9. Other applications (apps) are expensive and offer purchasers limited opportunities to try out the apps in advance, a significant issue for some apps whose content is poorly adapted from a reference text and difficult to use on a small screen 7.

Health and academic libraries have provided services and institutionally licensed a selection of PDA and mobile information resources for years 1,10,11. However, there are many challenges to providing information resources and services to library users that are unique to the mobile environment, including the availability of products that are usable on mobile platforms and can be institutionally licensed; authentication processes for accessing those products, which often depend on whether the content is accessed over wireless networks or downloaded to the device; and the variety of software platforms that need to be supported 10,12,13. The process of using institutionally licensed mobile resources is more complicated than simply downloading an app or viewing a website.

Although PDAs have been around for over a decade, the introduction of the iPhone, iPad, and other smartphones and tablets has changed the type of information that can be easily accessed on mobile devices. These changes have been accompanied by an increase in published research on the use of mobile devices in medicine, both in the medical literature and the library literature. A 2012 literature review examined published research on “innovative roles of the smartphone in the field of internal medicine…[including] patient care, medical reference, and continuing education…[and] uses of the smartphone in medical education, communication, and research” 14. The review found sixty research articles from 2007 to May 2012 that met the stated inclusion criteria. Despite this substantial number of studies, the authors concluded that more research is needed to understand how these devices are being used 14. Three recent studies in the medical literature are particularly notable because they examined mobile device use for point-of-care information among medical students and professionals, a topic of interest for medical librarians. One study explored app use among residents in the United States 7; another examined the use of mobile devices in medical education at the University of Alberta 15; and a third surveyed smartphone use by medical students and junior doctors in the United Kingdom 16. These studies indicated frequent use of mobile devices as reference and information management tools in clinical practice and medical training among faculty, students, and residents, with a trend toward higher use among newer professionals and trainees. However, these studies did not address some aspects of mobile device information use that are particularly important to librarians, specifically, the ways that users search for information and that libraries provide information resources. The results of these studies are also of limited value to health sciences libraries, as they focus on one specific user group or one institution and do not provide data on the full range of students and practitioners of medicine across all specialties served by a typical health sciences library.

In addition to the above-mentioned studies, the health sciences library literature contained three recent studies that surveyed physicians and medical trainees regarding their use of library services on mobile devices. Chatterley and Chojecki reported that students were using specific clinical apps and were facing technical barriers to their use but completed their study before iPhones were available 5. The studies by Bala and Gupta 17 and Bushhousen et al. 18 demonstrated that clinicians and students used their mobile devices for a wide variety of library services and other tasks, including clinical information use. All three studies were limited to specific geographic regions and did not take the use of tablets into account. To improve the provision of services and resources, it is essential that librarians learn more about medical information use on all types of mobile devices from a variety of user groups. The current study was designed to fill these gaps in knowledge through a multisite, cross-specialty examination of mobile device use in medicine, with a particular focus on questions that were important to librarians.

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RESEARCH QUESTIONS
The research questions addressed by this project were:

What is the extent to which medical trainees and faculty use their mobile devices when answering clinical questions and finding medical information?
What are the facilitators and barriers to using mobile devices to find information related to medical studies and clinical work?
How do health libraries support mobile users' clinical information needs?
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METHODS
This study was a web-based survey with participants from four Canadian universities: McGill University, University of Alberta, University of Calgary, and University of Ottawa. At the time of the study, access to popular library-licensed resources such as UpToDate, Lexicomp, PEPID, and DynaMed varied at each institution, though each institution had access to at least one of the above resources. Each university library also had a specialized web page that facilitated access to library-licensed mobile resources.

The survey was developed by three health sciences librarians. Survey development was guided by the previous work of Chatterley and Chojecki 5. The survey was pretested for face validity by two health sciences librarians at McGill University and the University of Alberta. The survey consisted of fourteen items (Appendix, online only).

Each university involved in the study received ethics approval from its respective institutional ethics board. An email invitation with a link to a web survey hosted at McGill was sent to prospective participants via departmental email discussion lists, personal contacts, and a link to the survey on relevant internal websites. The front page of the survey explained the project in more detail, explaining that the survey was being conducted “in order to know how you are using your mobile device,” and provided information regarding the ethics approval for each institution. The survey was open and data were collected from January 2012 to April 2012. Two reminder emails were sent.

The target population was medical trainees, graduate students, and faculty members (including both full-time faculty who may or may not have clinical responsibilities and clinical instructors) from the four medical training university centers. Specifically, undergraduate or graduate students (including medical residents) in a degree program offered through a medical faculty at one of the four institutions involved in the study or a faculty member or instructor associated with a medical faculty at one of the four institutions were included in the study.

Descriptive statistics were collated and summarized using SPSS 19 19.

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RESULTS
User groups and device ownership

There were 1,210 individuals who responded to the survey, which is an estimated response rate of 6%–8%. (Due to the diverse composition of the 4 medical faculties involved in the study, the exact number of potential respondents could not be accurately determined, but the authors estimated it to be 15,000–20,000 individuals.) Most participants reported owning a mobile device (1,120, 92.6%). Those who did not report owning a mobile device were not given the option to continue with the rest of the survey, so no demographic information is available for this group. Of the 1,092 participants who provided demographic information, 169 were preclinical undergraduate medical students (15.5%), 93 were clinical undergraduate students (8.5%), 316 were medical residents (28.9%), 92 were graduate students (8.4%), 382 were faculty members and clinical instructors (35.0%), and 36 select