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MOBILE (CELLULAR) TELEMENTORING IN BOTSWANA

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University of Pennsylvania Medical School, Philadelphia, PA, USA; 2Medical College of Wisconsin, Milwaukee, WI, USA; 3Botswana-UPenn Partnership, Gaborone, Botswana; 4University of Pennsylvania, Biomedical Library, Philadelphia, PA, USA; 5University of Botswana, Gaborone, Botswana; 6University of Pennsylvania Medical Center, Department of Dermatology, Philadelphia, PA, USA, carrie.kovarik@uphs.upenn.edu

Aileen Y. Chang, BA, Medical Student, Sankalpo Ghose, BS, Medical Student, Ryan Littman-Quinn, BA, Rachel B. Anolik, 1,3 4 5 3,4 3,6 BS, Medical Student, Andrea Kyer, BFA, Loeto Mazhani, MD, Anne K. Seymour, MS, Carrie L. Kovarik, MD
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OBJECTIVES
1. Demonstrate that point-of-care applications are effectively utilized by resident physicians to provide clinical care in resource-limited settings. 2. Demonstrate that mobile telementoring is an effective tool for training resident physicians in resource-limited settings.

METHODOLOGY
Participants • 7 resident physicians: 4 Internal Medicine, 3 Pediatrics Mobile Device • Google MyTouch 3G phone • Phone features: • Android OS • Data-enabled SIM cards (Orange Foundation) • Built-in 3.2 megapixel camera • E-mail, web browser access • Point-of-care applications, locally loaded: • Skyscape: Dynamed, Archimedes • uCentral: 5-Minute Clinical Consult, 5-Minute Clinical Consult Pediatrics, A-Z Drug Facts, Cochrane Abstracts, Red Book, Taber’s Medical Encyclopedia, and others (Unbound Medicine) • ePocrates Rx • Telemedicine application for submission of challenging cases to mentors (ClickDiagnostics) Logistics • Training session by study personnel on basics of using the phone and point-of-care tools • Participants strongly encouraged to maximize utilization phones, in and out of the medical setting • Participants had access to study personnel throughout the first eight weeks for troubleshooting assistance Data Collection • Surveys collecting qualitative data were administered at four and eight weeks following distribution of phones • Feedback solicited throughout the study

CONCLUSIONS
Mobile phones loaded with point-of-care applications are effectively utilized by resident physicians in resource-limited settings. Most commonly used applications include drug formularies and clinical decision-making resources (e.g. 5 Minute Clinical Consult, Dynamed). Residents are interested in having mobile access to evidence-based medical literature to guide clinical decision making. There is a range of user comfort with mobile technology. Training sessions are helpful and should be geared towards a variety of users comfort levels. Ability to use a mobile device for both data and phone services will likely increase utilization.

INTRODUCTION
Telemedicine is playing an increasingly greater role in the delivery of health information and services in resourcelimited settings. Telementoring, which is a subset of telemedicine, allows for remote mentoring of students and residents at a distance. The University of Botswana (UB) School of Medicine, which welcomed its first class of medical students and residents in 2009, is committed to providing high-level onsite educational resources for trainees. During their training, students/residents rotate in district clinics in resource-poor and remote locations, where internet-based educational resources may be inaccessible and specialty mentors may not be readily available. We felt that a point-of-care tool would be of great value in helping students/residents train and care for patients. We also believed that these tools would encourage them to continue practicing in remotely located clinics and continue to practice in Botswana. In this pilot study, we explored the role of mobile (cellular) telementoring in resident (physicians in specialty training) education in Botswana. We are interested in the utilization of a mobile device for point-of-care tools and remote mentoring.

FUTURE DIRECTIONS
Evaluate telemedicine application for discussing cases with mentors when residents rotate at remote outreach clinics. Explore the role of open educational resources (OER) in mobile telementoring. Scale-up project to include incoming UB residents, including the new Family Medicine residents based in Mahalapye, Botswana, and possibly UB medical students. Consider options for sustainability.

RESULTS
Between follow-up at 4 weeks and 8 weeks, residents increased their usage of the phone, which can be primarily attributed to increased opportunity for use and growing familiarity. Residents became familiar with the phone through various ways: initial training session, help from other residents, spending time alone with the phone. Some residents used the phone not only for access to point-ofcare applications in the medical setting, but also for supplementary medical reading while at home. Most frequently used point-of-care applications: 5-Minute Clinical Consult, 5-Minute Pediatric Clinical Consult, ePocrates Rx. Half of residents desired more access to journals and medical literature. At the 4 week follow-up session, several residents were concerned about protecting the phone while not in use. Subsequently, a protective pouch for storing the phone was given to each of the residents. All residents requested phone services for the mobile device, which currently only has data service.

ACKNOWLEDGEMENTS
This work has been made possible by support from the Orange Foundation in Botswana, Unbound Medicine, Inc., and the University of Botswana School of Medicine. Travel support provided by the University of Pennsylvania School of Medicine Global Health Program and the Botswana-UPenn Partnership.