Doctors should learn smarter ways to use smartphones in clinical practice, a Canadian study of physicians in teaching hospitals suggests.

Smartphones are believed to make doctors more accessible to patients, connected to other health professionals and available during medical emergencies.

Clinicians perceived trainees as being rude or disrespectful for texting during patient care. (Valentin Flauraud/Reuters)

For a study in Tuesday's issue of the Journal of Hospital Medicine, Dr. Robert Wu of Toronto’s University Health Network summarized the impact of smartphone use on the learning experience of medical trainees.

"This study is the first to describe the intersection of clinical communication with smartphones and medical education," Wu's team concluded.

Not surprisingly, the researchers said, with the improved ability and mobility to communicate, medical trainees perceived being more connected with team members. But the increased connectedness also led to more interruptions.

"Educators should be aware of these findings and develop curriculum to address the negative impact of smartphone use in the clinical training environment."

As part of the study, researchers conducted interviews with residents, medical students, attending physicians and other clinicians at five large teaching hospitals in Toronto from June 2009 to September 2010.

Residents were also job shadowed during the regular work day and evening on-call shifts. The volume and content of e-mails from consenting residents at two hospitals were analyzed.

Texting vs paging

Instead of the difficulties associated with paging and waiting for a response, nurses typically found it easier to call or text residents directly.

"Some of [the nurses] rely a little bit more on the BlackBerry so that they will tend to call you a bit more frequently for things that maybe sometimes they should try to find the answer for themselves," one resident told the interviewer.

"They're easier to find," a nurse said.

Residents also said they found smartphones useful in situations where they felt unsure of their competence doing a procedure.

On the other hand, supervisors perceived that the rapid access lowered the threshold for trainees to contact them instead of looking up information themselves.

When residents responded to smartphone interruptions or started texting during patient care or formal teaching sessions, clinicians perceived trainees as being rude or disrespectful.

The study shows how healthcare information technology can cause unintended consequences on medical education, the researchers said.

"In essence, the trainee becomes 'more global, less local,'" they wrote. "Being more global translates to increased connections with people separated in physical space. Yet, this increased global connectedness resulted in the trainee being less local, with attention diverted elsewhere, taking away from the quality," of interactions.

The authors suggested smarter communication systems that limit interruptions by separating out urgent messages. Doctors could also inform senders about protected educational time such as rounds.