Introduction

Currently, information and communication technologies (ICT) are used in all spheres of human activities, including education. The use of ICT radically affected traditional learning approaches such as teacher-centered learning, mass instruction, once pace to all, using only textbooks and learning only in classrooms. Students’ learning began to be supported electronically in the form of e-learning. The learning approaches have become learner centered, flexible in sense of accessing it from anywhere and any-time, collaborative, or interactive [1]. However, with the emergence of mobile devices, such as netbooks, tablets or smart phones, the so-called mobile learning (m-learning) has become a new approach to traditional learning [2].

There are many definitions of m-learning. One of them is provided by Crompton [3] who defines m-learning as educating across various contexts via social and content interactions by using personal electronic devices. Park, Nam, and Cha [4] expand that m-learning is a new and independent part of e-learning where the education contents are handled solely by mobile technology devices. The important aspect of m-learning is that educational resources, tools and materials can be accessed at anytime and anywhere by using a mobile device [5]. Traxler [6] lists the main characteristics that define m-learning and differ it from e-learning. These include: spontaneity; privacy; portability; situation; informality; bite size; light weight; context awareness; connectivity; personalized device; and interactivity. It is especially the portability and light weight which enable learners to carry them easily and thus access the learning content on the go via simple navigation, when they travel by bus or train or waiting for their courses, i.e. independent of their location. In addition, its content is also shorter, more personalized and interactive than traditional e-learning materials, whose content is more linear and consists of longer compact units [7]. Therefore, it seems that e-learning is mainly suitable for dissemination of knowledge, its in-depth analysis and retention, as well as for the training of busy professional staff, while m-learning appears to be suitable for fast acquisition of knowledge and skills, its assessment and immediate feedback [8].

As research shows [9, 10], both e-learning and m-learning have a positive effect on the educational process, particularly when compared with no intervention. In fact, they seem to have effectiveness similar to traditional learning methods [9]. However, Sung, Chang, and Lie [11] claim that the overall effect of using mobile devices in education is better than when using desktop computers or not using mobile devices as an intervention, with a moderate effect size of 0.523. Ciampa [12] emphasizes its motivational role in the whole process of learning because ownership of the device increases commitment to using and learning from it. Lee, Han, and Lee [13] expand that m-learning positively affects learning attitude, improving education interest and concentration.

Mobile devices have also become ubiquitous in medical education, where they are used, for example, for the assessment, examination, collection of supervisory reports and student feedback, or downloadable course-specific materials [14]. As Masika et al. [15] point out, mobile learning is popular among medical students and should be used in promoting access and quality of medical education. In addition, 80% of doctors in the USA currently use a smartphone or a medical app in their practice [16].

Therefore, the aim of this study, on the basis of the literature review of randomized controlled trials, is to examine the use of m-learning in medical education and discuss its effect on student learning process in order to help future medical professionals deliver better care for patients and populations.

Methods

The methodology of this review study is based on Moher, Liberati, Tetzlaff, Altman [17]. The methods used for this review study include a literature search in the world’s acknowledged databases Web of Science, Scopus, and MEDLINE. The search was based on the key words: mobile technologies AND medical education; mobile learning AND medical education. The search was done for the period of 2010 till December 2017. The selection period starts with the year of 2010 because this is the year when mobile learning started to penetrate into medical education. In addition, methods of comparison and evaluation of the findings from the selected studies were applied. The study was included if it matched the corresponding period, i.e., from 2010 up to December 2017; if it was aimed at the research topic, i.e., at the use of mobile learning in medical education, especially for those studying medicine, as well as for doctors and other healthcare personnel; if it was a randomized controlled trial (RCT); and if it was written in English. Therefore, survey studies, e.g. [15], or the articles dealing with general public, e.g. [18], were excluded. Thus, theoretical articles, review articles and book chapters were excluded. Nevertheless, the review articles and other descriptive research studies were then used in other parts of this manuscript (i.e., Introduction or Discussion) in order to describe and compare the findings.

Findings

Altogether ten RCT [19,20,21,22,23,24,25,26,27,28] were detected. Four studies analyzed the impact of text messaging via mobile phones on the delivery of learning materials [20, 25, 26] and on personal guidance [27], two studies evaluated the effectiveness of mobile learning apps in the acquisition of new knowledge [21, 24], one focused on mobile augmented reality [19], one on the impact of a mobile device (netbook) on learning [22], one on the use of multimedia software app for mobile platforms and its effect on teaching and learning process [23] and one study evaluated the use of mobile learning videos on student performance [28]. Overall, all identified studies evaluated the effectiveness of a mobile device or mobile app as an educational tool on learning outcomes. In addition to that, several studies also concentrated on some unique features of mobile device or application such as its attractiveness [19], content interactivity [21], multimedia attractiveness [23], and personalized approach [27]. All of them used standardized methods of assessment such as pre- and post- tests, descriptive statistics, paired t-test, and multiple linear regression. Apart from one RCT [25], the samples of subjects were relatively small. In addition, the intervention period, depending on the type of mobile device and learning purpose, also significantly differed. However, predominantly, the intervention period was short. The findings of the RCT are summarized in alphabetical order of their first author in Table 1 below.

Table 1 An overview of the main findings from the detected RCT (author’s own processing)
Full size table

Discussion

As the results of this review show, all studies apart from two [25, 26] confirmed that the use of mobile device or mobile app as an educational tool had a positive effect on the acquisition of knowledge and skills among medical students. The reason is that these medical students, usually at the age of 18–26, use mobile devices, especially smartphones on a daily basis and therefore, they are willing to exploit them in their studies [21]. Mobile devices are nowadays available and easily accessible. Albrecht et al. [19] and Bruce-Low et al. [22] also point out that these are especially attractiveness and interactivity that prompt student engagement in using these mobile devices.

Furthermore, the findings reveal that the acquisition and retention of new knowledge are particularly efficient when using a mobile device [19, 21,22,23, 27, 28]. This is also supported by de Sena et al. [23] who claim that the personal computing landscape is currently characterized by increasingly widespread access to content on mobile devices. The availability and portability of knowledge can enhance learning, which seems particularly valuable as it can optimize the teacher’s role in solving the specific difficulties of each student. The findings also show that mobile devices and apps were found efficient in learning new medical procedure [23] and acquiring new skills [24], as well as improving practice behavior of general practitioners in the management of a disease [27]. This is also confirmed by other studies. Masters and Al-Rawahi [29] report that their medical students use the mobile apps for learning clinical guidelines and for obtaining medical reference tools. Masika et al. [15] in their study state that the most accessed mobile app types were disease management apps (88% of respondents), procedure guides (88%), and medical dictionaries (87%). Walsh [30] indicates that a lot of medical education on mobile devices is aimed at assessments.

The results of this review (cf. [21, 22, 28]) also suggest that learning via mobile devices should be used as a supplement to traditional, face-to-face learning. In this way, it can far more contribute to the enhancement, retention, and facilitation of the acquired knowledge and skills, as well as it can promote and develop the constructivist type of learning. This finding was also confirmed in a study by Bert et al. [31]. Moreover, Lumsden et al. [14] indicate that medical teachers should reflect on the use of mobile devices in their teaching and attempt to find the most suitable way of their exploitation in the educational process to meet students’ needs. In fact, there is no need of no-intervention-controlled studies or comparisons with traditional teaching modalities, but there is a need of research studies exploring the strengths and weaknesses of the use of mobile devices in the enhancement of learning, as well as its effective use (cf. [32]).

However, in spite of the benefits of mobile learning such as its time-saving, easy of access and use, portability, or interactivity of its content, there are also certain constraints which hinder its exploitation. These include the cost of device, the small size of its screen, limited memory and battery, technical problems, or security issues (cf. [15, 21, 29]). Furthermore, the results also revealed that delivery of learning material via text messaging was not that effective (cf. [20, 25, 26]). The reason might be busy schedules of medical professionals [26] or the fact that explicit instructions for self-study were missing [25].

The limitations of this study consist in a limited choice of the selected studies, as well as in small sample sizes and slightly different methodologies used in them.

Conclusion

This study aimed to explore the use of mobile learning, especially in medical education, and discuss its effect on student learning process. The findings revealed that mobile learning was becoming a new trend in the medical educational process. In addition, it confirmed that it was efficient, especially in the acquisition of new knowledge and skills. Nevertheless, so far, the role of mobile learning has been perceived as an appropriate complement to traditional learning. Therefore, more research should be conducted on the efficacy of the use mobile learning in medical education, as well as to explore the unique features of mobile devices for the enhancement of learning outcomes.