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A discussion of the merits of tablet computers in medical education

Lawrence Almond, G Chawla, S Brydges, E Peile, Warwick Medical School


Information technology (IT) has been used as a valuable tool in medical education for more than a decade. IT provides teachers and students with a continuously accessible on-line library with a vast quantity of information that can be quickly and easily obtained. Recent research suggests an increasingly positive attitude towards the use of IT within medical courses, which has led to an increased demand for computer integration. (Ringrose 2005) This has placed a considerable responsibility on teaching faculties who must now carefully select the most appropriate hardware to employ.

This paper discusses the relative merits of Tablet personal computers (PCs) in relation to the hardware typically used by medical schools, and examines the results of a survey of staff and student attitudes towards Tablet PCs at Warwick Medical School following a short trial of their use. Whilst we acknowledge that our survey reflects attitudes to Tablet PC use in medical education, we also recognise their role in enhancing the pedagoglical principles employed in any group teaching session.

Choosing the appropriate hardware:

There are a number of types of hardware available to teaching faculties, each with their relative advantages. Most undergraduate courses in the United Kingdom rely heavily on desktop PCs for students’ teaching and learning, as these have the advantages of being relatively cheap to provide, usable by all students and staff without any additional training and can be controlled centrally. These facets, whilst understandably attractive to teaching faculties, do not necessarily make desktop PCs the best teaching and learning medium for staff and students. Desktop PCs can act as a barrier to communication, which can limit their use in small group sessions, and the fact that they are not readily portable means that they can never adequately replace a file of notes and cannot be carried between study areas. Students may also have difficulty locating a free desktop PC at busy times and, as a result of their communal use, students may be prevented from personalising their computer with favourite online study sites, their own files or other useful study materials.

Laptop computers can overcome some of these difficulties and being portable and personal can be used readily in small group sessions without presenting the same physical barrier to group learning. Laptop computers cannot however overcome such problems as student preference for taking handwritten notes in lectures and small groups, and offer no assistance to those students who are less computer literate. In short, laptops cannot fully bridge the gap between computer based learning and traditional learning methods. It is in this context that Tablet PCs are growing in recognition as an ideal medium for bridging this gap. (Eurell 2005)

Tablet PCs:

Tablet PCs are portable computers, which are equipped with a sensitive screen designed to interact with a specialised pen. The pen can be used as one would normally use a mouse and may also be used to take hand-written notes for those students who feel less comfortable word processing. The screen of the tablet can be folded on top of the keyboard making it more convenient for note taking and preventing the screen barrier between individuals in small group sessions. Unlike a touch screen, the tablet PC screen receives information only from the pen and therefore can be leaned upon when note taking, and subsequently students can print and file their notes if required. The digital handwritten notes may also be recognised and converted into text should the student require more legible notes for revision or note sharing. Like laptops, Tablet PCs can be carried between study areas and have wireless facilities to allow students to go on-line during problem based learning (PBL) sessions.

This study aims to assess the role of Tablet PCs in group learning facilitation and discusses the practicalities of their implementation.


A questionnaire-based survey was conducted at Warwick Medical School in May 2006 following a two month trial of the use of Tablet PCs by group learning facilitators (GLFs) in small group sessions. 176 students were questioned regarding their current attitudes to computer use within the medical curriculum, the hardware they are currently using and their opinion on the use of Tablet PCs by staff to facilitate group work. 82 (47%) students completed the questionnaire. GLFs were also asked for feedback following the trial - all 6 (100%) responded.


The survey showed that 32.9% of students currently owned a desktop PC, 74.4% a laptop and 9.8% a pocket PC or equivalent. These results were in line with other research on computer use in medical education, which has shown a continuing increase in the degree of integration of IT into medical students’ learning and studying techniques, as well as a clear preference for laptops over desktops. (Ringrose 2005) Of the Warwick medical students surveyed, 66.7% felt that owning a laptop would increase their use of computers (for work-related activity) outside of normal working hours, even though 85% stated that they already used a computer at least once a day for work related tasks.

The advantages of laptops in terms of portability and personalisation were evidenced by those surveyed, but importantly, 71.7% thought that Tablet PCs would be preferable to laptop PCs for use by students in small group sessions. The ability of Tablet PCs to allow traditional note taking whilst retaining the advantages of computer use is a key attraction for students, particularly as only 32.5% of students surveyed stated that they would prefer to take lecture notes using a keyboard, with 67.5% preferring to take handwritten notes.

Tablet PCs were also praised by the GLFs, all of whom (six) reported that they facilitated teaching above other hardware, particularly as projected images or pre-prepared slides could be annotated by the GLFs whilst teaching in order to highlight key points or quiz group members. (Figure 1) In addition, they could be used like a traditional blackboard during tutorials allowing the GLFs to write or draw graphs and diagrams during the session and project these to the students. (Figure 2) The GLFs also liked that they could make notes or annotate slides whilst facing the group, and retaining eye contact. Any slides created or annotated as a result of teaching or discussion during the group work could be saved and distributed electronically to the students.

Fig 1 & 2 

Figure 1. Projected image which has been annotated by the GLF in order to question students and facilitate group discussion. Original image from Drake RL, Vogl W, Mitchell AWM. Gray's Anatomy for Students, 1st Edition, 2005, with permission from Elsevier.

Figure 2. Projected image created by the GLF during the teaching session to aid explanation.

The GLFs found that Tablet PCs could be used as a key tool in the shift away from didactic teaching approaches towards more student-centred and problem-solving approaches. Tablet PCs enhanced small group collaborative learning without the intrusiveness of a screen acting as a barrier between teacher and students. They were also easily transportable between group sessions and quick to set up, and allowed GLFs to make use of both visual and audio facilities, for instance in teaching auscultation of heart murmurs and breath sounds or when viewing radiographs or three-dimensional anatomical images. 86% of students surveyed felt that they had benefited from the improved visual aids.

Table 1. Results of student questionnaire and GLF feedback.
 Questions to students  Response
 How often do you use a computer for work related tasks?

At least 1 day = 70 (85%)
Less than 1 day = 12 (15%)

 Do you currently own a computer? Please specifiy. Desktop = 27 (33%)
Laptop = 61 (74%)
Pocket PC = 8 (10%)
 Would having your own laptop increase your use of computers outside of normal working hours? Yes = 55 (67%)
No = 27 (33%) 
 Do the better visual aids available on computer e.g. 3d anatomical images help you to retain information for longer? Yes = 71 (86%)
No = 11 (14%) 
 Would you prefer to take lecture notes using a keyboard computer (if on-line lecture slides were provided)? Keyboard notes = 27 (33%)
Handwritten = 55 (67%) 

 Do you think Tablet PCs would be better than normal laptops for use by students in group work?

Yes = 59 (72%)
No = 23 (28%) 
 Would you be happy to purchase your own laptop/tablet for compulsory use on the course? If NO, please specify your reason(s). Yes = 36 (44%)
No = 46 (56%)
(Financial = 87%) 
 Group Learning Facilitator feedback Response 
 Did Tablet PCs significantly enhance group learning facilitation during the trial?  Yes = 6 (100%)
No = 0 (0%) 
 Did the additional features of the Tablet PCs enhance group discussion over and above that of the desktop PCs which were also available? Yes = 5 (83%)
No = 1 (17%) 


Whilst some reviewers feel that medical students already have considerable resources at their disposal in the form of books, lectures, videos and, of course, real patients, it must be recognised that there is an increasing shift towards computer based learning in medical schools (Greenhalgh 2001, Issroff 2001). Computers can combine a variety of stimuli to keep the students’ interest, encourage information retention and provide realistic clinical cases that students can learn from. Many medical institutions are also realising that computers will need to take a larger role in facilitating the learning of clinical medicine through computer simulated clinical cases. This is a result of the considerable changes in inpatient demographics and the vast increase in medical student numbers (over 55% since 1997) causing students to receive comparatively less exposure to patients in hospitals (DoH 2004).

Although our survey reports the attitudes of medical students and medical trainers to Tablet PC use, we recognise a similar positive role for Tablet PCs in enhancing other (non-medical) group sessions. Tablet PCs help students develop effective learning strategies in order to ‘learn how to learn’, and encourage student engagement and collaboration. By reinforcing these general pedagogic principles Tablet PCs demonstrate their potential to enhance group work in any setting.

There is no doubt that medical schools and other teaching faculties are realising the benefits of computer based learning but, despite the recognised advantages of Tablet PCs, the decision to integrate them into undergraduate curricula is one that university faculties are cautious about making. Our survey has highlighted that both GLFs and students felt group facilitation had benefited from the use of Tablet PCs. However, students have expressed views that personal Tablet PCs would have an even greater positive affect on small group learning particularly in PBL sessions. If Tablet PCs were to be provided to students, or if students were required to purchase them as part of their study tools, there would be important financial considerations. In our survey at Warwick Medical School, 56% of students stated that they would not be willing to purchase a Tablet PC themselves for compulsory use on the medical course, 87% having this view due to financial concerns. A review of Tablet PC use in schools conducted in 2004-2005 identified cost as being a critical factor in their uptake (Twining 2005). Although the price of Tablet PCs has fallen they remain more expensive than similarly specified laptop computers. The extent to which this differential in costs is justified is crucial, and depends upon the additional benefits that Tablet PCs offer relative to other types of computer hardware. Twining’s review concluded that Tablet PCs could offer significant benefits to schools, over and above that of laptop computers, though warned that this additional benefit must be realised in order for Tablet PCs to justify their cost differential.

In addition to the initial expenditure on hardware, if Tablet PCs were to be fully integrated into undergraduate courses, further resources in terms of time and cost would need to be spent on training for staff and students. The technological infrastructure must also be in place to ensure wireless internet connection and system security, and to ensure that remote access to online resources is available to students during their vacations. Again this would also be required for laptops, but would need to be carefully considered prior to the integration of such forms of portable hardware into undergraduate curricula.

Aside from cost and resource considerations, the attitude of students towards the use of Tablet PCs may not be clear for some time following their integration. The survey demonstrated student enthusiasm towards Tablet PCs, particularly for group learning facilitation, but this initial enthusiasm may not be maintained over a longer period (Eitel 2001). Teaching faculties would need to pay careful attention to the longer term effects of Tablet PC use on student learning and performance, and pilot schemes for Tablet PC based learning are likely to be an essential pre-requisite to any large-scale integration.


In this environment of increasing computer integration, and as the shift towards problem based learning continues, teaching faculties need to tackle their choice of computer hardware to ensure it is the most appropriate available for their undergraduates. Desktop PCs are unlikely to be the future of computer based learning since they are not readily amenable to use in group work, and teaching faculties must therefore weigh up the alternatives. The survey at Warwick Medical School demonstrated that both students and teachers alike felt that Tablet PCs were the best choice for facilitating group learning when used by GLFs. By combining the advantages of laptops with the ability for use as a handwriting tool, Tablet PCs are also ideally suited to use by students in lectures and small groups and may be used by those who are less confident with computer hardware. Their use also enhances traditional pedagogic principles through facilitation of student collaboration and engagement and problem based learning. As a result, Tablet PCs may be the most suitable hardware available to allow the benefits of computer based learning to be fully integrated into university teaching programmes.


Ringrose T. (2005) Online National Medical Student Survey of Computer use. Proceedings of the Third International Conference of Evidence-based Health Care Teachers and Developers - Building Bridges between Research and Teaching, Taormina, Italy. November

Eurell JA et al. (2005) Tablet Computers in the Vetinary Curriculum. Journal of Veterinary Medical Education, 32:1, 113-6

Original Image from: Drake RL, Vogl W, Mitchell AWM. (2005) Gray’s Anatomy for Students, 1st Edition, with permission from Elsevier

Greenhalgh T. (2001) Computer assisted learning in undergraduate medical education. British Medical Journal, 322, 40-44

Issroff K. (2001) Computer-supported collaborative learning: an introduction; in Daetwyler, C. (Ed) The use of Computers in (medical) Education. Austrian Association for Didactics in Higher Education, Innsbruck

Medical Schools: Delivering the Doctors of the Future, (2004) Department of Health Publications

Twining P, Evans D, et al. (2005) Should there be a future for Tablet PCs in schools? Journal of Interactive Media and Education, 20, 1-18

Eitel F, Kuprion J et al. (2001) Why we had to get rid of Computer-based Tutorials as part of the syllabus in our Learning Centre; in Daetwyler, C. (Ed) The use of Computers in (medical) Education. Austrian Association for Didactics in Higher Education, Innsbruck

Citation for this Editorial
Almond, L. & Chawla, G. & Brydges, S. & Peile, E. (2007) A discussion of the merits of tablet computers in medical education.. Warwick Interactions Journal Vol 11 No. 2 (Issue 30). Available online at:
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