Group differences in physician responses to handheld presentation of clinical evidence: a verbal protocol analysis

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Danielle M Lottridge, 1 Mark Chignell,1 Romana Danicic-Mizdrak,2 Nada J Pavlovic,1 Andre Kushniruk,3 and Sharon E Straus4

Lottridge DM, Chignell M, Danicic-Mizdrak R, Pavlovic NJ, Kushniruk A, Straus SE. Group differences in physician responses to handheld presentation of clinical evidence: a verbal protocol analysis. BMC Med Inform Decis Mak. 2007 Jul 26;7:22.

First review


More and more physicians, today, are adopting the use of handheld mobile computers for the presentation of clinical evidence. The purpose of this study is to access the needs and preferences of physicians regarding the use of Pocket PCs vs. Tablet PCs. Study Selection: Physicians from three user groups providing the majority of care in Ontario were selected to participate in the study. The three user groups were: General Internists, Family Physicians, and Internal Medicine Residents. The General Internists and Family Physicians were randomly selected from a group of physicians that had completed a survey on mobile computers. They had been selected from Toronto, a large urban area, and Sault St. Marie, a small urban area. Internal Medicine Residents were enlisted from the Internal Medicine Training Program at the University of Toronto.


47 physicians partook in a 70-min. testing session in which they were required to complete several tasks using the Pocket PC and Tablet PC as evidence-based medicine resources to answer a variety of clinical questions. All sessions were videotaped and audio recorded by a human factors engineering expert.


The majority of comments about Clinical Evidence were concerned with the usability of the presentation of the content – with the majority being positive. Participants commended the devices’ ease of navigability, scrolling and formatting. Comments on content were split fairly equally amongst the positive and negative. Residents had more positive comments compared to negative, while General Internists and Family Physicians had more negative comments concerning content. Physicians had differing preferences for the handheld mobile devices. Family Physicians preferred the screen size of the Tablet PC, while the General Internists preferred portability and saw less need for screen size. The Internal Medicine Residents liked the screen size of the Tablet PC, but preferred the portability of the Pocket PC. Family Physicians focused more on the usefulness for the device rather than the usability of the device. They were interested in how it would fit into their office and if it could print patient materials. General Internists were more concerned with portability, due to the nature of their work. Internal Medicine Residents favored both the large screen of the Tablet, as well as the portability of the Pocket PC, however, favored portability over screen size.


This study investigated the differences in physician responses to the handheld presentation of clinical evidence. It is concluded that physician needs and preferences are the ultimate determinants when choosing the most ideal handheld device. Different types of physicians will have different needs and preferences dependent on their work role. It is vital to study the work role in order to determine the handheld device that most conforms to their needs.

Second review


Since physicians use mobile computers in the health care environment, authors stress the importance of obtaining information about users' needs and preferences regarding these devices and relevant clinical practice tools available. The authors’ goal was to develop a wireless medical information system that would bring the latest evidence to frontline physicians via handheld devices; then they attempt to identify individual differences in physicians' needs for the presentation of evidence resources and preferences for mobile devices.


A usability testing session, aimed at designing, developing and evaluating clinical tools for mobile devices, was adopted in order to assess the differential customization requirements pertaining to identifiable subgroups of users. Study participants consisted of physicians selected from 3 user groups: general internists, family physicians, and internal medicine residents, both from urban and semi-urban settings. Interviews were conducted that consisted of using prototypes in response to task-based scenarios, and they were implemented on tablet style PCs and pocket PCs.


Forty-seven physicians recruited from general internal medicine, family practice clinics and a residency training program participated in the study. Findings included:

  1. Physician specialty had a greater impact on device and information-presentation preferences than age and gender. Different user groups preferred differing formats and information depth and breadth (tablet or pocket PC).
  2. A significant negative correlation between age and search engine use with use declining with increasing age.
  3. Positive usability comments focused on navigability, scrolling and formatting issues such as colors and spacing.
  4. Family physicians prefer bottom-line guideline information more than the other groups; they also prefer larger screens and are less concerned about mobility. Internal medicine physicians are most concerned about mobility, while residents prefer large screen size and high mobility.


The study explored user needs for the presentation of clinical evidence on handheld computers. It found that different types of physicians have different needs and preferences for evidence-based resources and handheld devices. This study shows how user testing can be incorporated into the process of design to inform group-based customization.


This study demonstrates that handheld presentation of clinical evidence should be personalized according to the requirements and preferences of different types of physicians. Users demonstrated different needs for the amount of evidence shown and the level of detail provided.