Review
Smartphones and the plastic surgeon

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Summary

Surgical trainees are facing limited training opportunities since the introduction of the European Working Time Directive. Smartphone sales are increasing and have usurped computer sales for the first time. In this context, smartphones are an important portable reference and educational tool, already in the possession of the majority of surgeons in training. Technology in the palm of our hands has led to a revolution of accessible information for the plastic surgery trainee and surgeon.

This article reviews the uses of smartphones and applications for plastic surgeons in education, telemedicine and global health. A comprehensive guide to existing and upcoming learning materials and clinical tools for the plastic surgeon is included. E-books, podcasts, educational videos, guidelines, work-based assessment tools and online logbooks are presented.

In the limited resource setting of modern clinical practice, savvy plastic surgeons can select technological tools to democratise access to education and best clinical care.

Section snippets

Smartphone platforms

The first smartphone was developed by Palm in 2001 and provided the basis for others to follow. In 2007 the Apple iPhone revolution began with a more streamlined, intuitive experience. Although it offered little new, the Apple experience quickly cornered the market with a virtual ‘App store’ for ITunes and all downloadable applications (apps). Google has developed its own smartphone,the Android OS, with its own online application store called ‘Marketplace’.24

Smartphones applications for the plastic surgeon

Apps are being developed for every imaginable use.25 Relative to other specialities, there are fewer plastic surgery-specific apps available.26 However, as smartphone ownership increases so will their use.27 The Mersey Burns app28 is an award-winning example. The alternative, as Freshwater pointed out, is to use our ingenuity to make non-specific apps useful to the plastic surgeon.29 A list of apps plastic surgeons may find useful,30 as well as their prices, is summarised in Table 1 (Figure 1).

Mobile websites

‘Mobile’ versions of websites enable easier viewing on the smartphones without the need for an app. Table 2 summarises sites relevant to plastic surgeons.

Podcasts and video

White et al. found that 80% of 93 students who had integrated podcasts into existing study habits had improved knowledge and were more interested.31 Plastic surgery podcasts are widely available over the Internet; smartphones enable access to online medical education videos at a time convenient for the trainee.32, 33 Sites such as YouTube can show live surgical procedures and clinical examinations.34

Surgical rehearsal platforms

Computed tomography (CT), magnetic resonance imaging (MRI) and three-dimensional (3D) stereophotograms are being used to provide accurate insights in preoperative anatomic relationships and expected pathologies. Neurosurgery has developed the use of these accurate anatomical images to create powerful integrated workstations designed to support and train in virtual reality in real cases, without the potential for damage to the patient.35 In another system based on models from patient CT, MRI and

Ebooks

The development of Amazon's Kindle has led to the ebook industry commanding more than half of the US book market across all formats. A survey carried out by Franko demonstrated that high-quality textbooks made available through mobile phone apps were the single most requested technological development.23 Amazon has since developed an app that allows access to virtually any book. This is economically and environmentally wise. All major textbooks now have an ebook version including Green's

Assessments

Assessment drives learning and is an essential component of competency-based education.39 Completed workplace-based assessments (WPBAs) are required to pass the academic year and are usually carried out on the job. Depending on Internet access, smartphones can allow the trainee and trainer to discuss and complete assessments contemporaneously.

Research

In the context of carrying out research parallel to regular work duties, data collection can be arduous and time consuming. However, smartphones can be used to collect data for clinical research, in alliance with a Google Docs survey smartphone app.40

Patient care – telemedicine

Already in plastic surgery, some pathologies are routinely photographed for documentation and comparison. Evaluation and triage of patients using telemedicine and digital images can improve consultation and time management by the remote plastic surgeon and ultimately assist the treating practitioner in Accident and Emergency (A&E) or the community.41, 42 This can ensure that the most appropriate care is given at the referring centre, limiting delay of treatment and mitigating possible problems

Global health

There are 60,000,000 health-care workers globally. Despite this, hundreds of thousands of people die annually because of a critical shortage of health-care workers in much of the world. Technological advancements can help to leverage the health-care workers' knowledge in resource-rich areas, with relevant contextual experience to train and mentor health-care workers without the economic, environmental, personnel and personal costs of relocation. For the plastic surgeon involved in global health

Requirements

Phones that would support the apps include: iPhone 3GS, iPhone 4, 4S or 5. iOS 4.3, ideally with an unlimited data plan. In hospitals with limited mobile reception many of the apps can be downloaded onto the smartphone so that Internet is not required. There are also numerous other speciality guidelines which can be viewed in portable document format (PDF). Some trainees have used sterile Ioban to cover their tablet/smartphone, so that they can continue to interact with this tool in a sterile

A word of caution for smartphones in the workplace

Patient confidentiality must be respected and the General Medical Council (GMC) has released guidelines on how to ensure this is done. The vast majority of smartphone apps and resources pose no risk to patient confidentiality. Elogbook apps have in-built data-protection mechanisms and to date, there have been no reports of data loss. Clinical photographs in particular must be taken with appropriate consent with dedicated digital cameras, and there is no evidence that smartphones have led to a

Funding

None.

Conflict of interest

None.

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