Background: Innovation in graduate medical education is driven by the recognition of residents as adult learners. Increasing digitization provides for exciting opportunities to make the learning process more interactive. The use of audience response devices, or clickers, have been shown to be highly effective in higher education by improving engagement and participation in the classroom and providing real time feedback (often anonymously) to the adult learner. However, the time and monetary investment can be prohibitive for smaller groups. Given the ubiquity of cellphones, online app based response systems on personal devices can circumvent these problems.

Purpose: Our aim was to encourage a more interactive resident-run didactic session using an easily accessible technology that would motivate resident participation and promote a non-threatening learning environment.

Description: To foster a resident-as-teacher curriculum, internal medicine residents in their second and third years of training are required to create and lead several didactic sessions during their ambulatory block rotations. Residents are given the choice of format for these sessions but are asked to make lectures interactive.
This academic year, the use of an online phone application was piloted for interactive lectures. The application, Poll Everywhere , allows for live audiences to participate in real time and analyze the response. Polls include, but are not limited to, multiple choice, clickable images, ranking, and word cloud. To enter a response to the live poll, participants simply send a text message or answer at a customized web address.

Overall, residents gave positive feedback after using the application, claiming that this method was engaging and helpful in assessing their own knowledge. In our sessions, responses were kept anonymous which permitted residents to answer questions without fear of judgement from peers, including the resident running the session. This was particularly important when questions were deemed difficult or pertained to sensitive material. Ease of accessibility to the poll was also praised, with most residents opting to send responses via text message. The application was easy to install and use, requiring about 5-10 minutes of preparatory time. The responses were gathered with text messages, hence may be used in locations with poor internet connectivity. The process was cost-effective as it did not require procurement of new hardware, allowing for easy roll-out of the pilot.
Some concerns regarding the use of smartphone-based application included the possibility of residents using the smartphones for non-academic work, getting distracted with social media or text messages. It can affect concentration, retention and recollection of information as has been shown in previous studies. Though smartphones are ubiquitous, the use of web-based applications can be exclusionary for students/residents who may not have a smartphone. This is particularly concerning as learning environments must be inclusive of all.

Conclusions: A smartphone-based response system can be an effective tool to increase engagement, participation, and enjoyment of didactic sessions but users should be aware of drawbacks such as increased potential for distractions.