The use of computer and information technology is on an escalation. The internet, one of the key developments in this field, provides instant access to latest medical information [1]. Computer assisted management of medical information has also increased. The evolving nature of medical knowledge and technology requires that medical practitioners develop computer skills to enhance the quality of patient care and for ongoing education and research [2]. There was an urgent need to do this study on medical students. Medical students are spending increasing amount of their time on electronic devices like laptops, smart phones, tablets, Personal Computers, etc. So this study was done to examine this issue in detail to see how this time can be channelized to meet their education goals, to improve their efficiency, productivity and also to make sure it does not hamper their education, moral, psychological, physical health and safety. We did not include the issue of e-waste in this study as in our opinion very little e-waste is being generated by medical colleges and hospitals in India.

Objectives of the study are to gather data from the students of a medical college to-

1. Find the prevalence and pattern of utilization of electronic devices,
2. Evaluate the pattern, purpose of internet usage and factors influencing it,
3. Assess the need for incorporating computer education in medical curriculum.

After taking permission from Institutional Ethics Committee & Research Committee a cross-sectional study was conducted in November 2015 in a Private medical college in Central Kerala, India. All medical students were included in the study. Consent was obtained from the students by disclosing that the data collected is for research purpose, that the pretested questionnaire is anonymous and their participation in the study is voluntary.

For convenience, in our study following criteria was given and defined for family income, i.e. >Rs 6 lakhs /year as Upper Income and < or equal to Rs 6 lakhs/year income as Lower Income Family, as we did not want to make multiple small groups based on per capita income or above and below poverty line.

Table-8: Significant Differences among sexes for e-devices use

Degree of Freedom =1, N=350.

Table-9: Utilization of e-devices by urban and rural students

Degree of Freedom = 1, N=350

Table-10: Difference in online behavior among

Thirty five (10%) students did not spend any time on e-devices in a day. Eighty four (24%) did not spend any time on internet in a day. Ninety (25.7%) do not spend any money to get access to the internet. Two hundred and fifty five (79.4%) spend 2 hours or less on internet and 91(26%) did not know how much money they spent on the internet as their parents paid the bill directly. Only 2 students (0.6%) are connected to internet 24 hours a day.

On doing further t-test on 95(27.1%) students who complained of eye strain as compared to 254(72.8%) who did not have eye strain, we found that those with complains of eye strain were spending an average of 4.76 hours per day on e-devices, as compared to an average of 2.94 hours on e-devices per day by those who did not complain of eye strain, a mean difference of 1.817 hours per day, t=2.650, and P=0.009. Thus there was a significant difference on number of hours spent on e-devices and complain of eye strain.

Even though those with complain of eye strain spent a mean of 0.347 hours more on internet per day, the difference was not significantly associated with complain of eye strain (t=.969, P=.333). We further looked into the second highest complain of headache reported by 68(19.4%) students. We found that those complaining of headache were spending an average of 1.158 and 0.520 hours more on e-devices and internet per day,

Two hundred and nineteen (62.6%) had no problems in using the internet, 40(11.4%) were not able to use internet as they lacked time, 3(0.9%) due to inadequate computer education, 22(6.3%) due to lack of accessibility, 31(8.9%) lack of interest, 29(8.3%) because it is expensive, only 2(0.6%) felt it lacked privacy, and 3(0.9%) considered it as insecure.

Forty five (12.9%) would like to have some computer and internet classes. Eighty eight (25.1%) preferred reading e-books than conventional textbooks. One hundred fifty two (43.4%) felt that e-device usage made their academic performance better and 40(11.4%) felt it became worse while 154(44%) felt it had no effect on their academic performance. So in total 55.4% felt it had no effect on their academic performance or made it worse.

Cross Tabulations: Junior students had significantly lower experience in laptop use as compared to seniors (χ² 57.794, p=0.000). They also had a significantly lower ownership of laptops (χ²18.389, p=0.001). Older students had significantly more laptop experience (χ²35.497, p=0.000).

Religion had no significant difference in the use of mobile phone, smart phone, laptop, and tablet computer. Table 9 shows the utilization of e-devices by urban and rural students. The urban students who have ever used and owned mobile phones were proportionately less than rural students. But the prevalence of utilization and ownership of smart phones and laptops are higher among urban students. Urban students use smart phone daily more than rural students while it is vice versa for mobile phones.

In table 10, it can be seen that female students are following male students, many times closely, in online behavior; but the girls are much wiser than boys in not giving personal information to the strangers online, and more girls do not go online regularly without any work.

Religion wise significant differences- Only 54(69.2%) Christians and 37(74.0%) Muslim students ever downloaded anything from internet as compared to 187(84.2%) Hindu students (χ² 9.004, DF 2, p=0.011). Similarly using the internet ever for banking was only 3(6.0%) among Muslims, 8(10.3%) among Christians as compared to 41(18.5%) among Hindus.

There was no significant difference religion wise in physical discomfort, place of access of

A student has to attend classes for eight hours and needs good sleep of eight hours, taking another two hours for lunch, dinner, breakfast and bath etc. a total of 18 hours are busy hours. This leaves only five to six hours in a 24 hour day to study. For our calculation we are taking the daily study time to be six hours. Table 11 clearly shows the 256(73.35%) students who did regular social networking spent on an average 1.4 hours (23.3% of study time) more per day on e-devices. The 257(73.43%) students who did social networking, spent on an average 1.13 hours (18.83% of study time) more per day on internet. Those who did social networking regularly as compared to those who did not, the time spent, which comes from study time (almost 42.12% of their average study time daily) is a lot.

Average time spent for internet usage by the students in our study is 1.81 hours per day whereas from other studies done by Maroof et al and Unnikrishnan et al, it was found to be less than three (3) hours per week.[6, 7] From their study about 34.5% students prefer textbooks than internet whereas 25.1% of students in our study prefer e-books. According to our study students (66.6%) preferred internet as it provides latest information and this was high when compared to the above study which gave a result of 58.1%.

Based on the study done by Kochhar et al students had problems in using internet due to lack of time (51.43%), lack of interest (5.71%), cost of accessing (20%), and privacy (<50%) while ours were 11.4%, 8.9%, 8.3%, 0.6%, respectively. [8] The data obtained indicates that majority of the medical students participated in the study embrace and use internet for entertainment.

While looking at the figures from table 4, in the context of medical students we have to take in account that medical students are supposed to study a lot and understand a lot of different complex subjects and ideas during their medical education. This regular medical study, the primary purpose of coming to medical college, also requires work that is a strain on the eyes and can give headache, complain that was found in 27.1% and 19.4% of students. T-test clearly showed (Table 5) that hours spent on e-devices was significantly associated with complain of eye strain. Medical students need to make a choice of more mature behavior with e-device use and those who have eye strain, need to reduce the number of hours they spend on e-devices per day, this is likely to benefit them and reduce their complain of eye strain.

So, especially for entertainment (movies and music) and e-book download, students need to have their own internet connection. Once downloaded students share these files quite freely in the college. Some students are spending a lot of time on the internet and e-devices and some of those are suffering from eye strain. They need, as a mature and grown up adult, to make a choice to reduce the time they are spending on e-devices to come back to positive health.

The internet was used regularly by the medical students in social networking (73.4%), entertainment (56.9%), and academic purpose (62.6%). Entertainment and social networking is important for morale and happiness, and e-devices are useful. But 11.4% of the students felt that the academic performance became worse with e Device usage. Hence proper planning and utilization of e-devices are needed. Some students are giving their personal information to strangers online, this has to be avoided for the reasons of privacy and security. Compared to ten (10) years ago, the use of e-devices has become an epidemic, and all colleges need to put a control on it by educating against overuse of e-devices.

The author acknowledges the encouragement provided by Principal Dr. (Commodore) MJ John and Head of the Department of Community Medicine Professor (Dr.) Raju Antony for this study; we also acknowledge the help given by House Surgeons Dr. Christy G. Kulathinal, Dr. Darshana D. Sadasivan, Dr. Devi Balasubramaniyam, Dr. Devi Prasannakumar, and Dr. Divya Thankachan.