WhatsApp Doc? Examining the Pluses and Minuses of WhatsAppbased Educational Threads

By Shayan Azizi, MD and Anthony Scoccimarro, MD

Up to one-third of our time on earth is spent sleeping, with each of the remaining two-thirds fractioned respectively between work and life duties. This contrasts with the irregular, and often erratic lifestyles of many U.S. medical residents live who spend upward of 13 hours per day, up to six days a week, at their hospitals. This leaves precious little time to take care of life duties, let alone to increase their medical knowledge and prepare for board exams. Hands-on experience trumps all; however, time spent reviewing the literature and understanding the pathophysiology behind our actions in health care are crucial, both for the sake of our patients and for our own decision-making and self-confidence. With advancements in technology and an overwhelming surplus of resources available to students, residents, and medical providers, the question arises: How can busy residents with limited time continuously and efficiently enhance their medical knowledge?

What’s

Good About WhatsApp?

While our textbooks collect dust on our bookshelves, our smartphones are usually either in our pockets or in our hands. On top of the many free and paid apps that residents can install on their phones to study on the go, the past decade has witnessed the dawn of a new mode of learning and discussion: WhatsApp threads. With more than two billion users globally, this encrypted instant messaging system has recently become a platform for students and residents to discuss medical cases, dissect daily EKGs, and review board exam material — all while on shift, on the train ride home, or during a lull in the middle of the day. Not surprisingly, a 2017 study by Dr. Sonia Gon amongst MBBS (Bachelor of Medicine and Bachelor of Surgery) students at the department of pathology at Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, Haryana, India, found that one of the top advantages of WhatsApp-based learning was the real-time presence of the teaching facilitator and the anywhere-anytime nature of learning it allowed. Similarly, in a large, 23-study review by Dr. E. Coleman from the Department of Intensive Care and Anaesthesia, St James’s Hospital, Trinity College, Dublin, Ireland, involving medical students, the common benefit users found was an increase in learning opportunities when face-to-face learning is no longer possible.

With the introduction of any new mode of learning, such as WhatsAppbased education, there are nuances and potentials for improvement. Users can find themselves flooded with messages or unable to retain the information they’ve acquired or use it in a practical way. So now that this new form of instantly and easily accessible, discussion-based education is widely available, a new question arises: how can this mode of pedagogy be improved?

Room for Improvement

Emergency medicine residents at Lincoln Medical Center, a level one county hospital in the Bronx, New York, participated in a blind, anonymous survey to study the strengths and areas for potential improvement of WhatsAppbased chat groups. During each academic year, attending physicians and residents at all postgraduate levels informally post interesting cases to the threads, including EKG cases, ultrasound findings, and clinical scenarios that offer a take-home learning point. These threads are where all-inclusive, informal fireside chats take place to discuss the unique cases encountered. The survey administered to residents toward the end of the academic year followed a minimum full year of exposure to the respective WhatsApp threads. The survey links were administered to residents during conference hours, with no time limit to complete. The survey included four queries which were to be answered on a rating scale between 0-10, with 0 being strongly in disagreement and 10 being strongly in agreement. The four queries included: 1.) WhatsApp threads improve my educational confidence; 2.) WhatsApp threads should be continued throughout residency; 3.) WhatsApp threads are more practical than traditional educational resources; and 4.) WhatsApp threads are helpful in consolidating content to memory.

From the 23 responses, the mean score amongst residents for improvement of their education confidence was 7.1. The mean score as to whether WhatsApp threads should be continued throughout residency was 8.3. The mean score regarding whether residents consider WhatsApp threads more practical than traditional education was 6. The mean score pertaining to whether residents consolidated the knowledge on the WhatsApp to memory was 5.5. Furthermore, subjective anonymous comments on factors that may improve the quality of the threads included:

• A summary of the daily learning points

• More consistency with themed weekly topics

• A weekly summary of the learning points discussed

• Discussing one concept at a time

• Not starting a new discussion prior to the previous one concludes

• More structure and moderation

WhatsApp threads are equitable (since everyone who has a phone can participate) although inequivalent to the quality of education and engagement that in-person teaching offers. The quality of these discussion groups can be optimized if a higher degree of moderation occurs by the host to allow participants to equally engage and if an interval summary of the teaching points discussed during the chat is provided.

Furthermore, closing remarks and conclusions should be made prior to starting a new topic of discussion; this would allow students to formulate their thoughts and help retain the concept.

If effectively utilized, WhatsApp based discussions can help fill gaps of knowledge created when meeting with professors in a traditional classroom situation or conference is not feasible.

About The Authors

Dr. Azizi is a second-year emergency medicine resident at Lincoln Medical Center, Bronx, New York City. @ShayanAzizi10

Dr. Scoccimarro is assistant program director for Lincoln Emergency Medicine, Bronx, New York City.