The use of WhatsappⓇ as a way to deliver plastic surgery teaching during the COVID-19 pandemic.

Dear Sirs,

The COVID-19 pandemic presents a significant challenge for every aspect of healthcare. Due to the imposition of lockdown and the need socially distance, teaching opportunities for trainees have drastically reduced. To help maintain the highest quality education, the Plastic and Reconstructive Surgery Team at Leeds Teaching Hospitals are now using the instant messaging service WhatsAppⓇ to deliver case based discussion to trainees in the region.

Many healthcare practitioners have had their roles redefined needing to overcome drastic changes to their daily routines due to the developing COVID-19 pandemic. Elective surgery has been cancelled, and with a reducing number of patients presenting with non COVID-19 pathologies, the scope for speciality specific, workplace based training has diminished. The imposition of ‘lockdown’ and the requirement to socially distance also had an impact on training by limiting the number of people in one place, meaning face-to-face courses, conferences, regional teaching, morbidity and mortality and multi-disciplinary team meetings have had to be cancelled. As with many other specialities, Plastic Surgery trainees are needing to find different ways to access educational opportunities.

The current situation presents an unprecedented challenge to surgical education. Numerous novel techniques have been pursued to deliver effective training with many turning to social media to help deliver teaching. In addition to YouTube based lecture series and webinars, the Plastic Surgery Department at Leeds Teaching Hospitals NHS Trust has been able to deliver focussed, effective teaching via the free encrypted cross platform service WhatsAppⓇ (Figure 1 ). This has enabled us to continue to explore the breadth of the syllabus despite a vast reduction in clinical exposure without the need for unity in time or place. Trainees have been invited to a WhatsAppⓇ group where trainers are able to facilitate case based discussions and lead question and answer sessions. In some instances, multimedia tools such as previously published images and videos have been used to explain complex concepts. The cases were structured using the Intercollegiate Surgical Curriculum Programme (ISCP) work-based assessment (WBA) templates to facilitate their completion. The content is readily accessible and encourages interactivity as it allows all users to share ideas on a secure platform which remains saved so a trainee can work through the sessions at their own pace or revisit topics. They are delivered in an informal manner to ensure active involvement by all grades however professionalism is maintained throughout. To ensure privacy we never share patient details or any identifiable data despite WhatsApp having end-to-end encryption. We are also conscious of flooding trainees with messages and understand the importance of having personal time, something especially valuable in this current climate.

Figure 1

Two screenshots from the trainee WhatsAppⓇ group showing case-based discussions using publicly available images. Identifiable information has been redacted to maintain confidentiality.

During these difficult times, it is essential to develop innovative ways to ensure high quality teaching and trainee development whilst maintaining safety of trainer, trainee and patient. Although research evaluating the role of WhatsAppⓇ and Social Media in the delivery of medical education is sparse, anecdotal evidence tends to be positive. Coleman et al. carried out a modified 5-stage scoping review into the use of WhatsApp in medical education citing ‘anywhere learning’ as one of the major benefits. There were however concerns about the safety of information on the platform and the potential for the volume of messages to become somewhat intrusive. A great deal of flexibility is required when implementing and developing unproven learning methods and, to ensure effectiveness, it is important that all participants feel safe, heard and reassured. The pandemic has inevitably changed the way teaching is delivered. Embracing the change and developing novel education methods can ensure highly trained registrars and ultimately continued quality patient care. We advocate the use of WhatsAppⓇ to aid trainees in their development and believe with careful structure and organisation it can become an excellent adjunct to more traditional teaching methods moving forward.

Declaration of Competing Interest

The authors would like to confirm that there are no conflicts of interest