Text Messaging in Medical Education

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Text Messaging in Medical Education

Today’s medical students and residents are from theﬁrst generation of digital natives: those who grew up with cell phones, text messaging, and the Internet. They are comfortable with e-innovation,1 are in-creasingly disengaged from traditional teaching methods within medical schools and residency programs, and are quick to embrace new teaching technologies. Students instead stream lectures from home, use electronic devices to access medical journals online, and use “smart” phone applications during rounds. Adapting teaching methods within medical schools and residencies to connect with this generation of e-learners is challenging. Text messaging (short mes-sage service) offers a method of bridging the gap between traditional teaching styles and the educational styles of millennial learners be-cause of its ease, familiarity, and asynchronous nature. Among adults aged 18 to 29 years, 94% own a cell phone, and of those, 97% send and receive text messages.2Some residency programs even provide trainees with smart phones.3 The prevalence, acceptance, and low cost of text messaging make it particularly inviting as a potentially high-yield learning tool in medical education.

FOUNDATION OF TEXT MESSAGING USE IN EDUCATION

Texting has already become a well-accepted way to communicate with and engage students in high school and undergraduate settings, with a variety of platforms available for teachers.4–6Teachers may use text messages to remind students about assignments, to deliver rapid-ﬁre surveys or quizzes during class, or to conduct course-wide discussions (either within or outside the standard classroom period).7 Texting platforms are unique in that they allow participants to ask questions or discuss topics via the comfort of anonymity, which may promote participation and enhance learning.8 This form of feedback direct from one’s mobile phone is popular. Texting that occurs directly be-tween learner and teacher, although it may not afford anonymity to the student from the teacher, still allows students to pose questions anonymously from their peers (often in real time). It also provides teachers immediate feedback regarding whether learners are ade-quately assimilating information, both as individuals and as an entire group. By engaging students in a familiar medium (text messaging), teachers open the door to new styles of learning. Negative student responses to texting occur when the time that messages are sent and subsequently received is perceived to encroach on one’s personal time.4 Cost may also be a factor, although texting fees continue to decline.

AUTHORS:Matthew A. Broom, MD, Gregory T. Adamson, BA, and Lauren R. Draper, MD

Department of Pediatrics, Saint Louis University School of Medicine, St Louis, Missouri

KEY WORDS

text messaging, texting, short message service, medical education

Dr Broom developed the ideas regarding texting in medical education and drafted critical parts of the original manuscript; Mr Adamson and Dr Draper reviewed and revised the manuscript; and all authors approved theﬁnal manuscript as submitted.

www.pediatrics.org/cgi/doi/10.1542/peds.2013-1529

doi:10.1542/peds.2013-1529

Accepted for publication Sep 6, 2013

Address correspondence to Matthew A. Broom, MD, Department of Pediatrics, Saint Louis University School of Medicine at SSM Cardinal Glennon Children’s Medical Center, 1465 S Grand Blvd, St Louis, MO 63104. E-mail: broomma@slu.edu

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2014 by the American Academy of Pediatrics FINANCIAL DISCLOSURE:The authors have indicated they have noﬁnancial relationships relevant to this article to disclose. FUNDING:No external funding.

POTENTIAL CONFLICT OF INTEREST:The authors have indicated they have no potential conﬂicts of interest to disclose.

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EXPERIENCES WITH TEXT MESSAGING IN MEDICAL EDUCATION

Despite its acceptance in other settings, there are remarkably few studies eval-uating the utility and use of text mes-saging as an educational tool for medical students or residents in training.8–10One of the more applicable studies assessed learning in obstetrics and gynecology.10 Residents received information on breast cancer both via text message (2 or 3 messages per day for 17 days) and through a printed booklet. Whereas both groups improved, pre- and posttest scores revealed that the residents performed signiﬁcantly better on the questions that referenced information provided to them via text message, and residents also felt more motivated to learn from the texted messages.

The prevalent usage of texting among residents within a surgical residency program has been used to successfully introduce a text message–based duty-hour monitoring system.9 The study noted that residents are both

pro-ﬁcient with their cellular phones and comfortable with using text messag-ing to interact with their residency program. In a short period of time, duty-hour compliance among 39 resi-dents increased to 100% without be-ing overly intrusive on residents’time.

EMBRACING NEW OPPORTUNITIES WITH TEXTING IN MEDICAL EDUCATION

Although the use of text messaging as a learning tool in graduate medical education is uncommon, the accep-tance of texting as an easy, simple form of personal communication among residents is ubiquitous.9,10Information sent via text message can be quickly read by the recipient and does not re-quire the user to access the Internet, log-in to an e-mail account, or down-load any document; this fast-paced

style appeals to medical trainees. Text messaging in medical education can function as both a private or a broad (group) method of communication.

Individualized, private texts may have benefit as a gentle reminder for res-idents to update or work on their in-dividualized learning plans, which may be linked to specific content suggested by faculty, chief residents, or an ad-visor. Text messages may also serve to kick-off a larger discussion, either within the training program, or across an entire department. This interaction could take place via back-and-forth messaging (eg, resident to resident or resident to faculty), through an on-line discussion board or serve as a springboard for scheduled educational didactic sessions (eg, morning report, noon conference). Texting of specific educational messages could serve as a learning tool in a larger“topic of the week”across a department (eg, a text for an Oncology Week:“Tumor lysis syn-drome: HYPERuricemia, HYPERkalemia, and HYPERphosphatemia with HYPO-calcemia”). Themes may help consoli-date learning and increase discussion between trainees and faculty. Trainees absent from traditional educational conferences (eg, due to shift-scheduling) would still benefit from an educa-tional pearl received via text message.

What residents choose to do with the texts also holds potential. They may delete messages immediately or save them, in essence creating an acces-sible study guide. Because text mes-sages received via smart phone are innately categorized by author, mes-sages sent from a single texting plat-form would allow users to compile strings of educational messages avail-able for quick review at the user’s convenience. Given the fast-paced na-ture of residency training, having a few minutes to scroll through knowledge-based text messages on board-relevant material via a smart phone may have

greater appeal to millennial learners than looking up similar information in a review book.

Although opportunities clearly exist with 1-way texting of information to trainees, it is important to consider the possibility of 2-way texting pro-grams. Instead of messages containing only factual information, they could be question-based and seek trainee input. In this format, trainees could have the ability for a 1-way reply (eg, answering the question only to the sender) or potentially reply to all recipients of the original message. Training programs would have the ability to hybridize texting curricula, balancing texts of medical knowledge with open-ended questions posed to trigger residency-wide discussions on themed topics. Texting curricula could be developed by individual training programs or via a collaborative effort across several residency programs. The minimal geo-graphic boundaries and efﬁcient na-ture of cellular service would enable enrollment of a large number of train-ees and further increase the possibility of interaction. Learners could be di-vided into“texting teams”to help facili-tate group participation and knowledge sharing. Programs that enact broad, 2-way texting platforms should con-sider appointing a representative to monitor the discussion. As with all forms of communication, perception and etiquette are paramount. In medi-cal education, trainees interact with other trainees, faculty, staff, patients, and families throughout the day. A texting curriculum provides opportu-nities for modeling and feedback fo-cused on how to interact with one’s mobile device in front of others. Dem-onstrating to learners the appropriate usage, timing, and contextual implica-tions of mobile devices during patient interactions is an important compo-nent of medical education with mil-lennial trainees. Being mindful of both

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patients’ feelings and one’s institu-tional culture and attitudes toward mobile learning will be imperative.

The starting points for evaluating medical-texting platforms are medical schools and residency programs. A thorough analysis and discussion with participants regarding the best time to send messages to avoid a negative impact on the learning intervention will be critical to the success of any new platform. As medical educators, we should continue to extend our com-fort zone and experiment with new

educational methods to best connect with our learners. We should embrace the growing wave of mobile technology in education and actively examine how text messages may assist us in teaching. If, through the use of texting, trainees can acquire new information that they would not have otherwise obtained, academic investment into these methods may well be worth it. We believe that text messaging, a communication medium already ac-cepted and used daily by medical stu-dents and resistu-dents, will develop its

niche in both undergraduate and grad-uate medical education. The best lec-turers can still fall short of their intended objectives if their message does not stick with the audience. With text messaging, the ideas will not be lost; learners have the texts and can review them repeatedly. So as we ponder the poor attendance at noon conference or once-packed lecture halls, or lament the“good ole days”of morning report, take a look at your phone and consider text messaging in medical education: RUUP4IT?

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Washington, DC: Pew Research Center American Life Project; 2012

3. Duran-Nelson A, Gladding S, Beattie J, Nixon LJ. Should we Google it? Resource use by internal medicine residents for point-of-care clinical decision making.Acad Med. 2013;88(6):788–794

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DOI: 10.1542/peds.2013-1529 originally published online February 17, 2014;

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Text Messaging in Medical Education

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2014;133;e491

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Text Messaging in Medical Education

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