Page 291 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 7 of 9 Original Research

facilitated learning. Their participants also cited how useful Generalisability
it was to look back at old recorded learning discussions. 20
The results of the study show that WhatsApp is perceived as
an effective means of learning and clinical support in this
Improved clinical confidence among our participants could study group. This mobile application can then be applied
be because of two main aspects: accessibility and case- to other clinical disciplines (not only IDs), from other health
based learning. Doctors could easily access the application, settings (private, district, provincial level), as a learning
could easily access old cases in the application and could intervention. The target population groups that could
easily access new knowledge by asking for guidance on the potentially use this intervention include, for example, doctors
application. Wani et al. found that doctors started management in other clinical disciplines who need expert advice or access
of patients quicker after using WhatsApp clinician advice regarding patient management, allied health professionals
because of faster access to that advice, and that they found (such as nurses, physiotherapists, occupational therapists)
23
that management to be more effective. It is often laborious who need clinical supervision and advice from senior
trying to find best evidence-based management in medical consultants regarding patients they are managing. As this
literature, especially in a time-constrained clinical setting. study looks at the use of the WhatsApp group in a clinical
Also, the application of that knowledge is sometimes broad, setting for patient management and further medical learning,
with medical theory not always correlating clearly to what is it would be difficult to comment if its use would be applicable
found in clinical practice. By providing input on a specific outside of the medical field.
case (in a specific South African clinical setting) and supporting
the clinician in managing the case in real time, a clinician’s The second outcome of the study was to assess if patient
confidence can be further bolstered. The WhatsApp group confidentiality breaches had occurred with the posting of
provides a form of case-based learning, which has been cases, and if doctors were aware of the legal obligations
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shown to tie theory to practice and promote deeper learning. they are under when posting patient case details on a social
Studies that use interactive techniques for CME, such as case media platform. The findings of this study could definitely
discussions, produce a favourable change in professional be generalised to any health profession. It would aid in
practices and outcomes. This correlates to a similar reported raising awareness of the pitfalls of posting cases on social
25
outcome in our study. media, and in doing so, protect health professionals from
any future litigation as well as protecting their patient’s
Clinicians’ knowledge and use of confidentiality.
informed consent
Although WhatsApp is relatively safe in terms of hacking Limitations
and leaking of confidential content because of its end-to-end There are several limitations to this study. Although many
encryption of data, there is still much concern about its use in attempts were made to get responses from the group, only
medical literature and the impact on patient confidentiality. 55% (n = 91) of participants submitted responses; the selection
26
The majority of our study participants reported being aware was therefore not random, and could introduce some bias.
that they needed to obtain documented patient consent when The small sample size and simple survey framework could
posting a patient-related image (photographs, case report, affect the overall results, with resultant wide CIs. Some
laboratory report) on social media. However, less than half further bias could have been introduced by the online format
of participants actually obtained consent. There seems to be of the questionnaire (with possible technical inability to fill it
a discrepancy in what the clinicians reported to know, in correctly). A possible bias might have also occurred if any
and what they did to maintain patient confidentiality in this of the collaborating NGO clinicians filled in the questionnaire,
study. although only four were active in the group at the time.
We did not collect any demographic data from the respondents.
Several authors share similar concerns that the use of The retrospective nature of the study could also affect
patient data needs to be regulated when using social media, the participants’ responses, as recall of their experiences of
and that there needs to be a review of the roles and the chat group over a period of 1 year could vary from
responsibilities of medical professionals when using such their original experiences. The investigators could also not
14
platforms. Mars and Escott found few reports of patient determine from the study if the responses received to posted
consent being regularly sought when sending patient questions were from peers or specialists. A more accurate
information over WhatsApp. They concluded that doctors observation of the WhatsApp group would have been
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need to be told what steps to take to maintain confidentiality. obtained through direct analysis of the chat contents, but this
was not approved by local ethical governing bodies without
In our study’s WhatsApp group, group rules were posted written consent from each doctor (which would be beyond
advising clinicians to remove any patient identifiers from our scope given the study’s retrospective nature).
any medical images when posting. This helped in some
ways towards preserving patient confidentiality, but further Conclusion
education needs to be iterated to our study group regarding
obtaining actual documented consent from the patients The initial aim of this study was to show that participating
themselves. in a WhatsApp group was a useful adjunct learning tool

http://www.sajhivmed.org.za 284 Open Access