"Siilo" – A New Instant Messaging Application for Medical Professionals and a Novel Platform for Medical Education

doi:10.21203/rs.3.rs-2062455/v1

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"Siilo" – A New Instant Messaging Application for Medical Professionals and a Novel Platform for Medical Education

https://doi.org/10.21203/rs.3.rs-2062455/v1

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Background: The use of instant mobile messaging applications has rapidly grown in recent decades. WhatsApp is the most common of these, but it has several limitations for use in medical settings when it comes to medical data confidentiality and security, and convenience of use. In this paper we introduce "Siilo" – a new mobile phone application specifically designed for medical professionals – as an alternative messaging application, addressing its advantages for use in the medical field. Particularly, we intend to present its potential use for medical education which we discovered during the COVID-19 pandemic when the need for virtual teaching platforms has risen, and considering studies that have shown improvement in student satisfaction and achievement in educational programs that included the use of instant mobile messaging applications.

Methods: During the pandemic, we evaluated possible uses of this application in the teaching and assessment of medical students during their clinical studies, and here we present a case-based learning program that was applied among fifth-year medical students in their rotation in the Obstetrics and Gynecology ward.

Results: We demonstrated that with the utilization of "Siilo", the program improved students’ satisfaction and learning experience.

Conclusion: "Siilo" is an effective educational tool we recommend to integrate with medical studies worldwide.

Instant messaging

Mobile application

Case studies

Instant messaging applications for mobile phones have recently grown in popularity among medical personnel, including both physicians and medical students [1]. During the COVID-19 pandemic, medical education was largely transferred to virtual platforms, making such applications an increasingly important tool for medical education. "Siilo" is a secure instant messaging application that was designed for medical professionals, with an interface that is somewhat based on the popular instant messaging application WhatsApp [2].

"Siilo" offers several advantages over other instant messaging services that are vital for its use in medical settings. Firstly, and most importantly, features of information security and data encryption were given high priority, to ensure that medical confidentiality is not compromised. The application meets European standards for information security and is protected by a personal password that is required in each login [3]. For the authentication of users, the application verifies identities based on medical license number and additional personal details. To maintain patient privacy, it contains a built-in blurring tool, which enables users to obscure patients' personal details.

Another advantage that makes the application highly suitable for medical education is the ability to create individual folders for each case, where text messages and relevant media files (pictures, videos, documents) can be updated, to allow for clear follow-up of discussion regarding each patient. Hence, users can conduct separate discussions about several patients simultaneously, without confusing them with each other.

Regarding the convenience of use, cases can be reached at any time and at any physical location, and discussions on them can be conducted also in an asynchronous fashion. Thus, student groups could theoretically be gathered from multiple sites within or outside their country. Finally, "Siilo" can be installed on any smart mobile device, and a desktop version was developed as well, so it is available for anyone.

Several studies that examined the usage of instant messaging applications in the field of medical education reported increased motivation for learning [4, 5], higher satisfaction from the learning process [6, 7, 8], and improved outcomes (e.g., better test scores) [5, 8] among students who used such apps for studying. In addition, these applications have been shown to contribute to positive relationships between doctors and students [9].

Based on the understanding that communication via digital means has become central to the lives of students and physicians and considering the advantages of "Siilo" over similar applications, we wanted to explore how the special features of this application can be utilized to improve clinical teaching of medical students using a case-based learning program that we developed using "Siilo". Our primary goal was to evaluate student satisfaction from using this platform.

A "Siilo" group was created for fifth-year medical students, on their clinical rotation in the Obstetrics and Gynecology ward at the Hadassah-Hebrew University Medical Center, Jerusalem, Israel, between June 21 and July 23, 2020. During the last week of their clinical rotation, after the students acquired the appropriate theoretical knowledge, they were invited to participate in case-based educational activities including three evolving cases, prepared especially for the students on the topics of gynecologic ultrasounds, obstetrics, and fertility. Each case was introduced with a brief description and related questions; the case evolved according to students’ questions, which were answered with additional data relevant to the case, as well as further questions.

We also conducted two questionnaires for the evaluation of this teaching method: one before each teaching session to assess the participants' expectations from it, and another after the session where they were asked to report their satisfaction with the program.

Case details

Case 1. Gynecologic ultrasound. The case included 54 messages, including 37 text messages, seven ultrasound videos, six ultrasound images, two graphs, one PDF file, and one link to a YouTube video. One physician and seven students actively participated in this case, and seven additional students were observed without active participation.

Case 2. Obstetrics. The case included 78 messages, including 68 text messages, three ultrasound images, two PDF files, two graphs, two diagrams, and one picture. Nine students participated in the discussion, and five additional students were observed without active participation.

Case 3. Fertility. The case included 108 messages, including 107 text messages and one photo. Nine students participated in the discussion, and five were observed without active participation.

Participants’ feedback

Before joining the study groups, most students (73.3%) predicted that practicing evolving clinical cases during their rotation in the ward would help them acquire the required theoretical knowledge (Figure 1). Students shared their expectations to “have a clear review of basic, common cases,” “practice clinical thinking and understanding the consequences of treatment choices,” and “experience good clinical instruction, with helpful, timely technical support, hopefully without encountering many technical difficulties.”

After the learning sessions have ended, most students (57.1%) reported that the program was highly effective, and only one student reported that it was ineffective. Most students found "Siilo" easy to use. All participating students stated that the "Siilo" case studies contributed to their exam preparedness. Most students (72%) wished to participate in additional "Siilo" case studies during their clinical rotations (Figure 2).

When asked to summarize their overall experience, students answered as follows: “This is an excellent platform for learning and practicing while on clinical rotations”; “The exercise was good, and it involved many important topics. The addition of simulations during the exercise was impactful”; “In my opinion, it was excellent, and I wish there were more.”

In this study, medical students found case-based learning using the instant messaging mobile application "Siilo" to be helpful and rewarding. The students’ cooperation, participation, and self-reported satisfaction rates on a feedback questionnaire showed a high satisfaction rate from the experimental educational program. The majority of students reported that the teaching sessions were effective, easy to use, and contributed to their success on exams. Students stated they would like to participate in similar educational exercises in the future.

Numerous studies have evaluated the importance of various communication applications for students and doctors. Zulfikar et al. [4] found that using instant messaging mobile applications increases motivation for learning and knowledge among students. Dar et al. [6] and Meerasai and Mohesh [7] showed increased student satisfaction from learning using instant messaging applications, and Hossain et al. [9] demonstrated that messaging applications provide an effective tool for communication and learning among medical students and doctors, as well as improve relationships between them. Another study by Mohanakrishnan et al. [10] found an advantage in transferring relevant information via messaging applications to prepare for frontal lectures, and a study by Dyavarishetty and Patil [5] showed that students who participated in case-based learning via educational messaging groups earned higher scores on exams compared to their peers who did not.

This study is the first to use the "Siilo" application for virtual teaching sessions for medical students. This new application, created specifically for medical professionals, is not yet well-known. Still, we found it to provide a user-friendly platform that is highly secured and well-suited for teaching students on clinical rounds, as it allows users to create cases and manage separate discussions in parallel. It is possible that by using the "Siilo" app, future doctors will realize the importance of secured communication applications to protect patients' private information. Likewise, it has the potential to educate users towards organized work and management of complex medical cases that require cooperation between multiple teams using an orderly, dedicated platform.

However, the application has a few limitations. The use of the application requires internet access, which may be limited in some areas. In addition, the relatively small size of smartphone screens limits the use of images with fine details or figures with many items. Lastly, not all students own a smartphone that is suitable for this application, although a desktop version of this app is available.

Future studies can explore satisfaction with the application among larger student samples and may include comparative research methods to evaluate success rates among students who used the application as an educational tool compared to those who did not. Furthermore, further studies are needed to evaluate the application’s efficiency and ease of use among medical teams when managing real-time cases.

This study, which examined an advanced teaching approach using the instant messaging application for mobile phones "Siilo", which was specifically designed to meet medical professionals' needs, demonstrated its potential as an effective user-friendly educational tool, with adequate information security for communication among medical teams. Participants’ high satisfaction rate, cooperation, and wish for its use in the future – are all indicators that this is an effective tool for enriching medical students during their clinical rotations. We encourage the integration of this application in medical training programs to enhance clinical instruction for students worldwide.

COVID-19 - Coronavirus disease 2019

Ethics approval and consent to participate: For this type of study, formal consent was not required and was waived by the institutional review board of Hadassah Hebrew University Medical center. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Consent for publication: Not applicable.
Availability of data and materials: The datasets generated during the current study are available from the corresponding author upon reasonable request.
Competing interests: The authors declare no competing interests.
Funding: No funding to declare.
Authors' contributions: TS, OT, UD, SP, MS and DK reviewed the literature and wrote the paper. DK performed the statistical analyses for this study. TS and DK designed the data collection. All authors read and approved the final version of the manuscript.
Acknowledgments: None.

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"Siilo" – A New Instant Messaging Application for Medical Professionals and a Novel Platform for Medical Education

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Background

Methods

Results

Discussion

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