The new competency-based undergraduate medical program emphasizes on the use of technology for imparting knowledge, and promoting self-directed learning in Indian medical graduate [1], including e-learning [2]. With the easy availability of the internet and smart phones, messages via phone lines (SMS) [2] or via social media ie, Whats App, Messenger etc are highly prevalent [3]. I read with interest the recent article by Kapoor, et al. [4] reporting on use of Whats App as a tool for undergraduate classroom teaching. I compliment the authors for addressing this under-explored area in medical education in India. I have the following observations related to the study.

First, only 40 students (32.2%) were enrolled out of a total of 124 students. The principle strength of e-learning tools is their easy availability at all times, thus facilitating asynchronous learning [5] and the ability to overcome resource-constraints. If only 1/3rd of the students are using a modality routinely, it may not be an efficacious educational aid in real life, howsoever effective it may be in an experimental study. Secondly, there was no comparison done of the intervention group (WhatsApp group) with the control group (conventional classroom teaching), this may introduce multiple problems in assessing the effect, the main one being the Hawthorne effect [6]. Thirdly, less than 50% of the volunteer students participated in the discussion. The reason for low participation was not collected, but would have been an important addition to the literature. It is not clarified in the paper whether a pretest was done after conventional classroom teaching of the topic, or without any educational inputs. It would have been still better if the post test scores of both intervention and non intervention groups could have been compared. We have recently used this methodology in a study assessing effect of text messaging (SMS)-based instructions on 92 undergraduate medical students [7]. However, we did not find a significant difference in post-test scores of intervention and control groups, despite good acceptability.

Thus, using e-learning to overcome the reported faculty crunch in medical education in India is a pressing need, given its low cost and high student acceptance [5]. However, more well-conducted research on easily acceptable e-learning modalities in the Indian context is needed to demonstrate its place in the current medical education setting.

References

1. Medical Council of India. Competency Based Undergraduate Curriculum for the Indian Medical Graduate Vol. II. Available from https://www.mciindia.org/CMS/ wpcontent/uploads/2019/01/UG-Curriculum-Vol-II.pdf. Accessed on November 20, 2019

2. Sandars J. Mobile phones in undergraduate medical education: The tide is beginning to flow. Available at: http://connection.ebscohost.com/c/articles/23175511/ mobile-phones-undergraduate-medical-educationtide-beginning-flow. Accessed on December 10, 2019.

3. Mahmoodabad SM, Barkhordari A, Nadrian H, Moshiri O, Yavari MT. Survey of ownership and use of mobile phones among medical science students in Yazd. Pak J Biol Sci. 2009;12:1430-3.
4. Kapoor A, Tiwari V, Kapoor A. Teaching undergraduates beyond the classroom: Use of whats app. Indian Pediatr. 2019; 56: 967-9.

5. Dhir SK, Verma D, Batta M, Mishra D. E-learning in medical education in India. Indian Pediatr. 2017;54:871-7.
6. McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67:267–77.

7. Agarwal A, Khalil S, Sethi M, Mishra D. Text-messaging to supplement classroom teaching: A nonrandomized controlled trial. MAMC Journal of Medical Sciences. 2018;4:128-32.