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This study was carried out in addition to the official teaching program of the residents and was not integrated into usual teaching nor did it replace previous teaching.

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Noninclusion criteria were refusal to participate, noncompatibility of a mobile phone to download WhatsApp, and failure to download WhatsApp. The inclusion criteria were ongoing medical residency, possession of a mobile phone that could download the WhatsApp app, and attestation for agreement to use WhatsApp for this study. Agreement to participate was provided online by email or telephone by each resident who could stop participating at any time.

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All information about and during the trial was sent by email, and participants knew that the WhatsApp group was the “intervention” group. All participants received information before any study procedures were undertaken, and residents were invited to participate as subjects in the study. The Ethics and Evaluation Committee for Non-Interventional Research of Rouen University Hospital approved the study (E2017-37). Since computer-based e-learning did not show any noninferiority compared to traditional teaching, it was chosen as a control teaching platform for this study.

This prospective, randomized, unblinded, multicenter study was conducted among first- and second-year anesthesiology residents from four French university hospitals with trauma center (Amiens, Caen, Lille, and Rouen) comparing WhatsApp to a control group. As severe trauma is one of the leading causes of death in the world, with more than 5 million deaths, and posttraumatic hemorrhage is the leading cause of mortality, we selected posttraumatic hemorrhage management as the topic for our teaching and evaluation. The main objective of this study was to measure the impact of WhatsApp on clinical reasoning by using the SCT. Thus, we hypothesized that WhatsApp could have the same effect as practice exchange groups on clinical reasoning. Similar to practice exchange groups, WhatsApp allows direct communication between teachers and students with the possibility of discussing real clinical cases and commenting on residents’ management of the case. Residents involved in tutored practice exchange groups have better medical reasoning, as evaluated by the script concordance test (SCT), which is a well-validated medical reasoning–assessment tool for residents. However, there is no prospective study comparing WhatsApp to any other teaching modality. Both of these observational studies showed satisfaction among WhatsApp participants and highlighted the ease of use and the quick access to lessons through the app. The first reports of the use of this app for educational purposes date to the early 2017, for teaching medical students or training pathology residents. In view of its popularity with medical students, it seems interesting to envisage a new use of WhatsApp, by orienting it toward an educational objective (with the opportunity to recover screen time from students).

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Participants are free to choose when they want to access the information posted and can view and interact with other group members regarding the information delivered at any time. It allows communication between group participants without the need for unity in place or time. The WhatsApp smartphone app, developed by WhatsApp Inc (owned by Facebook Inc, Menlo Park, CA), is the most widely used instant messaging app in the world, with more than one billion active users per month and more than 40 billion WhatsApp messages exchanged each day in 2016. The time spent on mobile phone screens per day (“screen time”) has increased exponentially since the introduction of the latest-generation phones known as smartphones, in particular, among young people, leading to a growing interest of mobile learning (m-learning) among teachers.

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Moreover, the emergence of social networks facilitates personal and professional communication and exchange. E-learning has many organizational advantages over face-to-face teaching: temporal and spatial flexibility for learners, live updates, and easy and uniform dissemination of teaching resources for teachers. Many computer-based teaching materials have been developed in recent years, and electronic learning (e-learning) is becoming increasingly popular in medical schools, with the appearance of guides on e-learning deployment.