An emergency department (ED)-based WhatsApp group that posted about interesting cases and picked out useful learning points was advertised on posters to ED staff. It was titled ED SHORTs to reflect the short cases that were presented. Prehospital colleagues quickly noticed this and asked to join the group. While there is significant overlap between hospitalbased and prehospital medicine, the emergency medicine (EM) registrars that had created the group felt that cases with a prehospital focus could contain more relevant learning for prehospital clinicians than those that were presented on the ED SHORTs group. A separate group was therefore created for prehospital staff with cases of relevance to prehospital practice.
The College of Paramedics (2022) states:
‘We believe that the health and social care workforce should have the opportunity to undertake continuing professional development (CPD) activity.’
It defines CPD as:
‘[adding] to your skills, knowledge, professional identity and ways of thinking so that you stay up to date and practise safely and effectively, now and in the future.’
The development of this WhatsApp group for prehospital clinicians has revealed an appetite for greater flexibility in the provision of CPD and appreciation for interprofessional learning.
Method
WhatsApp was selected to host the group due to its end-to-end encryption, ubiquitous use and ability to host large private groups. A closed group was created with access requested via a QR code (only available from clinicians already on the group) linking to a Google Form on which applicants’ details can be submitted. The group faculty (EM registrars, prehospital emergency medicine fellows and trainees or critical care paramedics) then confirm that the phone numbers are those of current prehospital NHS staff by confirmatory email on the secure wales.nhs.uk email system. The group grows by word-of-mouth with those in the group telling colleagues about it and allowing them to scan the QR code, which is available as the image at the top of the WhatsApp group.
The General Medical Council (GMC) (2017) states:
‘The use of information about patients is essential to the education and training of medical students, doctors in training and other healthcare students and trainees.’
In providing teaching on this group, the faculty members have found scenarios from real cases, and records associated with those cases, to be educationally essential.
Following the GMC (2017) guidance quoted below, each case – as well as any supportive material used in the discussion – are completely anonymised:
‘If the doctor or student is not providing or supporting the patient's care, anonymised information should be used for education and training purposes whenever practicable.’
Only non-identifiable resources such as electrocardiograms (ECGs) and radiological images are included. The Royal College of Radiology (2017) also supports this approach for anonymised radiological images. The local health board information governance guidance does not expand on this. Therefore, the faculty decided that compliance with GMC (2017) guidelines as above would satisfy confidentiality obligations.
An automated CPD recording function was created, providing curriculum-mapped reflective learning records that could be monitored by the faculty. A link is posted at the end of each case to a Google Form allowing participants to reflect on learning from the case and any further self-directed education. Reflections on the case are transferred from the Google Form to a certificate automatically, which provides evidence of learning. These automated CPD certificates are provided in the name of the group's faculty and are not affiliated with or accredited by any other organisation. The faculty can use the CPD recording function to ensure correct transfer of key learning using this education medium. The Google Form also allows for feedback (outside of the CPD certificate) direct to the faculty with suggestions on future topics and ways to improve the group.
Collaboration with clinical leads within the local ambulance service means that content can be tailored to meet local needs; for example, a case covering newly released local stroke guidelines. It also ensures that senior ambulance service staff on the group can monitor content, ensuring that discussions follow recognised guidelines and are not viewed as a license to change an individual's scope of practice.
Cases
Cases with valuable learning points relevant to prehospital care are identified by the faculty (with suggestions encouraged from all members of the entire teaching group), and used as the framework for a moderated discussion. A case is presented by a single member of the faculty on a weekly basis (with faculty members having freedom to choose a case based on personal experience or specific interests). A faculty of ten with diverse experiences and interests takes turns presenting cases to ensure a broad mix of relevant content. After the initial part of the case has been presented, questions will be posed (allowing both direct responses and often polls) and a moderated discussion is then facilitated. Following the discussion, a detailed conclusion is provided with reference to relevant guidelines (for example, those from the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) and the National Institute for Health and Care Excellence (NICE)). Each case is finished with a summary of key learning points and signposting is provided to further evidence-based sources. Topics are diverse with examples including:
A single in-person event has been held, where a case was presented in the prehospital clinician SHORTs format as part of a regional teaching day. However, in all other instances, cases are presented using text, still images and open-source videos on the WhatsApp platform.
Results and feedback
As of November 2024, 80 cases have been discussed over two and a half years and are ongoing. By word of mouth, the group has grown to include 200 prehospital staff with sessions led by ten different faculty members across different areas of interest. Group participants are mainly paramedics (56%) and emergency medical technicians (EMTs) (34%). Over 130 CPD reflective records have been created, providing evidence to participants of CPD through documentation of reflective practice on the case and any further self-directed learning. The reflections and feedback also allow the faculty to both monitor uptake of learning outcomes and source feedback on development of the group.
Feedback for this initiative has been overwhelmingly positive, evidenced by the continued growth of the group and by more formal feedback obtained through a recent anonymous Google Forms survey of 50 participants:
This last point demonstrates the value of asynchronous learning to a busy workforce in which a large proportion will be unable to engage with the live discussion. Informal feedback has revealed an appreciation for the multidisciplinary approach, which has enabled a culture of shared learning across staff groups and has proven benefits (Guraya and Barr, 2018). The faculty members have also benefited from regular interaction with paramedics who have different areas of expertise.
Conclusion
There is a desire for novel forms of education among incredibly busy prehospital staff working in a rapidly evolving environment. Interprofessional education can help develop a culture of shared learning across staff groups (Guraya and Barr, 2018). While certainly not meant to replace traditional, formal CPD, these novel methods can augment them and provide a degree of flexibility and interactivity that has proven extremely popular. This educational group continues to grow with an ambition to liaise more closely with local prehospital educational leads to match cases to local needs and to hold more in-person events to further facilitate interprofessional learning.