Journal of Computer Assisted Learning

2.1 Pharmacotherapy introduction class and pharmacy students

A total of 120 pharmacy students were enrolled in a pharmacotherapy introduction course in their fourth year of a 6‐year continuous Master of Science programme at the Peking University, China. This course was scheduled once a week for 3 hr for 17 consecutive weeks, to help them understand the rationale behind therapeutic decisions, introductory information on principles, concepts, processes, and skills in pharmacotherapy that were provided. These case studies aimed to offer opportunities for students to apply skills in pharmacotherapy.

This course was taught by a group of lecturers and covered a variety of pharmacotherapeutic topics. One of the authors (T. W.) taught three classes at Weeks 12–14 with the MMBC activity, which covered pain management, depression, and osteoporosis. At Week 12, 20 min of class time was devoted to introducing MMBC activity and teaching students how to join and participate in group chats.

Four WeChat groups with 30 students each were created for this MMBC activity. Because the educators needed to address issues concerning professionalism and privacy when using social networking sites (Cain, Scott, & Akers, 2009), a recommendation for students was to create a new account for this assignment. The instructor and one graduate student were invited into each WeChat group to track students' messages. The graduate students were responsible for creating an archive of all messages and tabulating the number of messages sent by each student. It was required that all messages should be posted appropriately and professionally.

2.2 Survey instrument

In class, there was a web‐based survey tool (www.sojump.com) administered to all students at Week 16 following the completion of all case discussions from Weeks 12–14. The participation in this survey was voluntary, and it did not have effects on the final grades of students. Five questions addressed the demographic data, and 12 questions from previously validated work (Halic, Lw, Paulus, & Spence, 2010; H. J. So & Brush, 2008; Wang, Wang, & Shi, 2013) to addressed the following aspects of MMBC: perceived learning (Questions 1–7), sense of community (Questions 8–10), and satisfaction in comparison with other case studies (Questions 11–12). Students would rate each item on a 5‐point Likert‐type scale: strongly disagree, disagree, be neutral, strongly agree, and agree. For each question, the frequency statistics were calculated. In addition, there were two open‐ended questions for students to have an opportunity to comment on their dislikes and likes of using MMBC. The authors read each response to the open‐ended questions and collected the data into the categories based on common themes. A response could be categorized in multiple categories when covering more than one theme. A different faculty member reviewed all responses and categories for agreement; any discrepancies were resolved by consensus.

2.3 Mobile messaging‐based case studies

The instructor developed a series of 20 various cases (i.e., the miniassignments and questions based on one major patient case) for his portion of the course (Weeks 12–14). These cases closely paralleled the lectures that were presented in the didactic portion of the course and focused on the key issues related to many things like therapeutics, the provision of patient counselling information, selection of appropriate drug therapy, and monitoring parameters for changes in therapy. As these cases were designed for a pharmacotherapy introduction class, the level of complexity was simple (an example is in Appendix A). Figure 1 shows a case as posted in WeChat, and Table 1 provides the format of the pharmaceutical care plan.

All four of the WeChat groups received the same four cases each week. One case was posted daily in the group chats from Monday to Thursday, and each case was required to be completed within 1 day. Students were assigned to review the cases and post at least one message every week (five messages minimum) regarding a potential care plan to respond to the four cases of that week. They were encouraged to post as many times as they were willing to as long as their content were focusing on the cases. Online discussions among group members were encouraged.

Each text message regarding the care plan could contain several paragraphs and had no word count limits. Voice messages were not allowed to exceed 20% of the total number of messages sent by each student (e.g., if a student decides to post five messages, then only one voice message is allowed) to minimize the difficulty of reviewing. Voice messages were deemed difficult to review because they need to be “opened” and may have incurred data network charges. Images correlated with the pharmaceutical care plan, such as a screenshot of a reliable health information mobile webpage were encouraged.

When participating in the online discussions, it is required for students to integrate the skills, attitudes, and knowledge learned from the curriculum and then learn to apply. They were also encouraged to have a discussion on the cases outside of class as well as outside of WeChat. The posted messages needed to be written in a structured and insightful way so as to reflect the study, critical thinking, and problem solving skills of students. The following aspects of pharmacotherapy were expected to be addressed in the messages: (a) disease state information, (b) therapeutic goals, (c) drug information, (d) adverse drug events, (e) drug interactions, (f) monitoring plan, and (g) patient education. Instructions and examples were provided in class. The MMBC activity was worth 2 points (2% of students' final grade). Students would receive credit for completing at least five messages. Figure 2 shows an example of a pharmaceutical care plan posted in WeChat.

2.4 Analysis of online discussions

Interaction is an essential concept highlighted by CSCL in the learning process. It is useful for students to discuss information and solve problems collected from different perspectives (Hernández‐Leo et al., 2006; Lehtinen, 2003). For this study, interaction was assessed by measuring comments in the group chats, replies to messages, and the number of @messages. Learner–content interaction was indicated through students' messages regarding the cases. Learner–learner interaction was referential through students' @messages to others. Examples of these different types of messages are shown in Figure 3. Because there were a large number of messages and it was difficult to differentiate between various types of replies, only messages that replied to the immediate previous message were counted as “reply messages.”

3.1 Analysis of WeChat massages

During the 3 weeks in which students' posts were recorded, our 120 students posted a total of 723 messages, including 682 text messages, 22 image messages, and 19 voice messages. Figure 4 shows how voice and image messages are included into the online group discussions. Of the 682 text messages, 62 were @messages, and 225 were reply messages (including 23 @messages). The number of posts for each student varied from zero to nine, and one student did not meet the minimum of five posts (see Table 2). For each student, the average number of messages was about 5.7. No inappropriate posts were identified.

3.2 Student survey

A total of 114 (95%) students finished the student survey. Results indicated that 55.3% of the participants were female, and that the majority of students were aged between 21 and 23 years. Approximately 66.7% used an Android phone. Notably, 97.4% of the students completed their case studies in their dormitory. The baseline demographic data for respondents is provided in Table 2. It should be noted that the majority (81.5%) of students had regular or more familiarity experience with smartphones. Students' attitudes towards the MMBC are showed in Table 3. Students' descriptive responses regarding the MMBC are provided in Table 4. As mentioned previously, these responses were of the open‐ended type. Overall, majority of students preferred MMBC to traditional case studies, as seen through the results of Questions 11 (57%) and 12 (59%).

3.3 DISCUSSION

Using mobile messaging application (WeChat) within an appropriate pedagogical frame can help developing skills and knowledge for students, stimulating additional research and readings, and sharing experience and knowledge with their peers. Although MMAs has been adopted in the educational setting, this study is the first to report a case discussion using WeChat app in college from China.

3.4 Advantages of MMBC

The results of the student survey demonstrated certain distinctive advantages of MMBC. First, students indicated that the MMBC facilitated online interaction and promoted communication. The number of reply comments and @comments (225 and 62 messages, respectively) demonstrated a sufficient amount of interaction. Secondly, students indicated that the MMBC stimulated their motivation to learn. This may be explained by the fact that most participants were 21–23 years old college students, because it has been concluded that they prefer using WeChat over other platforms. This phenomenon could be explicated by a national survey conducted in over 208 colleges in China: The majority of college students in China (87.4%) are WeChat users, and students preferred WeChat because its new and unique concept matched more with their personalities (Zheng, 2014).

The quantity of messages that contained the “@” could help improve the online attentiveness among students, which may have also contributed to creating a learning environment in which the students can be motivated and engaged. Hence, the case studies which were introduced through the most popular MMA (WeChat app) in China attracted pharmacy students and potentially motivated students to learn more relative knowledge outside of generic assignments. Furthermore, MMBC allowed students to send multimedia messages such as voice messages and images, which may have also increased students' interests through the variety in presentation of information. Thirdly, students agreed that the MMBC made collaboration available without the limitations of place and time. The overwhelming majority of students indicated that they could participate in this project in their dormitories instead of the classroom settings. They also commented that they enjoyed the team‐learning atmosphere.

3.5 Lessons learned

The survey results suggest that the MMBC had some disadvantages as well. First, some students stated that the interactions and messages did not help much. This might be because the interaction was not in real time, thereby leading to responses that were often delayed because different students attended the discussion at varying times. Others claimed that reading repetitive messages from different classmates wasted time, which may have explained why the average number of replies per student was only just above the required number. One way to address this deficit is to set up a shorter time interval for discussion to make interaction more instant and to ensure online participation, for example, requiring students to participate on discussion within 3 hr after the case was posted.

Secondly, the quality of interaction was indicated as a major problem. Only 21% of the students agreed that the quality of interaction with other students was good. Fittingly, the complaints are in line with the drawbacks of CSCL, low efficiency in interaction, as mentioned by previous studies (Briggs, Reinig, & Vreede, 2011). In order to improve the quality of interaction, it may be beneficial to ask students to provide rationale and evidence for their clinical opinions. Finally, 36% of students mentioned that it was not convenient to type on a smartphone, especially when it was necessary to type a large amount of characters. This may have also affected the average number of replies per student. Now, Tencent Company (https://www.tencent.com/zh‐cn/index.html) has created personal computer version of WeChat (http://weixin.qq.com/cgi‐bin/readtemplate?t=win_weixin), which may facilitate the tying efficiency.

For educators who intend to use MMBC, several recommendations can assist in improving the efficiency and quality of collaboration learning: (a) use small groups (e.g., less than 30 students) to promote interactions among students; (b) require students to read all messages sent by group members to avoid duplicate messages; (c) encourage students to present references such as web links or screenshots of webpages to increase the quality of messages; (d) design a collaborative schedule that divides the discussion into different sections according to the case format; and (e) schedule a set time for online discussions in order to ensure joint participation.

3.6 Limitations

There are several limitations to our study. First, this study was based on only one case study and included only one group of students in a single school. Second, some classmates are already “friends” in WeChat; they could send private messages related to case study to each other, which would not have been counted as a part of the assignment. Lastly, all the cases used in this study were simple cases for a pharmacotherapy introduction class. Whether complicated cases (e.g., patients with multiple conditions) could be discussed through WeChat was not tested in this study.