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<TITLE>WhatsApps as a platform for virtual teaching in Imaging in times of COVID-19 </TITLE>
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<div align="right"><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><B>RESEARCH PAPER</B></font></div>
<p>&nbsp;</p>
<P align="center"><font size="4" face="Verdana, Arial, Helvetica, sans-serif"><strong>WhatsApps as a platform for virtual teaching in Imaging in times of COVID-19</B>
</strong></font>
<P align="center"><font size="4" face="Verdana, Arial, Helvetica, sans-serif">WhatsApps como plataforma para la ense&ntilde;anza virtual 
en Imagenolog&iacute;a en tiempos de la COVID-19 </font>
<p>&nbsp;</p>
<p>&nbsp;</p>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Leidel&eacute;n Esquivel Sosa<SUP>1*</SUP> <a href="https://orcid.org/0000-0002-8062-8716" target="_blank">https://orcid.org/0000-0002-8062-8716</a><br>
</font><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Maryla Mart&iacute;nez-Fort&uacute;n 
Amador<SUP>2 </SUP><a href="https://orcid.org/0000-0001-8641-5490" target="_blank">https://orcid.org/0000-0001-8641-5490</a><br>
</font><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Madyaret &Aacute;guila Carbelo<SUP>2</SUP> <a href="https://orcid.org/0000-0002-0250-9236" target="_blank">https://orcid.org/0000-0002-0250-9236</a><br>
</font><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Elio Llerena Rodr&iacute;guez<SUP>2</SUP> <a href="https://orcid.org/0000-0002-7270-7481" target="_blank">https://orcid.org/0000-0002-7270-7481</a></font>
<p>&nbsp;</p>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><SUP>1 </SUP>Villa Clara University of Medical Sciences. &quot;Jos&eacute; Luis Miranda&quot; University teaching 
Pediatric Hospital. Santa Clara. Villa Clara. Cuba.<br>
</font><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><SUP>2</SUP> Villa Clara University of Medical Sciences. &quot;Arnaldo Mili&aacute;n Castro&quot; University teaching 
Cl&iacute;nical-Surgical Hospital. Santa Clara. Villa Clara. Cuba. </font>
<p>&nbsp;</p>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><SUP>*</SUP> Author for correspondence. E-mail: <a href="mailto:leidelen@infomed.sld.cu">leidelen@infomed.sld.cu</a></font>
<p>&nbsp;</p>
<p>&nbsp;</p>
<hr>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><B>ABSTRACT</B>
</font>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif">The pandemic produced by the SARS-COV-2 coronavirus led to the implementation of 
measures for isolation and physical and social distancing in the world and particularly in Cuba. 
The WhatsApps application has characteristics that justify its use in postgraduate teaching 
in Imaging, as a virtual modality, for which the &quot;Radiology&quot; group was created, made up 
of teachers and residents of different hospitals in Cuba and other countries; This platform made 
it possible to maintain and promote teaching in times of pandemic with real cases of 
COVID-19 and other diseases that were analyzed in this way. It is the objective of the authors to 
share their experiences as they are novel, feasible, stable and well accepted in the 
teaching-learning process. </font>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><B>MeSH:</B> coronavirus infections; imaging, three-dimensional; information technologies 
and communication projects; education, medical.
</font>
<hr>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><B>RESUMEN</B>
</font>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif">La pandemia producida por el coronavirus SARS-COV-2 
provoc&oacute; la implementaci&oacute;n de medidas para el aislamiento y el distanciamiento f&iacute;sico y social en el mundo y particularmente en 
Cuba. La aplicaci&oacute;n WhatsApps posee caracter&iacute;sticas que justifican su uso en la ense&ntilde;anza 
de posgrado en Imagenolog&iacute;a, como modalidad virtual, por lo que se cre&oacute; el grupo 
&quot;Radiolog&iacute;a&quot; formado por docentes y residentes de diferentes hospitales en Cuba y otros pa&iacute;ses; 
esta plataforma permiti&oacute; mantener y potenciar la docencia en tiempos de pandemia con casos 
reales de la COVID-19 y otras enfermedades que fueron analizadas por esta v&iacute;a. Es objetivo de 
los autores compartir sus experiencias por ser novedosas, factibles, estables y bien aceptadas 
en el proceso ense&ntilde;anza aprendizaje. </font>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><B>DeSC: </B>infecciones por coronavirus; imagenolog&iacute;a tridimensional; proyectos de tecnolog&iacute;as de informaci&oacute;n 
y comunicaci&oacute;n; educaci&oacute;n m&eacute;dica. </font>
<hr>
<p>&nbsp;</p>
<p>&nbsp;</p>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Submitted: 12/07/2020<br>
</font><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Accepted: 21/07/2020 </font>
<p>&nbsp;</p>
<p>&nbsp;</p>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">The current pandemic produced by SARS-COV-2 caused the disease known as COVID-19 
which produced in the world, particularly in Cuba, the implementation of measures for physical 
and social isolation and distancing. These led to a pause in conventional medical teaching and led 
to the search for new ways to maintain a standard in normal teaching 
practices.<SUP>(1)</SUP>
</font>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">In previous similar situations, multiple forms of exchange with students were used, which 
allowed maintaining a teacher-student link. Some of them were more used as videoconferences, 
virtual meetings, and use of websites and / or power point with voice recorded on a certain 
platform.<SUP>(2)</SUP> At the present time this fact does not ostensibly differ from the strategies adopted in 
different countries, taking into account the existence of unequal development standards and with it 
the selection of different ways and forms. All or several of these options could be used in university 
or hospital institutions with the necessary resources, but the situation is very different in 
some universities or hospitals in Latin America due to the region's own 
shortcomings.<SUP>(3)</SUP>
</font>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Distance learning medical education allows teaching and evaluating the dimensions of 
medicine not related to human contact: scientific knowledge or the algorithms of clinical reasoning as 
it has been developing for years in the 
world.<SUP>(4)</SUP> This type of virtual teaching constitutes a 
challenge for managers, professors and students at the university, due to the necessary support for 
its implementation. The availability of the internet, the ability of the teacher to teach 
distance courses, the management of virtual platforms by students and teachers, and academic 
and technological support at the university, among many other factors, are 
essential.<SUP>(3)</SUP>
</font>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Distance training evolves at the same time that Information and Communication 
Technologies (ICT) develop. Teaching needs expand and diversify, to which immediacy and continuous 
updating are added as essential factors.<SUP>(5)</SUP>
</font>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Distance medical teaching has obvious limitations as it is insufficient to support holistic 
professional learning;<SUP>(4)</SUP> however, the performance of synchronous activities can have a positive 
influence, favor a more direct contact and a more effective supervision of the teacher and the 
student.<SUP>(2)</SUP>
</font>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">From a methodological point of view, in clinical practice there are educational formats with less 
or greater impact. Small group interactive and case-based learning have been shown to have 
the greatest impact. Paradoxically, lectures or written materials alone do not produce great 
changes in medical practice. There are four elements that contribute to the development of teaching 
and learning strategies through the use of 
ICT:<SUP>(6)</SUP>
</font>
<p>&nbsp;</p>
<ul>
  <li>
    <div align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Carrying out asynchronous activities. </font></div>
  </li>
  <li>
    <div align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Carrying out synchronous activities (debates). </font></div>
  </li>
  <li>
    <div align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">The participation of geographically dispersed professionals. </font></div>
  </li>
  <li>
    <div align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Online collaborative activities achieve collective knowledge development. </font></div>
  </li>
</ul>
<p>&nbsp;</p>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Achieving an adequate use of ICT and stability of the selected path allows them to 
be implemented efficiently. Besides this, the visual has a greater consumption than the textual 
and the students consider convenient technology-based solutions to support learning 
and assessment, as well as communication tools between 
peers.<SUP>(4,7)</SUP>
</font>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">In Cuba, the limitation of classroom teaching during the pandemic led teachers to adapt 
or reinvent old formulas to the context of current circumstances . The Imaging specialty was 
not exempt from this, adding the great practical component that it has in the services of 
conventional radiology, ultrasound, computerized axial tomography and magnetic resonance as basic 
elements in its training.
</font>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">The world is experiencing a growing trend towards the use of the Internet that allows a 
greater coverage and scope of distance learning medical education, in comparison with the 
traditional one, <SUP>(6)</SUP> with access to dissimilar platforms and use of applications, which constitutes a 
feasible, stable and interesting way for teaching exchange. Finding the right method is vital to 
maintaining an interesting form of interaction.
</font>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">WhatsApps Messenger is a messaging application, available for Android and other 
smartphones. Use the internet connection (4G/3G/2G/ EDGE or Wi-Fi when possible) from a mobile phone 
to send and receive messages, calls, photos, videos, documents, voice messages. It allows you 
to form groups, but it is neither a social network, nor it allows you to belong to large communities 
or read information, opinions or assessments of unknown people.
</font>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">These characteristics justify the selection of this application in postgraduate teaching in 
Imaging: it only allows receiving messages from contacts, it does not disclose advertising and it 
accepts information in photos, videos and texts, making it appropriate for teaching. The images are 
the basis of this specialty, the photos and videos of x-rays, ultrasounds, computed axial 
tomography and magnetic resonance imaging, associated to a specific clinical picture, allow 
diagnostic discussions in virtual ward rounds with topics within the content of the specialty.
</font>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">The &quot;Radiology&quot; WhatsApp group in Villa Clara is made up of teachers from different 
hospitals, imaging residents, foreign graduates from different countries in Latin America and the 
Caribbean and includes doctors who are fulfilling an internationalist mission. This diversity 
strengthened teaching with real, national and international cases, including studies of COVID-19 from 
countries with a high rate of infection, which contributed to an imaging preparation before the 
pandemic spread in Cuba. </font>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">The characteristics of the group show the four criteria for the development of teaching 
and learning strategies through ICT, which are evident in the formation of this teaching group: 
when presenting a case (complying with medical ethics) there is a Asynchronous activity, the 
selection of a specific time for group debate with the participation of the majority generates a 
synchronous activity, in the exchange with members from different countries who support the discussion 
with criteria and images, geographic dispersion is manifested, and collaborative activities online 
are enhanced with updated bibliography. This exchange was daily during the forced social 
isolation. Teaching ward rounds using WhatsApps must constitute a tool that lasts beyond the 
current moment.
</font>
<P align="justify"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Special situations like pandemics are opportunities to set priorities and develop new 
methods; Without ceasing to renew traditional forms of the educational process, these experiences 
must be enhanced because they are more modern, generate individual exchange, are feasible to 
handle, stable and interesting for their users, and favor an steady development in medical 
teaching quality. The creation of groups through WhatsApps is a proven way and it&#180;s a platform for 
virtual teaching in Imaging or in any other specialty of medical sciences where it is applied; this 
criteria is endorsed by the experience of these authors. </font>
<p>&nbsp;</p>
<P align="center"><font size="3" face="Verdana, Arial, Helvetica, sans-serif"><B>BIBLIOGRAPHIC REFERENCES</B>
</font>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif">1. Granma.cu [Internet]. Habana: Editorial Semanario Granma. 1996c [actualizado 
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<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif">2. Vergara de la Rosa E, Vergara Tam R, &Aacute;lvarez Vargas M, Camacho Saavedra L, 
G&aacute;lvez Olortegui J. Educaci&oacute;n m&eacute;dica a distancia en tiempos de COVID-19. Educ Med Super 
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<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif">5. Ablan Candia F, Gr&uuml;ber de Bustos E. Arocha Rodulfo JI. Estrategias para la educaci&oacute;n 
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<p>&nbsp;</p>
<p>&nbsp;</p>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><B>Declaration of interests</B>
</font>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif">The authors declare no conflict interest.
</font>
<p>&nbsp;</p>
<p>&nbsp;</p>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><B>Contribution of the authors</B>
</font>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Leidel&eacute;n Esquivel Sosa: carried out web searches, analyzed the bibliography and wrote the draft.<br>
</font><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Maryla Mart&iacute;nez-Fort&uacute;n Amador, Madyaret &Aacute;guila Carbelo y Elio Llerena Rodr&iacute;guez: carried out 
web searches, analyzed the bibliography and agreed with the draft. </font>
<p>&nbsp;</p>
<p>&nbsp;</p>
<P><font size="2" face="Verdana, Arial, Helvetica, sans-serif">This article has been published under license of <a href="https://creativecommons.org/licenses/by-nc-sa/4.0/legalcode" target="_blank">Creative Commons</a></font>
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