This qualitative study, including semistructured interviews, was a collaboration between the Department of General Surgery in Khoo Teck Puat Hospital and the Lee Kong Chian School of Medicine (LKCMedicine) in Singapore. The study was conducted between August and September 2021.

Ethical approval was obtained from the Nanyang Technological University Institutional Review Board (#IRB-2021-377).

TESLA was developed in October 2020 to support students’ learning of general surgery during the COVID-19 pandemic. The questions were constructed using clinical scenarios encountered during clinical practice by a practicing general surgeon (author CLK). The channel consisted of weekly MCQs, succinct explanations of the correct responses aligned with Telegram word limit restrictions, and supplemental learning resources, such as illustrations and relevant published papers (Figure 1). Students answered the questions anonymously and were encouraged to leave comments or request clarifications via a group chat function. This format appears to benefit students by promoting learning and enabling information retention [25,26].

Medical students attending clinical years 4 and 5 in LKCMedicine who had completed their general surgery module and had used TESLA for at least 1 month were invited to participate in this study. Per the qualitative research methodology, the sample size was expected to be 10-12 participants [27], according to reaching data saturation, defined as no new themes emerging in 3 consecutive interviews [28]. All participants read a study information sheet and signed the informed consent form before data collection began. After completing the interviews, participants were compensated with a digital voucher of SG $20 (US $14.22).

A thorough literature review was conducted to develop an inventory of open- and closed-ended questions. The initial interview topic guide was pilot-tested on 3 LKCMedicine students and reviewed to improve the clarity and flow of the interview (Multimedia Appendix 1). The interview included questions about the impact of COVID-19 on medical education, the use of apps to support learning, and the use of the TESLA channel.

Individual, online semistructured interviews were conducted by a male undergraduate year 4 medical student (author MS) using Zoom, a videoconferencing app. MS took part in qualitative research training before conducting the interviews. Interviews lasted around 30 minutes and were audio-recorded using Zoom. The audio recordings were transcribed and proofread (MS) to ensure accuracy. Participants remained anonymous in the transcription and data analysis. The data were analyzed following Burnard’s thematic analysis method [29], comprising familiarization with the transcripts by reading them multiple times, creation of initial codes, and subsequent development of themes from the codes by 2 independent researchers. The codes were subsequently compared and discussed by the researchers to reach a consensus on the final list of codes (Multimedia Appendix 2). We used NVivo (QSR International), a computer-assisted qualitative data analysis software package, to analyze the data. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (Multimedia Appendix 3) [30].

We interviewed 13 students for this study, of which 11 (85%) were in year 4 and 2 (15%) were in year 5. Their participation in the surgical education support channel ranged from 1.5 to 18 months.

Two main themes were identified: (1) learning as a medical student (2) the role of mLearning in medical education (Figure 2). We present each theme, along with its subthemes and relevant participants’ quotes, next.

This study explored medical students’ perceptions of learning during the COVID-19 pandemic, the role of mLearning in medical education, and the use of a Telegram channel to support surgical education. Students experienced important changes in their learning during the COVID-19 pandemic, particularly the substantial decrease in clinical, hands-on, and experiential learning, leading to a rise in virtual learning. The use of mobile apps to support learning, although already in use prepandemic, increased. Students found these apps useful as a refresher or to consolidate learning and valued the development of the TESLA, as they found it relevant and trustworthy.

Medical students consistently reported disruptions in learning due to the pandemic, particularly the substantial decrease in face-to-face, experiential learning in health care institutions. Digital learning tools, including mobile apps, were increasingly used to compensate for the lack of face-to-face learning. This shift to digital-based learning was not unique to our student population but was consistently reported in medical schools worldwide [5,31,32]. Digital tools were an adequate substitute for theoretical learning and revisions ahead of examinations, although they could not substitute face-to-face patient interactions in the learning of clinical skills. The use of digital technologies in medical education has steadily increased for over a decade, although their adoption was not consistent. However, only with the onset of the COVID-19 pandemic was widespread adoption of digital learning seen in medical schools worldwide. This educational shift was accompanied by added flexibility and increased emphasis on individual learning preferences, which are valued by students and educators alike. At the same, time, the wide differences in digital readiness observed in high- and low- and middle-income countries translated to inadequate training for students unable to access educational materials [32,33], while the lack of access to health care institutions also impacted the acquisition of critical clinical skills [33].

Mobile apps to support medical education were widely used by students. They selected a combination of proprietary study apps, consisting mostly of question banks and other revision tools, and study groups created in popular messaging apps, such as the Telegram group presented in this paper. A recent systematic review on the use of mobile apps in education in health care professions reported these tools as effective to enhance knowledge and skills in a range of topics, including anatomy, dermatology, and surgery [34], but it did not provide information about the type of mobile apps described in the included studies. Furthermore, another review on the use of social media in medical education in the context of the COVID-19 pandemic highlighted the use of messaging apps, such as Facebook, Twitter, Instagram, and WhatsApp [35], to organize groups to post revision topics or questions and share articles and as communication tools to inform students of changes in schedules, important deadlines, or administrative tasks [15,18]. None of these studies presented compelling evidence that the use of proprietary study apps or messaging apps would be advantageous. Furthermore, the students interviewed for this study appear to use a combination of both types of apps, each of which may provide specific advantages or disadvantages. For example, study apps may offer students a trustworthy source of information, particularly if recommended by instructors or peers, but their content may not be relevant to the local context and the associated cost might be a deterrent for some students. In contrast, messaging apps are readily available, usually free of charge, and students may already be familiar with their functionalities, but their content may not be adequately verified.

The students interviewed in our study consistently reported a preference for Telegram over other messaging apps, referring to the flexibility and enhanced functionalities the app offers. The evidence for the use of social media and messaging apps has focused particularly on the use of WhatsApp, Facebook, and Instagram compared to Telegram, whose role in medical education remains relatively unexplored [11]. Telegram may offer key advantages, such as a poll function that allows for the development of MCQs, the possibility of creating large groups of up to 200,000 members, and enhanced data security safeguards, which may increase its appeal in educational settings [11,24]. Further studies on the use of Telegram for medical education are required.

Our study was undertaken in 1 medical school in Singapore, a city-state with a high penetration of smartphones, and as such, our findings and recommendations may not be generalizable to other contexts. Although our findings were more focused on the use of Telegram channels, the findings may apply to the use of other messaging apps to support medical education.

We used a stringent qualitative methodology in this study. The number of students recruited was aligned with sample size guidelines for qualitative studies, and they had varied experiences with the use of mobile apps to support medical education. Data analysis was performed by 2 independent researchers and reviewed by other members of the research team to increase the validity of our findings.

The findings of this qualitative evaluation of medical students’ perceptions of the use of messaging apps appear to support their use in medical education. Table 1 presents a series of suggestions to implement when creating study groups using messaging apps, based on our experience deploying TESLA and students’ feedback. Nevertheless, experimental clinical trials evaluating the effectiveness of mLearning compared to other learning approaches are urgently needed.

The use of apps and other digital tools to support medical education increased during the COVID-19 pandemic. mLearning was commonly used among medical students to consolidate their learning and revise examination topics. In general, Telegram was preferred over other messaging apps for its user interface and multifunctionality, and TESLA was evaluated as useful, relevant, and trustworthy. Experimental clinical trials on the use of mobile apps to support medical education are urgently needed.