asynchronousA significant portion of the technology industry is built around social media and asynchronous chat platforms that seek to connect people. Modern tools are designed with the intention to maximize engagement with push notifications, engagements, and emoji/like integrations that maximize the “dopamine rush” for users; “social media addiction” is a known phenomenon. These tools, when repurposed for learning, provide an easy and user-friendly platform for learners to discuss educational objectives. Chats are the quickest communication form, occurring in real-time and encouraging spontaneity and adaptation. There is a sense of forgiveness, and oftentimes if the chat is anonymous, a high degree of confidence for participation among learners. Use of a moderator is a KEY factor in keeping the discussion professional (and alive!) [1].



WhatsApp Groups

WhatsApp is a free messaging app that allows small and large groups to send text or voice messages and to participate in video or audio calls. Conversations can also share photographs, videos, weblinks, or documents. It is available on mobile or desktop devices but does require an active cellular number when registering for an account. Whatsapp allows for open groups, and is widely used internationally. Lots of innovators have already written about the utility of this platform as a space for discussing cases with trainees (see these examples from med students, and other specialties including dermatology, pathology, radiology, cardiology).


  1. The application is a free service, provided users already have a cellular number for registration.
  2. The interface is user-friendly and within a few seconds of downloading the app, one can start chatting with friends.
  3. Whatsapp syncs and imports your mobile contact lists so that you can easily find friends to start a discussion.
  4. Multiple modalities of connection (text, audio, or video) allow for different avenues of communication.
  5. Can avoid using cellular data to make phone calls via WiFi connection
  6. User can set up notifications for new messages and mute channels for a period if they become overwhelming or too noisy
  7. No ads or commercials, giving you space to just enjoy the features of the app
  8. Can be used on multiple operating systems – iOS, Android and Windows
  9. Group calls make it easy to reach multiple people at once.
  10. Ability to broadcast the same message to multiple individual chats at once
  11. One of the most popular messaging apps internationally; widely used among the international student population


  1. Notifications, especially in larger group discussions, can be overwhelming.
  2. Cannot send large files (documents max out at 100MB and videos max out at 16MB)
  3. The lack of search function requires users to know each other’s cell phone numbers in order to initiate communications.
  4. No “logout” option. There are minimal pause functions, but there is a mute function for groups or specific people which allows users to  “opt-in” to checking on certain contacts (knowing you may miss parts of the conversation).
  5. A maximum of 256 users can be added to a group.
  6. International phone numbers are difficult to add, as they require country codes.
  7. The default setting is that media files download to your phone, which can clutter storage on limited hard drive phones (although this option can be turned off in the settings function).

Tips for success

  1. Be sure everyone in the group has the capability to download the app.
  2. Decide if you want notifications for messages and use the settings accordingly.
  3. If you are starting a group, reach out to individuals first to see if they would like to join and collect/confirm cell phone numbers.
  4. Do not be afraid to politely leave a group if your participation is no longer necessary. Doing so can help maintain a sense of work-life balance.
  5. Export your group communications and store them in an email for later access.
  6. A very popular use is to have an open group that anyone can join, often to broadcast updates about a particular topic, such as a class, a project, or news event.
  7. Although it is encrypted from the end-user to end-user, this does not mean there is privacy. In fact, there have been legal cases where these messages were obtained through a subpoena.



Slack is a communication and collaboration tool that offers real-time messaging as well as the ability to archive, search and share files. Conversations happen in channels that are organized by topic, project, team, etc and allow for a communal place for sharing information and working on projects. Slack has both desktop and mobile apps, so you can have it wherever you go.


  1. It is simple for new users with minimal setup time and an obvious interface.
  2. There is a long list of applicationss that can be added as integrations (e.g.Google drive) to share content easily.
  3. Reduces email traffic. This may be IMPERATIVE for some administrators right now in order to help filter email threads that can quickly become out of date).
  4. Acts as a digital hub and home base for remote teams. At ALiEM this is our MAIN vehicle for making great content like this happen. Our ALiEM Faculty Incubator is run almost entirely on Slack (after an in-person kickoff event), and we use this platform for our annual programming [2].
  5. It creates an informal environment to have conversations.
  6. Messages are archived and easy to search.
  7. Real-time and asynchronous communication allows users to participate in active discussions and to catch up on team conversations that may be missed.
  8. Ability to set up private groups for specific tasks/projects, so the entire group is not bombarded with unnecessary posts.


  1. It can be difficult to disconnect. Don’t be afraid to mute notifications on Slack if you’re at work or at an important meeting. Some individuals opt to completely silence all notifications, and “pull” data down on demand to reduce the frequency of being pinged.
  2. Depending on the volume of messages, earlier topics can be buried, leaving holes in communication. Setting up channels to have different conversations can be key. For the ALiEM Faculty Incubator, we have channels like “journal_club”, “random”, and “thanks-brags-congrats”, which all serve different functions.
  3. It can be difficult to sustain a deep conversation from start to finish.
  4. Multiple, simultaneous conversations can be difficult to track.
  5. Despite separate channels, going back through conversations to find a specific topic can be challenging and time-consuming.
  6. Slack has numerous beeps, buzzes, alerts that can sometimes be more of a distraction than an assistance.
  7. This can be challenging for group adoption, especially if people are not tech-savvy.
  8. The free version only stores up to 10,000 messages after which it will start deleting. You have to pay for unlimited message storing. Any file storage beyond 5GB can be purchased and is likely a necessity for a large group or long-standing project.

Tips for success

  1. Set rules for the team to understand, agree and all adopt. Discuss expectations for message response times, and how to highlight what is time-sensitive versus what can wait.
  2. Set up “office hours” so that you can disconnect and keep a work-life balance. On that same note, use the “do not disturb mode” to restrict interruptions. You can also mute notifications.
  3. Create channels for targeted collaboration. Include all files, discussions, images etc. pertaining to that project within that specific channel.
  4. Assign an “owner” to each channel to ensure accountability and ensure there is someone to drive forward projects or conversations.
  5. Use @mentions to bring a specific person or people’s attention to a question or assigned task.
  6. Use the Slackbot to schedule reminders (function = /remind) instead of a separate calendar.
  7. Use the “do not disturb” mode to restrict contact when you’re at that really important COVID-19 meeting, on shift, or sleeping after a shift.
  8. Unsubscribe from channels that are no longer relevant or active to decrease clutter.

Microsoft Teams

Microsoft Teams is a communication, collaboration, and task management medium that offers real-time messaging, file-sharing, and transparent task assignments. Task management allows everyone in that particular team to see which member is responsible for a specific facet of a task from start to finish. It allows for accountability; team members can assign dates and tag team members to tasks. Similar to Slack, conversations can occur in channels that are organized by topic, project, team, etc and allows for a communal place for information sharing and project development. Teams have both desktop and mobile apps, so you can have it wherever you go.


  1. Most institutional academic hospitals have Microsoft licenses that come with Microsoft teams. Obviously, this will be location dependent.
  2. Often comes with large scale professional training, similar to Epic for most institutions, so users who are not familiar with the tool can learn quickly. You can schedule these for your team and avoid having to teach each user independently.
  3. Many of the chat functions and layout features are similar to Slack (even uses similar colors) so others who have not used Microsoft but may be familiar with Slack can usually pick it up quickly.
  4. It comes with a Wiki function as well as video chat and task management capabilities. Teams can use the app to edit shared documents, take meeting notes, and keep all of it in a shared app. The option to perform all functions within one workspace allows users to consolidate their technology savvy, but may be overwhelming for some.
  5. Has a large application library for integrations, generally focused on institutional needs. Many Microsoft integrated institutions that use apps such as Outlook and its Calendar function have Teams as their Task Management and communication app. It also integrates with outside apps (e.g. Onenote, OneDrive) and other Microsoft products.


  1. Not necessarily free. Pricing plans may be included with an institutional subscription. Personal use subscriptions range from $99.99 to $149.99 and vary on the number of users allowed. Business use ranges from $5.00/user/month to $12.50/user/month with an annual commitment.
  2. Must have specific security features installed in order to be HIPAA compliant. Check with your institution.
  3. Newer-kid-on-the-block for in the area of productivity software.
  4. As with all Microsoft Office products, there can be a steep learning curve.
  5. Hard to convince people who live on Slack or Whatsapp for everything else to transition to a separate platform.
  6. It doesn’t integrate well with Google Calendar and other Google products.
  7. Doesn’t yet integrate with audio function like other competitors (e.g. Slack) but rumor has it, the capability will be there soon (check out this blog post which hints this integration will occur by April 2020).

Tips for success

  1. Like slack, consider “office hours,” and set ground rules for the team to understand, agree and all adopt. Discuss expectations for message response times, and how to highlight what is time-sensitive versus what can wait.
  2. Use channels for targeted collaboration. Include all files, discussions, images etc. pertaining to that project within that specific channel. Create clear rules regarding how and when channels should be created as well as named, as they can quickly become unwieldy.
  3. Assign an “owner” to each channel to ensure transparent accountability and ensure there is someone to drive forward projects or conversations that may have stalled.
      • Use the task management aspect to assign tasks to specific members with specific due dates.
  4. Use @mentions to bring a specific person or people’s attention to a question or assigned task.
  5. Use the “do not disturb” mode to restrict constant pings.
  6. Unsubscribe from channels that are no longer relevant or active to decrease clutter


Voice Thread is an asynchronous, interactive tool allowing users to enter recordings of verbal commentary into a presentation. Presentations may be a slideshow or a poster, and users can enter their comments at a specific time point in the presentation.


  1. Users can enter comments at any time point in the presentation (ie: at minute 5 of the presentation or at slide 12).
  2. Users can asynchronously enter comments and therefore do not need to be captured in real-time. Comments can then be added to a slideshow or presentation that adds a more immersive experience to educational materials.
  3. Users can choose between adding their comments in audio format, video or through text.
  4. Can be easily integrated into already existent online courses through learning management systems.


  1. Not a tool that is utilized in real-time; rather, the comments all collate into the predefined presentation.
  2. One has to select a certain time in the presentation or a certain slide upon which to insert the comment.
  3. Users may be uncomfortable using their voice, as this is usually hidden in a text-heavy online learning community.
  4. Comments are not private and any comments added can be seen by anyone with access to the presentation.

Tips for success

  1. Voice Threads are best utilized as a question and answer format for predefined presentations.
  2. Consider adding Voice Threads to any asynchronous lectures, presentations of posters or slideshows.
  3. Voice Threads can substitute for traditional, in-person office hours
  4. Allow users to watch a demonstration video or have a practice presentation where users can trial each of the comment forms such as text comments, video recordings, and audio comments.

Conflict of Interests: The ALiEM team would like to thank Slack, Inc. for their generous support of the ALiEM Connect project during this difficult time. None of the ALiEM team members are receiving direct funding from their company.

Summary Infographic:

Stay tuned for the rest of this burst series, and if you missed them, check out our introduction post and posts highlighting real time videoconferencing, recording technologies, and small group conversations. For more information regarding remote work and education, check out ALiEM Remote.

Don’t want to reinvent the wheel for your weekly resident conferences? Check out ALiEM Connect, a live educational telecast with a concurrent moderated backchannel discussion.


  1. Chan TM, Joshi N, Lin M, Mehta N. Using Google Hangouts on Air for Medical Education: A Disruptive Way to Leverage and Facilitate Remote Communication and Collaboration. J Grad Med Educ. 2015 Jun; 7(2):171-173. PMID: 26221429
  2. Chan TM, Gottlieb M, Sherbino J, Cooney R, Boysen-Osborn M, Swaminathan A, Ankel F, Yarris LM. The ALiEM faculty incubator: a novel online approach to faculty development in education scholarship. Academic Medicine. 2018;93(10):1497-502. PMID: 29877914






Yusuf Yilmaz, PhD

Yusuf Yilmaz, PhD

Postdoctoral Fellow, McMaster Faculty of Health Sciences Education Research
Innovation and Theory (MERIT) Program, McMaster University
Fareen Zaver, MD

Fareen Zaver, MD

Chief Operating Officer, Chief Resident Incubator 2017-18
Lead Editor/Co-Founder of ALiEM Approved Instructional Resources - Professional (AIR-Pro)
Champion, 2016-17 ALiEM Chief Resident Incubator
Board Member, 2016-17 ALiEM Wellness Think Tank
Deputy Head - Education and Clinical Assistant Professor for Emergency Medicine
University of Calgary Emergency Department
Fareen Zaver, MD


@UCalgaryEM Clinical Educator, interests in transition to practice, gender equity, #FOAMed @ALiEMteam & @WeAreCanadiEM #Meded #genderequity
Shuhan He, MD
ALiEM Senior Systems Engineer;
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer,
Shuhan He, MD
Anita A Thomas, MD, MPH

Anita A Thomas, MD, MPH

Assistant Professor
Department of Pediatrics, Division of Emergency Medicine
University of Washington/Seattle Children’s Hospital
Teresa Chan, MD, MHPE
ALiEM Associate Editor
Emergency Physician, Hamilton
Associate Professor, McMaster University
Assistant Dean, Program for Faculty Development, McMaster University Ontario, Canada
Teresa Chan, MD, MHPE


ERDoc. #meded #FOAMed Own views expressed. Contributor to @ALiEMteam, @WeAreCanadiEM, ICE Blog, #FeminEM. @MedEdLIFE founder. Works @McMasterU & @HamHealthSci
Kathryn Fisher, MD, MS

Kathryn Fisher, MD, MS

Medical Education Fellow, Assistant Professor, Assistant Clerkship Director, Baylor College of Medicine
Sarah Mott, MD

Sarah Mott, MD

Chief Logistics Officer ALiEM Wellness Think Tank 2019-20
Staff Emergency Physician
Emergency Care Consultants