Chapter 4 presents the results of a study by Palaganas, involving participants in an online continuing education course that used an emoji-capable, text-based platform, offered through the Center for Medical Simulation in Boston, Massachusetts. The chapter outlines the study, the compiled data, and the relevant findings. The study yields further insights into the potential for using the emoji code as an effective literacy and communication tool in a higher education context – namely, in a healthcare professional education program. Further, there is discussion of an interview with Dr. Shuhan He, a prominent proponent of emoji use in healthcare situations, wherein he goes over the impetus for his creation of the heart emoji.

The goal of Chapter 5 is to examine emoji use across the healthcare landscape, as well as what implications related to emoji theories can be gleaned from such usage and how emoji use can be applied to training healthcare professionals more generally. Prominently discussed in the chapter are clinical studies that indicate emoji writing (between practitioners and patients) may actually enhance medical outcomes. Also highlighted is the empirically attested fact that emoji scales and models may be good gauges for assessing well-being. The overall conclusion that can be drawn from the studies is that emoji might affect patients positively. Emoji are not medical cures in themselves, needless to say; they are simple pictures that affect patients positively, much like humor. They may also counteract the so-called nocebo effect, defined as a detrimental effect on health produced by psychological or psychosomatic factors such as negative expectations of treatment or prognosis.

Chapter 7 distills from the empirical studies their implications for emoji theories overall and for their applicability to the educational and healthcare realms. The studies have borne a number of concrete implications for emoji theory in general, including how they fit in with communication theories, including nonverbal aspects. Several theoretical notions are developed as well, generalizing them from previous chapters, including the apparent function of emoji as “annotators” of meaning, not just conveyors of prosodic or gestural features in writing. Another notion is that of episodic meaning, whereby the placement of an emoji in the episodes that constitute a message adds to it semiotically. Emoji grammar is thus more appropriately characterized as an episodic grammar.

Using both the Petcoff and Palaganas studies as a point of departure, this chapter looks at the more general educational implications of bringing emoji into pedagogical practices. The underlying premise is that emoji not only are highly understandable images, aiding learning but also can create a positive environment, making teaching and interaction congenial and open to all learners, no matter their backgrounds or learning capacities, since emoji give them an equal voice. Emoji allow for a destigmatized approach, especially for disadvantaged learners who might not be able to adequately speak for themselves. Emoji are a psychological conduit that can easily open up lines of interaction to virtually everyone. Once this is achieved, any subject matter, from English to mathematics, can be imparted broadly through any type of learning style.

Chapter 2 summarizes the findings of a research project conducted by Petcoff in which she explores using emoji as a viable literacy and postsecondary writing teaching tool. Her work chronicles the teaching situation in a Texas community college, whereby an integrated reading and writing project was devised in which students attempted to demonstrate mastery of State-mandated literacy content areas using both traditional writing and the emoji code. The project provides data-driven findings that allow for the exploration of semioliteracy as a teaching approach, as well how the shared meanings of emoji by students constitute an unconscious semiotic domain. The Petcoff study offers opportunities for further research with similar groups of learning, via iconographic tracking and rendered ecologies with a particular focus on advancing literacy within the framework of first-year and postsecondary writing instructional efforts. Parallels between semioliterate qualities used in reading and writing instruction and healthcare, as well as healthcare professional education, are discussed at the conclusion of the chapter.

The historical relationship between semiotics and healthcare is explored in Chapter 3. The authors look specifically at the link between education and healthcare communications that is established by the use of emoji in such communications. The semioliterate nature of healthcare and its implications for respective education are explored, particularly as these relate to early diagnoses based on physical signs and symptoms. Parallels are then drawn between the semioliterate qualities of emoji in the Petcoff study (Chapter 2) and the potentiality of emoji as an effective doctor-to-patient healthcare communicative tool. The chapter concludes by considering how the emoji code can be inserted into traditional healthcare professional education settings, so as to show students how effective it can be in practitioner–patient interactions.

Chapter 1 offers an in-depth, historically based discussion of the research on emoji and on matters of general concern regarding this unique type of visual character, along with a rationale for the need for a comprehensive treatment of emoji in education. The authors describe the reasons for focusing on higher education, particularly health professional education. They begin by examining the background work on emoji theory and research and offer initial insights into the discourse and semiotic functions of the emoji code. Such functions form the basis for considering the emoji code as a teaching tool that may be used to craft hybrid literacy-focused instruction (textual and visual). The discursive and recursive properties of emoji form the basis of semioliteracy, a theory that one of the authors (Petcoff) contends offers a basis for emoji use in developmental reading and writing and across several higher education academic fields. Specifically, the chapter addresses the potential use of emoji as a literacy instruction tool in both higher education and healthcare professional education.