JMIR Publications

ABSTRACT

Background:

Effective communication skills are essential in diagnosis and treatment processes and building of the doctor-patient relationship. We studied whether digital education can improve the quality of future doctors’ communication skills.

Objective:

The aim of this systematic review was to evaluate the effectiveness of digital education for communication skills development.

Methods:

We performed a systematic review and searched seven electronic databases and two trial registries for randomized controlled trials (RCTs) and cluster RCTs (cRCTs) published between January 1990 and September 2018. Two reviewers independently screened the citations, extracted data from the included studies and assessed risk of bias. We also assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment.

Results:

We included 12 studies with 2053 medical students, of which 10 were RCTs and two were cRCTs. The digital education included online modules, virtual patient (VP) simulations and video-assisted oral feedback. The control groups included didactic lectures, oral feedback, standard curriculum, role-play and no intervention as well as less interactive forms of digital education. The overall risk of bias was high; and the quality of evidence ranged from moderate to very low. For skills outcome, meta-analysis of three studies comparing digital education to traditional learning showed no statistically significant difference in postintervention skills scores between the groups (SMD = -0.19, 95% CI: -0.9 to 0.52, N=3 studies (304 students), I2=86%, small effect size, low quality evidence). Similarly, a meta-analysis of four studies comparing the effectiveness of blended digital education (i.e. online or offline digital education plus traditional learning) to traditional learning showed no statisticially significant difference in postintervention skills between the groups (SMD= 0.15, 95% CI: -0.26 to 0.56, I2=86%, N=4 studies (762 students), small effect size, low quality evidence). Meta-analysis of four studies comparing more interactive to less interactive forms of digital education also showed no difference in postintervention skills scores between the two groups (SMD=0.12, 95%CI: -0.09 to 0.33, I2=40%, N=4 studies (864 students), small effect size, moderate quality evidence). For knowledge outcome, two studies comparing the effectivenesss of blended online digital education to traditional learning reported no difference in postintervention knowledge scores between the groups (SMD=0.18, 95% CI: -0.2 to 0.55, I2=61%, N= 2 studies (292 students), small effect size, low quality evidence). Two studies (446 students) comparing the effectivness of blended online digital education to traditional learning assessed the students’ attitude towards the outcome (skills acquisition) and reported no difference between the groups or favored blended online education over training learning with didactic lectures. One study comparing different forms of digital education, reported higher attitude scores in VP simulation groups compared to online module (SMD=0.71, 95% CI: 0.51 to 0.91). Two studies assessed students’ satisfaction and either favored the intervention group or reported similar effectiveness in the intervention group compared to traditional learning group. One study assessed patient-related outcome (i.e. patients’ satisfaction) with blended online digital education compared to traditional learning with group discussion and reported higher postintervention scores in the intervention group (SMD=-0.43, 95% CI: -0.73 to -0.13). None of the included studies reported adverse outcomes or economic evaluation of the interventions.

Conclusions:

Our findings show no significant difference in communication skills between medical students receiving traditional learning or digital education with online modules or virtual patient simulations. Similarly, the more interactive forms of digital education reported similar effectiveness or no difference in post-intervention skills outcome compared to the less interactive forms of digital education. There is a need for further research to evaluate the effectiveness of other forms of digital education such as VR, serious gaming and mobile learning on medical students’ attitude, satisfaction, patient-related outcomes as well as the adverse effects and cost-effectivness of digital education. Clinical Trial: n/a