JMIR Publications

ABSTRACT

Background:

Globally, online and local area network-based (LAN) digital education (ODE) has grown in popularity. Blended learning is the use of ODE along with traditional learning. Studies have shown the increasing potential of these technologies in training medical doctors yet the evidence for its effectiveness and cost-effectiveness is unclear.

Objective:

This review evaluated the effectiveness of online and LAN-based digital education (ODE) in improving medical doctors’ knowledge, skills, attitude, satisfaction (primary outcomes), practice or behavior change, patient outcomes and cost-effectiveness (secondary outcomes).

Methods:

We searched seven electronic databases for randomized controlled trials (RCTs), cluster-randomized trials (cRCTs), and quasi-randomized trials from January 1990 to March 2017. Two review authors independently extracted data and assessed the risk of bias. Due to high heterogeneity in terms of populations, interventions, comparators and outcomes, we were unable to conduct the pre-planned meta-analyses. Instead we have presented the findings narratively. When possible, we present outcomes using standardized mean difference (SMD) for continuous variables and risk ratios (RR) for dichotomous variables. In the main review we have presented only comparisons ODE vs self-directed/face-to-face learning and blended learning vs self-directed/face-to-face learning, rest of the comparisons are presented in Multimedia Appendix 1.

Results:

Ninety-three studies (N = 16,895) were included of which seventy-six studies compared ODE (including blended) vs self-directed/face-to-face learning. Overall the effect of ODE (including blended) on post-intervention knowledge, skills, attitude, satisfaction, practice or behavior change and patient outcomes was inconsistent and ranged mostly from no difference between the groups to higher post-intervention score in the intervention group (small to large effect size, very low to low quality evidence). Twenty-one studies reported higher knowledge score (small to large effect size; very low quality) for the intervention while 20 studies reported no difference in knowledge between the groups. Seven studies reported higher skill score in the intervention (large effect size; low quality) while thirteen studies reported no difference in skill score between the groups. One study reported higher attitude score for the intervention (very low quality), while 4 studies reported no difference in attitude score between the groups. Four studies reported higher post-intervention physician satisfaction with the intervention (large effect size; low quality), while six studies reported no difference in satisfaction between the groups. Eight studies reported higher post-intervention practice or behavior change for the ODE group (small to moderate effect size; low quality) while five studies reported no difference in practice or behavior change between the groups. One study reported higher improvement in patient outcome, while three others reported no difference in patient outcome between the groups. None of the included studies reported any unintended/adverse effects, cost-effectiveness of the interventions.

Conclusions:

Empiric evidence from majority of the studies reported that ODE and blended learning may be equivalent to self-directed/face-to-face learning for training physicians'. Few other studies demonstrated that ODE and blended learning may significantly improve learning outcomes compared to self-directed/face-to-face learning. The quality of the evidence in these studies was found to be low and very low for knowledge. Given the inconsistent findings, further high quality RCTs are required before evidence of efficacy can be concluded.