JMIR Publications

ABSTRACT

Background:

Spaced digital education applies digital tools to deliver educational content via multiple, repeated learning sessions separated by pre-specified time intervals. Spaced digital education appears to promote acquisition and long-term retention of knowledge, skills, and change in clinical behavior.

Objective:

The aim of this review was to assess the effectiveness of spaced digital education in improving pre- and post-registration healthcare professionals’ knowledge, skills, attitudes, satisfaction and change in clinical behavior.

Methods:

This review followed Cochrane’s methodology and PRISMA reporting guidelines. We searched MEDLINE, Embase, Web of Science, ERIC, PsycINFO, CINAHL, CENTRAL, and ProQuest Dissertation and Theses Database from 1990 to February 2023. We included randomized controlled trials, cluster randomized controlled trials and quasi- randomized controlled trials comparing spaced digital education with non-spaced education, spaced non-digital education, traditional learning or no intervention for pre- or post-registration healthcare professionals. Study selection, data extraction, study quality and certainty of evidence were assessed by two independent reviewers. Meta-analyses were conducted using random effect models.

Results:

We included 23 studies evaluating spaced online education (n=17, 74%) or spaced digital simulation (n=6, 26%) interventions. Most studies assessed one or two outcomes, including knowledge (n=15, 65%), skills (n=9, 39%), attitudes (n=8, 35%), clinical behavior change (n=8, 35%) and satisfaction (n=7, 31%). Most studies had unclear or high risk of bias (n=19, 83%). Spaced online education was superior to massed online education for post-intervention knowledge (n=9, SMD: 0.32, 95% CI: 0.13, 0.51, I2=66%, moderate certainty of evidence). Spaced online education (n=3) was superior to massed online education (n=2) and no intervention (n=1) (SMD: 0.67, 95% CI: 0.43, 0.91, I2=5%, moderate certainty of evidence) for post-intervention clinical behavior change. Spaced digital simulation was superior to massed simulation for post-intervention surgical skills (n=2, SMD: 1.15, 95% CI: 0.34, 1.96, I2=74%, low certainty of evidence). Spaced digital education positively impacted confidence and satisfaction with the intervention.

Conclusions:

Spaced digital education is effective for improving knowledge, and particularly for substantially improving surgical skills and promoting clinical behavior change in in pre- and post-registration healthcare professionals. Our findings support the use of spaced digital education interventions in undergraduate and post-graduate health professions education. Clinical Trial: This systematic review was registered in PROSPERO (CRD42021241969) on April 14, 2021.