Offline digital education for medical students: systematic review and meta-analysis by the digital health education collaboration

Journal of Medical Internet Research

Volumn 21, Issue 3, 2019, Pages

  Kyaw, Bhone Myint ^a   Posadzki, Pawel ^b   Dunleavy, Gerard ^b   Semwal, Monika ^b   Divakar, Ushashree ^b   Hervatis, Vasilis ^c   Car, Lorainne Tudor ^a,d  

^a LEE KONG CHIAN SCHOOL OF MEDICINE   (Singapore)

^b NANYANG TECHNOLOGICAL UNIVERSITY   (Singapore)

^c KAROLINSKA INSTITUTE   (Sweden)

^d IMPERIAL COLLEGE LONDON   (United Kingdom)

Author keywords

Medical; Medical education; Meta analysis; Randomized controlled trials; Students; Systematic review

Indexed keywords

HEALTH EDUCATION; HUMAN; MEDICAL EDUCATION; MEDICAL STUDENT; META ANALYSIS; PROCEDURES; PSYCHOLOGY; RANDOMIZED CONTROLLED TRIAL (TOPIC);

EDUCATION, MEDICAL; HEALTH EDUCATION; HUMANS; RANDOMIZED CONTROLLED TRIALS AS TOPIC; STUDENTS, MEDICAL;

EID: 85063713133     PISSN: None     EISSN: 14388871     Source Type: Journal    
DOI: 10.2196/13165     Document Type: Review

References (69)

1. World Health Organization. 2016. High-Level Commission on Health Employment and Economic Growth Health workforce URL: http://www.who.int/hrh/com-heeg/en/[accessed 2018-11-14] [WebCite Cache ID 73uaCutCo].
2. Anand S, Bärnighausen T. Human resources and health outcomes: cross-country econometric study. Lancet 2004;364(9445):1603-1609. [doi:10.1016/S0140-6736(04)17313-3] [Medline: 15519630].
3. Campbell J, Dussault G, Buchan J, Pozo-Martin F, Guerra AM, Leone C, et al. World Health Organization. 2013. A universal truth: no health without a workforce URL: https://www.who.int/workforcealliance/knowledge/resources/GHWA-AUniversalTruthReport.pdf [accessed 2019-03-01] [WebCite Cache ID 76Xhm6eKa].
4. Chen LC. Striking the right balance: health workforce retention in remote and rural areas. Bull World Health Organ 2010 May;88(5):323, A [FREE Full text] [doi:10.2471/BLT.10.078477] [Medline: 20461215].
5. Hongoro C, McPake B. How to bridge the gap in human resources for health. Lancet 2004;364(9443):1451-1456. [doi:10.1016/S0140-6736(04)17229-2] [Medline: 15488222].
6. Luxton E. World Economic Forum. 4 billion people still don't have internet access. Here's how to connect them URL: https://www.weforum.org/agenda/2016/05/4-billion-people-still-don-t-have-internet-access-here-s-how-to-connect-them/[accessed 2019-02-27] [WebCite Cache ID 74aFf1JDH].
7. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet 2010 Dec 04;376(9756):1923-1958. [doi:10.1016/S0140-6736(10)61854-5] [Medline: 21112623].
8. World Health Organization. 2015. eLearning for undergraduate health professional education: A systematic review informing a radical transformation of health workforce development URL: http://www.who.int/hrh/documents/14126-eLearningReport.pdf [accessed 2018-11-14] [WebCite Cache ID 73ua0wCm4].
9. Carr MM, Reznick RK, Brown DH. Comparison of computer-assisted instruction and seminar instruction to acquire psychomotor and cognitive knowledge of epistaxis management. Otolaryngol Head Neck Surg 1999 Oct;121(4):430-434. [doi:10.1016/S0194-5998(99)70233-0] [Medline: 10504600].
10. Hudson JN. Computer-aided learning in the real world of medical education: does the quality of interaction with the computer affect student learning? Med Educ 2004 Aug;38(8):887-895. [doi:10.1111/j.1365-2929.2004.01892.x] [Medline: 15271050].
11. Crisp N, Gawanas B, Sharp I, Task Force for Scaling Up Education and Training for Health Workers. Training the health workforce: scaling up, saving lives. The Lancet 2008 Feb;371(9613):689-691. [doi:10.1016/s0140-6736(08)60309-8] [Medline: 18295028].
12. Brandt MG, Davies ET. Visual-spatial ability, learning modality and surgical knot tying. Can J Surg 2006 Dec;49(6):412-416 [FREE Full text] [Medline: 17234070].
13. Greenhalgh T. Computer assisted learning in undergraduate medical education. BMJ 2001 Jan 06;322(7277):40-44 [FREE Full text] [Medline: 11141156].
14. Glicksman JT, Brandt MG, Moukarbel RV, Rotenberg B, Fung K. Computer-assisted teaching of epistaxis management: A Randomized Controlled Trial. Laryngoscope 2009 Mar;119(3):466-472. [doi:10.1002/lary.20083] [Medline: 19235749].
15. Hunt CE, Kallenberg GA, Whitcomb ME. Medical students' education in the ambulatory care setting: background paper 1 of the Medical School Objectives Project. Acad Med 1999 Mar;74(3):289-296. [Medline: 10099654].
16. Woo MK, Ng KH. A model for online interactive remote education for medical physics using the Internet. J Med Internet Res 2003;5(1):e3 [FREE Full text] [doi:10.2196/jmir.5.1.e3] [Medline: 12746208].
17. Rasmussen K, Belisario JM, Wark PA, Molina JA, Loong SL, Cotic Z, et al. Offline eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction. J Glob Health 2014 Jun;4(1):010405 [FREE Full text] [doi:10.7189/jogh.04.010405] [Medline: 24976964].
18. Hervatis V, Kyaw B, Semwal M, Dunleavy G, Tudor CL, Zary N. PROSPERO CRD42016045679. 2016 Apr 15. Offline and computer-based eLearning interventions for medical students' education [Cochrane Protocol] URL: http://www.crd.york.ac.uk/PROSPERO/display-record.php?ID=CRD42016045679 [accessed 2019-02-18] [WebCite Cache ID 76GXpzD6T].
19. Car J, Carlstedt-Duke J, Tudor Car L, Posadzki P, Whiting P, Zary N, Digital Health Education Collaboration. Digital Education in Health Professions: The Need for Overarching Evidence Synthesis. J Med Internet Res 2019 Dec 14;21(2):e12913 [FREE Full text] [doi:10.2196/12913] [Medline: 30762583].
20. Posadzki P, Bala M, Kyaw B, Semwal M, Divakar U, Koperny M, et al. Offline digital education for post-registration health professions: A systematic review by the Digital Health Education collaboration. J Med Internet Res (forthcoming) 2018:a [FREE Full text].
21. Kyaw BM, Saxena N, Posadzki P, Vseteckova J, Nikolaou CK, George PP, et al. Virtual Reality for Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res 2019 Jan 22;21(1):e12959 [FREE Full text] [doi:10.2196/12959] [Medline: 30668519].
22. Tudor Car L, Kyaw BM, Dunleavy G, Smart NA, Semwal M, Rotgans JI, et al. Digital Problem-Based Learning in Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res 2019 Feb 28;21(2):e12945 (forthcoming) [FREE Full text] [doi:10.2196/12945] [Medline: 30816846].
23. Gentry SV, Gauthier A, Ehrstrom BL, Wortley D, Lilienthal A, Tudor Car L, et al. Serious gaming and gamification education in health professions: A systematic review by the Digital Health Education Collaboration. J Med Internet Res (forthcoming) 2018:a (forthcoming) [FREE Full text].
24. Dunleavy G, Nikolaou CK, Nifakos S, Atun R, Law GCY, Tudor Car L. Mobile Digital Education for Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res 2019 Feb 12;21(2):e12937 [FREE Full text] [doi:10.2196/12937] [Medline: 30747711].
25. Semwal M, Whiting P, Bajpai R, Bajpai S, Kyaw BM, Tudor Car L. Digital Education for Health Professions on Smoking Cessation Management: Systematic Review by the Digital Health Education Collaboration. J Med Internet Res 2019 Mar 04;21(3):e13000 [FREE Full text] [doi:10.2196/13000] [Medline: 30829576].
26. Huang Z, Semwal M, Lee SY, Tee M, Ong W, Tan WS, et al. Digital Health Professions Education on Diabetes Management: Systematic Review by the Digital Health Education Collaboration. J Med Internet Res 2019 Feb 21;21(2):e12997 [FREE Full text] [doi:10.2196/12997] [Medline: 30789348].
27. Barr H, Freeth D, Hammick M, Koppel I, Reeves S. CAIPE: Centre for the Advancement of Interprofessional Education. 2000. Evaluations of interprofessional education: A United Kingdom review for health and social care URL: https://www.caipe.org/resources/publications/barr-h-freethd-hammick-m-koppel-i-reeves-s-2000-evaluations-of-interprofessional-education [accessed 2019-03-07] [WebCite Cache ID 76hlNDi45].
28. Endnote (X.8.2). Philadelphia, PA: Clarivate Analytics; 2018. URL: https://endnote.com/downloads/available-updates/[accessed 2019-03-01] [WebCite Cache ID 76XdZ69fO].
29. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. London: The Cochrane Collaboration; 2011. URL: http://crtha.iums.ac.ir/files/crtha/files/cochrane.pdf [accessed 2019-03-01] [WebCite Cache ID 76XcKQdGg].
30. Puffer S, Torgerson D, Watson J. Evidence for risk of bias in cluster randomised trials: Review of recent trials published in three general medical journals. BMJ 2003 Oct 04;327(7418):785-789 [FREE Full text] [doi:10.1136/bmj.327.7418.785] [Medline: 14525877].
31. Cook DA, Hatala R, Brydges R, Zendejas B, Szostek JH, Wang AT, et al. Technology-enhanced simulation for health professions education: A systematic review and meta-analysis. JAMA 2011 Sep 07;306(9):978-988. [doi:10.1001/jama.2011.1234] [Medline: 21900138].
32. RevMan. Review Manager 5.3. Copenhagen: The Nordic Cochrane Centre: The Cochrane Collaboration; 2014. URL: https://community.cochrane.org/help/tools-and-software/revman-5 [accessed 2019-03-01] [WebCite Cache ID 76Xbuy3C8].
33. Schünemann HJ, Oxman AD, Higgins JPT, Vist GE, Glasziou P, Guyatt GH. Presenting results and 'Summary of findings' tables (Chapter 11). In: Cochrane Handbook for Systematic Reviews of Interventions. London: The Cochrane Collaboration; 2008.
34. Chan RJ, Webster J, Marquart L. Information interventions for orienting patients and their carers to cancer care facilities. Cochrane Database Syst Rev 2011 Dec 07(12):CD008273. [doi:10.1002/14651858.CD008273.pub2] [Medline: 22161425].
35. Ackermann O, Siemann H, Schwarting T, Ruchholtz S. [Effective skill training by means of E-learning in orthopaedic surgery]. Z Orthop Unfall 2010 May;148(3):348-352. [doi:10.1055/s-0029-1240549] [Medline: 20135601].
36. Amesse LS, Callendar E, Pfaff-Amesse T, Duke J, Herbert WN. Evaluation of Computer-aided Strategies for Teaching Medical Students Prenatal Ultrasound Diagnostic Skills. Med Educ Online 2008 Sep 24;13:13 [FREE Full text] [doi:10.3885/meo.2008.Res00275] [Medline: 20165541].
37. Armstrong P, Elliott T, Ronald J, Paterson B. Comparison of traditional and interactive teaching methods in a UK emergency department. Eur J Emerg Med 2009 Dec;16(6):327-329. [doi:10.1097/MEJ.0b013e32832b6375] [Medline: 19421067].
38. Carrero E, Gomar C, Penzo W, Fábregas N, Valero R, Sánchez-Etayo G. Teaching basic life support algorithms by either multimedia presentations or case based discussion equally improves the level of cognitive skills of undergraduate medical students. Med Teach 2009 May;31(5):e189-e195. [doi:10.1080/01421590802512896] [Medline: 19241215].
39. Cheng Y, Liu DR, Wang VJ. Teaching Splinting Techniques Using a Just-in-Time Training Instructional Video. Pediatr Emerg Care 2017 Mar;33(3):166-170. [doi:10.1097/PEC.0000000000000390] [Medline: 25834963].
40. Davis J, Crabb S, Rogers E, Zamora J, Khan K. Computer-based teaching is as good as face to face lecture-based teaching of evidence based medicine: A randomized controlled trial. Med Teach 2008;30(3):302-307. [doi:10.1080/01421590701784349] [Medline: 18484458].
41. de Jong Z, van Nies JA, Peters SW, Vink S, Dekker FW, Scherpbier A. Interactive seminars or small group tutorials in preclinical medical education: Results of a randomized controlled trial. BMC Med Educ 2010 Nov 13;10:79 [FREE Full text] [doi:10.1186/1472-6920-10-79] [Medline: 21073744].
42. Desch LW, Esquivel MT, Anderson SK. Comparison of a computer tutorial with other methods for teaching well-newborn care. Am J Dis Child 1991 Nov;145(11):1255-1258. [Medline: 1951216].
43. Devitt P, Palmer E. Computer-aided learning: An overvalued educational resource? Med Educ 1999 Feb;33(2):136-139. [Medline: 10211264].
44. Elves AW, Ahmed M, Abrams P. Computer-assisted learning; experience at the Bristol Urological Institute in the teaching of urology. Br J Urol 1997 Nov;80 Suppl 3:59-62. [Medline: 9415087].
45. Fasce E, Ramírez L, Ibáñez P. [Evaluation of a computer-based independent study program applied to fourth year medical students]. Rev Med Chil 1995 Jun;123(6):700-705. [Medline: 8525222].
46. Finley JP, Sharratt GP, Nanton MA, Chen RP, Roy DL, Paterson G. Auscultation of the heart: A trial of classroom teaching versus computer-based independent learning. Med Educ 1998 Jul;32(4):357-361. [Medline: 9743795].
47. Gelb DJ. Is newer necessarily better?: Assessment of a computer tutorial on neuroanatomical localization. Neurology 2001 Feb 13;56(3):421-422. [Medline: 11171920].
48. Green MJ, Levi BH. Teaching advance care planning to medical students with a computer-based decision aid. J Cancer Educ 2011 Mar;26(1):82-91 [FREE Full text] [doi:10.1007/s13187-010-0146-2] [Medline: 20632222].
49. Hilger AE, Hamrick HJ, Denny FWJ. Computer instruction in learning concepts of streptococcal pharyngitis. Arch Pediatr Adolesc Med 1996 Jun;150(6):629-631. [Medline: 8646314].
50. Holt RI, Miklaszewicz P, Cranston IC, Russell-Jones D, Rees PJ, Sönksen PH. Computer assisted learning is an effective way of teaching endocrinology. Clin Endocrinol (Oxf) 2001 Oct;55(4):537-542. [Medline: 11678838].
51. Lee CSC, Rutecki GW, Whittier FC, Clarett MR, Jarjoura D. A comparison of interactive computerized medical education software with a more traditional teaching format. Teaching and Learning in Medicine 1997 Jan;9(2):111-115. [doi:10.1080/10401339709539824].
52. MacFadyen JC, Brown JE, Schoenwald R, Feldman RD. The effectiveness of teaching clinical pharmacokinetics by computer. Clin Pharmacol Ther 1993 Jun;53(6):617-621. [Medline: 8513652].
53. Mangione S, Nieman LZ, Greenspon LW, Margulies H. A comparison of computer-assisted instruction and small-group teaching of cardiac auscultation to medical students. Med Educ 1991 Sep;25(5):389-395. [Medline: 1758315].
54. McDonough M, Marks IM. Teaching medical students exposure therapy for phobia/panic - randomized, controlled comparison of face-to-face tutorial in small groups vs. solo computer instruction. Med Educ 2002 May;36(5):412-417. [Medline: 12028390].
55. Mojtahedzadeh R, Mohammadi A, Emami AH, Rahmani S. Comparing live lecture, internet-based & computer-based instruction: A randomized controlled trial. Med J Islam Repub Iran 2014;28:136 [FREE Full text] [Medline: 25694994].
56. Nola M, Morović A, Dotlić S, Dominis M, Jukić S, Damjanov I. Croatian implementation of a computer-based teaching program from the University of Kansas, USA. Croat Med J 2005 Jun;46(3):343-347 [FREE Full text] [Medline: 15861510].
57. Perfeito JA, Forte V, Giudici R, Succi JE, Lee JM, Sigulem D. [Development and assessment of a multimedia computer program to teach pleural drainage techniques]. J Bras Pneumol 2008 Jul;34(7):437-444 [FREE Full text] [Medline: 18695787].
58. Pusic MV, Leblanc VR, Miller SZ. Linear versus web-style layout of computer tutorials for medical student learning of radiograph interpretation. Acad Radiol 2007 Jul;14(7):877-889. [doi:10.1016/j.acra.2007.04.013] [Medline: 17574137].
59. Ram SP, Phua KK, Ang BS. The effectiveness of a computer-aided instruction courseware developed using interactive multimedia concepts for teaching Phase III MD students. Medical Teacher 2009 Jul 03;19(1):51-52. [doi:10.3109/01421599709019348].
60. Santer DM, Michaelsen VE, Erkonen WE, Winter RJ, Woodhead JC, Gilmer JS, et al. A comparison of educational interventions. Multimedia textbook, standard lecture, and printed textbook. Arch Pediatr Adolesc Med 1995 Mar;149(3):297-302. [Medline: 7532074].
61. Seabra D, Srougi M, Baptista R, Nesrallah LJ, Ortiz V, Sigulem D. Computer aided learning versus standard lecture for undergraduate education in urology. J Urol 2004 Mar;171(3):1220-1222. [doi:10.1097/01.ju.0000114303.17198.37] [Medline: 14767306].
62. Shomaker TS, Ricks DJ, Hale DC. A prospective, randomized controlled study of computer-assisted learning in parasitology. Acad Med 2002 May;77(5):446-449. [Medline: 12010707].
63. Solomon DJ, Ferenchick GS, Laird-Fick HS, Kavanaugh K. A randomized trial comparing digital and live lecture formats [ISRCTN40455708. BMC Med Educ 2004 Nov 29;4:27 [FREE Full text] [doi:10.1186/1472-6920-4-27] [Medline: 15569389].
64. Stanford W, Erkonen WE, Cassell MD, Moran BD, Easley G, Carris RL, et al. Evaluation of a computer-based program for teaching cardiac anatomy. Invest Radiol 1994 Feb;29(2):248-252. [Medline: 8169104].
65. Summers A, Rinehart GC, Simpson D, Redlich PN. Acquisition of surgical skills: A randomized trial of didactic, videotape, and computer-based training. Surgery 1999 Aug;126(2):330-336. [Medline: 10455902].
66. Taveira-Gomes T, Prado-Costa R, Severo M, Ferreira MA. Characterization of medical students recall of factual knowledge using learning objects and repeated testing in a novel e-learning system. BMC Med Educ 2015 Jan 24;15:4 [FREE Full text] [doi:10.1186/s12909-014-0275-0] [Medline: 25616353].
67. Vichitvejpaisal P, Sitthikongsak S, Preechakoon B, Kraiprasit K, Parakkamodom S, Manon C, et al. Does computer-assisted instruction really help to improve the learning process? Med Educ 2001 Oct;35(10):983-989. [Medline: 11564203].
68. Vivekananda-Schmidt P, Lewis M, Hassell AB, ARC Virtual Rheumatology CAL Research Group. Cluster randomized controlled trial of the impact of a computer-assisted learning package on the learning of musculoskeletal examination skills by undergraduate medical students. Arthritis Rheum 2005 Oct 15;53(5):764-771 [FREE Full text] [doi:10.1002/art.21438] [Medline: 16208642].
69. Vivekananda-Schmidt P, Lewis M, Hassell AB, ARC Virtual Rheumatology CAL Research Group. Cluster randomized controlled trial of the impact of a computer-assisted learning package on the learning of musculoskeletal examination skills by undergraduate medical students. Arthritis Rheum 2005 Oct 15;53(5):764-771 [FREE Full text] [doi:10.1002/art.21438] [Medline: 16208642].