August, 2016 - SUPPORT Summary of a systematic review | print this article |

Does Internet based learning in the health professions improve learning outcomes?

Internet based learning is increasingly used in the training and ongoing education of health professionals. Concerns about the effects of this medium of teaching and learning have stimulated a large body of research. This summary describes a review and meta-analysis of research on the effectiveness of internet based learning by health professions.

 

Key messages

  • Internet-based learning methods compared with no inter-vention may improve health professionals’ knowledge, but it is not known whether they improve skills and behaviours of health professionals, or if they lead to beneficial effects on patients.

-Practise exercises, tutorials, online discussions and longer duration courses may improve the effects of internet-based learning.

  • It is not known whether Internet-based learning by health professions improves knowledge or other outcomes when compared to other forms of teaching and learning.

 

Background

Internet-based learning has become a popular approach to medical education since the advent of the World Wide Web in 1991. It permits learners to participate at a time and place convenient to them, facilitates innovation in instructional methods, and potentially allows instruction to be tailored to the individuals needs.

Several studies have been undertaken to assess the effectiveness of internet–based learning. This review included sutdies of the use of internet-based learning at any stage in training or practice by health professionals. The authors also sought to determine factors that could explain differences in effect across participants, settings, interventions, outcomes and study designs.



About the systematic review underlying this summary

Review objectives: To assess the effects of internet-based learning by health professionals
Type of What the review authors searched for What the review authors found
Study designs & interventions Internet based learning for health professionals at any stage of training or practice
201 studies (including observational and experimental designs) of internet based learning for health professionals, addressing a wide range of topics, and using a range of modalities for teaching and learning
Participants Health profession learners (including students and practising physicians, nurses, dentists, pharmacists and others) Health profession learners
Settings All settings and languages
All settings
Outcomes Satisfaction; learning (knowledge, attitudes, skills); behaviours or effects on patients Knowledge, skills, behaviours and effects on patients, satisfaction
Date of most recent search: January 2008
Limitations: The review is from 2008 and the studies up to 2007. New information is likely to be available.

To assess the effects of internet-based learning by health professionals

Cook DA, Levinson AJ, Garside S, et al. Internet-based learning in the health professions: a meta-analysis. JAMA 2008; 300:1181-96.

Summary of findings

Findings are reported separately for the two main comparisons - internet-based learning compared to no intervention and compared to non-internet-based learning. Key findings of sub-analyses are also reported.

 

1) Internet based learning compared to no intervention

Internet based learning was compared to no learning intervention for health professionals. Satisfaction outcomes were not reported, as no studies reported meaningful outcomes of this type.

  • Internet-based learning may improve knowledge. The certainty of this evidence is low.
  • It is not known if they improve skills, behaviours or patient care when compared to no intervention. The certainty of this evidence is very low.
  • Practise exercises may enhance skills acquisition, but not knowledge or behaviours. The certainty of this evidence is low.
  • Tutorials, longer duration courses and online peer discus-sions may improve behaviours and effects on patient care. The certainty of this evidence is low.

 

Internet-based learning compared to no intervention

People:  Health professionals
Settings
:  Classroom or practice
Intervention
: Internet-based learning
Comparison
: No intervention
Outcomes Impact Certainty of the evidence
(GRADE)

Knowledge

There was a large effect on knowledge outcomes.

Pooled effect size 1.00 (95% CI 0.90 to 1.10)

High interactivity, ongoing access to course materials, online discussion, not associated with larger effects.

High quality studies were associated with smaller effects.

Pooled effect size 0.71 (95% CI 0.51 to 0.92)

Low

Skills

Overall, the effect on skills was uncertain.

Pooled effect size 0.85 (95% CI 0.49 to 1.20).

Practice exercises were associated with larger effects.

Pooled effect size 1.01 (95% CI 0.60-1.43)

High interactivity, repetition, and online discussion were not associated with larger effects.

Very Low

Behaviours and patient care

Overall, the effects on behaviours and patient care were uncertain. Pooled effect size 0.82 (95% CI 0.63 to 1.20)

Tutorials, longer duration courses and online peer discussion were associ-ated with larger effects.

Very Low

 

GRADE: GRADE Working Group grades of evidence (see above and last page). CI = confidence interval.

 

2) Internet-based learning compared to non-internet-based learning

Internet-based learning by health professionals was compared to alternative instructional media, including face-to-face teaching and learning.

  • It is not known whether internet-based learning improves knowledge, satisfaction, skills, or patient care compared to non-internet-based learning. The certainty of this evidence is very low.
  • Short courses and single instance learning interventions may provide greater learner satisfaction. The certainty of this evidence is low.
  • Online discussion and longer duration courses may have a greater effect on knowledge. The certainty of this evidence is low.

Internet-based learning compared to non-internet-based learning

People:  Health professionals

Settings:  Classroom or practice

Intervention: Internet-based learning

Comparison: Non-internet-based learning interventions

Outcomes

Impact

Standardised mean differences

Certainty of the evidence
(GRADE)

Knowledge

Overall, the effect on knowledge was uncertain. Pooled effect size 0.12 (95% CI 0.003 to 0.24) Internet courses using online discussion and longer courses were associated with larger effects.

Very Low

Skills

Overall, the effect on skills was uncertain. Pooled effect size 0.09 (95% CI -0.26 to 0.44) High levels of interactivity, practice exercises and peer discussion were associated with larger effects.

Very Low

Behaviours and patient care

Overall, the effect on behaviours and patient care was uncertain. Pooled effect size 0.51 (95% CI -0.24 to 1.25) Online discussion and single instance interventions were associated with larger effects.

Very Low

Satisfaction

Overall, the effect on satisfaction was uncertain. Pooled effect size 0.10 (95% CI -0.12 to 0.32) Short courses and single instance rather than ongoing access internet-based interventions were associated with larger effects.

Very Low

GRADE: GRADE Working Group grades of evidence (see above and last page). CI = confidence interval.

Relevance of the review for low-income countries

Findings Interpretation*
APPLICABILITY

Studies in all languages were included, but authors did not indicate whether this included studies from low- income countries. 

 

  • The findings may be relevant to countries that have easy and reliable access to the internet.
EQUITY

Impacts on equity were not reported.

  • Internet-based learning could improve access to learning for students and health professionals in rural communities and other settings where travel for training is difficult.
  • Internet-based learning may increase equity where face-to-face learning is not an option for students and health professions. However, it may also decrease equity for health professionals in rural communities, if access to the internet is worse than it is in urban areas.
ECONOMIC CONSIDERATIONS

No studies reported costs or cost-effectiveness.

  • The use of any internet-based learning interventions should include costing.
MONITORING & EVALUATION
  • A wide range of study designs and methods were used, with heterogeneous results.
  • The effects of internet-based learning interventions in low-income countries is uncertain.
  • The use of internet-based learning interventions in low-income countries should be monitored and the effects of these interventions should be evaluated.

*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low-income countries. For additional details about how these judgements were made see: www.supportsummaries.org/methods

Additional information

Related literature

Cook DA, Levinson AJ, Garside S, et al. Instructional design variations in internet-based learning for health profes-sions education: a systematic review and meta-analysis. Acad Med 2010; 85:909-22.

 

Ruiz JG, Mintzer MJ, Leipzig RM. The Impact of e-learning in medical education. Acad Med 2006; 81:207-12.

 

This summary was prepared by

Gabriel Rada, Pontificia Universidad Católica de Chile; and Lilian D. Dudley, Faculty of Health Sciences, University of Stellenbosch, South Africa.

 

Conflict of interest

None declared. For details, see: www.supportsummaries.org/coi

 

Acknowledgements

This summary has been peer reviewed by: Fernando Althabe and David Cook.

 

This review should be cited as

Cook DA, Levinson AJ, Garside S, et al. Internet-based learning in the health professions: a meta-analysis. JAMA 2008; 300:1181-96.

 

The summary should be cited as

Gabriel Rada, Lilian Dudley. Does Internet based learning in the health profes-sions improve learning outcomes? A SUPPORT Summary of a systematic review. August 2016. www.supportsummaries.org

 

Keywords

internet-based learning, distance learning, distance education, evidence-informed health policy, evi-dence-based, systematic review, health systems research, health care, low and middle-income countries, developing countries, primary health care.

 



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