Mobile Digital Education for Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration (Preprint)

BACKGROUND There is a pressing need to implement efficient and cost-effective training to address the worldwide shortage of health professionals. Mobile digital education (mLearning) has been mooted as a potential solution to increase the delivery of health professions education as it offers the opportunity for wide access at low cost and flexibility with the portability of mobile devices. To better inform policy making, we need to determine the effectiveness of mLearning. OBJECTIVE The primary objective of this review was to evaluate the effectiveness of mLearning interventions for delivering health professions education in terms of learners’ knowledge, skills, attitudes, and satisfaction. METHODS We performed a systematic review of the effectiveness of mLearning in health professions education using standard Cochrane methodology. We searched 7 major bibliographic databases from January 1990 to August 2017 and included randomized controlled trials (RCTs) or cluster RCTs. RESULTS A total of 29 studies, including 3175 learners, met the inclusion criteria. A total of 25 studies were RCTs and 4 were cluster RCTs. Interventions comprised tablet or smartphone apps, personal digital assistants, basic mobile phones, iPods, and Moving Picture Experts Group-1 audio layer 3 player devices to deliver learning content. A total of 20 studies assessed knowledge (n=2469) and compared mLearning or blended learning to traditional learning or another form of digital education. The pooled estimate of studies favored mLearning over traditional learning for knowledge (standardized mean difference [SMD]=0.43, 95% CI 0.05-0.80, N=11 studies, low-quality evidence). There was no difference between blended learning and traditional learning for knowledge (SMD=0.20, 95% CI –0.47 to 0.86, N=6 studies, low-quality evidence). A total of 14 studies assessed skills (n=1097) and compared mLearning or blended learning to traditional learning or another form of digital education. The pooled estimate of studies favored mLearning (SMD=1.12, 95% CI 0.56-1.69, N=5 studies, moderate quality evidence) and blended learning (SMD=1.06, 95% CI 0.09-2.03, N=7 studies, low-quality evidence) over traditional learning for skills. A total of 5 and 4 studies assessed attitudes (n=440) and satisfaction (n=327), respectively, with inconclusive findings reported for each outcome. The risk of bias was judged as high in 16 studies. CONCLUSIONS The evidence base suggests that mLearning is as effective as traditional learning or possibly more so. Although acknowledging the heterogeneity among the studies, this synthesis provides encouraging early evidence to strengthen efforts aimed at expanding health professions education using mobile devices in order to help tackle the global shortage of health professionals.

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Virtual Reality for Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration (Preprint)

10.2196/preprints.12959 ◽

2018 ◽

Author(s):

Bhone Myint Kyaw ◽

Nakul Saxena ◽

Pawel Posadzki ◽

Jitka Vseteckova ◽

Charoula Konstantia Nikolaou ◽

...

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Clinical Practice ◽

Health Professionals ◽

Cognitive Skills ◽

Meta Analysis ◽

Health Professions ◽

Risk Of Bias ◽

Traditional Learning ◽

Digital Education

BACKGROUND Virtual reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional multimedia sensory environments in real time to gain practical knowledge that can be used in clinical practice. OBJECTIVE The aim of this systematic review was to evaluate the effectiveness of VR for educating health professionals and improving their knowledge, cognitive skills, attitudes, and satisfaction. METHODS We performed a systematic review of the effectiveness of VR in pre- and postregistration health professions education following the gold standard Cochrane methodology. We searched 7 databases from the year 1990 to August 2017. No language restrictions were applied. We included randomized controlled trials and cluster-randomized trials. We independently selected studies, extracted data, and assessed risk of bias, and then, we compared the information in pairs. We contacted authors of the studies for additional information if necessary. All pooled analyses were based on random-effects models. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to rate the quality of the body of evidence. RESULTS A total of 31 studies (2407 participants) were included. Meta-analysis of 8 studies found that VR slightly improves postintervention knowledge scores when compared with traditional learning (standardized mean difference [SMD]=0.44; 95% CI 0.18-0.69; I2=49%; 603 participants; moderate certainty evidence) or other types of digital education such as online or offline digital education (SMD=0.43; 95% CI 0.07-0.79; I2=78%; 608 participants [8 studies]; low certainty evidence). Another meta-analysis of 4 studies found that VR improves health professionals’ cognitive skills when compared with traditional learning (SMD=1.12; 95% CI 0.81-1.43; I2=0%; 235 participants; large effect size; moderate certainty evidence). Two studies compared the effect of VR with other forms of digital education on skills, favoring the VR group (SMD=0.5; 95% CI 0.32-0.69; I2=0%; 467 participants; moderate effect size; low certainty evidence). The findings for attitudes and satisfaction were mixed and inconclusive. None of the studies reported any patient-related outcomes, behavior change, as well as unintended or adverse effects of VR. Overall, the certainty of evidence according to the GRADE criteria ranged from low to moderate. We downgraded our certainty of evidence primarily because of the risk of bias and/or inconsistency. CONCLUSIONS We found evidence suggesting that VR improves postintervention knowledge and skills outcomes of health professionals when compared with traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness, and clinical practice or behavior change.

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Digital Problem-Based Learning in Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration (Preprint)

10.2196/preprints.12945 ◽

2018 ◽

Cited By ~ 2

Author(s):

Lorainne Tudor Car ◽

Bhone Myint Kyaw ◽

Gerard Dunleavy ◽

Neil A Smart ◽

Monika Semwal ◽

...

Keyword(s):

Systematic Review ◽

Health Professionals ◽

Digital Technology ◽

Digital Health ◽

Problem Based Learning ◽

Health Professions ◽

Pooled Analysis ◽

Risk Of Bias ◽

Traditional Learning ◽

Digital Education

BACKGROUND The use of digital education in problem-based learning, or digital problem-based learning (DPBL), is increasingly employed in health professions education. DPBL includes purely digitally delivered as well as blended problem-based learning, wherein digital and face-to-face learning are combined. OBJECTIVE The aim of this review is to evaluate the effectiveness of DPBL in improving health professionals’ knowledge, skills, attitudes, and satisfaction. METHODS We used the gold-standard Cochrane methods to conduct a systematic review of randomized controlled trials (RCTs). We included studies that compared the effectiveness of DPBL with traditional learning methods or other forms of digital education in improving health professionals’ knowledge, skills, attitudes, and satisfaction. Two authors independently screened studies, extracted data, and assessed the risk of bias. We contacted study authors for additional information, if necessary. We used the random-effects model in the meta-analyses. RESULTS Nine RCTs involving 890 preregistration health professionals were included. Digital technology was mostly employed for presentation of problems. In three studies, PBL was delivered fully online. Digital technology modalities spanned online learning, offline learning, virtual reality, and virtual patients. The control groups consisted of traditional PBL and traditional learning. The pooled analysis of seven studies comparing the effect of DPBL and traditional PBL reported little or no difference in postintervention knowledge outcomes (standardized mean difference [SMD] 0.19, 95% CI 0.00-0.38). The pooled analysis of three studies comparing the effect of DPBL to traditional learning on postintervention knowledge outcomes favored DPBL (SMD 0.67, 95% CI 0.14-1.19). For skill development, the pooled analysis of two studies comparing DPBL to traditional PBL favored DPBL (SMD 0.30, 95% CI 0.07-0.54). Findings on attitudes and satisfaction outcomes were mixed. The included studies mostly had an unclear risk of bias. CONCLUSIONS Our findings suggest that DPBL is as effective as traditional PBL and more effective than traditional learning in improving knowledge. DPBL may be more effective than traditional learning or traditional PBL in improving skills. Further studies should evaluate the use of digital technology for the delivery of other PBL components as well as PBL overall.

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Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration (Preprint)

10.2196/preprints.14676 ◽

2019 ◽

Author(s):

Andrzej A Kononowicz ◽

Luke A Woodham ◽

Samuel Edelbring ◽

Natalia Stathakarou ◽

David Davies ◽

...

Keyword(s):

Systematic Review ◽

Digital Health ◽

Health Professions ◽

Virtual Patient ◽

Traditional Education ◽

Health Professions Education ◽

Virtual Patients ◽

Patient Simulations ◽

Digital Education ◽

Clinical Scenarios

BACKGROUND Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education. OBJECTIVE The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction. METHODS We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. RESULTS A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI −0.17 to 0.39, I2=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I2=88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence. CONCLUSIONS Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low- and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients.

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Digital Education for Health Professions on Smoking Cessation Management: Systematic Review by the Digital Health Education Collaboration (Preprint)

10.2196/preprints.13000 ◽

2018 ◽

Cited By ~ 2

Author(s):

Monika Semwal ◽

Penny Whiting ◽

Ram Bajpai ◽

Shweta Bajpai ◽

Bhone Myint Kyaw ◽

...

Keyword(s):

Systematic Review ◽

Smoking Cessation ◽

Health Professionals ◽

Digital Health ◽

Health Professions ◽

Primary Objective ◽

Setup Cost ◽

Digital Education ◽

Blended Education ◽

Smoking Cessation Therapy

BACKGROUND Tobacco smoking, one of the leading causes of preventable death and disease, is associated with 7 million deaths every year. This is estimated to rise to more than 8 million deaths per year by 2030, with 80% occurring in low- and middle-income countries. Digital education, teaching, and learning using digital technologies have the potential to increase educational opportunities, supplement teaching activities, and decrease distance barriers in health professions education. OBJECTIVE The primary objective of this systematic review was to evaluate the effectiveness of digital education compared with various controls in improving learners’ knowledge, skills, attitudes, and satisfaction to deliver smoking cessation therapy. The secondary objectives were to assess patient-related outcomes, change in health professionals’ practice or behavior, self-efficacy or self-rated competence of health professionals in delivering smoking cessation therapy, and cost-effectiveness of the interventions. METHODS We searched 7 electronic databases and 2 trial registers for randomized controlled trials published between January 1990 and August 2017. We used gold standard Cochrane methods to select and extract data and appraise eligible studies. RESULTS A total of 11 studies (number of participants, n=2684) were included in the review. All studies found that digital education was at least as effective as traditional or usual learning. There was some suggestion that blended education results in similar or greater improvements in knowledge (standardized mean difference, SMD=0.19, 95% CI −0.35 to 0.72), skill (SMD=0.58, 95% CI 0.08-1.08), and satisfaction (SMD=0.62, 95% CI 0.12-1.12) compared with digital education or usual learning alone. There was also some evidence for improved attitude (SMD=0.45, 95% CI 0.18-0.72) following digital education compared with usual learning. Only 1 study reported patient outcomes and the setup cost of blended education but did not compare outcomes among groups. There were insufficient data to investigate what components of the digital education interventions were associated with the greatest improvements in learning outcomes. CONCLUSIONS The evidence suggests that digital education is at least as effective as usual learning in improving health professionals’ knowledge and skill for delivering smoking cessation therapy. However, limitations in the evidence base mean that these conclusions should be interpreted with some caution. CLINICALTRIAL PROSPERO CRD42016046815; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=46815

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Serious Gaming and Gamification Education in Health Professions: Systematic Review (Preprint)

10.2196/preprints.12994 ◽

2018 ◽

Cited By ~ 2

Author(s):

Sarah Victoria Gentry ◽

Andrea Gauthier ◽

Beatrice L'Estrade Ehrstrom ◽

David Wortley ◽

Anneliese Lilienthal ◽

...

Keyword(s):

Systematic Review ◽

Health Professions ◽

Traditional Learning ◽

Controlled Trials ◽

Cochrane Central Register ◽

Limited Evidence ◽

Large Magnitude ◽

Serious Gaming ◽

Professional Attitudes ◽

Digital Education

BACKGROUND There is a worldwide shortage of health workers, and this issue requires innovative education solutions. Serious gaming and gamification education have the potential to provide a quality, cost-effective, novel approach that is flexible, portable, and enjoyable and allow interaction with tutors and peers. OBJECTIVE The aim of this systematic review was to evaluate the effectiveness of serious gaming/gamification for health professions education compared with traditional learning, other types of digital education, or other serious gaming/gamification interventions in terms of patient outcomes, knowledge, skills, professional attitudes, and satisfaction (primary outcomes) as well as economic outcomes of education and adverse events (secondary outcomes). METHODS A comprehensive search of MEDLINE, EMBASE, Web of Knowledge, Educational Resources Information Centre, Cochrane Central Register of Controlled Trials, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature was conducted from 1990 to August 2017. Randomized controlled trials (RCTs) and cluster RCTs were eligible for inclusion. Two reviewers independently searched, screened, and assessed the study quality and extracted data. A meta-analysis was not deemed appropriate due to the heterogeneity of populations, interventions, comparisons, and outcomes. Therefore, a narrative synthesis is presented. RESULTS A total of 27 RCTs and 3 cluster RCTs with 3634 participants were included. Two studies evaluated gamification interventions, and the remaining evaluated serious gaming interventions. One study reported a small statistically significant difference between serious gaming and digital education of primary care physicians in the time to control blood pressure in a subgroup of their patients already taking antihypertensive medications. There was evidence of a moderate-to-large magnitude of effect from five studies evaluating individually delivered interventions for objectively measured knowledge compared with traditional learning. There was also evidence of a small-to-large magnitude of effect from 10 studies for improved skills compared with traditional learning. Two and four studies suggested equivalence between interventions and controls for knowledge and skills, respectively. Evidence suggested that serious gaming was at least as effective as other digital education modalities for these outcomes. There was insufficient evidence to conclude whether one type of serious gaming/gamification intervention is more effective than any other. There was limited evidence for the effects of serious gaming/gamification on professional attitudes. Serious gaming/gamification may improve satisfaction, but the evidence was limited. Evidence was of low or very low quality for all outcomes. Quality of evidence was downgraded due to the imprecision, inconsistency, and limitations of the study. CONCLUSIONS Serious gaming/gamification appears to be at least as effective as controls, and in many studies, more effective for improving knowledge, skills, and satisfaction. However, the available evidence is mostly of low quality and calls for further rigorous, theory-driven research.

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Mobile Digital Education for Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

Journal of Medical Internet Research ◽

10.2196/12937 ◽

2019 ◽

Vol 21 (2) ◽

pp. e12937 ◽

Cited By ~ 39

Author(s):

Gerard Dunleavy ◽

Charoula Konstantia Nikolaou ◽

Sokratis Nifakos ◽

Rifat Atun ◽

Gloria Chun Yi Law ◽

...

Keyword(s):

Systematic Review ◽

Health Education ◽

Digital Health ◽

Meta Analysis ◽

Health Professions ◽

Digital Education

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A Systematic Review of Competency-Based Education Effort in the Health Professions

Handbook of Research on Competency-Based Education in University Settings - Advances in Higher Education and Professional Development ◽

10.4018/978-1-5225-0932-5.ch018 ◽

2017 ◽

pp. 352-378 ◽

Cited By ~ 2

Author(s):

Wenxia Wu ◽

Brian C. Martin ◽

Chen Ni

Keyword(s):

Health Professionals ◽

Health Professions ◽

Health Professions Education ◽

Future Research ◽

Quality Healthcare ◽

Competency Based Education ◽

Emerging Trends ◽

Competency Based ◽

Future Research Directions ◽

Educational Delivery

Quality healthcare cannot be achieved without competent health professionals. Competency-based education (CBE) is an educational delivery option that may prove to be effective in meeting that need. Through a systematic literature review using content analysis techniques, this chapter explores the conceptual complexity and operational challenges of using CBE in health professions education. Drawing a picture of how competencies are defined and developed in the context of health professions education, this chapter summarizes current practices of integration, delivery, and assessment of competencies. Challenges, emerging trends, and future research directions are also identified. This review found that, unlike in medical education, there are different sets of competencies for most various healthcare disciplines and sub-disciplines and this review suggests that CBE can be a viable model that will enable health professions education to address the diverse needs of health professionals.

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Test-enhanced learning in health professions education: A systematic review: BEME Guide No. 48

Medical Teacher ◽

10.1080/0142159x.2018.1430354 ◽

2018 ◽

Vol 40 (4) ◽

pp. 337-350 ◽

Cited By ~ 18

Author(s):

Michael L. Green ◽

Jeremy J. Moeller ◽

Judy M. Spak

Keyword(s):

Systematic Review ◽

Health Professions ◽

Health Professions Education ◽

Test Enhanced Learning ◽

Enhanced Learning

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Determinants and outcomes of motivation in health professions education: a systematic review based on self-determination theory

Journal of Educational Evaluation for Health Professions ◽

10.3352/jeehp.2016.13.19 ◽

2016 ◽

Vol 13 ◽

pp. 19 ◽

Cited By ~ 39

Author(s):

Cesar Orsini ◽

Vivian I. Binnie ◽

Sarah L. Wilson

Keyword(s):

Systematic Review ◽

Grey Literature ◽

Quality Criteria ◽

Health Professions ◽

Health Professions Education ◽

The Self ◽

Self Determination ◽

Mediation Effects ◽

Academic Activities ◽

Research Profile

Purpose: This study aimed at conducting a systematic review in health professions education of determinants, mediators and outcomes of students’ motivation to engage in academic activities based on the self-determination theory’s perspective. Methods: A search was conducted across databases (MEDLINE, CINHAL, EMBASE, PsycINFO, and ERIC databases), hand-search of relevant journals, grey literature, and published research profile of key authors. Quantitative and qualitative studies were included if they reported research in health professions education focused on determinants, mediators, and/or outcomes of motivation from the self-determination and if meeting the quality criteria. Results: A total of 17 studies met the inclusion and quality criteria. Articles retrieved came from diverse locations and mainly from medical education and to a lesser extent from psychology and dental education. Intrapersonal (gender and personality traits) and interpersonal determinants (academic conditions and lifestyle, qualitative method of selection, feedback, and an autonomy supportive learning climate) have been reported to have a positive influence on students’ motivation to engage in academic activities. No studies were found that tested mediation effects between determinants and students’ motivation. In turn, students’ self-determined motivation has been found to be positively associated with different cognitive, affective, and behavioural outcomes. Conclusion: This study has found that generally, motivation could be enhanced by changes in the educational environment and by an early detection of students’ characteristics. Doing so may support future health practitioners’ self-determined motivation and positively influence how they process information and their emotions and how they approach their learning activities.

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