Vaona A, Banzi R, Kwag KH, et al. E-learning for health professionals. Cochrane Database Syst Rev. 2018 Jan 21;1:CD011736. doi: 10.1002/14651858.CD011736.pub2.
Discipline Area Score
Nurse 6 / 7
Rehab Clinician (OT/PT) 5 / 7
Physician 5 / 7

BACKGROUND: The use of e-learning, defined as any educational intervention mediated electronically via the Internet, has steadily increased among health professionals worldwide. Several studies have attempted to measure the effects of e-learning in medical practice, which has often been associated with large positive effects when compared to no intervention and with small positive effects when compared with traditional learning (without access to e-learning). However, results are not conclusive.

OBJECTIVES: To assess the effects of e-learning programmes versus traditional learning in licensed health professionals for improving patient outcomes or health professionals' behaviours, skills and knowledge.

SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, five other databases and three trial registers up to July 2016, without any restrictions based on language or status of publication. We examined the reference lists of the included studies and other relevant reviews. If necessary, we contacted the study authors to collect additional information on studies.

SELECTION CRITERIA: Randomised trials assessing the effectiveness of e-learning versus traditional learning for health professionals. We excluded non-randomised trials and trials involving undergraduate health professionals.

DATA COLLECTION AND ANALYSIS: Two authors independently selected studies, extracted data and assessed risk of bias. We graded the certainty of evidence for each outcome using the GRADE approach and standardised the outcome effects using relative risks (risk ratio (RR) or odds ratio (OR)) or standardised mean difference (SMD) when possible.

MAIN RESULTS: We included 16 randomised trials involving 5679 licensed health professionals (4759 mixed health professionals, 587 nurses, 300 doctors and 33 childcare health consultants).When compared with traditional learning at 12-month follow-up, low-certainty evidence suggests that e-learning may make little or no difference for the following patient outcomes: the proportion of patients with low-density lipoprotein (LDL) cholesterol of less than 100 mg/dL (adjusted difference 4.0%, 95% confidence interval (CI) -0.3 to 7.9, N = 6399 patients, 1 study) and the proportion with glycated haemoglobin level of less than 8% (adjusted difference 4.6%, 95% CI -1.5 to 9.8, 3114 patients, 1 study). At 3- to 12-month follow-up, low-certainty evidence indicates that e-learning may make little or no difference on the following behaviours in health professionals: screening for dyslipidaemia (OR 0.90, 95% CI 0.77 to 1.06, 6027 patients, 2 studies) and treatment for dyslipidaemia (OR 1.15, 95% CI 0.89 to 1.48, 5491 patients, 2 studies). It is uncertain whether e-learning improves or reduces health professionals' skills (2912 health professionals; 6 studies; very low-certainty evidence), and it may make little or no difference in health professionals' knowledge (3236 participants; 11 studies; low-certainty evidence).Due to the paucity of studies and data, we were unable to explore differences in effects across different subgroups. Owing to poor reporting, we were unable to collect sufficient information to complete a meaningful 'Risk of bias' assessment for most of the quality criteria. We evaluated the risk of bias as unclear for most studies, but we classified the largest trial as being at low risk of bias. Missing data represented a potential source of bias in several studies.

AUTHORS' CONCLUSIONS: When compared to traditional learning, e-learning may make little or no difference in patient outcomes or health professionals' behaviours, skills or knowledge. Even if e-learning could be more successful than traditional learning in particular medical education settings, general claims of it as inherently more effective than traditional learning may be misleading.

Comments from MORE raters

Nurse rater

As a clinical nurse educator, I am surprised by the results. The focus on e-learning has taken away a lot of opportunities for practical learning and this adds to the argument that we still need hands on experience.

Nurse rater

The results in this review are useful, in that there is no or little effect about this subject among the professionals.

Nurse rater

As an educator, I find the discussion of e-learning has been broached many times. This is something that is really good to read.

Physician rater

The finding of no demonstrable differences in learning whether done through traditional sources or electronic media is reassuring both for educators and for practicing clinicians who need to remain abreast of the latest information.

Physician rater

Surprising result.

Physician rater

In light of recent controversy regarding board certification and ongoing professional education, this Cochrane review looked at e-learning to see if it impacted the process of care or patient outcomes as compared to conventional learning. They found 16 studies with over 5000 participants and concluded there was no substantial improvement with e-learning. Using patient outcomes as well as process measures lends greater validity to the benefits of an intervention.

Rehab Clinician (OT/PT) rater

The authors note "that e-learning is not a single entity" yet do not adequately account for that, given their broad definition of e-learning. Sub-group analyses were not performed. The findings would better support further review and study of the various components and features of e-learning, rather than a definitive statement that "when compared to traditional learning, e-learning may make little or no difference in patient outcomes or health professionals' behaviours...", particularly when just one of the 16 studies included in the review "addressed patient outcomes" and "two studies addressed" health professionals' behaviours.
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