impact of e-learning for post-graduated medical education: a systematic review

Impact of e-learning for post-

graduated medical education: a

systematic review

I N T R O D U C T I O N T O M E D I C I N E

Authors: Ana Silveira; Catarina Rodrigues; Fábia Carvalho; Joana Vargas; João

Faria; Leonor Marques; Luís Braz; Orlando Cardoso; Rui Cerqueira; Sofia Baptista;

Sofia Saldanha; Susana Santos.

Supervisors: Mário Dinis Ribeiro, MD, PhD; Altamiro da Costa Pereira, MD, PhD.

2 0 0 6 / 2 0 0 7

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S U M M A R Y


This presentation’s main goal is to give an overview

of our study, highlighting it’s final results, conclusions and a

brief discussion about the limitations we faced.

To achieve such a goal, we opted to keep a global

perspective of the study design, by showing the steps we

have performed since the background information, research

methods, results, conclusions and a final comment on the

future perspectives.

McKimm J et al. McKimm J et al. BMJ VOLUME 326 19 APRIL 2003;Nelson E A, Nurs Adm Q. 2003 Jan-Mar;27(1):29-32.

Distance Education is a concept known since the 19th

century. With the development of World Wide Web it has

taken a large step towards the creation of e-Learning.

World Wide Web – Use of the Internet to present various

types of information.

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I N T R O D U C T I O N

I m p o r t a n t C o n c e p t s


Internet - A global network of computers divided into subsets.

e-Learning (web-based learning – WBL) - Online computer

(web)-based educational training through electronic means,

such as web, intranet, or other multimedia materials .

McKimm J et al. McKimm J et al. BMJ VOLUME 326 19 APRIL 2003;Nelson E A, Nurs Adm Q. 2003 Jan-Mar;27(1):29-32.

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Virtual Learning Environments - a set of electronic

teaching and learning tools, a platform providing online

student support and electronic communication.

Medical schools have been implementing Virtual

Learning Environments (like “moodle”, for example).

McKimm J et al. McKimm J et al. BMJ VOLUME 326 19 APRIL 2003.

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Medical education is education related to the practice of

being a medical practitioner, either the initial training to

become a doctor or further training thereafter.

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Vozenilek J, et al. ACAD EMERG MED d November 2004, Vol. 11, No. 11.

Medical

EducationDistance Education(computer-based)

e-

Learning

Examples:• Virtual reality (High-fidelity human patient

simulator);

• WBL environments (on-line theorical courses).

To Understand the impact of e-Learning in medical

post-graduate education

How often is e-Learning used by Medical Doctors?

Which are its effects in learning/training?

• Is e-learning effective?• What are participants’ attitudes?

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R e s e a r c h Q u e s t i o n s a n d A i m


Study Design: Systematic Review;

Data Base: Medline (PubMed) and Scopus;

Target population: Articles about medical post-graduate

web based courses;

Keywords:

• “e-learning”;

• “Web-based learning”;

• “post-graduation”;

• “medical education”;

• “distance education”.

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M E T H O D S


• Inclusion criteria:

- Original Scientific papers/manuscripts assessing e-

learning in post-graduate medical education.

• Exclusion Criteria:

- Written in other languages than Portuguese,

English or Spanish;

- With no information about at least one of these

topics: - Frequency of usage of E-

learning;

- Efficiency;

- Effects in clinical performance;

- Participants’ attitudes.

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M E T H O D S


• Pubmed:

(("Education, Medical/education"[MeSH] OR "Education,

Medical/methods"[MeSH] OR "Education, Medical/statistics and

numerical data"[MeSH]) * ("Education,

Distance/classification"[MeSH] OR "Education,

Distance/methods"[MeSH] OR "Education, Distance/statistics and

numerical data"[MeSH]))

OR

(("e-learning" OR "web-based learning“ OR "electronic learning")

AND “medical education”)

188 articles found

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• Scopus:

(TITLE-ABS-KEY("E-Learning" OR "web-based learning“ OR

"Electronic Learning" OR distance) AND TITLE-ABS-KEY("Medical

Education")

45 articles found

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Scopus

N = 45

PubMed

N = 1888180 37

Total found=225

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Fluxogram (selection of participants)

• We built a data base on SPSS with the results of the

application of the inclusion and exclusion criteria.

Measuring Agreement

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M E T H O D S


Proportion of agreement=

(99+106)/225=91,1%

(1) Quantitative results: (2) Qualitative results:

a. Year of publication;

b. Country;

c. Medical speciality.

a. Frequency of usage;

b. Efficiency of e-learning;

c. Effects in clinical performance;

d. Participants attitudes:

◦ Positive aspects;

◦ Negative aspects.

• We added to the SPSS data base the quantitative results.

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M E T H O D S


We chose what kind of information would to be

extracted from the articles that were analyzed:

a. Year of

publication:

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R E S U L T S

Q u a n t i t a t i v e


b. Country:

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R E S U L T S



3

9

1

41

2

c. Medical

speciality:

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R E S U L T S



OMMITEDFamily MedicineRadiologyReproductive Medicine

Medical PhysicsOccupational Medicine

medical speciality

8

6

4

2

0

Fre

qu

ency

6

1

8

2

1

2

medical speciality

HospitalOthers

a. Frequency of usage:

• No article was found presenting information about the

number of medical doctors using WBL platforms or

participating in online courses;

• 3 articles referred other information under this

domain:

- Number of users is increasing (2 articles);

- Mainly female or young users (1 article);

- Number of web-based courses is increasing (1

article);

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R E S U L T S

Q u a l i t a t i v e


b. Efficiency of e-learning:

4 articles had information on this domain:

- There is an higher knowledge gain in WB learners

(3 articles);

- Simulators, which create virtual models, were found

to be comparable to conventional training (1 article).

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Some study designs:

- A pretest/posttest self-controlled study, involving

two groups: a WBL and a “face to face” group.@

R E S U L T S



Wiecha JM, Chetty VK, Pollard T,Shaw PF. Web-based versus face-to-face learning of diabetes management: the results of a comparative trial of educational methods. Fam Med. 2006 Oct;38(9):647-52.

Some study designs:

- A study used case vignettes to evaluate physicians

knowledge of biologic and chemical threats. Responses to

clinical vignettes were compared between both groups:

participants and nonparticipants.

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Casebeer L, Andolsek K, Abdolrasulnia M, Green J, Weissman N, Pryor E, Zheng S, Terndrup T. Evaluation of an online bioterrorism continuing medical education course. J Contin Educ Health Prof. 2006 Spring;26(2):137-44

c. Effects in clinical performance:


- WBL enables doctor to overcome the

embarrassment factor (1 article);

- students/practioneers that used WBL proved to

respond more quickly an appropriately in real clinical

situations than those who had learnt from a conventional

(“face-to-face”) course (2 articles);

- on-line courses increase:

◦ Confidence in treatment;

◦ Awareness in prescribing habits (1 article).

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d. Participants attitudes:


◦ 9 articles reefer positive participants’ attitudes:

- Students and teachers appreciate these

methods’ characteristics (3 articles):

▪ Learning delivery

▪ Ease of access

▪ Availability at any time

▪ Personalized instruction

▪ Interactivity

▪ Good learning interface

▪ Ease in updating contents

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- CRISIS Model:

Harden RM. A new vision for distance learning and continuing medical education. J Contin Educ Health Prof. 2005 Winter;25(1):43-51

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- Besides, e-learning allows to:

▪ Decrease teachers/tutors salaries (4 articles);

▪ Avoid the necessity of teachers/students to travel (4

articles);

▪ Reduce the need for big buildings (4 articles);

▪ Avoid paper based material and books (4 articles);

▪ Decrease in amount of time needed for teaching (1

article)

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◦ 3 articles reefer negative participants’ attitudes:

- Difficulties in implementating e-learning (2 articles);

- Low motivation level for those

practioneers/students who spend too much time in front of

the computer, instead of contacting with patients (1 article).

Family medicinen = 8

Hospital(reproductive medicine;

radiology)n = 3

Other(occupational medicine;

medical physics)n = 3

Frequency of usage

Increase in number of users(1) -

There is an increasing number of post-graduate web based courses (1)

Efficiency of e-learning

Knowledge gains measured in on-line theoretical tests(3)

Software based simulators

are comparable toconventional training

(1)

-

Effects on clinical

performance

Enhances practioneers performance measured

in practical tests(2)

- -

Participants Attitudes

Positive (4)Negative (1)

Positive(2) Positive (1)Negative (1)

R E S U L T S



1. The number of WBL users and courses is increasing, which

shows that there is a growing interest on this area;

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D I S C U S S I O N


2. On-line users learn quicker and have a slightly superiority

in clinical performance than conventional curricula users;

3. The difficulty about the analysis of the 2nd conclusion was

to explain why this occurs:

a. face-to-face learners could reveal a lack of

attention during the oral discussion sessions;

b. there is a low level of motivation among WB

learners that cannot have enough contact with

patients.

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D I S C U S S I O N


4. Web-based courses are, at least, comparable to

conventional ones so instead of deciding which is better,

they should be used as complements;

5. E-learning has proved to be a consistent method among

the clinical and practical subjects rather than in theoretical

ones. Since we know that, in post-graduation, the clinical

practice is highlighted, WBL appears more often in post-

graduate CME than in basic academic courses;

6. Reliable overall evaluation, based on randomized

controlled trials to provide data on the effectiveness of

online course intervention is still missing.

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D I S C U S S I O N


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D I S C U S S I O N

M a i n L i m i t a t i o n s


• The number of studies in this field (e-learning in

postgraduate medical education) is reduced;

• Among these, the number of included articles was low:

many of them only describe characteristics and functioning

of programs of e-learning rather than their implementation

and impact;

• The language;

• The articles found revealed to be heterogenic and include

much more qualitative considerations than quantitative and

statistical data;

• We didn't have access to 44% of the included articles.

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F U T U R E P E R S P E C T I V E S


It would be important to make more studies evaluating

the implementation of WBL courses.

We can anticipate that medical education will

increasingly take advantage of the benefits of distance

learning to improve the quality of post-graduation courses.

Site

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A N N E X E S


http://users.med.up.pt/med06101/orl/who_are_we.htm

impact of e-learning for post-graduated medical education: a systematic review

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