Table 1 Characteristics of included studies
Study, design, country | Learning modality | Guideline topic area | No. (type) of participants | Knowledge | Skill | Satisfaction | Behaviour | Patient outcome | Conclusion |
|---|---|---|---|---|---|---|---|---|---|
Digital education vs no intervention | |||||||||
Attin et al. [30], RCT, USA | I: Online scenario-based simulation module discussion C: No intervention | Resuscitation | 31 nursing students | – | Post-test mean score on a performance-based test SMD 0.93 [0.18, 1.68] | – | – | – | Skills: digital education > no intervention |
Butzlaff et al. [31], RCT, Germany | I: Online/offline learning module C: No intervention | Dementia, congestive heart failure, urinary tract infection and prevention of colorectal carcinoma | 72 primary care physicians | Post-test mean score on a 25-item MCQ SMD 0.43 [− 0.03, 0.90] | – | – | – | – | Knowledge: digital education = no intervention |
Kerfoot et al. [32], RCT, USA | I: Email-delivered, spaced education C: No intervention | Prostate cancer screening | 95 primary care clinicians (physicians, nurse practitioners, physician assistants) | Post-test mean score on a 19-item MCQ SMD 1.52 [1.06, 1.97] | – | – | Proportion of inappropriate PSA screening based on a per patient record RR 0.75 [0.69, 0.82] | – | Knowledge: digital education > no intervention Behaviour: digital education > no intervention |
Stewart et al. [33], RCT, USA | I: Online module and discussion C: No intervention | Preventive health practices for peri-menopausal patient, diabetic care | 58 primary care physicians | Post-test mean score on a 21-item questionnaire for preventive health practices for peri-menopausal women SMD 0.84 [0.30, 1.38] Post-test mean score on a 22-item questionnaire for type 2 diabetic care SMD 0.32 [− 0.30, 0.84] | – | – | Post-test mean scores from Chart audit for quality of practice on prevention for peri-menopausal patient SMD 0.35 [− 0.18, 0.87] Post-test mean scores from Chart audit for quality of practice on diabetes care SMD 0.01 [− 0.51, 0.52] Post-test mean scores assessed by undercover standardised patients for physician behaviours for prevention case SMD 0.25 [− 0.27, 0.77] Post-test mean scores assessed by undercover standardised patients for physician behaviours for diabetes case SMD 0.23 [− 0.28, 0.75] | – | Knowledge: digital education ≥ no intervention Behaviour: digital education = no intervention |
Digital education vs traditional learning | |||||||||
Bell et al. [34], RCT, USA | I: Online module C: Printed resources (including guidelines) | Care after myocardial infarction | 162 primary care and internal medicine residents | Post-test mean score on MCQ SMD 0.22 [− 0.08, 0.53] | – | Post-test mean score from a 5-item survey SMD 1.41 [1.06, 1.75] | – | – | Knowledge: digital education = traditional learning Satisfaction: digital education > traditional learning |
Fordis et al. [35], RCT, USA | I: Online module C: Small-group tutorial | Cholesterol management in adults | 103 primary care physicians | Post-test mean estimates on a 39-item MCQ and fixed choice responses | – | Proportion of participants rating the learning experience as “(very) good” RR 0.93 [0.85, 1.02] | Proportion of patients screened for dyslipidaemia as per patient record RR 1.02 [0.95, 1.10] Proportion of patients treated for dyslipidaemia as per patient record RR 1.05 [0.94, 1.16]* | – | Knowledge: digital education = traditional learning Behaviour: digital education = traditional learning Satisfaction: digital education = traditional learning |
Hemmati et al. [36], RCT, Iran | I: PowerPoint presentation C: Lecture | Resuscitation | 80 physicians | Post-test mean score on a 20-item MCQ SMD 0.43 [− 0.02, 0.87] | – | Post-test mean score from a 15-item survey SMD 3.48 [2.77, 4.18] | – | – | Knowledge: digital education = traditional learning Satisfaction: digital education > traditional learning |
Jousimaa et al. [37], cRCT, Finland | I: CD-ROM-based guidelines C: Printed guidelines | Consultation practice behaviours | 139 physicians | – | – | – | Proportion of laboratory examinations compliant with guidelines from a computer file log RR 1.01 [0.98, 1.03] Proportion of radiological examinations compliant with guidelines from computer file log RR 1.01 [0.99, 1.02] Proportion of physical examinations compliant with guidelines from computer file log RR 0.98 [0.96, 1.00] Proportion of other examinations compliant with guidelines from computer file log RR 0.93 [0.85, 1.01] Proportion of procedures compliant with guidelines from computer file log RR 0.95 [0.85, 1.05] Proportion of Physiotherapy sessions compliant with guidelines from computer file log RR 0.98 [0.85, 1.12] Proportion of non-pharmacologic treatment compliant with guidelines from computer file log RR 0.96 [0.87, 1.06] Proportion of pharmacological treatments compliant with guidelines from computer file log RR 0.98 [0.95, 1.01] Proportion of referrals compliant with guidelines from computer file log RR 1.01 [0.99, 1.02] | – | Behaviour: digital education = traditional learning |
Nurse [38], RCT, USA | I: PowerPoint presentation C: Lecture | Pushing and positioning during labour | 10 nurses | Post-test mean score on a survey SMD − 0.79 [− 2.11, 0.53] | – | Post-test mean score on Allen’s semantic differential scale SMD 2.26 [0.49, 4.04] | – | – | Knowledge: digital education = traditional learning Satisfaction: digital education > traditional learning |
Schwid et al. [39], RCT, USA | I: Online simulation module C: Printed guidelines | Resuscitation | 45 anaesthesiology residents | – | Post-test mean score on Megacode performance checklist SMD 1.13 [0.50, 1.76] | – | – | – | Skills: digital education > traditional learning |
Shenoy [40], cRCT, USA | I: Online modules C: Printed guidelines | Physical therapy | 45 physiotherapists | Mean change score on a 38-item MCQ MD 0.04 [−1.22, 1.31] | – | – | Proportion of patients who received all interventions per guideline as per patient records RR 0.84 [0.45, 1.60] Proportion of patients who received most intervention per guideline as per patient records RR 1.01 [0.75, 1.37] Proportion of patients who received at least one intervention per guideline as per patient records RR 1.35 [0.47, 3.87] | Post-test mean score Patient Quality of life from Oswestry Disability Questionnaire MD − 1.82, [− 7.37, 3.72] | Knowledge: digital education = traditional learning Behaviour: digital education = traditional learning Patient outcomes: digital education = traditional learning |
Stephan et al. [41], RCT, Germany | I: Video demonstration C: Peer teaching | Paediatric basic life support | 88 medical students | – | Post-test mean score on OSCE examination SMD − 3.72 [− 4.42, − 3.02] | – | – | – | Skills: digital education < traditional learning |
Digital education (more interactive) vs digital education | |||||||||
Bonevski et al. [42], RCT, Australia | I: Online module with performance feedback C: Online module | Screening behaviour for cholesterol, blood pressure and cervical screening and identification of risk behaviours (smoking, alcohol consumption, benzodiazepine use) | 19 primary care physicians | – | – | – | Proportion of patients with cholesterol screening as per physician checklist RR 1.35 [1.12, 1.63] Proportion of patients accurately identified for alcohol consumption as per physician checklist RR 1.14 [1.01, 1.28] Proportion of patients with BP screening as per physician checklist RR 1.08 [0.99, 1.18] Proportion of patients accurately identified for long-term benzodiazepine use as per physician checklist RR 1.14 [0.91, 1.43] Proportion of patients accurately identified for smoking as per physician checklist RR 1.01 [0.87, 1.19] Proportion of patients accurately identified for benzodiazepine use as per physician checklist RR 1.03 [0.93, 1.15] Proportion of patients with BP screening as per physician checklist RR 1.06 [0.87, 1.30] | – | Behaviour: digital education (more interactive) ≥ digital education |
Billue et al. [43], cRCT, USA Crenshaw et al. [44], cRCT, USA Estrada [45], cRCT, USA | I: Website with performance feedback and reminders C: Online resources | Glucose, blood pressure and lipids control | 205 primary care physicians | – | – | – | Rate of medication intensification for HbA1C control as per patient records RR 1.05 [0.88, 1.24] Rate of medication intensification for BP control as per patient records RR 0.98 [0.75, 1.27] Rate of medication intensification for LDL control as per patient records RR 1.35 [0.94, 1.93] | Proportion of patients with optimal control of HbA1C (< 7%) as per patient records RR 1.10 [0.98, 1.24] Proportion of patients with optimal control of BP as per patient records RR 1.10 [0.92, 1.32] Proportion of patients with optimal control of LDL as per patient records RR 0.95 [0.86, 1.05] | Behaviour: digital education (more interactive) = digital education Patient outcome: digital education (more interactive) = digital education |
Kerfoot et al. [46], RCT, USA | I: Email-delivered, spaced education game C: Online resources | Blood pressure control | 111 primary care physicians | Post-test mean score on a 24-item MCQ SMD 0.81 [0.43, 1.20] | – | – | Rate of monthly medication intensification as per patient records RR 0.95 [0.54, 1.67] Rate of monthly lifestyle counselling as per patient records RR 0.91 [0.66, 1.26] | Duration of the hypertensive period as per as per patient records HR 1.043 [1.007, 1.081] | Knowledge: digital education (more interactive) > digital education Behaviour: digital education (more interactive) = digital education Patient outcome: digital education (more interactive) > digital education |
Leszczynski et al. [47], RCT, Poland | a) Online modules with audio-visual material, a questionnaire and feedback b) Online modules with audio-visual material c) Online modules with textual-graphical material | Resuscitation | 65 emergency medicine students | Post-test mean change score on a 30-item MCQ (a vs c) SMD 0 [− 0.60, 0.60] Post-test mean change score on a 30-item MCQ (a vs b) SMD 0.10 [− 0.5, 0.70] Post-test mean change score on a 30-item MCQ (b vs c) SMD −0.10 [− 0.72, 0.52] | – | – | – | – | Knowledge: digital education (more interactive) = digital education |
Schroter et al. [16], RCT, UK | I: Online module and knowledge-based feedback and customization C: Online resources | Diabetes management | 1054 physicians and nurses | Post-test mean score on a 19-item MCQ SMD − 0.09 [− 0.21, 0.03] | – | – | Self-reported practice change via survey RR 0.93 [0.83, 1.04] | Knowledge: digital education (more interactive) = digital education Behaviour: digital education (more interactive) = digital education | |