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Table 1 Characteristics of included studies

From: Health professions digital education on clinical practice guidelines: a systematic review by Digital Health Education collaboration

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
  1. Abbreviations: BP blood pressure, cRCT cluster randomised controlled trial, HR hazard ratio, LDL low-density lipoproteins, MCQ multiple choice questionnaire, RCT randomised controlled trial, RR risk ratio, SMD standardised mean difference, vs versus