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Transcript of Impact of e-learning for post-graduated medical education: a systematic review I N T R O D U C T I O...
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
I N T R O D U C T I O N T O M E D I C I N E
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
I N T R O D U C T I O N T O M E D I C I N E
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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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
I N T R O D U C T I O N T O M E D I C I N E
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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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
I N T R O D U C T I O N T O M E D I C I N E
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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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
I N T R O D U C T I O N T O M E D I C I N E
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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
I N T R O D U C T I O N T O M E D I C I N E
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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I N T R O D U C T I O N
R e s e a r c h Q u e s t i o n s a n d A i m
I N T R O D U C T I O N T O M E D I C I N E
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
I N T R O D U C T I O N T O M E D I C I N E
• 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
I N T R O D U C T I O N T O M E D I C I N E
• 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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M E T H O D S
I N T R O D U C T I O N T O M E D I C I N E
• 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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M E T H O D S
I N T R O D U C T I O N T O M E D I C I N E
Scopus
N = 45
PubMed
N = 1888180 37
Total found=225
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M E T H O D S
I N T R O D U C T I O N T O M E D I C I N E
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
I N T R O D U C T I O N T O M E D I C I N E
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
I N T R O D U C T I O N T O M E D I C I N E
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
I N T R O D U C T I O N T O M E D I C I N E
b. Country:
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R E S U L T S
Q u a n t i t a t i v e
I N T R O D U C T I O N T O M E D I C I N E
3
9
1
41
2
c. Medical
speciality:
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R E S U L T S
Q u a n t i t a t i v e
I N T R O D U C T I O N T O M E D I C I N E
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
I N T R O D U C T I O N T O M E D I C I N 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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R E S U L T S
Q u a l i t a t i v e
I N T R O D U C T I O N T O M E D I C I N E
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
Q u a l i t a t i v e
I N T R O D U C T I O N T O M E D I C I N E
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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R E S U L T S
Q u a l i t a t i v e
I N T R O D U C T I O N T O M E D I C I N E
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:
4 articles had information on this domain:
- 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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R E S U L T S
Q u a l i t a t i v e
I N T R O D U C T I O N T O M E D I C I N E
d. Participants attitudes:
11 articles had information on this domain:
◦ 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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R E S U L T S
Q u a l i t a t i v e
I N T R O D U C T I O N T O M E D I C I N E
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R E S U L T S
Q u a l i t a t i v e
I N T R O D U C T I O N T O M E D I C I N E
- 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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R E S U L T S
Q u a l i t a t i v e
I N T R O D U C T I O N T O M E D I C I N E
- 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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R E S U L T S
Q u a l i t a t i v e
I N T R O D U C T I O N T O M E D I C I N E
◦ 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
Q u a l i t a t i v e
I N T R O D U C T I O N T O M E D I C I N E
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
I N T R O D U C T I O N T O M E D I C I N E
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
I N T R O D U C T I O N T O M E D I C I N E
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
I N T R O D U C T I O N T O M E D I C I N E
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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
I N T R O D U C T I O N T O M E D I C I N E
• 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
I N T R O D U C T I O N T O M E D I C I N E
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
I N T R O D U C T I O N T O M E D I C I N E