Global eHealth Unit, School of Public Health, Imperial College London, London, UK.
National Healthcare Group, Singapore.
J Glob Health. 2014 Jun;4(1):010405. doi: 10.7189/jogh.04.010405.
The world is short of 7.2 million health-care workers and this figure is growing. The shortage of teachers is even greater, which limits traditional education modes. eLearning may help overcome this training need. Offline eLearning is useful in remote and resource-limited settings with poor internet access. To inform investments in offline eLearning, we need to establish its effectiveness in terms of gaining knowledge and skills, students' satisfaction and attitudes towards eLearning.
We conducted a systematic review of offline eLearning for students enrolled in undergraduate, health-related university degrees. We included randomised controlled trials that compared offline eLearning to traditional learning or an alternative eLearning method. We searched the major bibliographic databases in August 2013 to identify articles that focused primarily on students' knowledge, skills, satisfaction and attitudes toward eLearning, and health economic information and adverse effects as secondary outcomes. We also searched reference lists of relevant studies. Two reviewers independently extracted data from the included studies. We synthesized the findings using a thematic summary approach.
Forty-nine studies, including 4955 students enrolled in undergraduate medical, dentistry, nursing, psychology, or physical therapy studies, met the inclusion criteria. Eleven of the 33 studies testing knowledge gains found significantly higher gains in the eLearning intervention groups compared to traditional learning, whereas 21 did not detect significant differences or found mixed results. One study did not test for differences. Eight studies detected significantly higher skill gains in the eLearning intervention groups, whilst the other 5 testing skill gains did not detect differences between groups. No study found offline eLearning as inferior. Generally no differences in attitudes or preference of eLearning over traditional learning were observed. No clear trends were found in the comparison of different modes of eLearning. Most of the studies were small and subject to several biases.
Our results suggest that offline eLearning is equivalent and possibly superior to traditional learning regarding knowledge, skills, attitudes and satisfaction. Although a robust conclusion cannot be drawn due to variable quality of the evidence, these results justify further investment into offline eLearning to address the global health care workforce shortage.
全球短缺 720 万名医护工作者，且这一数字还在不断增加。师资短缺更为严重，这限制了传统教育模式。电子学习可能有助于满足这一培训需求。脱机电子学习在网络接入较差的偏远和资源有限地区很有用。为了确定在离线电子学习方面的投资，我们需要根据知识和技能的获取、学生的满意度以及他们对电子学习的态度来确定其有效性。
我们对参加本科医学相关学位课程的学生的离线电子学习进行了系统评价。我们纳入了将离线电子学习与传统学习或替代电子学习方法进行比较的随机对照试验。我们于 2013 年 8 月检索了主要的文献数据库，以确定主要关注学生对电子学习的知识、技能、满意度和态度以及卫生经济学信息和不良影响等次要结果的文章。我们还检索了相关研究的参考文献列表。两位评审员独立从纳入的研究中提取数据。我们使用主题总结方法综合研究结果。
共有 49 项研究，包括 4955 名参加本科医学、牙科、护理、心理学或物理治疗研究的学生符合纳入标准。在 11 项测试知识增益的研究中，有 3 项发现电子学习干预组的增益明显高于传统学习组，而有 21 项未发现显著差异或结果不一。有 1 项研究未对差异进行检验。有 8 项研究发现电子学习干预组的技能增益明显更高，而另外 5 项测试技能增益的研究未发现组间差异。没有研究发现脱机电子学习较差。一般来说，没有发现电子学习与传统学习相比在态度或偏好方面存在差异。不同电子学习模式之间也没有发现明显的趋势。大多数研究规模较小，且存在多种偏倚。
我们的研究结果表明，在知识、技能、态度和满意度方面，离线电子学习与传统学习相当，甚至可能更优。由于证据质量存在差异，因此无法得出确凿的结论，但这些结果证明有理由进一步投资离线电子学习以解决全球卫生保健人员短缺问题。
