Kyaw Bhone Myint, Posadzki Pawel, Paddock Sophie, Car Josip, Campbell James, Tudor Car Lorainne
Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Norfolk & Norwich University Hospital, Colney Lane, Norwich, United Kingdom.
J Med Internet Res. 2019 Aug 27;21(8):e12967. doi: 10.2196/12967.
Effective communication skills are essential in diagnosis and treatment processes and in building the doctor-patient relationship.
Our aim was to evaluate the effectiveness of digital education in medical students for communication skills development. Broadly, we assessed whether digital education could improve the quality of future doctors' communication skills.
We performed a systematic review and searched seven electronic databases and two trial registries for randomized controlled trials (RCTs) and cluster RCTs (cRCTs) published between January 1990 and September 2018. Two reviewers independently screened the citations, extracted data from the included studies, and assessed the risk of bias. We also assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations assessment (GRADE).
We included 12 studies with 2101 medical students, of which 10 were RCTs and two were cRCTs. The digital education included online modules, virtual patient simulations, and video-assisted oral feedback. The control groups included didactic lectures, oral feedback, standard curriculum, role play, and no intervention as well as less interactive forms of digital education. The overall risk of bias was high, and the quality of evidence ranged from moderate to very low. For skills outcome, meta-analysis of three studies comparing digital education to traditional learning showed no statistically significant difference in postintervention skills scores between the groups (standardized mean difference [SMD]=-0.19; 95% CI -0.9 to 0.52; I=86%, N=3 studies [304 students]; small effect size; low-quality evidence). Similarly, a meta-analysis of four studies comparing the effectiveness of blended digital education (ie, online or offline digital education plus traditional learning) and traditional learning showed no statistically significant difference in postintervention skills between the groups (SMD=0.15; 95% CI -0.26 to 0.56; I=86%; N=4 studies [762 students]; small effect size; low-quality evidence). The additional meta-analysis of four studies comparing more interactive and less interactive forms of digital education also showed little or no difference in postintervention skills scores between the two groups (SMD=0.12; 95% CI: -0.09 to 0.33; I=40%; N=4 studies [893 students]; small effect size; moderate-quality evidence). For knowledge outcome, two studies comparing the effectiveness of blended online digital education and traditional learning reported no difference in postintervention knowledge scores between the groups (SMD=0.18; 95% CI: -0.2 to 0.55; I=61%; N=2 studies [292 students]; small effect size; low-quality evidence). The findings on attitudes, satisfaction, and patient-related outcomes were limited or mixed. None of the included studies reported adverse outcomes or economic evaluation of the interventions.
We found low-quality evidence showing that digital education is as effective as traditional learning in medical students' communication skills training. Blended digital education seems to be at least as effective as and potentially more effective than traditional learning for communication skills and knowledge. We also found no difference in postintervention skills between more and less interactive forms of digital education. There is a need for further research to evaluate the effectiveness of other forms of digital education such as virtual reality, serious gaming, and mobile learning on medical students' attitude, satisfaction, and patient-related outcomes as well as the adverse effects and cost-effectiveness of digital education.
有效的沟通技巧在诊断和治疗过程以及建立医患关系中至关重要。
我们的目的是评估针对医学生开展的数字教育在沟通技能培养方面的效果。总体而言，我们评估数字教育是否能够提高未来医生的沟通技能质量。
我们进行了一项系统评价，检索了7个电子数据库和2个试验注册库，以查找1990年1月至2018年9月发表的随机对照试验（RCT）和整群随机对照试验（cRCT）。两名综述作者独立筛选文献、从纳入研究中提取数据并评估偏倚风险。我们还使用推荐分级的评估、制定与评价（GRADE）评估法评估证据质量。
我们纳入了12项涉及2101名医学生的研究，其中10项为RCT，2项为cRCT。数字教育包括在线模块、虚拟患者模拟和视频辅助口头反馈。对照组包括讲授式讲座、口头反馈、标准课程、角色扮演，以及无干预措施，还有互动性较低的数字教育形式。总体偏倚风险较高，证据质量从中等到非常低不等。对于技能结果，三项比较数字教育与传统学习的研究的荟萃分析显示，两组干预后技能得分在统计学上无显著差异（标准化均数差[SMD]= -0.19；95%CI -0.9至0.52；I²=86%，N=3项研究[304名学生]；效应量小；低质量证据）。同样，四项比较混合式数字教育（即在线或离线数字教育加传统学习）与传统学习效果的研究的荟萃分析显示，两组干预后技能在统计学上无显著差异（SMD=0.15；95%CI -0.26至0.56；I²=86%；N=4项研究[762名学生]；效应量小；低质量证据）。四项比较互动性较高和较低的数字教育形式的额外荟萃分析也显示，两组干预后技能得分几乎没有差异或无差异（SMD=0.12；95%CI：-0.09至0.33；I²=40%；N=4项研究[893名学生]；效应量小；中等质量证据）。对于知识结果，两项比较混合式在线数字教育与传统学习效果的研究报告称，两组干预后知识得分无差异（SMD=0.18；95%CI：-0.2至0.55；I²=61%；N=2项研究[292名学生]；效应量小；低质量证据）。关于态度、满意度和与患者相关的结果的研究结果有限或不一致。纳入的研究均未报告干预措施的不良后果或经济评估。
我们发现低质量证据表明，在医学生沟通技能培训方面，数字教育与传统学习一样有效。混合式数字教育在沟通技能和知识方面似乎至少与传统学习一样有效，甚至可能更有效。我们还发现，互动性较高和较低的数字教育形式在干预后技能方面没有差异。有必要进一步研究评估虚拟现实、严肃游戏和移动学习等其他形式的数字教育对医学生态度、满意度和与患者相关的结果的有效性，以及数字教育的不良影响和成本效益。
