Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Hum Resour Health. 2023 Feb 24;21(1):13. doi: 10.1186/s12960-023-00799-4.
This systematic review and meta-analysis identified early evidence quantifying the disruption to the education of health workers by the COVID-19 pandemic, ensuing policy responses and their outcomes.
Following a pre-registered protocol and PRISMA/AMSTAR-2 guidelines, we systematically screened MEDLINE, EMBASE, Web of Science, CENTRAL, clinicaltrials.gov and Google Scholar from January 2020 to July 2022. We pooled proportion estimates via random-effects meta-analyses and explored subgroup differences by gender, occupational group, training stage, WHO regions/continents, and study end-year. We assessed risk of bias (Newcastle-Ottawa scale for observational studies, RοB2 for randomized controlled trials [RCT]) and rated evidence certainty using GRADE.
Of the 171 489 publications screened, 2 249 were eligible, incorporating 2 212 observational studies and 37 RCTs, representing feedback from 1 109 818 learners and 22 204 faculty. The sample mostly consisted of undergraduates, medical doctors, and studies from institutions in Asia. Perceived training disruption was estimated at 71.1% (95% confidence interval 67.9-74.2) and learner redeployment at 29.2% (25.3-33.2). About one in three learners screened positive for anxiety (32.3%, 28.5-36.2), depression (32.0%, 27.9-36.2), burnout (38.8%, 33.4-44.3) or insomnia (30.9%, 20.8-41.9). Policy responses included shifting to online learning, innovations in assessment, COVID-19-specific courses, volunteerism, and measures for learner safety. For outcomes of policy responses, most of the literature related to perceptions and preferences. More than two-thirds of learners (75.9%, 74.2-77.7) were satisfied with online learning (postgraduates more than undergraduates), while faculty satisfaction rate was slightly lower (71.8%, 66.7-76.7). Learners preferred an in-person component: blended learning 56.0% (51.2-60.7), face-to-face 48.8% (45.4-52.1), and online-only 32.0% (29.3-34.8). They supported continuation of the virtual format as part of a blended system (68.1%, 64.6-71.5). Subgroup differences provided valuable insights despite not resolving the considerable heterogeneity. All outcomes were assessed as very-low-certainty evidence.
The COVID-19 pandemic has severely disrupted health worker education, inflicting a substantial mental health burden on learners. Its impacts on career choices, volunteerism, pedagogical approaches and mental health of learners have implications for educational design, measures to protect and support learners, faculty and health workers, and workforce planning. Online learning may achieve learner satisfaction as part of a short-term solution or integrated into a blended model in the post-pandemic future.
本系统评价和荟萃分析确定了 COVID-19 大流行对卫生工作者教育的干扰的早期证据，随之而来的政策反应及其结果。
根据预先注册的方案和 PRISMA/AMSTAR-2 指南，我们系统地筛选了 MEDLINE、EMBASE、Web of Science、CENTRAL、clinicaltrials.gov 和 Google Scholar，时间范围为 2020 年 1 月至 2022 年 7 月。我们通过随机效应荟萃分析汇总了比例估计，并通过性别、职业群体、培训阶段、世界卫生组织区域/大陆和研究结束年份探索了亚组差异。我们使用纽卡斯尔-渥太华量表（NOS）评估观察性研究的偏倚风险，使用 ROB2 评估随机对照试验（RCT）的偏倚风险[RCT]），并使用 GRADE 评估证据确定性。
在筛选的 171489 篇文献中，有 2249 篇符合条件，包括 2212 项观察性研究和 37 项 RCT，代表了来自 1109818 名学习者和 22204 名教师的反馈。该样本主要由本科生、医生和来自亚洲机构的研究人员组成。感知到的培训中断率估计为 71.1%（95%置信区间 67.9-74.2），学习者再部署率为 29.2%（25.3-33.2）。大约三分之一的学习者出现焦虑（32.3%，28.5-36.2）、抑郁（32.0%，27.9-36.2）、倦怠（38.8%，33.4-44.3）或失眠（30.9%，20.8-41.9）。政策反应包括转向在线学习、评估创新、COVID-19 特定课程、志愿服务以及学习者安全措施。对于政策反应的结果，大多数文献都与认知和偏好有关。超过三分之二的学习者（75.9%，74.2-77.7）对在线学习感到满意（研究生比本科生更满意），而教师满意度略低（71.8%，66.7-76.7）。学习者更喜欢面对面的学习方式：混合学习 56.0%（51.2-60.7）、面对面学习 48.8%（45.4-52.1）、纯线上学习 32.0%（29.3-34.8）。他们支持将虚拟格式作为混合系统的一部分继续使用（68.1%，64.6-71.5）。尽管未能解决相当大的异质性，但亚组差异提供了有价值的见解。所有结果均被评估为极低确定性证据。
COVID-19 大流行严重扰乱了卫生工作者的教育，给学习者带来了巨大的心理健康负担。其对学习者职业选择、志愿服务、教学方法和心理健康的影响，对教育设计、保护和支持学习者、教师和卫生工作者以及劳动力规划都具有重要意义。在线学习可以作为短期解决方案的一部分实现学习者的满意度，也可以在大流行后的未来整合到混合模式中。
