A systematic review and meta-analysis of online versus alternative methods for training licensed health care professionals to deliver clinical interventions

Richmond et al. BMC Medical Education (2017) 17:227 DOI 10.1186/s12909-017-1047-4 RESEARCH ARTICLE Open Access A systematic review and meta-analysis of online versus alternative methods for training licensed health care professionals to deliver clinical interventions Helen Richmond1*, Bethan Copsey2, Amanda M. Hall3, David Davies4 and Sarah E. Lamb1,2 Abstract Background: Online training is growing in popularity and yet its effectiveness for training licensed health professionals (HCPs) in clinical interventions is not clear. We aimed to systematically review the literature on the effectiveness of online versus alternative training methods in clinical interventions for licensed Health Care Professionals (HCPs) on outcomes of knowledge acquisition, practical skills, clinical behaviour, self-efficacy and satisfaction. Methods: Seven databases were searched for randomised controlled trials (RCTs) from January 2000 to June 2015. Two independent reviewers rated trial quality and extracted trial data. Comparative effects were summarised as standardised mean differences (SMD) and 95% confidence intervals. Pooled effect sizes were calculated using a random-effects model for three contrasts of online versus (i) interactive workshops (ii) taught lectures and (iii) written/ electronic manuals. Results: We included 14 studies with a total of 1089 participants. Most trials studied medical professionals, used a workshop or lecture comparison, were of high risk of bias and had small sample sizes (range 21-183). Using the GRADE approach, we found low quality evidence that there was no difference between online training and an interactive workshop for clinical behaviour SMD 0.12 (95% CI -0.13 to 0.37). We found very low quality evidence of no difference between online methods and both a workshop and lecture for knowledge (workshop: SMD 0.04 (95% CI -0.28 to 0.36); lecture: SMD 0.22 (95% CI: -0.08, 0.51)). Lastly, compared to a manual (n = 3/14), we found very low quality evidence that online methods were superior for knowledge SMD 0.99 (95% CI 0.02 to 1.96). There were too few studies to draw any conclusions on the effects of online training for practical skills, self-efficacy, and satisfaction across all contrasts. Conclusions: It is likely that online methods may be as effective as alternative methods for training HCPs in clinical interventions for the outcomes of knowledge and clinical behaviour. However, the low quality of the evidence precludes drawing firm conclusions on the relative effectiveness of these training methods. Moreover, the confidence intervals around our effect sizes were large and could encompass important differences in effectiveness. More robust, adequately powered RCTs are needed. Keywords: Online training/learning, Internet based training/learning, E-learning, Health professionals, Continuing education, Professional development, Training, Meta-analysis, Systematic review * Correspondence: 1 Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK Full list of author information is available at the end of the article © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Richmond et al. BMC Medical Education (2017) 17:227 Background The current ‘gold standard’ training for Health Care Professionals (HCPs) in clinical interventions is face-toface workshops, supplemented with manuals and clinical supervision [1]. However, this training method places high demand on resources [2], and has limited reach due to geographical factors and restricted class sizes [3, 4]. Internet based (online) training packages are growing in popularity, offering potential advantages over alternative training methods such as widespread access in a range of settings (home, work, public spaces), personalised instruction, and regularly updated content [5–7]. Despite these advantages, there are several cited concerns including no physical presence of a teacher, learner isolation, and lack of peer support and competition [7]. These concerns are exacerbated when using online methods for developing interpersonal and high-level clinical skills, where contextual clinical reasoning underpins competence [8]. The most recent review in this area was conducted in 2008 and included 76 studies of randomised and nonrandomised trials evaluating online methods versus alternative training for practicing and student HCPs. The results of their analyses suggested that there were no differences between training methods on knowledge, skills, satisfaction, and behavioural outcomes; with some interventions favouring online and others favouring the alternative [2]. The authors suggested that the lack of consistency in effects may be partly explained by the heterogeneity of learner groups, outcome measurement tools, and interventions. Therefore, the aim of this current review was to update the evidence in this rapidly developing field, and specifically focus on practicing HCPs in order to provide more contextualised information of effectiveness for this population. Specifically, we will provide a more in depth exploration of the intervention aims, content, and delivery to help guide future research in this area and provide practical implications for educators in this field. Aim and objectives The aim was to systematically review the literature on the effectiveness of online methods for training licensed HCPs in a clinical intervention/topic. Our main objective was to determine the effectiveness of online versus alternative methods of training in clinical interventions/topics on knowledge and practical skills in licensed HCPs. Secondary outcomes of interest included participant satisfaction, selfefficacy, clinical behaviour, and patient outcomes. Methods This systematic review and meta-analysis followed recommendations from the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA statement for systematic reviews and meta-analyses [9, 10]. Page 2 of 14 Data sources and searches Studies were identified through an electronic search of studies from the year 2000 to 2 June 2015 in the following databases: MEDLINE (Ovid); CINAHL (Ovid); EMBASE (Ovid); AMED (Ovid); Pedro (physiotherapy evidence database); The Cochrane Library, and ASSIA. References of included studies and relevant systematic reviews were also screened. An example search strategy is provided in Additional file 1. Since (...truncated)