@Article{info:doi/10.2196/12968,
author="Posadzki, Pawel
and Bala, Malgorzata M
and Kyaw, Bhone Myint
and Semwal, Monika
and Divakar, Ushashree
and Koperny, Magdalena
and Sliwka, Agnieszka
and Car, Josip",
title="Offline Digital Education for Postregistration Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="24",
volume="21",
number="4",
pages="e12968",
keywords="randomized controlled trial; systematic review; medical education",
abstract="Background: The shortage and disproportionate distribution of health care workers worldwide is further aggravated by the inadequacy of training programs, difficulties in implementing conventional curricula, deficiencies in learning infrastructure, or a lack of essential equipment. Offline digital education has the potential to improve the quality of health professions education. Objective: The primary objective of this systematic review was to evaluate the effectiveness of offline digital education compared with various controls in improving learners' knowledge, skills, attitudes, satisfaction, and patient-related outcomes. The secondary objectives were (1) to assess the cost-effectiveness of the interventions and (2) to assess adverse effects of the interventions on patients and learners. Methods: We searched 7 electronic databases and 2 trial registries for randomized controlled trials published between January 1990 and August 2017. We used Cochrane systematic review methods. Results: A total of 27 trials involving 4618 individuals were included in this systematic review. Meta-analyses found that compared with no intervention, offline digital education (CD-ROM) may increase knowledge in nurses (standardized mean difference [SMD]=1.88; 95{\%} CI 1.14 to 2.62; participants=300; studies=3; I2=80{\%}; low certainty evidence). A meta-analysis of 2 studies found that compared with no intervention, the effects of offline digital education (computer-assisted training [CAT]) on nurses and physical therapists' knowledge were uncertain (SMD 0.55; 95{\%} CI --0.39 to 1.50; participants=64; I2=71{\%}; very low certainty evidence). A meta-analysis of 2 studies found that compared with traditional learning, a PowerPoint presentation may improve the knowledge of patient care personnel and pharmacists (SMD 0.76; 95{\%} CI 0.29 to 1.23; participants=167; I2=54{\%}; low certainty evidence). A meta-analysis of 4 studies found that compared with traditional training, the effects of computer-assisted training on skills in community (mental health) therapists, nurses, and pharmacists were uncertain (SMD 0.45; 95{\%} CI --0.35 to 1.25; participants=229; I2=88{\%}; very low certainty evidence). A meta-analysis of 4 studies found that compared with traditional training, offline digital education may have little effect or no difference on satisfaction scores in nurses and mental health therapists (SMD --0.07; 95{\%} CI --0.42 to 0.28, participants=232; I2=41{\%}; low certainty evidence). A total of 2 studies found that offline digital education may have little or no effect on patient-centered outcomes when compared with blended learning. For skills and attitudes, the results were mixed and inconclusive. None of the studies reported adverse or unintended effects of the interventions. Only 1 study reported costs of interventions. The risk of bias was predominantly unclear and the certainty of the evidence ranged from low to very low. Conclusions: There is some evidence to support the effectiveness of offline digital education in improving learners' knowledge and insufficient quality and quantity evidence for the other outcomes. Future high-quality studies are needed to increase generalizability and inform use of this modality of education. ",
issn="1438-8871",
doi="10.2196/12968",
url="http://www.jmir.org/2019/4/e12968/",
url="https://doi.org/10.2196/12968",
url="http://www.ncbi.nlm.nih.gov/pubmed/31017584"
}