Table 6 Summary of articles focused on media used to deliver instruction
From: Effective in-service training design and delivery: evidence from an integrative literature review
Citation | Study design | Participants | Intervention | Key findings |
|---|---|---|---|---|
Augestad K and Lindsetmo R 2009 | Systematic review: 51 articles reviewed to determine usefulness of videoconferencing as a clinical and educational tool | Surgeons | Media: video | Review discussed primarily observational data on the use of videoconferencing for provision of lecture, mentoring and POC support for emergencies or trauma settings. Methodology of studies is weak, but shows promise for providing POC and mentoring to rural settings from specialists in other geographical areas. |
Country: Norway and developed countries | Technique: multiple | |||
Frequency: NR | ||||
Bloomfield J et al. 2010 | RCT to test if the theory and skill of handwashing can be taught more effectively when taught using computer-assisted learning compared to conventional face-to-face teaching | Nursing students | Media: computer-based vs live | The computer-assisted learning module was an effective strategy for teaching both theory and practice of handwashing to nursing students and was found to be at least as effective as conventional, face-to-face teaching methods. However, this finding must be interpreted with caution in light of sample size and attrition rates. |
n = 242, I = 113, C = 118 | Techniques: multiple | |||
Country: UK | Frequency: single | |||
Intervention group received theory via computer-based module; control group via instructor-led. The objectives and content were the same, both groups included practice opportunities. | ||||
Bradley P et al. 2005 | Prospective RCT and qualitative evaluation to compare self-directed, computer-based learning to traditional, live, interactive education techniques | Medical students | Technique: self-directed vs interactive | There were no differences in outcomes for the computer-based group compared to the live, interactive group in knowledge acquisition, critical appraisal skills or attitudes toward EBM. This trial and its accompanying qualitative evaluation suggest that self-directed, computer-assisted learning may be an alternative format for teaching EBM. |
I = 85, C = 90 | ||||
Country: Norway | Media: computer-based vs live | |||
Frequency: single | ||||
Intervention group received self-directed, computer-based modules on EBM; control group received live, interactive sessions. | ||||
Choa et al. 2008 | Single-blinded, cluster randomized trial to compare the effectiveness of audiovisual animated CPR instruction with audio, dispatcher-assisted instruction in participants with no previous CPR training; both via mobile phones | Allied health professionals, hospital employees | Media: mobile, audiovisual animation vs audio instructions from live dispatcher | Audiovisual animated CPR instruction via mobile phone resulted in better scores in checklist assessment and time interval compliance in participants without CPR skill compared to those who received CPR instructions from a dispatcher. However, the accuracy of important psychomotor skill measures was unsatisfactory in both groups. |
Technique: POC | ||||
I = 44, C = 41 | ||||
Country: Korea | ||||
Frequency: single | ||||
Intervention group used mobile phone application with audiovisual animation instructions for CPR; control group received audio guidance from a live dispatcher. | ||||
Chui S et al. 2009 | Experimental research design with two groups, one pre-test and two post-tests, to determine the effectiveness of computer-based interactive instruction vs video didactic instruction | Nurses | Media: computer-based vs video | Interactive, computer-assisted instruction increased student assessment correctness compared to video didactic instruction for in-service neurological nursing education after statistical adjustments for length of experience. |
I = 44, C = 40 | Technique: self-directed interactive vs didactic | |||
Country: Taiwan | Frequency: single | |||
Intervention group received computer-based, interactive educational module; control group watched a video of a lecture. | ||||
Curran V and Fleet L 2005 | Systematic review to evaluate the nature and characteristics of the web-based CME, based on Kirkpatrick levels of evaluation; 86 studies were identified, majority were descriptive | Physicians | Media: Internet | Inconclusive evidence to identify the most effective characteristics of web-based CME due to a lack of studies focusing on performance change. Findings suggest web-based CME is effective in enhancing knowledge and attitudes. Several studies suggest interactive CME that requires participant activity and the chance to practice skills can effect changes in practice behaviours. |
Technique: multiple | ||||
Frequency: both single and multiple | ||||
Farmer A et al. 2008 | Systematic review: 23 studies reviewed to determine the usefulness of print-based materials in practice behaviours or clinical practice outcomes | Health care professionals | Media: print | Insufficient information to support the effectiveness of print-based educational materials compared to other interventions. Print materials may have a beneficial effect on process outcomes compared to no intervention, but not on clinical practice outcomes. |
Technique: didactic | ||||
Frequency: single | ||||
Fordis M et al. 2005 | RCT to determine if Internet-based CME can produce changes comparable to those produced via live, small group, interactive CME with respect to physician knowledge and behaviours that have an impact on patient care | Physicians | Media: Internet-based vs live, interactive | Internet-based CME can produce objectively measured changes in behaviour as well as sustained gains in knowledge that are comparable or superior to those realized from an effective, live, group-based activity. The Internet-based intervention was associated with a significant increase in the percentage of high-risk patients treated with pharmacotherapeutics according to guidelines compared to the live, group-based control group. |
n = 97; I = 49, randomly assigned Internet-based over 2 weeks; C1 = 44, single, live, interactive session; C2 = 18, from same sites received nothing | Technique: self-directed vs interactive | |||
Frequency: single | ||||
Intervention group received Internet-based modules over 2 weeks; one control group received a live, interactive session and the other control group received nothing. | ||||
Country: USA | ||||
Hadley J et al. 2010 | Cluster RCT to evaluate the educational effectiveness of a clinically integrated e-learning course for teaching basic EBM among post-graduate medical trainees compared to a traditional lecture-based course of equivalent content | Post-graduate medical trainees, interns | Media: Internet vs live | An e-learning course in EBM was as effective in improving knowledge as a standard lecture-based course. There was no statistically significant difference in knowledge of participants in the e-learning course compared to the lecture-based course. The benefits of an e-learning approach include standardization of teaching materials and it is a potential cost-effective alternative to standard, lecture-based teaching. |
Techniques: multiple | ||||
Frequency: single | ||||
Intervention group received clinical integrated, e-learning course on EBM; control group received live, didactic-based course. | ||||
Seven clusters of 237 | ||||
I = 88, C = 72 | ||||
Country: UK | ||||
Harrington S and Walker B 2004 | RCT to determine effectiveness of computer-based training compared with the traditional, instructor-led format | Nurses | Media: computer-based vs live | The computer-based group significantly outperformed the instructor-led group on the knowledge sub-test at post-test (gain of 28% vs 26%). Participants reported linked, computer-based learning and researchers noted potential for efficiencies and cost reduction. |
n = 1,294, I = 670, C = 624 | Technique: didactic vs self-directed | |||
Country: USA | Frequency: single | |||
Intervention group received self-directed, computer-based instruction; control group received instructor-led, live instruction. Both groups had the same objectives and content. | ||||
Horiuchi S et al. 2009 | RCT compared web-based to live instruction | Nurses or midwives | Media: Internet vs live | No significant differences in knowledge were observed between the web-based and face-to-face group. However, the web-based instruction was rated as more flexible and affordable and had a lower drop-out rate than the face-to-face programme. |
n = 93; C = 45, web-based; I = 48, live | Techniques: multiple | |||
Frequency: single | ||||
Intervention group received web-based instruction; control group received didactic live instruction. | ||||
Country: Japan | ||||
Kemper K et al. 2006 | National randomized 2 x 2 factorial trial | Health professionals | Media: Internet | There were statistically significant improvements in knowledge, confidence and communication scores after the course for each of the Internet–based delivery methods, with no significant differences in any of the three outcomes by delivery strategy. Outcomes were better for those who paid for continuing education credit. |
n = 1,267; completion rate = 62%; Group 1 = 318; Group 2 = 318; Group 3 = 318; Group 4 = 313 | Technique: self-directed | |||
Frequency: single | ||||
Group 1: four modules delivered weekly over 10 weeks by email (drip-push); Group 2: modules accessible on web site with four reminders weekly for 10 weeks (drip-pull); Group 3: 40 modules delivered within 4 days by email (bolus-push); and Group 4: 40 modules available on the Internet with one email informing participants of availability (bolus-pull). | ||||
Country: USA | ||||
Leung G et al. 2003 | RCT to compare the effectiveness of mobile, POC support vs print-based job aids | 4th year medical students | Media: mobile vs print | Both the PDA and pocket card groups showed improvements in scores for personal application and current use of EBM. The PDA group showed slightly higher scores in all five outcomes, whereas those for the pocket card group were not appreciably different from the previous rotation. |
Technique: POC | ||||
n = 169; I = 54; C/pocket card = 55; C/nothing = 55 | ||||
Frequency: single | ||||
Intervention group given PDA devices with clinical decision support tools; one control group was given a pocket card containing guidelines and the other control group received no intervention. | ||||
Country: China | ||||
Liaw S et al. 2008 | Cluster randomized trial to determine the effectiveness of locally adapted practice guidelines and education about paediatric asthma management, delivered to general practitioners using interactive, small group workshops | General practitioners | Media: live vs print only | Using interactive small group workshops to disseminate locally adapted guidelines was associated with improvement in general practitioners’ knowledge and confidence to manage asthma compared to receiving guidelines alone in the control arm, but did not change their self-reported provision of written action plans. |
n = 29, randomly assigned; I = 18, live, interactive plus guidelines; C/guidelines only = 18; C/nothing = 15 | Technique: interactive vs reading | |||
Country: Australia | ||||
Frequency: single | ||||
Intervention group received live, interactive sessions plus guidelines; control groups received guidelines only and no intervention. | ||||
Rabol L et al. 2010 | Systematic review: 18 studies reviewed to determine outcomes of live, classroom-based, multi-professional team training | Health professionals | Media: live | Although most studies had weak design methods, findings from the 18 studies concluded that team-based training led to positive participant evaluation, knowledge gain and behaviour change. However, the impact on clinical outcomes was limited. |
Technique: multiple | ||||
Frequency: single | ||||
Sulaiman N et al. 2010 | Same study design as Liaw S et al. 2008 for CPE intervention, but used questionnaires to determine any impact on completing written action plans or patient outcomes | 411 patient surveys from patients of three arms utilized in Liaw, S., et al. 2008 at baseline; 341 at follow-up | See Liaw S et al. 2008 | The interactive, small group workshops failed to translate into increased ownership of written action plans, improved control of asthma or improved quality of life, compared to receiving guidelines alone or control intervention. |
Country: Australia | ||||
Triola M et al. 2006 | RCT to compare effectiveness of virtual patients to live, standardized patients for improving clinical skills and knowledge | Health professionals | Media: virtual patient vs live patient | Improvements in diagnostic abilities were equivalent in groups who experienced cases either live or virtually. There was no subjective difference perceived by learners. Using virtual cases has the potential for cost efficiencies. |
I = 23, C = 32 | Technique: case-based | |||
Country: USA | Frequency: single | |||
Intervention group received two live, standardized patient cases and two virtual patient cases; control group received four standardized patient cases. | ||||
Turner M et al. 2006 | Randomized, controlled, crossover trial to compare efficacy, student preference and cost of web-based, virtual patient vs live, standardized patient | 2nd year medical students | Media: virtual patient vs live patient | There was no statistical difference in learning outcomes between the web-based and standardized patient; however, students preferred the standardized patient format. Start-up costs were comparable, but the ongoing costs of the web-based format were less expensive, suggesting that web-based teaching may be a viable strategy. |
I = 25, C = 24 | Technique: case-based | |||
Country: USA | Frequency: single | |||
Intervention group received web-based instruction for one topic, then standardized patient for another topic. This was reversed for the second cohort, or control group, standardized patient first followed by web-based instruction. | ||||
Wutoh R et al. 2004 | Systematic review: 16 articles reviewed to determine the effect of Internet-based CME interventions on physician performance and health care outcomes | Physicians | Media: Internet | Results demonstrate that Internet-based CME are just as effective in imparting knowledge as traditional formats of CME. However, there is a lack of quality studies to conclude significant positive changes in practice behaviour and additional studies are needed. |
Technique: multiple | ||||
Frequency: both single and multiple | ||||
You J et al. 2009 | Prospective, randomized study to investigate usefulness of video via mobile device as an instruction tool | Surgical residents | Media: mobile videoconferencing/feedback | The overall success rate for performing needle thoracocentesis was significantly higher for the mobile phone video intervention compared to the control group without aided instruction. Participants also rated the mobile phone intervention with significantly higher scores for instrument difficulty and procedure satisfaction. |
I = 24, C = 25 | Technique: live, interactive with and without mobile POC feedback using video | |||
Country: South Korea | ||||
Frequency: single | ||||
Both intervention groups had a didactic session, performed a thoracentesis on a manikin while using video on a mobile phone and received feedback from a live instructor; control group did not receive any video-aided guidance. |