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Table 3 Summary of articles focused on techniques

From: Effective in-service training design and delivery: evidence from an integrative literature review

Citation

Study design

Participants

Intervention

Key findings

Aki E et al. 2010

Systematic review: five articles reviewed to determine the effectiveness of educational gaming on learning

Mostly medical students

Technique: educational games

Findings in three of the five RCTs suggested but did not confirm a positive effect of the games on medical students’ knowledge.

Media: multiple

Frequency: NR

Blaya J et al. 2010

Systematic review: 45 articles included for review, only three related to POC support, included qualitative and quantitative data

Nurses in developing countries

Technique: didactic vs POC

POC findings: studies were weak but indicated knowledge improved and increased rapport in trusting personal judgment.

Media: computer-based vs live

Frequency: NR

Bruppacher H et al. 2010

Prospective, single-blinded RCT to determine if simulation or interactive techniques are better for teaching weaning a patient from anaesthesia

Anaesthesiology trainees, post-graduate year 4

Technique: simulation vs interactive

The simulation group scored significantly higher than the seminar group at both post-test and retention test. Clinical decision-making/psychomotor skills can be acquired via simulation.

I = 10, C = 10

Media: live

Country: China

Frequency: single

Intervention group received simulation-based training; control group received an interactive seminar.

Daniels K et al. 2010

Prospective RCT to determine if simulation is more effective than didactic in obstetric emergency management

Residents and labour and delivery nurses

Technique: simulation vs interactive

Simulation-trained teams had superior performance scores when tested in a labour and delivery drill. In an academic training programme, didactic and simulation-trained groups showed equal results on written test scores.

I = 16, C = 16

Media: live

Country: USA

Frequency: single

Intervention group received simulation-based training; control group received an interactive seminar.

De Lorenzo R and Abbott C 2004

RCT to determine if the adult learning model improves student learning in terms of cognitive performance and perception of proficiency in military medic training

Army medic students

Technique: interactive vs didactic

The adult learning model offered only a modest improvement in cognitive evaluation scores over traditional teaching. Additionally, students in the traditional teaching model assessed themselves as proficient more frequently than instructors, whereas instructor and student perception of proficiency were more closely matched in the adult learning model.

n = 150, I = 81, C = 69

Media: live

Country: USA

Frequency: single

Intervention group emphasized the principles of adult learning including small group interactive approach, self-directed study, multimedia didactics and intensive integrated practice of psychomotor skills; control group received a traditional, lecture-based course.

Harder BN 2010

Systematic review: 23 articles reviewed to evaluate the use of clinical simulation in health care education

Health professionals

Technique: simulation

Inconclusive evidence about the use of simulation due to a low number of studies. However, the use of simulation, as opposed to other education and training methods (motor skills laboratory sessions with task trainers, computer-based instruction and lecture classes), increased students’ clinical skills in the majority of studies.

Media: multiple

Frequency: single

Herbert C et al. 2004

RCT to assess the impact of individualized feedback and live, interactive group education on prescriptive practices

Physicians

Technique: audit and feedback vs interactive plus audit and feedback vs interactive session only vs nothing

Increase in prescribing preference for correct drug class in module and “prescribing portraits” (graphic comparisons between individual, group and evidence based prescribing practices) group. Evidence-based educational interventions combining personalized prescribing feedback with interactive group discussion can lead to modest but meaningful changes in physician prescribing.

I1 = 48, audit and feedback only; I2 = 47, interactive module only; I3 = 49, interactive plus audit and feedback; C = 56, nothing

Media: live

4,394 charts reviewed

Frequency: single

Country: Canada

Issenberg S et al. 2005

Systematic review: 109 studies reviewed to determine the use of high-fidelity medical simulations that lead to most effective learning

Health professionals

Technique: simulation

The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These conditions include: providing feedback, repetitive practice, curriculum integration, range of difficulty, multiple learning strategies, capture clinical variation, controlled environment, individualized learning, defined outcomes and simulator validity.

Media: multiple

Frequency: both single and multiple

Lamb D 2007

Literature review: nine articles reviewed to determine effectiveness of experiential (focused on simulations) learning

Health professionals

Technique: simulation

None of the studies showed conclusively that simulated learning improves patient outcome; however, evidence suggests human patient simulators to be advantageous over other modalities. They have been proven to be at least as effective as traditional teaching by didactic methods. Both human patient simulators (models) and computer-simulations may be effective.

Media: multiple

Frequency: both single and multiple

Laprise R et al. 2009

Cluster randomized trial of 122 general practitioners to determine if chart audits and feedback reminders after a CME event lead to better adherence to clinical guidelines

General practitioners

Technique: audit and feedback plus interactive vs interactive only

This study demonstrated significantly improved adherence in the intervention group using chart audits vs CME alone. The magnitude of the difference observed between the two groups in absolute pre-post intervention change is consistent with previous studies on the effectiveness of chart prompting in preventive care.

n = 122, I = 61, C = 61

Media: live

Chart audit of 2,344 consenting patient charts

Frequency: single vs multiple

Country: Canada

Intervention group and control group received the same CME intervention, a 2-hour live, interactive workshop. The intervention group also received six monthly follow-up visits from a nurse that included chart screening, audits and feedback, and a print-based checklist distribution and print summary of expert recommendations.

Lin C et al. 2010

RCT to determine if peer-tutored, PBL is preferable to didactic-based instruction for teaching nursing ethics

Nursing students

Technique: PBL vs didactic

Peer-tutored, PBL was shown to be more effective than conventional lecture-type teaching. Peer-tutored, PBL has the potential to enhance the efficacy of teaching nursing ethics in situations in which there are personnel and resource constraints.

I = 72, C = 70

Media: live

Country: Taiwan

Frequency: single

Intervention group received PBL technique; control group received didactic-based instruction.

McGaghie W et al. 2009a

Systematic review: nine of the JHU EPC systematic review articles reviewed to determine the effectiveness of simulation methods in medical education outside of CME

Health professionals

Technique: simulation

Due to a low number of studies, evidence on simulation methods is inconclusive. However, the direction of evidence points to the effectiveness of simulation training, especially for psychomotor and communication skills. Data analysis revealed a highly significant 'dose-response’ relationship among practice and achievement, with more practice producing higher outcome gains.

Media: multiple

Frequency: both single and multiple

Merien A et al. 2010

Systematic review: eight articles reviewed to determine the effectiveness of team-based training for obstetric care

Health professionals

Technique: team-based

Due to a low number of studies, evidence on teamwork training in simulation is inconclusive. However, introduction of multidisciplinary teamwork training with integrated acute obstetric training interventions in a simulation setting is potentially effective in the prevention of errors, thus improving patient safety in acute obstetric emergencies.

Media: live

Frequency: NR

Murad MH et al. 2010

Systematic review: 59 articles (enrolled 8,011 learners) reviewed to determine effectiveness of self-directed learning

Health professionals

Technique: self-directed

Moderate-quality evidence suggests that self-directed learning in health professions education is associated with moderate improvement in the knowledge domain compared with traditional teaching methods, and may be as effective in the skills and attitudes domains.

Media: multiple

Frequency: NR

Perry M et al. 2011

Systematic review: six articles representing five studies were reviewed to determine the effect of educational interventions in primary dementia care

Health professionals

Technique: multiple

Interactive workshops and decision support systems led to increased detection rates. Evidence shows moderate improvements in knowledge and techniques that required active participation tended to improve detection rates.

Media: multiple

Frequency: both single and multiple

Reynolds A et al. 2010

RCT to compare students’ knowledge using either simulation or didactic lecture

Midwifery students

Technique: simulation vs didactic

A significantly higher short-term reinforcement of knowledge and greater learner satisfaction was obtained using simulation-based training compared to image-based lectures when teaching routine management of normal delivery and resolution of shoulder dystocia to midwives in training.

I = 26, C = 24

Media: live

Country: Portugal

Frequency: single

Intervention group received simulation-based training; control group received didactic lectures with print visuals.

Smits P et al. 2003

RCT to compare effectiveness of PBL vs didactic for management of mental health problems

Post-graduate medical trainees

Technique: PBL vs didactic

The study found that both PBL and didactic-based instruction were effective, but had no statistical difference. The PBL programme appeared to be more effective than the lecture-based programme in improving performance, but received less favourable evaluations.

I = 59, C = 59

Media: live

Country: the Netherlands

Frequency: single

Intervention group received PBL technique; control group received didactic-based instruction.

Steadman R et al. 2006

RCT to determine if simulation is better than PBL for teaching assessment and management skills

4th year medical students

Technique: simulation vs PBL

Simulation-based teaching was superior to PBL for the acquisition of critical assessment and management skills.

I = 15, C = 16

Media: live

Country: USA

Frequency: single

Intervention group received simulation-based teaching; control group received PBL.

Sturm L et al. 2008

Systematic review: 11 articles reviewed to determine if skills acquired by simulation-based training transfer to the operative setting

Surgeons

Technique: simulation

Due to limited quality and methodology and a lack of relevant studies, a weak conclusion can be made supporting the transfer of skills developed in simulation to the operative setting. Evidence from one study showed better performance for participants who received simulation-based training before undergoing patient-based assessment than their counterparts who did not receive previous simulation training.

Media: multiple

Frequency: both single and multiple

Werb S and Matear D 2004

Systematic review: three systematic reviews and nine original research articles reviewed to examine evidence-based clinical teaching and faculty continuing education

Allied health professionals

Technique: PBL

PBL and evidence-based health care interventions were effective in increasing students’ knowledge of medical topics and their ability to search, evaluate and appraise medical literature. Dental students in a PBL curriculum, emphasizing evidence-based practices, scored higher on the National Dentistry Boards, Part I, than students in traditional curricula.

Media: multiple

Frequency: both single and multiple

White M et al. 2004

RCT to investigate effectiveness of PBL vs didactic for asthma management

Physicians

Technique: PBL vs didactic

There was no significant difference in knowledge gained or satisfaction with the facilitator between the PBL group and the lecture-based group. The PBL group rated the educational value higher than the didactic group.

I = 23, C = 29

Media: live

Country: Canada

Frequency: single

Intervention group received PBL technique; control group received didactic-based instruction.

Young J and Ward J 2002

Randomized trial to determine the effect of self-directed (distance) learning on knowledge, attitudes and practices related to smoking cessation

Family physicians

Technique: self-directed vs reading

Modest changes from baseline to post-test for both the distance learning group and self-directed group suggest a lack of significant evidence to support a distance or self-directed approach to address changes in practice.

I = 26, C = 27

Media: print

Country: Australia

Frequency: single

Intervention group received a self-directed learning module; control group received guidelines only.

Yuan H et al. 2008

Systematic review: 10 studies reviewed to determine the evidence to support PBL

Nursing students

Technique: PBL

Inconclusive evidence to support PBL. While several studies showed increased reported self-confidence in ability to make decisions, and several showed increased skills in critical thinking questions from the PBL group, overall findings were inconclusive due to a lack of quality studies.

Media: multiple

Frequency: both single and multiple

Zurovac D et al. 2011

Cluster RCT at 107 rural health facilities to determine if text-message reminders would improve provider adherence to national malaria treatment guidelines

Health professionals

Technique: reminders

The use of mobile technology showed significant improvement in case management practice for paediatric malaria cases among physicians with repetitive text-message reminders compared to control group.

119 health workers

Media: mobile phone

Case-management practices were assessed for 2,269 children who needed treatment

Frequency: repetitive

I = 1,157, C = 1,112

Intervention group received repetitive text messages over a 6-month period; control group received nothing.

Country: Kenya

  1. aJHU EPC systematic review. C Control, CME Continuing medical education, I Intervention, JHU EPC Johns Hopkins University Evidence-Based Practice Center, NR Not reported, PBL problem-based learning, POC point-of-care, RCT randomized controlled trial.