Does online learning work better than offline learning in undergraduate medical education? A systematic review and meta-analysis

Leisi Pei, Hongbin Wu, Leisi Pei, Hongbin Wu

Abstract

With the increasing use of technology in education, online learning has become a common teaching method. How effective online learning is for undergraduate medical education remains unknown. This article's aim is to evaluate whether online learning when compared to offline learning can improve learning outcomes of undergraduate medical students. Five databases and four key journals of medical education were searched using 10 terms and their Boolean combinations during 2000-2017. The extracted articles on undergraduates' knowledge and skill outcomes were synthesized using a random effects model for the meta-analysis.16 out of 3,700 published articles were identified. The meta-analyses affirmed a statistically significant difference between online and offline learning for knowledge and skill outcomes based on post-test scores (SMD = 0.81; 95% CI: 0.43, 1.20; p < 0.0001; n = 15). The only comparison result based on retention test scores was also statistically significant (SMD = 4.64; 95% CI: 3.19, 6.09; p < 0.00001). The meta-analyses discovered no significant difference when using pre- and post-test score gains (SMD = 3.03; 95% CI: -0.13, 4.13; p = 0.07; n = 3). There is no evidence that offline learning works better. And compared to offline learning, online learning has advantages to enhance undergraduates' knowledge and skills, therefore, can be considered as a potential method in undergraduate medical teaching.

Keywords: Online learning; meta-analysis; offline learning; systematic review; undergraduate medical education (UME).

Figures

Figure 1.
Figure 1.
Study inclusion flowchart.
Figure 2.
Figure 2.
Summary of the risk of bias.
Figure 3.
Figure 3.
Venn diagram of the 16 identified articles, clustered by the statistical methods used.
Figure 4.
Figure 4.
Meta-analysis of post-test performance.
Figure 5.
Figure 5.
Meta-analysis of post-test performance without the article of Subramanian et al.
Figure 6.
Figure 6.
Meta-analysis of pre- and posttest score gains.
Figure 7.
Figure 7.
Meta-analysis of retention test scores.

References

    1. Triola MM, Friedman E, Cimino C, et al. Health information technology and the medical school curriculum. Am J Manag Care. 2010;16(12Suppl HIT):54–13.
    1. Thompson P. The digital natives as learners: technology use patterns and approaches to learning. Comput Educ. 2013;65(7):12–33.
    1. Daniel J. Making sense of MOOCs: musings in a maze of myth, paradox and possibility. Open EducRes. 2013;2012(3):18.
    1. Cook DA, Levinson AJ, Garside S, et al. Internet-based learning in the health professions: a meta-analysis. Jama. 2008;300(10):1181.
    1. Bartley SJ, Golek JH. Evaluating the cost effectiveness of online and face-to-face instruction. J Educ Technol Soc. 2004;7(4):167–175.
    1. Muilenburg LY, Berge ZL. Student barriers to online learning: a factor analytic study. Distance Educ. 2005;26(1):29–48.
    1. Mayer RE. Multimedia learning. Psychol Learn Motiv. 2002;41(1):85–139.
    1. Richmond H, Copsey B, Hall AM, et al. A systematic review and meta-analysis of online versus alternative methods for training licensed health care professionals to deliver clinical interventions. BMC Med Educ. 2017;17(1):227.
    1. Davis J, Chryssafidou E, Zamora J, et al. Computer-based teaching is as good as face to face lecture-based teaching of evidence based medicine: a randomised controlled trial. Med Teach. 2007;7(1):23.
    1. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Epidemiol Biostat Public Health. 2009;6(4):e1–e34.
    1. Higgins JPGS, editors Cochrane handbook for systematic reviews of interventions version 5.1.0 [cited 2011 March]. Available from: In: The Cochrane Collaboration; 2011.
    1. Demers E, Lev B. A Rude awakening: internet shakeout in 2000. Rev Account Stud. 2001;6(2–3):331–359.
    1. Cattagni A, Farris E. Internet access in U.S. Public schools and classrooms: 1994-2000. Educ Stat Q. 2001;3(4):85.
    1. Reed DA, Cook DA, Beckman TJ, et al. Association between funding and quality of published medical education research. JAMA. 2007;298(9):1002–1009.
    1. Brydges R, Manzone J, Shanks D, et al. Self-regulated learning in simulation-based training: a systematic review and meta-analysis. Med Educ. 2015;49(4):368–378.
    1. Higgins JPT, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. Br Med J. 2003;327(7414):557–560.
    1. Cook DA, Hatala R, Brydges R, et al. Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. Jama. 2011;306(9):978.
    1. Cook DA. Randomized controlled trials and meta-analysis in medical education: what role do they play? Med Teach. 2012;34(6):468–473.
    1. Review Manager (RevMan) [computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2014.
    1. Phadtare A, Bahmani A, Shah A, et al. Scientific writing: a randomized controlled trial comparing standard and on-line instruction. BMC Med Educ. 2009;9(1):1–9.
    1. Heiman HL, Uchida T, Adams C, et al. E-learning and deliberate practice for oral case presentation skills: A randomized trial. Med Teach. 2012;34(12):820–826.
    1. Bhatti I, Jones K, Richardson L, et al. E-learning vs lecture: which is the best approach to surgical teaching? Colorectal DisOff J Ass Coloproctol. 2011;13(4):459–462.
    1. Chao SH, Brett B, Wiecha JM, et al. Use of an online curriculum to teach delirium to fourth‐year medical students: a comparison with lecture format. J Am Geriatr Soc. 2012;60(7):1328–1332.
    1. Yeung JC, Fung K, Wilson TD. Prospective evaluation of a web-based three-dimensional cranial nerve simulation. J Otolaryngol Head Neck Surg. 2012;41(6):426–436.
    1. Porter AL, Pitterle ME, Hayney MS. Comparison of online versus classroom delivery of an immunization elective course. Am J Pharm Educ. 2014;78(5):96.
    1. Assadi T, Mofidi M, Rezai M, et al. The comparison between two methods of basic life support instruction: video self-instruction versus traditional method. Hong Kong J Emerg Med. 2015;22(5):291–296.
    1. Arne P, Klaus K, Cord S. Self-directed learning can outperform direct instruction in the course of a modern German medical curriculum – results of a mixed methods trial. BMC Med Educ. 2016;16(1):158.
    1. Farahmand S, Jalili E, Arbab M, et al. Distance learning can be as effective as traditional learning for medical students in the initial assessment of trauma patients. Acta Med Iran. 2016;54(9):600.
    1. Shenoy SJ, Kuriakose C. Effects of E-learning as a teaching learning method in medical education. J Evol Med Dent Sci. 2016;99(5):7272–7275.
    1. Jordan J, Jalali A, Clarke S, et al. Asynchronous vs didactic education: it’s too early to throw in the towel on tradition. BMC Med Educ. 2013;13(1):105.
    1. Pusponegoro HD, Soebadi A, Surya R. Web-based versus conventional training for medical students on infant gross motor screening. Telemed J E Health. 2015;21(12):992.
    1. Subramanian A, Timberlake M, Mittakanti H, et al. Novel educational approach for medical students: improved retention rates using interactive medical software compared with traditional lecture-based format. J Surg Educ. 2012;69(2):253–256.
    1. Raupach T, Muenscher C, Anders S, et al. Web-based collaborative training of clinical reasoning: A randomized trial. Med Teach. 2009;31(9):e431.
    1. Sendra-Portero F, Torales-Chaparro OE, Ruiz-Gómez MJ, et al. A pilot study to evaluate the use of virtual lectures for undergraduate radiology teaching. Eur J Radiol. 2013;82(5):888.
    1. Solomon DJ, Ferenchick GS, Laird-Fick HS, et al. A randomized trial comparing digital and live lecture formats [ISRCTN40455708. BMC Med Educ. 2004;4(1):1–6.
    1. Yavner SD, Pusic MV, Kalet AL, et al. Twelve tips for improving the effectiveness of web-based multimedia instruction for clinical learners. Med Teach. 2015;37(3):239–244.
    1. Terrell SR, Dringus L. An investigation of the effect of learning style on student success in online learning environment. J Educ Technol Syst. 2000;28:3.
    1. Omar ND, Hassan H, Atan H. Student engagement in online learning: learners attitude toward E-mentoring. Procedia Soc Behav Sci. 2012;67(67):464–475.
    1. Johnson SD, Aragon SR, Shaik N, et al. Comparative analysis of learner satisfaction and learning outcomes in online and face-to-face learning environments. J Interact Learn Res. 2000;11(1):29–49.
    1. Robinson CC, Hullinger H. New benchmarks in higher education: student engagement in online learning. J Educ Bus. 2008;84(2):101–109.
    1. Deming DJ, Goldin C, Katz LF, et al. Can online learning bend the higher education cost curve? Am Econ Rev. 2015;105(5):496–501.
    1. Bettinger EP, Fox L, Loeb S, et al. Virtual classrooms: how online college courses affect student success. Am Econ Rev. 2017;107(9):2855–2875.
    1. Friedman CP, Donaldson KM, Vantsevich AV. Educating medical students in the era of ubiquitous information. Med Teach. 2016;38(5):504–509.
    1. Garrison DR, Vaughan ND. Blended Learning in Higher Education: Framework, Principles, and Guidelines. New York (NY): John Wiley & Sons; 2007; ix–xi.
    1. Rees EL, Quinn PJ, Davies B, et al. How does peer teaching compare to faculty teaching? A systematic review and meta-analysis. Med Teach. 2015;38(8):829–837.

Source: PubMed

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