NPC Archive Item: Internet-based learning is effective

NOTE – This is an archive post from the NPC and has not been updated since first publication. Therefore, some hyperlinks may no longer be working.
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Cook DA, Levinson AJ, Garside S, et al. Internet-Based Learning in the Health Professions. A Meta-analysis. JAMA 2008;300:1181–96

This review found internet-based learning is an effective way for health professionals to learn across a wide variety of medical topics, improving their knowledge and skills, changing their behaviours in practice and having positive effects on patient care.

All health professionals should engage in life-long learning and continuing professional development. Internet-based learning is a convenient way to do this and appears to be as effective as other methods. NPC is a recently launched internet-based NHS resource which many health professionals are finding useful.

What is the background to this?
Since the internet became widely available, internet-based learning has become an increasingly popular approach to medical education. This type of learning allows learners to participate at a time and place convenient to them, aids teaching methods that might be difficult in other formats, and has the potential to tailor learning for the individual. This systematic review and meta-analysis was conducted to identify and summarise studies of internet-based instruction involving learners from health professions, in order to ascertain its effectiveness.

What does this study claim?
This meta-analysis found internet-based learning was more effective than no intervention, with consistent moderate to large positive effects on knowledge, skills and behaviour outcomes compared with no intervention. When compared with non-internet-based learning, any benefits for internet-based learning were small and often non-significant, suggesting internet-based learning is similar, but not superior, in effectiveness to more traditional methods of learning.

Internet-based interventions vs. no intervention:

  • Satisfaction outcomes, no meta-analysis could be conducted
  • Knowledge outcomes, pooled effect size* 1.00; 95% confidence interval (CI) 0.90 to 1.10; P<0.001; n=126 studies
  • Skills outcomes, pooled effect size 0.85; 95% CI 0.49 to 1.20; P<0.001; n=16
  • Behaviours in practice and effects on patients, pooled effect size 0.82; 95% CI 0.63 to 1.02; P<0.001; n=32

Internet-based interventions vs. non-internet-based interventions:

  • Satisfaction outcomes, pooled effect size 0.10; 95% CI –0.12 to 0.32; P=0.37; n=43
  • Knowledge outcomes, pooled effect size 0.12; 95% CI 0.003 to 0.24; P=0.045; n=63
  • Skills outcomes, pooled effect size 0.09; 95% CI –0.26 to 0.44; P=0.61; n=12
  • Behaviours in practice and effects on patients, pooled effect size 0.51; 95% CI –0.24 to 1.25; P=0.18; n=6

* A useful guide to how large an Effect Size (or difference in means) is can be found here. (0.2 – small; 0.6 – moderate; 1.2 – large; 2.0 – very large).

So what?
As internet-based learning is becoming an increasingly popular approach to medical education, it is good to know that this type of learning is effective. Although, the review has limitations (particularly the fact that included studies varied widely in design, interventions and outcomes, etc, making pooling of results difficult), its overall conclusion is that internet-based learning is associated with favourable outcomes across a wide variety of learners, learning contexts, clinical topics, and learning outcomes. The finding that internet-based learning appears to be as effective as traditional methods of learning, i.e. not either superior or inferior to it, requires further study to ascertain which factors in particular make learning methods most effective. The authors suggest the most important questions that still need answering are “How can internet-based learning be effectively implemented?” and “When should Internet-based learning be used?”

The NPC recently launched a new internet-based NHS learning resource designed specifically for busy healthcare professionals and managers – NPC. This is freely available on the web and combines multimedia contents in a unique navigational structure. NPC allows you to:

  • Access high quality, evidence-based, up-to-date educational materials and resources relating to prescribing, therapeutics and medicines management.
  • Download NPC podcasts and blogs (such as this one).
  • Participate in active discussion forums with your peers.

Since its inception in September 2007, the NPC website has received over 5 million hits in total. Each month, the numbers of people using NPC are growing. In September 2008, NPC received over 40,000 visitors, over 9,000 of these being unique visitors.

The most accessed part of NPC is our ‘blogs’, which provide a quick and succinct commentary on a recent newsworthy health issue related to prescribing and/or medicines. There are lots of websites out there that highlight news items, but not many that advise as to whether this news means we should change our practice. We aim to do just that to help busy people concentrate on the stuff that matters to them as patients, or as healthcare professionals advising or looking after patients. Our ‘blogs’ and ‘podcasts’ can be delivered to you by RSS feed.

If you’ve not yet used all the facilities available on NPC, please take a look –  many health professionals are finding it a useful resource.

Study details:

Design, intervention, comparison and outcomes
Two systematic reviews with meta-analyses were conducted. The first explored internet-based instruction vs. no intervention and the second internet-based instruction vs. non-internet instructional methods. Studies were included if they reported evaluation of the internet to teach health professionals (doctors, dentists, nurses, pharmacists, dentists, vets, physiotherapists or occupational therapists) at any stage in training or practice, using any of the following outcomes: reaction or satisfaction (learner satisfaction with the course), learning (knowledge, attitudes, or skills in a test setting), behaviours (in practice), or effects on patients.

201 articles were analysed, 5 of which contributed to both analyses, representing 214 interventions:

  • Internet-based instruction vs. no intervention, 130 studies (n=19,234)
  • Internet-based instruction vs. non-internet based instruction, 76 studies (n=7,218).

Internet-based instruction addressed a wide range of medical topics, including diagnostics, therapeutics, ethics, evidence-based medicine, communication skills, etc. Non-internet instruction most often involved face-to-face courses or paper modules. Most knowledge outcomes consisted of multiple-choice tests. Skills outcomes included communication with patients, critical appraisal, medication dosing, cardiopulmonary resuscitation, and lumbar puncture – most often assessed using objective instructor or standardised patient observations. Behaviour and patient effects included various actual and perceived changes in practice, often self-reported.

ResultsHeterogeneity in results across studies was large in all analyses. Effect sizes were pooled using a random effects model. See above for details.

Sponsorship – Supported by intramural funds and a Mayo Foundation Education Innovation award.

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