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Efficacy of adaptive e-learning for health professionals and students: a systematic review and meta-analysis
  1. Guillaume Fontaine1,2,
  2. Sylvie Cossette1,2,
  3. Marc-André Maheu-Cadotte1,2,
  4. Tanya Mailhot2,3,
  5. Marie-France Deschênes1,
  6. Gabrielle Mathieu-Dupuis4,
  7. José Côté1,5,
  8. Marie-Pierre Gagnon6,7,
  9. Veronique Dubé1,5
  1. 1 Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
  2. 2 Research Center, Montreal Heart Institute, Montréal, Québec, Canada
  3. 3 Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
  4. 4 School of Librarianship and Information Science, Université de Montréal, Montréal, Québec, Canada
  5. 5 Research Center, University of Montreal Hospital Centre, Montréal, Québec, Canada
  6. 6 Faculty of Nursing, Université Laval, Québec City, Québec, Canada
  7. 7 Research Center, CHU de Québec-Université Laval, Québec City, Québec, Canada
  1. Correspondence to Guillaume Fontaine; guillaume.fontaine{at}umontreal.ca

Abstract

Objective Although adaptive e-learning environments (AEEs) can provide personalised instruction to health professional and students, their efficacy remains unclear. Therefore, this review aimed to identify, appraise and synthesise the evidence regarding the efficacy of AEEs in improving knowledge, skills and clinical behaviour in health professionals and students.

Design Systematic review and meta-analysis.

Data sources CINAHL, EMBASE, ERIC, PsycINFO, PubMed and Web of Science from the first year of records to February 2019.

Eligibility criteria Controlled studies that evaluated the effect of an AEE on knowledge, skills or clinical behaviour in health professionals or students.

Screening, data extraction and synthesis Two authors screened studies, extracted data, assessed risk of bias and coded quality of evidence independently. AEEs were reviewed with regard to their topic, theoretical framework and adaptivity process. Studies were included in the meta-analysis if they had a non-adaptive e-learning environment control group and had no missing data. Effect sizes (ES) were pooled using a random effects model.

Results From a pool of 10 569 articles, we included 21 eligible studies enrolling 3684 health professionals and students. Clinical topics were mostly related to diagnostic testing, theoretical frameworks were varied and the adaptivity process was characterised by five subdomains: method, goals, timing, factors and types. The pooled ES was 0.70 for knowledge (95% CI −0.08 to 1.49; p.08) and 1.19 for skills (95% CI 0.59 to 1.79; p<0.00001). Risk of bias was generally high. Heterogeneity was large in all analyses.

Conclusions AEEs appear particularly effective in improving skills in health professionals and students. The adaptivity process within AEEs may be more beneficial for learning skills rather than factual knowledge, which generates less cognitive load. Future research should report more clearly on the design and adaptivity process of AEEs, and target higher-level outcomes, such as clinical behaviour.

PROSPERO registration number CRD42017065585

  • Computer-assisted instruction
  • medical education
  • nursing education
  • e-learning
  • meta-analysis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors GF contributed to the conception and design of the review, to the acquisition and analysis of data and to the interpretation of results. Moreover, GF drafted the initial manuscript. SC contributed to the conception and design of the review, and to the interpretation of results. M-AM-C contributed to the conception and design of the review, to the acquisition of data and interpretation of results. TM contributed to the conception and design of the review, to the acquisition of data and to the interpretation of results. M-FD contributed to the conception and design of the review, to the acquisition of data and to the interpretation of results. GM-D contributed to the conception and design of the review, and to the interpretation of results. JC contributed to the interpretation of results. M-PG contributed to the interpretation of results. VD contributed to the interpretation of results. All review authors contributed to manuscript writing, critically revised the manuscript, gave final approval and agreed to be accountable for all aspects of work, ensuring integrity and accuracy.

  • Funding GF was supported by the Vanier Canada Graduate Scholarship (Canadian Institutes of Health Research), a doctoral fellowship from Quebec’s Healthcare Research Fund, the AstraZeneca and Dr Kathryn J Hannah scholarships from the Canadian Nurses Foundation, a doctoral scholarship from the Montreal Heart Institute Foundation, a doctoral scholarship from Quebec’s Ministry of Higher Education, and multiple scholarships from the Faculty of Nursing at the University of Montreal. M-AM-C was supported by a doctoral fellowship from Quebec’s Healthcare Research Fund, a doctoral scholarship from the Montreal Heart Institute Foundation, a doctoral scholarship from Quebec’s Ministry of Higher Education, and multiple scholarships from the Faculty of Nursing at the University of Montreal. TM was supported by a postdoctoral fellowship from Quebec’s Healthcare Research Fund, a postdoctoral scholarship from the Montreal Heart Institute Foundation. M-FD was supported by a doctoral fellowship from Canada’s Social Sciences and Humanities Research Council, and a scholarship from the Center for Innovation in Nursing Education.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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