Table 2

Characteristics of adaptive e-learning environments

First author, year	Clinical topic(s)	Theoretical framework(s)	Platform	Adaptivity subdomains
First author, year	Clinical topic(s)	Theoretical framework(s)	Platform	Adaptivity method	Adaptivity goals	Adaptivity timing	Adaptivity factors	Adaptivity types
Casebeer, 2003	Chlamydia screening	Transtheoretical model of change, problem-based learning, situated learning theory	NR	Designed adaptivity	To increase learning effectiveness (knowledge, skills).	Throughout the training, after case-based and practice-based questions.	User answers to questions	Content Navigation
Cook, 2008	Diabetes, hyperlipidaemia, asthma, depression	NR	NR	Designed adaptivity	To increase learning efficiency (knowledge gain divided by learning time).	After each case-based question in each module (17 to 21 times/module).	User knowledge	Content Navigation
Crowley, 2007	Dermopathology, subepidermal vesicular dermatitis	Cognitive tutoring	SlideTutor	Algorithmic adaptivity	To increase learning gains, metacognitive gains and diagnostic performance.	At the beginning of each case.	User actions: results of problem-solving tasks; requests for help	Content Navigation Presentation Multimedia Tools
Crowley, 2010	Dermopathology, melanoma	Cognitive tutoring	SlideTutor	Algorithmic adaptivity	To improve reporting performance and diagnostic accuracy.	At the beginning of each case.	User actions: results of problem-solving tasks; reporting tasks; requests for help	Content Navigation Presentation Multimedia Tools
de Ruijter, 2018	Smoking cessation counselling	I-Change Model	Computer-tailored e-learning programme	Designed adaptivity	To modify behavioural predictors and behaviour.	At the beginning of the training.	Demographics, behavioural predictors, behaviour	Content
El Saadawi, 2008	Dermopathology, melanoma	Cognitive tutoring	Report tutor	Algorithmic adaptivity	To teach how to correctly identify and document all relevant prognostic factors in the diagnostic report.	At the beginning of each case.	User actions, report features	Content Navigation Presentation Multimedia
El Saadawi, 2010	Dermopathology	Cognitive tutoring	SlideTutor	Algorithmic adaptivity	To facilitate transfer of performance gains to real world tasks that do not provide direct feedback on intermediate steps.	During intermediate problem-solving steps.	User actions: results of problem-solving tasks; reporting tasks; requests for help	Content Navigation Presentation Multimedia
Feyzi-Begnagh, 2014	Dermopathology, nodular and diffuse dermatitis	Cognitive tutoring, theories of self-regulated learning	SlideTutor	Algorithmic adaptivity	To improve metacognitive and learning gains during problem-solving.	During each case or immediately after each case.	User actions: results of problem-solving tasks; reporting tasks; requests for help	Content Navigation Presentation Multimedia Tools
Hayes-Roth, 2010	Brief intervention training in alcohol abuse	Guided mastery	STAR workshop	NR	To improve attitudes and skills.	During clinical cases.	User scores, user-generated dialogue	Content Navigation
Lee, 2017	Treatment of atrial fibrillation	NR	Learning assessment platform	Designed adaptivity	To increase learning effectiveness (knowledge, competence, confidence and practice).	After learning gaps identified in the first session.	Learning gaps in relation to objectives	Content
Micheel, 2017	Oncology	Learning style frameworks	Learning-style tailored educational platform	Designed adaptivity	To increase learning effectiveness (knowledge).	After assessing the learning style.	Learning style	Presentation Multimedia Tools
Morente, 2013	Pressure ulcer evaluation	NR	ePULab	Designed adaptivity	To increase learning effectiveness (knowledge, skills).	Each pressure ulcer evaluation.	User skills	Content
Munoz, 2010	Management of childhood illness	Learning styles framework	SIAS-ITS	Designed adaptivity	To increase learning effectiveness and efficiency.	At the beginning of the training.	User knowledge, user learning style	Content Tools
Romito, 2016	Transoesophageal echocardiography	Perceptual learning	TOE PALM	Algorithmic adaptivity	To improve response accuracy and response time.	After each clinical case.	User response accuracy, user response time	Content Navigation Multimedia
Samulski, 2017	Cytopathology, pap test, squamous lesions, glandular lesions	NR	Smart Sparrow	Designed adaptivity	To improve learning effectiveness.	During intermediate problem-solving steps.	User knowledge	Content Navigation
Thai, 2015	Electrocardiography	Perceptual learning theory, adaptive response-time-based algorithm	PALM	Algorithmic adaptivity	To improve perceptual classification learning effectiveness and efficiency.	After each user response.	User response accuracy, user response time	Content Presentation Multimedia Tools
Van Es, 2015	Diagnostic cytopathology, gynaecology, fine needle aspiration, exfoliative fluid	NR	Smart Sparrow	Designed adaptivity	To improve learning effectiveness.	During intermediate problem-solving steps.	User responses	Content Navigation Presentation Multimedia
Van Es, 2016	Diagnostic cytopathology,; gynaecology, fine needle aspiration, exfoliative fluid	NR	Smart Sparrow	Designed adaptivity	To improve learning effectiveness.	During intermediate problem-solving steps.	User responses	Content Navigation Presentation Multimedia Tools
Wong, 2015	Diagnostic imaging, chest X-rays, computed tomography scans	Cognitive load theory	Smart Sparrow	Designed adaptivity	To improve learning effectiveness.	During intermediate problem-solving steps.	User responses	Content
Wong, 2017	Fetal heart rate interpretation	Perceptual learning	PALM	Algorithmic adaptivity	To improve response accuracy and response time.	After each clinical case.	User response accuracy, user response time	Content Navigation Multimedia
Woo, 2006	Haemodynamics, baroreceptor reflex	NR	CIRCSIM tutor	Algorithmic adaptivity	To improve knowledge related to problem-solving tasks.	After each user response.	User knowledge, user responses	Content Navigation Tools

ePULab, electronic pressure ulcer lab; NR, not reported; PALM, perceptual adaptive learning module.; SIAS-ITS, SIAS intelligent tutoring system; TOE PALM, transoesophageal echocardiography perceptual adaptive learning module.