Efficacy of adaptive e-learning for health professionals and students: a systematic review and meta-analysis

Effects of reading media on reading comprehension in health professional education: a systematic review protocol

OBJECTIVE

To evaluate the effect of digital-based reading versus paper-based reading on reading comprehension among students, trainees, and residents participating in health professional education.

INTRODUCTION

Several reviews have examined the effects of reading media on reading comprehension; however, none have considered health professional education specifically. The growing use of electronic media in health professional education, as well as recent data on the consequences of digital-based reading on learning, justify the necessity to review the current literature to provide research and educational recommendations.

INCLUSION CRITERIA

Studies conducted with health professions students, trainees, and residents individually receiving educational material written in their first language in a paper-based or a digital-based format will be considered. Studies conducted among participants with cognitive impairment or reading difficulties will be excluded. Observational, experimental and quasi-experimental studies that assess reading comprehension measured by previously validated or researcher-generated tests will be considered.

METHODS

Relevant studies will be sought from CINAHL, Embase, ERIC, Google Scholar, MEDLINE, PsycINFO, and Web of Science (SCI and SSCI), without date or language restrictions. Two independent reviewers will perform title and abstract screening, full-text review, critical appraisal, and data extraction. Disagreements will be resolved through discussion or with a third independent reviewer. Synthesis will occur at four levels (i.e., study, participant, intervention, and outcome levels) in a table format. Data will be synthesized descriptively and with meta-analyses if appropriate.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020154519.

Effectiveness of a Theory- and Web-Based Adaptive Implementation Intervention on Nurses' and Nursing Students' Intentions to Provide Brief Counseling: Protocol for a Randomized Controlled Trial

BACKGROUND

Brief counseling can motivate patients to initiate health behavior change. However, increasing the provision of brief counseling by nurses is difficult due to contextual and practitioner-level factors impeding nurses' motivation and intentions to provide brief counseling (eg, unfavorable attitude toward brief counseling, lack of perceived control linked to barriers). Theory-based implementation interventions could address these practitioner-level factors and support evidence-based practice in the context of brief counseling. Web-based, adaptive e-learning (electronic learning) programs are a novel type of implementation intervention that could address the limitations of current brief counseling training programs, such as accessibility and personalization.

OBJECTIVE

This paper presents a study protocol for evaluating the effectiveness of the E_MOTIVA implementation intervention-a theory- and web-based adaptive e-learning program-to increase nurses' and nursing students' intentions to provide brief counseling for smoking, an unbalanced diet, and medication nonadherence.

METHODS

A two-group, single-blind, randomized controlled trial will be conducted with nurses and nursing students enrolled in a Bachelor of Science in Nursing program in Quebec, Canada. Participants in the experimental group will be allocated to the E_MOTIVA intervention-a theory- and web-based adaptive e-learning program-while participants in the active control group will be allocated to the E_MOTIVB intervention, a knowledge- and web-based standardized e-learning program. The E_MOTIVA intervention was designed to influence the constructs of the Theory of Planned Behavior (eg, attitude, subjective norms, and perceived behavioral control) in the context of brief counseling. The Cognitive Load Index and User Engagement Scale will be used to assess participants' cognitive load and engagement related to e-learning. Participants will complete the Brief Counseling Nursing Practices Questionnaire-Abridged Version at baseline and follow-up. All study measures will be completed online.

RESULTS

The study is ongoing. The results of the study will provide answers to the primary hypothesis (H1) that experimental group participants will demonstrate a greater change in the score of intentions to provide brief counseling between baseline (-T1) and follow-up (T4). Secondary hypotheses include greater improvements in scores of attitude (H2), subjective norms (H3), perceived control (H4), behavioral beliefs (H5), normative beliefs (H6), and control beliefs (H7) regarding brief counseling in the experimental group between baseline and follow-up. We also anticipate lower intrinsic and extrinsic cognitive loads (H8, H9), higher germane cognitive load (H10), and higher engagement (H11, H12) in the experimental group.

CONCLUSIONS

This study will be among the first in evaluating a novel type of implementation intervention, a theory- and web-based adaptive e-learning program, in nurses and nursing students. This type of intervention has the potential to support evidence-based practice through accessible, personalized training in wide-ranging domains in nursing.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN32603572; http://www.isrctn.com/ISRCTN32603572.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/18894.

Experiences of Nursing Students during the Abrupt Change from Face-to-Face to e-Learning Education during the First Month of Confinement Due to COVID-19 in Spain

The current state of alarm due to the COVID-19 pandemic has led to the urgent change in the education of nursing students from traditional to distance learning. The objective of this study was to discover the learning experiences and the expectations about the changes in education, in light of the abrupt change from face-to-face to e-learning education, of nursing students enrolled in the Bachelor’s and Master’s degree of two public Spanish universities during the first month of confinement due to the COVID-19 pandemic. Qualitative study was conducted during the first month of the state of alarm in Spain (from 25 March–20 April 2020). Semi-structured interviews were given to students enrolled in every academic year of the Nursing Degree, and nurses who were enrolled in the Master’s programs at two public universities. A maximum variation sampling was performed, and an inductive thematic analysis was conducted. The study was reported according with COREQ checklist. Thirty-two students aged from 18 to 50 years old participated in the study. The interviews lasted from 17 to 51 min. Six major themes were defined: (1) practicing care; (2) uncertainty; (3) time; (4) teaching methodologies; (5) context of confinement and added difficulties; (6) face-to-face win. The imposition of e-learning sets limitations for older students, those who live in rural areas, with work and family responsibilities and with limited electronic resources. Online education goes beyond a continuation of the face-to-face classes. Work should be done about this for the next academic year as we face an uncertain future in the short-term control of COVID-19.

Effectiveness of an adaptive eLearning intervention on dental students' learning in comparison to traditional instruction

There is a great deal of excitement in higher education about the value of adaptive learning to personalize learning paths according to students' individual needs. The authors explored the impact of an Adaptive Learning Platform (ALP) on learning, by comparing learning effectiveness between dental students who used the ALP in a blended learning environment formatively and summatively compared with students who did not use the ALP (i.e., face-to-face), as measured by students' performance on the final exam in a single review preparatory course during the academic years 2013-2018. Paired t-tests showed significant improvement in post-test scores across different course instructional modalities (P < 0.01). The learning gain was greater for students who studied using the ALP summatively (t = 26.20) than those who used it formatively or studied using a face-to-face format (t = 13.10 and 14.13, respectively). Controlling for pre-test scores, analysis of covariance tests indicate that: (1) intervention groups (formative and summative ALP) scored significantly higher than the traditional group (B = 9.34 points, P < 0.01, for summative ALP group) and (B = 4.47 points, P < 0.05, for formative ALP group), and (2) summative ALP group scored significantly higher than formative ALP group (B = 4.84 points, P < 0.05). This study provides empirical evidence that an adaptive learning intervention can have a significant impact on student learning performance. The success of any adaptive learning system relies mainly on sound instructional design. Technology will continue to grow at an overwhelming pace; the cautionary note the authors highlight is that conceptions of pedagogy, complemented by technology, must guide the development of adaptive learning systems.

Evaluation of Adaptive Feedback in a Smartphone-Based Game on Health Care Providers' Learning Gain: Randomized Controlled Trial

BACKGROUND

Although smartphone-based emergency care training is more affordable than traditional avenues of training, it is still in its infancy, remains poorly implemented, and its current implementation modes tend to be invariant to the evolving learning needs of the intended users. In resource-limited settings, the use of such platforms coupled with gamified approaches remains largely unexplored, despite the lack of traditional training opportunities, and high mortality rates in these settings.

OBJECTIVE

The primary aim of this randomized experiment is to determine the effectiveness of offering adaptive versus standard feedback, on the learning gains of clinicians, through the use of a smartphone-based game that assessed their management of a simulated medical emergency. A secondary aim is to examine the effects of learner characteristics and learning spacing with repeated use of the game on the secondary outcome of individualized normalized learning gain.

METHODS

The experiment is aimed at clinicians who provide bedside neonatal care in low-income settings. Data were captured through an Android app installed on the study participants' personal phones. The intervention, which was based on successful attempts at a learning task, included adaptive feedback provided within the app to the experimental arm, whereas the control arm received standardized feedback. The primary end point was completion of the second learning session. Of the 572 participants enrolled between February 2019 and July 2019, 247 (43.2%) reached the primary end point. The primary outcome was standardized relative change in learning gains between the study arms as measured by the Morris G effect size. The secondary outcomes were the participants individualized normalized learning gains.

RESULTS

The effect of adaptive feedback on care providers' learning gain was found to be g=0.09 (95% CI -0.31 to 0.46; P=.47). In exploratory analysis, using normalized learning gains, when subject-treatment interaction and differential time effect was controlled for, this effect increased significantly to 0.644 (95% CI 0.35 to 0.94; P<.001) with immediate repetition, which is a moderate learning effect, but reduced significantly by 0.28 after a week. The overall learning change from the app use in both arms was large and may have obscured a direct effect of feedback.

CONCLUSIONS

There is a considerable learning gain between the first two rounds of learning with both forms of feedback and a small added benefit of adaptive feedback after controlling for learner differences. We suggest that linking the adaptive feedback provided to care providers to how they space their repeat learning session(s) may yield higher learning gains. Future work might explore in more depth the feedback content, in particular whether or not explanatory feedback (why answers were wrong) enhances learning more than reflective feedback (information about what the right answers are).

TRIAL REGISTRATION

Pan African Clinical Trial Registry (PACTR) 201901783811130; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5836.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/13034.

Predictors of health professionals' satisfaction with continuing education: A cross-sectional study

OBJECTIVES

to verify which organizational, methodological, and resource-related characteristics of Continuing Health Education (CHE) help to best predict the professionals´ satisfaction.

METHOD

a cross-sectional study with multivariate logistic regressions to predict a high mean satisfaction with different dimensions of educational actions used: Overall satisfaction, Utility, Methodology, Organization and resources, and Teaching Capacity. 25,281 satisfaction questionnaires have been analysed completed by health professionals attending 1,228 training activities in Andalusia (Spain), during the period from March 2012 to April 2015.

RESULTS

the characteristics that best predict a high overall satisfaction are the following: clinical session type as opposed to the workshop (Odds Ratio [OR]=2.07, p<0.001); face-to-face attendance modality (OR=3.88, p<0.001) or semi-personal-attendance (OR=2.83, p<0.001), as opposed to e-learning; and 1-2 days in duration (OR=2.38, p<0.001) as opposed to those of between 3 and 14 days. A lower number of hours (OR=0.99, p<0.001) and a lower number of professionals (OR=0.98, p<0.05) also increase the probability. Having the educational actions accredited increases the probabilities in the following dimensions: Utility (OR=1.33, p<0.05), Methodology (OR=1.5, p<0.01) and Teaching capacity (OR=1.5, p<0.01).

CONCLUSION

the study provides relevant information on aspects that improve professional satisfaction, such as that e-learning activities should improve their content, teaching methods, and styles, or that face-to-face clinical sessions are the type of CHE with the greatest satisfaction.