Offline eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction

Health care workers are central to any health system; their activities are aimed at enhancing the health of the community, nation or region in general. However, these professionals are distributed unevenly across the globe; countries with lower relative need have the highest numbers of health workers, while those with the greatest burden of disease have a much smaller health workforce. The health worker crisis is at its worst in sub–Saharan Africa and Asia. Incidentally, countries in this region are facing a double burden of both infectious and non–communicable diseases [1], and they lack the funds, technology, infrastructure and trained health workers needed to provide basic health care service [2]. At this juncture; the WHO estimates a shortage of 7.2 million doctors, nurses, midwives and other health care professionals worldwide [3]. Addressing this shortfall in health care professionals through training requires a substantial investment. Meanwhile, the Internet and the development of information technologies have revitalized the exchange of information and training worldwide. Consequently, eLearning is used increasingly in medical and health professional education, to tackle the global shortage of health workers. eLearning is “an approach to teaching and learning, representing all or part of the educational model applied, that is based on the use of electronic media and devices as tools for improving access to training, communication and interaction and that facilitates the adoption of new ways of understanding and developing learning” [4]. It does not only differ from traditional learning (ie, face–to–face learning that takes place in a classroom environment) in the medium by which learning is delivered [5], but also affects the teaching and learning approaches used. eLearning can take the form of a full eLearning approach, which is entirely driven by technology, or be a mix of the traditional and fully computer–based methodologies (blended learning). Blended learning might be more suitable for health care training because of the need to combine hands–on skills–based training at a practical level as well as self–directed learning [6–10]. Lately, eLearning has started to make way into the developing countries and is believed to have huge potential for governments struggling to meet a growing demand for education while facing an escalating shortage of teachers [11]. However, in both the developing and non–developing countries, network connectivity and bandwidth availability are the key obstacles to the effective delivery of online eLearning [5,12]. Despite this, eLearning presents many opportunities for universities, including the reduction of the delivery costs [13], increased scalability [14], improved access and availability by removing geographical and temporal barriers and allowing access to relevant experts and novel curricula [15]. Online eLearning represents a further evolution of computer–assisted or computer based or offline eLearning and is an important tool in medical training and may transform the way medicine is taught [16]. In the recent years, nearly all medical schools in the USA and Canada employ online course materials [17]. eLearning could be full or blended, full eLearning can be distributed geographically and/or temporally, and communication between student and teacher is handled electronically. This manuscript focuses on online eLearning; systematic review of offline eLearning is published in a parallel article [18]. Online eLearning approaches varied widely in configuration (tutorial, asynchronous discussion, live conferencing, etc.), instructional methods (eg, practice exercises, cognitive interactivity) and presentation [17]. The majority of reviews of effectiveness of online eLearning included observational studies with several methodological deficiencies [16,17,19–22]. This systematic review aims to evaluate the effectiveness of online eLearning from randomised controlled trials conducted among undergraduate health professionals, specifically looking at its impact on students’ knowledge, skills, attitudes and satisfaction.