Table 6.

Summary of articles focused on media used to deliver instruction

Citation	Study design	Participants	Intervention	Key findings
Augestad K and Lindsetmo R 2009	Systematic review: 51 articles reviewed to determine usefulness of videoconferencing as a clinical and educational tool	Surgeons	Media: video	Review discussed primarily observational data on the use of videoconferencing for provision of lecture, mentoring and POC support for emergencies or trauma settings. Methodology of studies is weak, but shows promise for providing POC and mentoring to rural settings from specialists in other geographical areas.
		Country: Norway and developed countries	Technique: multiple
			Frequency: NR
Bloomfield J et al. 2010	RCT to test if the theory and skill of handwashing can be taught more effectively when taught using computer-assisted learning compared to conventional face-to-face teaching	Nursing students	Media: computer-based vs live	The computer-assisted learning module was an effective strategy for teaching both theory and practice of handwashing to nursing students and was found to be at least as effective as conventional, face-to-face teaching methods. However, this finding must be interpreted with caution in light of sample size and attrition rates.
		n = 242, I = 113, C = 118	Techniques: multiple
		Country: UK	Frequency: single
			Intervention group received theory via computer-based module; control group via instructor-led. The objectives and content were the same, both groups included practice opportunities.
Bradley P et al. 2005	Prospective RCT and qualitative evaluation to compare self-directed, computer-based learning to traditional, live, interactive education techniques	Medical students	Technique: self-directed vs interactive	There were no differences in outcomes for the computer-based group compared to the live, interactive group in knowledge acquisition, critical appraisal skills or attitudes toward EBM. This trial and its accompanying qualitative evaluation suggest that self-directed, computer-assisted learning may be an alternative format for teaching EBM.
		I = 85, C = 90
		Country: Norway	Media: computer-based vs live
			Frequency: single
			Intervention group received self-directed, computer-based modules on EBM; control group received live, interactive sessions.
Choa et al. 2008	Single-blinded, cluster randomized trial to compare the effectiveness of audiovisual animated CPR instruction with audio, dispatcher-assisted instruction in participants with no previous CPR training; both via mobile phones	Allied health professionals, hospital employees	Media: mobile, audiovisual animation vs audio instructions from live dispatcher	Audiovisual animated CPR instruction via mobile phone resulted in better scores in checklist assessment and time interval compliance in participants without CPR skill compared to those who received CPR instructions from a dispatcher. However, the accuracy of important psychomotor skill measures was unsatisfactory in both groups.
			Technique: POC
		I = 44, C = 41
		Country: Korea
			Frequency: single
			Intervention group used mobile phone application with audiovisual animation instructions for CPR; control group received audio guidance from a live dispatcher.
Chui S et al. 2009	Experimental research design with two groups, one pre-test and two post-tests, to determine the effectiveness of computer-based interactive instruction vs video didactic instruction	Nurses	Media: computer-based vs video	Interactive, computer-assisted instruction increased student assessment correctness compared to video didactic instruction for in-service neurological nursing education after statistical adjustments for length of experience.
		I = 44, C = 40	Technique: self-directed interactive vs didactic
		Country: Taiwan	Frequency: single
			Intervention group received computer-based, interactive educational module; control group watched a video of a lecture.
Curran V and Fleet L 2005	Systematic review to evaluate the nature and characteristics of the web-based CME, based on Kirkpatrick levels of evaluation; 86 studies were identified, majority were descriptive	Physicians	Media: Internet	Inconclusive evidence to identify the most effective characteristics of web-based CME due to a lack of studies focusing on performance change. Findings suggest web-based CME is effective in enhancing knowledge and attitudes. Several studies suggest interactive CME that requires participant activity and the chance to practice skills can effect changes in practice behaviours.
			Technique: multiple
			Frequency: both single and multiple
Farmer A et al. 2008	Systematic review: 23 studies reviewed to determine the usefulness of print-based materials in practice behaviours or clinical practice outcomes	Health care professionals	Media: print	Insufficient information to support the effectiveness of print-based educational materials compared to other interventions. Print materials may have a beneficial effect on process outcomes compared to no intervention, but not on clinical practice outcomes.
			Technique: didactic
			Frequency: single
Fordis M et al. 2005	RCT to determine if Internet-based CME can produce changes comparable to those produced via live, small group, interactive CME with respect to physician knowledge and behaviours that have an impact on patient care	Physicians	Media: Internet-based vs live, interactive	Internet-based CME can produce objectively measured changes in behaviour as well as sustained gains in knowledge that are comparable or superior to those realized from an effective, live, group-based activity. The Internet-based intervention was associated with a significant increase in the percentage of high-risk patients treated with pharmacotherapeutics according to guidelines compared to the live, group-based control group.
		n = 97; I = 49, randomly assigned Internet-based over 2 weeks; C1 = 44, single, live, interactive session; C2 = 18, from same sites received nothing	Technique: self-directed vs interactive
			Frequency: single
			Intervention group received Internet-based modules over 2 weeks; one control group received a live, interactive session and the other control group received nothing.
		Country: USA
Hadley J et al. 2010	Cluster RCT to evaluate the educational effectiveness of a clinically integrated e-learning course for teaching basic EBM among post-graduate medical trainees compared to a traditional lecture-based course of equivalent content	Post-graduate medical trainees, interns	Media: Internet vs live	An e-learning course in EBM was as effective in improving knowledge as a standard lecture-based course. There was no statistically significant difference in knowledge of participants in the e-learning course compared to the lecture-based course. The benefits of an e-learning approach include standardization of teaching materials and it is a potential cost-effective alternative to standard, lecture-based teaching.
			Techniques: multiple
			Frequency: single
			Intervention group received clinical integrated, e-learning course on EBM; control group received live, didactic-based course.
		Seven clusters of 237
		I = 88, C = 72
		Country: UK
Harrington S and Walker B 2004	RCT to determine effectiveness of computer-based training compared with the traditional, instructor-led format	Nurses	Media: computer-based vs live	The computer-based group significantly outperformed the instructor-led group on the knowledge sub-test at post-test (gain of 28% vs 26%). Participants reported linked, computer-based learning and researchers noted potential for efficiencies and cost reduction.
		n = 1,294, I = 670, C = 624	Technique: didactic vs self-directed
		Country: USA	Frequency: single
			Intervention group received self-directed, computer-based instruction; control group received instructor-led, live instruction. Both groups had the same objectives and content.
Horiuchi S et al. 2009	RCT compared web-based to live instruction	Nurses or midwives	Media: Internet vs live	No significant differences in knowledge were observed between the web-based and face-to-face group. However, the web-based instruction was rated as more flexible and affordable and had a lower drop-out rate than the face-to-face programme.
		n = 93; C = 45, web-based; I = 48, live	Techniques: multiple
			Frequency: single
			Intervention group received web-based instruction; control group received didactic live instruction.
		Country: Japan
Kemper K et al. 2006	National randomized 2 x 2 factorial trial	Health professionals	Media: Internet	There were statistically significant improvements in knowledge, confidence and communication scores after the course for each of the Internet–based delivery methods, with no significant differences in any of the three outcomes by delivery strategy. Outcomes were better for those who paid for continuing education credit.
		n = 1,267; completion rate = 62%; Group 1 = 318; Group 2 = 318; Group 3 = 318; Group 4 = 313	Technique: self-directed
			Frequency: single
			Group 1: four modules delivered weekly over 10 weeks by email (drip-push); Group 2: modules accessible on web site with four reminders weekly for 10 weeks (drip-pull); Group 3: 40 modules delivered within 4 days by email (bolus-push); and Group 4: 40 modules available on the Internet with one email informing participants of availability (bolus-pull).
		Country: USA
Leung G et al. 2003	RCT to compare the effectiveness of mobile, POC support vs print-based job aids	4th year medical students	Media: mobile vs print	Both the PDA and pocket card groups showed improvements in scores for personal application and current use of EBM. The PDA group showed slightly higher scores in all five outcomes, whereas those for the pocket card group were not appreciably different from the previous rotation.
			Technique: POC
		n = 169; I = 54; C/pocket card = 55; C/nothing = 55
			Frequency: single
			Intervention group given PDA devices with clinical decision support tools; one control group was given a pocket card containing guidelines and the other control group received no intervention.
		Country: China
Liaw S et al. 2008	Cluster randomized trial to determine the effectiveness of locally adapted practice guidelines and education about paediatric asthma management, delivered to general practitioners using interactive, small group workshops	General practitioners	Media: live vs print only	Using interactive small group workshops to disseminate locally adapted guidelines was associated with improvement in general practitioners’ knowledge and confidence to manage asthma compared to receiving guidelines alone in the control arm, but did not change their self-reported provision of written action plans.
		n = 29, randomly assigned; I = 18, live, interactive plus guidelines; C/guidelines only = 18; C/nothing = 15	Technique: interactive vs reading
		Country: Australia
			Frequency: single
			Intervention group received live, interactive sessions plus guidelines; control groups received guidelines only and no intervention.
Rabol L et al. 2010	Systematic review: 18 studies reviewed to determine outcomes of live, classroom-based, multi-professional team training	Health professionals	Media: live	Although most studies had weak design methods, findings from the 18 studies concluded that team-based training led to positive participant evaluation, knowledge gain and behaviour change. However, the impact on clinical outcomes was limited.
			Technique: multiple
			Frequency: single
Sulaiman N et al. 2010	Same study design as Liaw S et al. 2008 for CPE intervention, but used questionnaires to determine any impact on completing written action plans or patient outcomes	411 patient surveys from patients of three arms utilized in Liaw, S., et al. 2008 at baseline; 341 at follow-up	See Liaw S et al. 2008	The interactive, small group workshops failed to translate into increased ownership of written action plans, improved control of asthma or improved quality of life, compared to receiving guidelines alone or control intervention.
		Country: Australia
Triola M et al. 2006	RCT to compare effectiveness of virtual patients to live, standardized patients for improving clinical skills and knowledge	Health professionals	Media: virtual patient vs live patient	Improvements in diagnostic abilities were equivalent in groups who experienced cases either live or virtually. There was no subjective difference perceived by learners. Using virtual cases has the potential for cost efficiencies.
		I = 23, C = 32	Technique: case-based
		Country: USA	Frequency: single
			Intervention group received two live, standardized patient cases and two virtual patient cases; control group received four standardized patient cases.
Turner M et al. 2006	Randomized, controlled, crossover trial to compare efficacy, student preference and cost of web-based, virtual patient vs live, standardized patient	2nd year medical students	Media: virtual patient vs live patient	There was no statistical difference in learning outcomes between the web-based and standardized patient; however, students preferred the standardized patient format. Start-up costs were comparable, but the ongoing costs of the web-based format were less expensive, suggesting that web-based teaching may be a viable strategy.
		I = 25, C = 24	Technique: case-based
		Country: USA	Frequency: single
			Intervention group received web-based instruction for one topic, then standardized patient for another topic. This was reversed for the second cohort, or control group, standardized patient first followed by web-based instruction.
Wutoh R et al. 2004	Systematic review: 16 articles reviewed to determine the effect of Internet-based CME interventions on physician performance and health care outcomes	Physicians	Media: Internet	Results demonstrate that Internet-based CME are just as effective in imparting knowledge as traditional formats of CME. However, there is a lack of quality studies to conclude significant positive changes in practice behaviour and additional studies are needed.
			Technique: multiple
			Frequency: both single and multiple
You J et al. 2009	Prospective, randomized study to investigate usefulness of video via mobile device as an instruction tool	Surgical residents	Media: mobile videoconferencing/feedback	The overall success rate for performing needle thoracocentesis was significantly higher for the mobile phone video intervention compared to the control group without aided instruction. Participants also rated the mobile phone intervention with significantly higher scores for instrument difficulty and procedure satisfaction.
		I = 24, C = 25	Technique: live, interactive with and without mobile POC feedback using video
		Country: South Korea
			Frequency: single
			Both intervention groups had a didactic session, performed a thoracentesis on a manikin while using video on a mobile phone and received feedback from a live instructor; control group did not receive any video-aided guidance.

C Control, CME Continuing medical education, CPR Cardiopulmonary resuscitation, EBM Evidence-based medicine, I Intervention, NR Not reported, PDA Personal digital assistant.

POC Point-of-care, RCT Randomized controlled trial.