Table 1.

Studies examining the application of learning software and digital learning objects.

Study	Research design	Research purpose	Findings
Antoniou et al (2014) [36]	The user experienced a specific periodontology case and was asked to provide the optimal responses for each of the challenges of the case. A focus group of 9 undergraduate dentistry students experienced both the Web-based and the Second Life version of this virtual patient.	To assess the suitability of the Second Life MUVE as a virtual patient deployment platform for undergraduate dental education and to explore the requirements and specifications needed to meaningfully repurpose Web-based virtual patients in MUVEs.	The best practices of experiential and immersive game design should be organically incorporated in the repurposing workflow.
Chi et al (2014) [37]	A retrospective cohort study of University of Washington School of Dentistry predoctoral dental students (N=247). The experimental group consisted of first-year dental students (n=63) who received a video case. The historical control group consisted of second-, third-, and fourth-year dental students (n=184) who received a paper case during their first year. A 19-item online survey was administered to all enrolled predoctoral dental students in May 2011.	To compare outcomes associated with video and paper cases used in an introductory public health dentistry course.	Compared to paper cases, video cases significantly improved cognitive, affective, and overall learning outcomes for dental students.
Schwarz et al (2013) [35]	The latest development in the Medical Faculties Network was designed for indexing metadata about simulation-based learning objects. A questionnaire was used to explore students’ attitudes and interests in using the interactive algorithms as part of their health sciences studies.	To present and evaluate simulation-based tools for teaching and learning acute medicine issues.	The peer-reviewed algorithms were used for conducting PBL sessions in general medicine and in nursing. The feedback from the survey suggests that the interactive algorithms are effective learning tools to facilitate enhanced knowledge in the field of acute medicine.
Rampling et al (2012) [32]	A total of 24 students tried the scenario and gave feedback via an online survey.	To create a simulated patient with psychosis for psychiatric training within the online virtual environment of Second Life. After design and delivery of the scenario, medical students were asked to complete it and provide feedback.	The scenario was cumbersome, did not imitate real life, and was of little educational value. Multimedia representations of psychotic symptoms were more positively received and there may be scope for further development.
Bridges (2009) [27]	An intervention was conducted with Year 1 students through workshops that introduced the principles of concept mapping software. Qualitative ethnographic data included Year 1 group concept maps and content-specialist feedback on these. Quantitative data were collected using an online questionnaire.	To reports an intervention to improve both the quality of the concept mapping and submission process.	Students have improved in identifying concepts and relationships and that their maps have increased in complexity and are also more clearly presented. After workshops and trialing, concept mapping has positively affected their thinking processes and improved knowledge retention.
Conradi et al (2009) [33]	A virtual patient (VP) scenarios were designed for learners on a Paramedic Foundation Degree within the virtual world Second Life. A player using the MedBiquitous VP international standard allowed cases to be played both within Second Life and on the Web.	To describe and test the PREVIEW project, trailed a replacement to traditional paper PBL with VPs delivered through a virtual world platform.	The Second Life environment engages students effectively in learning, despite some technology barriers. Students perceived SL could provide a more authentic learner environment than classroom-based PBL.
Poulton et al (2009) [34]	A PBL module was converted to VPs, and delivered to 72 students in 10 tutorial groups, with 5 groups each week receiving VPs with options and consequences, and 5 groups receiving online VPs but without options.	To describe and evaluate the replacement of paper cases by interactive online VPs in PBL.	The replacement of paper cases by online interactive VPs was perceived as a success by students and tutors, and both groups appreciated the improvements in PBL process.
Corrigan et al (2008) [41]	Evaluation was in both a qualitative and a quantitative fashion. A postcourse survey of medical students was used to evaluate access, process, and outcome criteria. SURGENT was used by 98% of students, with 69% spending more than 30 minutes per session on the program.	To assess the introduction of a Web-based module to complement traditional surgical undergraduate curricula.	A Web-enhanced interactive surgical module in an undergraduate course can successfully convey information and understanding beyond the textbook. SURGENT will supplement textbooks and ward experience, allowing students to develop their clinical decision-making skills.
Silen et al (2008) [28]	Questionnaires were used to investigate the medical and physiotherapy students’ opinions about the different formats of visualizations and their learning experiences.	To support learning efficacy by developing and using 3D datasets in health sciences curricula and enhancing the knowledge about possible educational value of 3D visualizations in learning anatomy and physiology.	It was successful to implement 3D images in existing themes in programs. The results show that deeper knowledge is required about students’ interpretation of images/films regarding learning outcomes. There is also a need for preparations and facilitation principles connected to the use of 3D visualizations.
Hege et al (2007) [39]	Different integration strategies of e-learning are presented and compared regarding motivational aspects and acceptance of students and instructors.	To describe and compare different implementation strategies of case-based learning as an important component of e-learning.	A voluntary integration strategy combined with exam relevance of the content.is recommended. The assets and drawbacks of all described strategies are discussed.
Balslev et al (2005) [38]	11 residents were each assigned to 1 of 2 groups. Both groups analyzed an identical vignette of a patient case. Immediately after, 1 group watched a 2.5-minute video recording and the other group read a description of the same video recording. The groups then reanalyzed the case. Thinking processes were tapped by recording and analyzing the verbal group interaction.	To investigate whether adding a brief video case instead of an equivalent written text improves the cognitive and metacognitive processes of residents in PBL.	The verbal interaction showed statistically significant improvements in data exploration, theory building, and theory evaluation after the video case.
Nathoo et al (2005) [42]	Describe a case study of distinct, small-group tutorials over 2 years as part of the Human Nervous System and Behavior course at the Harvard Medical School. Students and faculty were interviewed following completion of the course and their utilization of the system was recorded and examined.	To assess the introduction of a Web-based innovation in medical education that complements traditional PBL curricula. Utilizing the case method as its fundamental educational approach, the Interactive Case-based Online Network allows students to interact with each other, faculty, and a virtual patient in difficult neurological cases.	This is the first study of the Interactive Case-based Online Network learning system in undergraduate medical education, a platform designed to facilitate collaboration outside of the classroom. Data on user perceptions and system utilization suggest that both faculty and students chose to adopt this online learning system as a means for collaboration.
Hudson (2004) [45]	Third-year medical undergraduates at Adelaide University, South Australia were randomly assigned to 4 groups. Following a pretest, only students in the didactic, problem-based, and free-text groups had 2 weeks of free access to a neuroradiology CAL. Learning was quantified by comparing the post- to pretest scores for each of the 4 groups.	To test the hypothesis that a Computer-aided learning (CAL) tutorial, will result in superior learning (ability to apply and retain knowledge) to that obtained in more passive CAL formats.	While users of an interactive CAL tutorial demonstrated significant learning outcomes compared to non-CAL users, these outcomes were not superior to those achieved from noninteractive CAL.
Sibbald (2004) [40]	Students performed 3 PBL exercises for the same topic. Educational outcomes and students perceptions from an online survey are reported.	To encourage self-directed skill development; addresses learning style preferences; quantitatively and qualitatively assesses the relative advantages of electronic-based vs traditional PBL tools on knowledge and skills building.	This project gave students a balanced, enhanced knowledge perspective from 3 PBL formats; promoted peer teaching, mentoring, and technology skills; and provided insights comparing Web-based tools to other methods for autonomous lifelong learning.
August-Dalfen & Snider (2003) [29]	The program ErgoROM was used with a group of third-year occupational therapy students (n=50) in a semester-long course at McGill University in Canada.	To explore the students’ perceptions of using the ErgoROM and impact of the CD-ROM learning experience on their active learning and critical thinking skills.	Overall, 91% of respondents rated the ErgoROM as either “excellent” or “very good.” Additionally they reported that ErgoROM had a positive impact on active learning and critical thinking.
Bowdish et al (2003) [43]	A quasi experimental, posttest-only research design compared the virtual problem-based learning (VPBL) and a text-based version of the same PBL exercise on students’ achievement, as measured by a set of selected physiology examination items, and their perceptions of the learning environment, as measured by the Teaching and Learning Environment Questionnaire.	To report the results and insights of an exploratory investigation of the effectiveness of a prototypic virtual problem-based learning (VPBL) exercise delivered via the Web that uses Hypermedia Assisted Instructional Technologies.	The VPBL is equally as effective as the text-based version for enhancing students’ learning and their learning environment in small-group PBL sessions.
Dornan et al (2003) [31]	Qualitative analysis of users’ requirements and development of a Web-based learning portfolio. Direct observation of users during a “think-aloud” protocol, a validated software users’ measurement inventory, and a questionnaire designed to test whether SkillsBase met its users’ requirements.	To evaluate the use of information and communications technology to present a curriculum of clinical skills in a user-friendly format.	SkillsBase meets the design specification for a training and reflective aid to learning clinical skills and is very usable.
Jha & Duffy (2002) [26]	The questionnaire was sent out to 150 Distance Interactive Learning in Obstetrics and Gynaecology (DIALOG). The qualitative data obtained from the evaluation resulted in 10 common items being identified by the majority of respondents.	To carry out a formative evaluation of DIALOG to determine whether DIALOG was achieving its educational objectives.	One of the main benefits of formative assessment is to determine what needs to be done to maintain or improve the program in future. 10 “golden rules” emerged from the evaluation of DIALOG.
Levine et al (1999) [44]	Success of utilization was measured by quantitative improvements in student perceptions and attitudes over a 3-year period.	To describe and assess the implement and integration of computer-based activities into a problem-based gross anatomy curriculum.	The data suggested increasingly positive and beneficial student attitudes toward educational technology, for networks as a faster and more effective method of student/faculty communication, and in the utilization of computer-based instruction for greater flexibility and efficiency in learning the laboratory material.
Andrew & Benbow (1997) [30]	A brief questionnaire was given to a random sample of 100 students at the beginning of the last lecture of the third-year lecture course.	To describe and evaluate the conversion of a traditional image archive into an image resource on compact disc.	This resource useful as an aid to revision, despite relative computer illiteracy, and it is anticipated that students on a new PBL course that incorporates experience with information technology will benefit even more readily when they use the database as an educational resource.