Table 1.

Summary of findings for online and local area network–based digital education as compared to self-directed learning. patient or population: postregistration medical doctors; setting: universities, hospitals, and primary care; intervention: online and local area network–based digital education; comparison: self-directed learning.

Outcomes	Number of participants (number of RCTsa)	Quality of evidence (GRADEb)	Direction of effects
Knowledge assessed with multiple-choice questions. Follow-up ranged from posttest to 1 year	3067 (29)	Very lowc,d,e,f	Seventeen studies [43-60] reported that ODEg was significantly more effective than self-directed learning (very low certainty evidence). Two studies [61,62] reported mixed results (very low certainty evidence). Ten studies [63-72] reported that ODE was as effective as self-directed learning (very low certainty evidence).
Skills assessed with OSCEh, diagnostic assessment, examination, questionnaires, and surveys. Follow-up ranged from posttest to 4 years	829 (8)	Lowc,d,i	Five studies [65,73-76] reported that ODE was significantly more effective than self-directed learning (low certainty evidence). Two studies [77,78] reported that ODE was as effective as self-directed learning (low certainty evidence). One study [54] reported self-directed learning was more effective than ODE (low certainty evidence).
Attitude assessed with questionnaires. Follow-up ranged from posttest to 136 days	392 (4)	Lowc,d	One study [47] reported that ODE was significantly more effective than self-directed learning (low certainty evidence). Another [66] reported that ODE was as effective as self-directed learning (low certainty evidence). Two studies [44,58] reported mixed results (low certainty evidence).
Satisfaction assessed with questionnaires. Follow-up ranged from posttest to 6 months	934 (6)	Lowc,d	Two studies [67,79] reported that ODE was significantly more effective (low certainty evidence). Three studies [54,58,80] reported that ODE was as effective as self-directed learning (low-certainty evidence). One study [61] reported mixed results (low certainty evidence).

^aRCT: randomized controlled trial.

^bGRADE: Grading of Recommendations, Assessment, Development and Evaluations.

^cRated down by one level for study limitations. Most studies were considered to be at an unclear or high risk of bias. Overall, the risk of bias for most studies was unclear due to a lack of information reported.

^dRated down by one level for inconsistency. There was variation in effect size (ie, very large and very small effects were observed).

^eRated down by one level for publication bias. The effect estimates were asymmetrical, suggesting possible publication bias.

^fVery low quality (+ – – –): We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.

^gODE: online and local area network–based digital education.

^hOSCE: objective structured clinical examination.

ⁱLow quality (+ + – –): Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect