Table 3.
Summary of findings for blended learning as compared to self-directed/face-to-face learning. patient or population: postregistration medical doctors; setting: universities, hospitals, and primary care; intervention: blended learning; comparison: self-directed/face-to-face learning.
| Outcomes | Number of participants (number of studies) | Quality of evidence (GRADEa) | Direction of effects |
| Knowledge assessed with multiple-choice questions. Follow-up ranged from posttest to 26 months | 4413 (7 RCTsb) | Very lowc,d,e,f | Two studies [96,97] reported that blended learning was significantly more effective in improving physicians’ knowledge than self-directed/face-to-face learning (very low certainty evidence). Five studies assessed together [96,98-101] reported that blended learning was as effective as self-directed/face-to-face learning (very low certainty evidence). |
| Skills assessed with OSCEg, diagnostic assessment, examination, questionnaires, and surveys. Follow-up ranged from posttest to 26 months. | 4131 (6 RCTs) | Lowc,d,h | Two studies [96,102] reported that blended learning may significantly improve physicians’ skills, and four studies [98,99,103,104] reported that blended learning may be as effective as face-to-face learning in improving skills (low certainty evidence). |
| Attitude assessed with a questionnaire. Follow-up assessed posttest | 61 (1 cRCTi) | Lowc,d | Kulier et al [105] compared a blended learning course on EBMj to a face-to-face EBM course and reported that the intervention may be as effective as the controls for improving physicians’ attitude. |
| Satisfaction assessed with questionnaires on a Likert scale. Follow-up ranged from posttest to 6 months | 166 (3 RCTs) | Lowc,d | Ali et al [98] compared ATLSk delivered through blended learning to a standard ATLS course and reported no difference in satisfaction between the groups (low certainty evidence). Kronick et al [106] compared 3 hours of online training to no training (self-directed training) and found that the intervention slightly improved satisfaction (low certainty evidence). Platz et al [100] compared basic ultrasound principles and extended focused assessment with sonography for trauma using blended learning as compared to face-to-face training and reported mixed results (low certainty evidence). |
aGRADE: Grading of Recommendations, Assessment, Development and Evaluations.
bRCT: randomized controlled trial.
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.
gOSCE: objective structured clinical examination.
hLow quality (+ + – –): Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect.
icRCT: cluster-randomized trial.
jEBM: evidence-based medicine.
kATLS: Advanced Trauma Life Support