Table 1.
Quality assessment of the evidence provided by the individual papers.
| Study | Internal validity | Score | Quality | Level in Kirkpatrick’s model | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | ||||
| Moro et al. 2017 | + | − | − | − | − | − | + | + | + | + | + | + | 60% | Moderate | 2B |
| Barmaki et al. 2019 | + | − | − | − | − | + | + | + | + | + | + | − | 60% | Moderate | 2A, 2B |
| Bork et al. 2019 | − | − | − | − | − | + * | + | + | + | + | + | + | 60% | Moderate | 2A, 2B |
| Henssen et al. 2019 | + * | − | − | − | + | + | + | + | + | + | + | + | 75% | Moderate | 2A, 2B |
| Bogomolova et al. 2020 | + | − | − | − | − | + | + | + | + | + | + | + | 75% | Moderate | 2A, 2B |
1. Was the method of randomization adequate?
2. Was the allocation concealed?
3. Was the participant blinded to the intervention?
4. Was the teacher blinded to the intervention?
5. Was the outcome assessor blinded to the intervention?
6. Was the dropout rate described and acceptable?
7. Were all randomized participants analyzed in the group to which they were allocated?
8. Are reports of the study free of suggestion of selective outcome reporting?
9. Were the groups similar at baseline regarding the most important prognostic indicators?
10. Were co-interventions avoided or similar?
11. Was the compliance acceptable in all groups?
12. Was the timing of the outcome assessment similar in all groups?
+ , criterion achieved; –, criterion not achieved; ∗ , assessors initially disagreed.
High: > 75% of the criteria have been fulfilled [≥ 10/12]. Where they have not been fulfilled the conclusions of the study or review are thought very unlikely to have been altered.
Moderate: 50–75% of the criteria have been fulfilled [6–9/12]. Those criteria that have not been fulfilled or not adequately described are thought unlikely to have altered the conclusions.
Low: Less than 50% of the checklist criteria were fulfilled [< 6/12]. The conclusions of the study are thought likely or very likely to alter had those criteria been fulfilled54–63.
Levels of change of knowledge according to the model of Kirkpatrick: (1) reaction; (2A) learning (change in attitude); (2B) learning (modification of knowledge or skills; (3) behavior (change in behavior); (4A) results (change in the system/organizational practice); and (4B) results (improvement in learner performance)20,21.
Printed below is the overview of the quality assessment as assessed by the second version of the Cochrane risk-of-bias tool for randomized trials (RoB 2).