Skip to main content

Some NLM-NCBI services and products are experiencing heavy traffic, which may affect performance and availability. We apologize for the inconvenience and appreciate your patience. For assistance, please contact our Help Desk at info@ncbi.nlm.nih.gov.

American Journal of Pharmaceutical Education logoLink to American Journal of Pharmaceutical Education
. 2021 Nov;85(10):8525. doi: 10.5688/ajpe8525

A Meta-Analysis of the Effect of Paper Versus Digital Reading on Reading Comprehension in Health Professional Education

Guillaume Fontaine a,b, Ivry Zagury-Orly c, Marc-André Maheu-Cadotte a,b,d, Alexandra Lapierre a,e, Nicolas Thibodeau-Jarry b,c, Simon de Denus b,f, Marie Lordkipanidzé b,f, Patrice Dupont g, Patrick Lavoie a,b,
PMCID: PMC8715975  PMID: 34301544

Abstract

Objective. Despite a rise in the use of digital education in health professional education (HPE), little is known about the comparative effectiveness of paper-based reading and its digital alternative on reading comprehension. The objectives of this study were to identify, appraise, and synthesize the evidence regarding the effect of how media is read on reading comprehension in the context of HPE.

Methods. Observational, quasi-experimental, and experimental studies published before April 16, 2021, were included if they compared the effectiveness of paper-based vs digital-based reading on reading comprehension among HPE students, trainees, and residents. Random-effects meta-analyses were performed using standardized mean differences.

Results. From a pool of 2,208 references, we identified and included 10 controlled studies that had collectively enrolled 817 participants. Meta-analyses revealed a slight but nonsignificant advantage to students reading paper-based HPE texts rather than digital text (standardized mean difference, -0.08; 95% CI -0.28 to 0.12). Subgroup analyses revealed that students reading HPE-related texts had better reading comprehension when reading text on paper rather than digitally (SMD =  -0.36; 95% CI -0.69 to -0.03). Heterogeneity was low in all analyses. The quality of evidence was low because of risks of bias across studies.

Summary. Current evidence suggests little to no difference in students’ comprehension when reading HPE texts on paper vs digitally. However, we observed effects favoring reading paper-based texts when texts relevant to the students’ professional discipline were considered. Rigorous studies are needed to confirm this finding and to evaluate new means of boosting reading comprehension among students in HPE programs.

Keywords: evidence synthesis, literature review, e-learning, reading material, health care education

INTRODUCTION

Digital education has become ubiquitous in health professional education (HPE).1-3 It can be defined as “the act of teaching and learning by means of digital technologies.”1 Digital education encompasses various teaching and learning approaches, ranging from the simple transformation of text from paper-based to digital formats (eg, portable document format) to the interactive use of sophisticated digital technologies.1 A majority of health professional students and practitioners report using a digital device in their studies or routine clinical practice.4,5 Despite the rise of digital education, little is known about the comparative effectiveness of reading media, ie, paper-based reading vs its digital alternative, on reading comprehension in HPE.6,7

Reading comprehension is a complex process that involves the ability to recall, understand, integrate, and evaluate text, and depends on several factors, including the reader (eg, vocabulary, degree of familiarity with the text), the reading content (eg, degree of complexity), and the reading media (see Table 1 for definitions).8,9 Reviews investigating the impact of reading media on reading comprehension have yielded inconsistent results but tend to favor paper-based reading for comprehension and retention of information.9-14 Proposed explanations for lower digital-based reading results include readers’ variable experience with technology, overconfidence in comprehension, and more superficial reading when using technology.15,16 Furthermore, the physical presence of a paper text may facilitate reading comprehension and learning.17

Table 1.

Definitions of Key Terms Used in a Review and Meta-Analysis of the Effect of Paper vs Digital Reading in Health Professional Education

graphic file with name ajpe8525-t1.jpg

Previous reviews have not examined the impact of reading media in the context of HPE, an exercise that is of both clinical, disciplinary, and cross-disciplinary interest. From a clinical standpoint, reading comprehension is essential to acquire the knowledge base for effective clinical decision-making that is required for the provision of safe, quality care.18,19 Health professional education often follows a similar, cross-disciplinary learning framework: a pre-clinical phase characterized by basic science education and a clinical phase integrating prior knowledge and applying it to cases in a clinical context. In all health professions, learners are driven by clinical considerations and a patient-centered perspective influencing their collection and processing of information and consequent decision-making. Examining reading comprehension in the context of HPE may eventually allow drawing inferences between reading comprehension and clinical outcomes.

From a disciplinary standpoint, tenets of disciplinary literacy suggest that the cognitive requirements for reading are intertwined with the specialized knowledge of those who produce and communicate knowledge within each discipline.20 This is in opposition to the view that reading builds on a generic set of skills and strategies, regardless of the discipline.21 While the effect of text genre on reading comprehension was considered in previous reviews, they did not examine whether the topic of the text was related to students’ discipline.9,10 Providing students with texts relevant to their discipline may aid their reading comprehension by building on prior knowledge and disciplinary habits of mind (eg, ways of thinking, reasoning, and critiquing).1 A key learning principle is relevancy; thus, students who deem a text less relevant could have a less meaningful learning experience.22 Thus, we believe differentiating between texts that are HPE-related and those that are not is fundamental.

Finally, from a cross-disciplinary standpoint, we believe that examining reading comprehension in HPE specifically also provides important insights for other fields of study. The current review will provide a new framework for examining reading comprehension in specific populations, a variable not explicitly controlled for in previous systematic reviews. This is important not only for providing meaningful material to learners, but also in terms of systematic review methodology as a way of reducing potential population and intervention heterogeneity. Thus, this systematic review and meta-analysis builds on previous evidence by considering studies in which the effectiveness of reading media on reading comprehension was evaluated in the context of HPE, examining the effect of text topics (HPE-related or non-HPE-related topics) considering students’ professional discipline, and including studies with graduate students. Our objective was to identify, appraise, and describe studies comparing the effectiveness of paper-based versus digital-based reading on reading comprehension among students, trainees, and residents in HPE.

METHODS

This systematic review and meta-analysis was conducted following the Joanna Briggs Institute guidelines.23 This paper is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the PRISMA-S guidelines for reporting literature searches.24,25 The protocol has been published and registered in the International Prospective Register of Systematic Reviews on April 28, 2020 (PROSPERO; CRD42020154519).26,27

This review considered observational, quasi-experimental, and experimental studies published in any language that compared the effectiveness of paper-based vs digital-based reading on reading comprehension. We defined reading comprehension as the immediate recall or understanding of the textual content among HPE students, trainees, and residents. We excluded studies conducted with individuals with reading difficulties, cognitive impairments, and related disorders. Paper-based reading was defined as reading text printed on paper (eg, books, articles). Digital reading was defined as “reading text on digital screens, including computers, tablets, mobile phones, and e-readers.”10 Studies examining media that included videos, animations, hyperlinks, web navigation, gamification, and adaptivity were excluded because these features could confound the results.10

The search strategy was designed to focus on three concepts: students, trainees, and residents participating in HPE (population); reading media (intervention); and reading comprehension (outcome). The search strategies for all databases are presented in Appendix 2. We performed searches in six databases (CINAHL via EbscoHost, EMBASE via OVID, ERIC via ProQuest, Medline via OVID, PsychInfo via EbscoHost, and Web of Science) on April 16 and 17, 2020.

Identified citations were uploaded in the Covidence software (Veritas Health Innovation, Melbourne, Australia; www.covidence.org). Duplicates were removed using Covidence. Two independent authors screened studies and reviewed full texts. Disagreements were resolved through discussion.

We worked independently and in duplicate to assess study quality using the Medical Education Research Study Quality Instrument (MERSQI).28 We also assessed risks of bias independently using the Effective Practice and Organization of Care (EPOC) risk of bias criteria.29 Risks of bias refer to methodological elements that could affect the internal validity of study results.

We used Covidence to perform data extraction independently and in duplicate. We extracted data at four levels: study level, participant level, intervention level, and outcome level. Data items extracted are specified in the published protocol.26 In addition, we have added variables related to the context of intervention implementation, including the degree of distraction (low, medium, or high) and presence of supervision (yes, no). We considered the degree of distraction: low, when reading and assessment of reading comprehension had been conducted in a supervised setting without evident mention of potential distractors; medium, when these had been conducted in a supervised setting with possible distractors (eg, multiple testing stations); and high, when these had been conducted in an unsupervised setting (eg, home) with an uncontrollable and unspecified degree of distraction.

The characteristics of studies and interventions were synthesized in a table. We undertook random-effects meta-analyses in Review Manager (RevMan) software, version 5.3 (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark, 2014) to compare the effects of paper vs digital reading on reading comprehension in HPE. Data were analyzed using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was assessed by examining the characteristics of the studies and using the I2 statistic. Three subgroup analyses were carried out to investigate the impact of moderators on statistical heterogeneity: HPE-related texts; reading time frame, presence of supervision. The risk of reporting bias was assessed qualitatively based on the country of study conduct, the year of study publication, and the statistical significance of study results.

We worked independently to assess the quality of evidence, or our confidence, in the pooled SMDs. We used the Grading of Recommendations Assessment, Development and Evaluation web-based software (GRADEpro, 2015, McMaster University and Evidence Prime, Inc, https://gradepro.org). We considered five factors for assessing the quality of evidence (risk of bias, indirectness of evidence, unexplained heterogeneity or inconsistency of results, imprecision of the results, probability of reporting bias).

RESULTS

From a pool of 2,208 potentially relevant articles, we found 10 quantitative, controlled studies comparing the effects of paper and digital reading on reading comprehension in HPE. Eight studies were included in the meta-analysis because they provided enough data to calculate SMD (Figure 1).

Figure 1.

Figure 1.

Flow Diagram of Article Screening and Selection

Selected characteristics of the studies included are summarized in Table 2. Nine studies were randomized controlled trials and one was a non-randomized controlled trial. Participants were undergraduate psychology students (n = 5),6,7,30-32 undergraduate dental students (n = 2),33 graduate medical students (n = 2),34,35 and graduate optometry students (n = 1), all of which were considered to be students in HPE.36-39 Studies involving graduate students, including medical and optometry students, accounted for three of the 10 studies included. The median sample size was 70 participants. All included studies were deemed of moderate quality according to the MERSQI; scores ranged from 10.5 to 12.5 out of 18 possible points.

Table 2.

Characteristics of Included Studies

graphic file with name ajpe8525-t2.jpg

Key characteristics of paper-based and digital-based reading media are summarized in Table 2. Reading topics varied greatly, ranging from oral histology to microeconomics. Whereas all studies included health professional students, the topic of texts was related to HPE in four studies, non-related to HPE in five studies, and not specified in one study. We observed significant variations regarding text length. The reading time was unlimited in five studies, limited to five to 25 minutes in four studies, and not specified in one study. In a majority of studies, students’ reading was supervised in a controlled setting (n = 7), which meant that there was a low or medium potential for distraction. In the three remaining studies, students read at home and were not supervised, suggesting a high potential for distraction.

All studies were judged to be at high risk of bias. The risk of selection bias was high or unclear in all studies, as was the risk of bias related to imbalances between groups in characteristics of participants at baseline. The risk of bias related to imbalances between groups in outcome measurements at baseline were high or unclear in eight studies.6,7,30-32,34-36 Six studies had a high or unclear risk of attrition bias.6,30-32,34,35 Six studies had a high or unclear risk of performance bias.6,7,32,34-36 Six studies had a high or unclear risk of contamination bias.6,30,32,34-36 Finally, the risk of reporting bias was low in all but one study.34

Two studies could not be pooled in the meta-analysis because of missing data.30,34 The pooled effect size across eight studies revealed a negligible and nonsignificant advantage of paper- over digital-based reading media for reading comprehension (SMD = −0.08; 95% CI −0.28 to 0.12; p = .43; Figure 2). Heterogeneity was low (I2 = 21%).

Figure 2.

Figure 2.

Forest Plot of Effect Sizes in Relation to Reading Comprehension

In a cluster-randomized trial with medical students, Matthes, Herzig, Muller, Stosch34 observed that a digital basic pharmacology e-book had a small, nonsignificant advantage over a similar paper book on final scores from a written multiple-choice examination (SMD = 0.27; p = .08). Similarly, in a study on introductory psychology students, Taylor30 noted no differences in reading comprehension between students who used digital texts and those who used paper texts (the effect size and the p value were non-reported and could not be calculated based on the data presented).

We conducted three subgroup analyses: studies in which students read texts on topics related to HPE vs non-related to HPE; studies in which reading time was unlimited vs limited; and studies in which reading was supervised vs unsupervised. We observed a modest, significant difference (p = .04) in favor of paper-based reading for HPE-related texts (SMD = −0.36; 95% CI −0.69 to −0.03; I2 = 0%) compared to non-HPE related texts (SMD = −0.08; 95% CI −0.17 to 0.24; I2 = 0%). We found no significant difference (p = .59) between paper and digital reading regarding reading time. We observed a modest, significant difference (p = .02) in favor of paper-based reading in unsupervised settings (SMD = −0.57; 95% CI −1.06 to −0.08; I2 = 0%) compared to supervised settings (SMD = 0; 95% CI −0.19 to 0.18; I2 = 0%). However, the two studies meta-analyzed for unsupervised settings were drawn from the same paper. The quality of the evidence regarding the effect of reading media on reading comprehension was deemed low because of the high risks of bias across studies. However, inconsistency, indirectness, and imprecision were deemed not serious.

DISCUSSION

This is the first systematic review and meta-analysis to compare the effect of paper-based and digital-based reading HPE media on students’ reading comprehension. We identified 10 studies published since 2001. The pooled effect size across eight studies revealed a negligible, nonsignificant advantage of paper-based over digital-based reading media for reading comprehension. Despite the small number of studies, a subgroup analysis revealed a modest significant increase in reading comprehension when students read paper copies of HPE texts compared to digital copies of the same texts. Risk of bias was generally high across studies, and the quality of evidence was low.

The negligible, nonsignificant advantage of paper-based reading found in this review is similar to the results of previous reviews.9,10,14 These reviews found a small, significant advantage of paper-based reading over digital-based reading.9,10,14 Our results also revealed marked variability regarding the characteristics of texts used to assess reading comprehension in HPE. Less than half of studies involved texts on topics related to students’ discipline (eg, oral histology, optometry), whereas the rest used texts on non-related topics (eg, short fiction, microeconomics). Prior research has highlighted the importance of text characteristics, including topic and relevance,1 when assessing reading comprehension. The significant difference in favor of paper-based reading for HPE-related texts echoes these previous findings; it suggests increased effects of reading media when considering texts relevant to students’ discipline.

Our findings reveal that unsupervised, uncontrolled environments led to a small but significant difference in favor of paper-based reading, when compared to supervised, controlled environments. This finding should be interpreted with caution: only two studies were unsupervised, both published by the same authors in a single article. That said, this finding may be explained by the fact that in unsupervised settings learners using digital devices may be more easily distracted by social media, digital notifications, or web browsing to name a few. This could explain why paper-based media appears to favor reading comprehension in unsupervised settings where learners are less exposed to such distractions. Research suggests that students regularly fall prey to distractions when using digital devices. Over a quarter of students self-report in-class, off-task distractions, and an estimated 50% of students’ laptop time is spent on tasks unrelated to their studies.40-42 Interestingly, the impact of digital-based reading is more negative for easy-to-read material than for hard-to read texts.43

Concerns for the distraction potential of digital devices such as smartphones or laptops may be minimized using e-readers, whose sole function is to enable reading. In our review, only one study focused on reading comprehension with e-readers7, as compared to computer- and paper-based media and no difference was found. However, that study was conducted in a low distraction, supervised setting. Another study with fifth grade students compared reading on e-readers and paper and found no significant differences in students’ attitudes, motivation or reading comprehension.44 Additional studies must be conducted before the impact of e-readers on reading comprehension can be appropriately assessed. These studies should directly compare electronic devices with a potential for distractions (eg, laptops, computers, smartphones) to e-readers that limit such distractions. Besides the degree of distraction, future studies should be explicit about the tasks that students are asked to perform and the restraints that are in place when using the digital device.

More studies on the effect of reading media on reading comprehension in HPE are needed using rigorous study designs (eg, randomized trials, non-inferiority trials, factorial trials), interventions, and outcome measures. Indeed, given the high risk of bias of the published literature, future studies should be conducted as per the most recent standards for trials (eg, Consolidated Standards of Reporting Trials [CONSORT]).45 Findings from properly designed RCTs, if consistent with our findings, may confirm that digital media is not inferior to paper-based media in terms of its impact on reading comprehension in HPE, a finding that could have significant implications for reading efficiency. Indeed, students reading computer passages read significantly faster than students who read on paper.36 Discrepancies in reading speed may impact the time efficiency that is central to future health care professionals’ practice.

Because of the various known advantages of digital media, namely, ease of access, organization, and eco-friendliness, the time-saving benefit of digital-based reading needs to be investigated. Educators and researchers need to consider that digital-based reading is only one educational component of modern e-learning programs, which may provide benefits for HPE that would not be possible through static, paper-based learning. For example, some e-learning programs include adaptivity features to personalize learning content through the consideration of each learner’s knowledge. This can increase learning efficiency, reduce superfluous cognitive load, and support learner engagement.46,47

However, in a commentary by Fjortoft and colleagues,48 the authors cautioned against pharmacy students’ overreliance on technology and the possible impact it could have on their long-term memory, suggesting a concurrent association with a decreased passing rate for the national board examinations in recent years. Although many variables can explain such a decreasing trend, this review provides preliminary insight as to whether the reading media should be considered as part of curricular planning.

This systematic review and meta-analysis has various strengths and limitations. In terms of strengths, the protocol was prospectively registered and published, which enhances the transparency of the research process. Moreover, the search strategy was developed over several months with an experienced librarian to ensure specificity, sensibility, and replicability. Regarding limitations, outcome measures varied across studies. To address this variation, we conducted meta-analyses using SMD to standardize the results of studies to a uniform scale before pooling them. Furthermore, although we had initially planned to assess the effect of reading media on skill development and clinical behavior, the absence of such data in the studies included prevented us from doing so.

CONCLUSION

This review did not find any significant differences between digital and paper-based reading except when the topic of the text and its relevance to students’ professional discipline was considered, in which case paper-based reading yielded a modest advantage over digital media. This review highlights the need for robust randomized trials in HPE using HPE-related texts to strengthen the quality and validity of the current evidence.

ACKNOWLEDGMENTS

This work was supported by the Cercle du Doyen, Faculty of Pharmacy, Université de Montréal, Canada.

REFERENCES

  • 1.Car J, Carlstedt-Duke L, Tudor Car L, et al. Digital education in health professions: the need for overarching evidence synthesis. J Med Internet Res . 2019;21(2):e12913. doi: 10.2196/12913 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Choules AP. The use of elearning in medical education: a review of the current situation. Postgrad Med J . 2007;83(978):212-216. doi: 10.1136/pgmj.2006.054189 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Shachar M, Neumann Y. Differences between traditional and distance education academic performances: a meta-analytic approach. Int Rev Res Open Dis . 2003;4(2). doi: 10.19173/irrodl.v4i2.153 [DOI] [Google Scholar]
  • 4.Canadian Medical Association. Ahead of the curve: Canadian doctors leap on mobile bandwagon. Future Pract. 2012.
  • 5.Curran V, Matthews L, Fleet L, Simmons K, Gustasfon DL, Wetsch L. A review of digital, social, and mobile technologies in health professional education. J Contin Educ Health Prof . 2017; 37(3):195-206. doi: 10.1097/CEH.0000000000000168 [DOI] [PubMed] [Google Scholar]
  • 6.Green TD, Perera RA, Dance LA, Myers EA. Impact of presentation mode on recall of written text and numerical information: hard copy versus electronic. N Am J Psychol . 2010;12(2):233-242. [Google Scholar]
  • 7.Margolin SJ, Driscoll C, Toland MJ, Kegler JL. E-readers, computer screens, or paper: does reading comprehension change across media platforms? Appl Cogn Psychol . 2013;27(4):512-519. doi: 10.1002/acp.2930 [Google Scholar]
  • 8.Elleman AM, Oslund EL. Reading comprehension research: implications for practice and policy. Policy Insights Behav Brain Sci . 2019;6(1):3-11. doi: 10.1177/2372732218816339 [Google Scholar]
  • 9.Singer LM, Alexander PA. Reading on paper and digitally: what the past decades of empirical research reveal. Rev Educ Res . 2017;87(6):1007-1041. doi: 10.3102/0034654317722961 [Google Scholar]
  • 10.Delgado P, Vargas C, Ackerman R, Salmeron L. Don't throw away your printed books: a meta-analysis on the effects of reading media on reading comprehension. Educ Res Rev . 2018;25:23-38. doi: 10.1016/j.edurev.2018.09.003 [Google Scholar]
  • 11.Dillon A. Reading from paper versus screens: a critical review of the empirical literature. Ergonomics . 1992;35(10):1297-1326. doi: 10.1080/00140139208967394 [Google Scholar]
  • 12.Kingston NM. Comparability of computer- and paper-administered multiple-choice tests for K–12 populations: a synthesis. Appl Meas Educ . 2008;22(1):22-37. doi: 10.1080/08957340802558326 [Google Scholar]
  • 13.Noyes JM, Garland KJ. Computer- vs. paper-based tasks: are they equivalent? Ergonomics . 2008;51(9):1352-1375. doi: 10.1080/00140130802170387 [DOI] [PubMed] [Google Scholar]
  • 14.Shudong W, Hong J, Young MJ, Brooks T, Olson J. Comparability of computer-based and paper-and-pencil yesting in K–12 reading assessments. Educ Psychol Meas . 2007;68(1):5-24. doi: 10.1177/0013164407305592 [Google Scholar]
  • 15.Mangen A, Olivier G, Velay JL. Comparing comprehension of a long text read in print book and on Kindle: where in the text and when in the story? Front Psychol . 2019;10(38):38. doi: 10.3389/fpsyg.2019.00038 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Lauterman T, Ackerman R. Overcoming screen inferiority in learning and calibration. Comput Hum Behav . 2014;35:455-463. doi: 10.1016/j.chb.2014.02.046 [Google Scholar]
  • 17.Chen G, Cheng W, Chang TW, Zheng X, Huang R. A comparison of reading comprehension across paper, computer screens, and tablets: does tablet familiarity matter? J Comput Educ . 2014;1(2-3):213-225. doi: 10.1007/s40692-014-0012-z [Google Scholar]
  • 18.Monteiro S, Sherbino J, Sibbald M, Norman G. Critical thinking, biases and dual processing: the enduring myth of generalisable skills. Med Educ . 2020;54(1):66-73. doi: 10.1111/medu.13872 [DOI] [PubMed] [Google Scholar]
  • 19.Norman GR, Monteiro SD, Sherbino J, Ilgen JS, Schmidt HG, Namede S. The causes of errors in clinical reasoning: cognitive biases, knowledge deficits, and dual process thinking. Acad Med . 2017;92(1):23-30. doi: 10.1097/ACM.0000000000001421 [DOI] [PubMed] [Google Scholar]
  • 20.Shanahan T, Shanahan C. What is disciplinary literacy and why does it matter? Top Lang Disord . 2012;32(1):7-18. doi: 10.1097/TLD.0b013e318244557a [Google Scholar]
  • 21.Fang Z, Coatoam S. Disciplinary literacy: what you want to know about it. J Adolesc Adult Lit . 2013;56(8):627-632. doi: 10.1002/jaal.190 [Google Scholar]
  • 22.Fink LD. Creating Significant Learning Experiences: An Integrated Approach to Designing College Courses. San Francisco, CA: John Wiley & Sons; 2013. [Google Scholar]
  • 23.Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. Chapter 3: Systematic reviews of effectiveness. In: Aromataris E, Munn Z, eds. Joanna Briggs Institute Reviewer's Manual. Adelaide, Australia: The Joanna Briggs Institute; 2017. [Google Scholar]
  • 24.Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev . 2015;4(1):1. doi: 10.1186/2046-4053-4-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Rethlefsen ML, Kirtley S, Waffenschmidt S, et al. PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. Syst Rev . 2021;10(1):39. doi: 10.1186/s13643-020-01542-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Fontaine G, Zagury-Orly I, de Denus S, et al. Effects of reading media on reading comprehension in health professional education: a systematic review protocol. JBI Evid Synth . 2020;18(12):2633-2639. doi: 10.11124/JBISRIR-D-19-00348 [DOI] [PubMed] [Google Scholar]
  • 27.Fontaine G, Zagury-Orly I, de Denus S, et al. Effects of reading media on reading comprehension in health professional education: a systematic review. PROSPERO CRD42020154519. 2020. Accessed November 8, 2021. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020154519 [DOI] [PubMed]
  • 28.Reed DA, Cook DA, Beckman TJ, et al. Association between funding and quality of published medical education research. JAMA. 2007;298:1002-1009. doi:10.1001/jama.298.9.1002 [DOI] [PubMed] [Google Scholar]
  • 29.Cochrane Effective Practice and Organisation of Care (EPOC). Data collection checklist. EPOC Resources for review authors. Norwegian Knowledge Centre for the Health Services. 2017. Accessed November 8, 2021. https://methods.cochrane.org/sites/methods.cochrane.org.bias/files/public/uploads/EPOC%20Data%20Collection%20Checklist.pdf
  • 30.Taylor AK. Students learn equally well from digital as from paperbound texts. Teach Psychol . 2011;38(4):278-281. doi: 10.1177/0098628311421330 [Google Scholar]
  • 31.Mayes DK, Sims VK, Koonce JM. Comprehension and workload differences for VDT and paper-based reading. Int J Ind Ergon . 2001;28(6):367-378. doi: 10.1016/s0169-8141(01)00043-9 [Google Scholar]
  • 32.Seehafer H. Effects of learning style on paper versus computerbased reading comprehension. Red River Psyc J . 2014;1:1-17. [Google Scholar]
  • 33.Ramseier CA, Ivanovic A, Woermann U, Mattheos N. Evaluation of a web-based application versus conventional instruction in the undergraduate curriculum of fixed prosthodontics. Eur J Dent Educ . 2012;16(4):224-231. doi: 10.1111/j.1600-0579.2012.00748.x [DOI] [PubMed] [Google Scholar]
  • 34.Matthes J, Herzig S, Muller E, Stosch C. Acceptance, use and effects of PDF e-books in a course on basic pharmacology. Med Teach . 2012;34(2):177. doi: 10.3109/0142159X.2012.644839 [DOI] [PubMed] [Google Scholar]
  • 35.Ramalingam Y, Raidu RS, Hariish G, Naidoo JP. Screen reading vs paper reading: an experimental study on the impact of different reading materials on recall and comprehension among students. Am J Educ Sci . 2018;4(4):136-143. [Google Scholar]
  • 36.McDowell P, Shank A. Reading comprehension and eye movement abilities: a comparison of digital and print presentations. Optom Vis Perf . 2019;7(5-6):309-314. [Google Scholar]
  • 37.Institute of Medicine (US) Committee on the Health Professions Education Summit. Introduction. In: Greiner A, Knebel E, eds. Health Professions Education: A Bridge to Quality. Washington, DC: National Academies Press (US); 2003. [PubMed] [Google Scholar]
  • 38.Jarvis I, Ker J. Ensuring standards for the extended role of optometry. Clin Teach . 2014;11(3):184-187. doi: 10.1111/tct.12101 [DOI] [PubMed] [Google Scholar]
  • 39.Wahass SH. The role of psychologists in health care delivery. J Family Community Med . 2005;12(2):63-70. [PMC free article] [PubMed] [Google Scholar]
  • 40.Witherby AE, Tauber SK. The current status of students’ note-taking: why and how do students take notes. J Appl Res Mem Cogn . 2019;8(2):139-153. doi: 10.1016/j.jarmac.2019.04.002 [Google Scholar]
  • 41.Ravizza SM, Uitvlugt MG, Fenn KM. Logged in and zoned out: how laptop internet use relates to classroom learning. Psychol Sci . 2017;28(2):171-180. doi: 10.1177/0956797616677314 [DOI] [PubMed] [Google Scholar]
  • 42.Flanigan AE, Titsworth S. The impact of digital distraction on lecture note taking and student learning. Instr Sci . 2020;48(5):495-524. doi: 10.1007/s11251-020-09517-2 [Google Scholar]
  • 43.Copeland L, Gedeon T. Visual distractions effects on reading in digital environments: a comparison of first and second english language readers. Paper presented at: Annual Meeting of the Australian Special Interest Group for Computer Human Interaction; Dec 7-10, 2015; Parkville, Australia. doi: 10.1145/2838739. 2838762
  • 44.Long D, Szabo S. E-readers and the effects on students’ reading motivation, attitude and comprehension during guided reading. Cogent Educ . 2016;3(1):1197818. doi: 10.1080/2331186X.2016.1197818 [Google Scholar]
  • 45.Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med . 2001;134(8):663-694. doi: 10.7326/0003-4819-134-8-200104170-00012 [DOI] [PubMed] [Google Scholar]
  • 46.Fontaine G, Cossette S, Maheu-Cadotte MA, et al. Efficacy of adaptive e-learning for health professionals and students: a systematic review and meta-analysis. BMJ Open . 2019;9:e025252. doi: 10.1136/bmjopen-2018-025252 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Fontaine G, Cossette S, Gagnon MP, Dubé V, Côté J. Effectiveness of a theory- and web-based adaptive implementation intervention on nurses’ and nursing students’ intentions to provide brief counseling: protocol for a randomized controlled trial. JMIR Research Protocols . 2020;9(7):e18894. doi: 10.2196/ 18894 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Fjortoft N, Gettig J, Verdone M. Smartphones, memory, and pharmacy education. Am J Pharm Educ . 2018;82(3):215-216. doi: 10.5688/ajpe7054 [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from American Journal of Pharmaceutical Education are provided here courtesy of American Association of Colleges of Pharmacy

RESOURCES