Table 2. Effect of Intervention on skill level.
| Study number | Author, year & country | Outcome of interest | Summary statistics (Percentage of mark/ Score by using mobile application (Mean±SD, P Value)) | Sample size (I: Intervention; C: Control) | Duration | Effectiveness of mobile application |
|---|---|---|---|---|---|---|
| 1 | Nadir et al, 2019, USA [42] | Change in skill level |
Mean percentages of completed checklist items: Int: 56.1±10.3; Cont: 49.4±7.4 for shortness of breath (P = 0.001); Int: 58±8.1; Cont: 49.8±7.0 for syncope (P<0.001) Mean GRS score for Syncope: Int:3.14±0.89; Cont: 2.6±0.97; P = 0.003 Mean GRS score for shortness of breath: Int:2.90±0.97; Cont: 2.81±0.80; P = 0.43 |
58 (C:29; I: 29) | 23 minutes | Effective in one condition (Out of 2) |
| 2 | Mamtora et al, 2018, UK [43] | Change in skill level |
Accurate description score (Out of 60): Dry AMD: Int: 47(78%); Cont: 28(47%) P < 0.05; CRVO: Int: 31(52%); Cont: 15(25%) P < 0.05; Papilloedema: Int: 28(47%); Cont: 29(48%) p = 0.52; Optic atrophy: Int: 50(83%); Cont: 34(57%); P = 0.08; PDR: Int: 43(72%); Cont: 32(53%); p = < 0.05 Accurate clinical diagnosis score (Out of 20): AMD: Int: 15(75%); Cont: 6(30%) P < 0.05; CRVO: Int: 8(40%); Cont: 6(30%); P = 0.48; Papilloedema: Int: 6(30%); Cont: 6(30%); P = 0.78; Optic atrophy: Int: 4(20%); Cont: 4(20%) P = 0.66; PDR: Int: 14(70%); Cont: 8(40%) P = 0.10 |
20 (C: 10; I: 10) | 15 min | Effective |
| 3 | Haubruck et al, 2018, UK [44] | Change in skill level |
Operation performance by OSATS (Points): Int: 38.0 [I50 = 7.0]; Cont: 30.5 [I50 = 8.0]; (P<0.001); Economy of time and motion: Int: 4.0 [I50 = 1.0]; Cont: 3.0 [I50 = 1.0]; (P = 0.004); Less helping need: Int: 4.0 [I50 = 1.0]; Cont: 2.0 [I50 = 1.0]; (P<0.001); Confident in handling of instruments: Int: 3.0 [I50 = 2.0]; Cont: 3.0 [I50 = 2.0] (P<0.001); Digital exploration of the pleural cavity: Int: 4.0 [I50 = 2.0]; Cont: 2.0 [I50 = 2.0](P<0.001); Median time of performing a CTI: Int: 4:15; Cont: 4:17 min. |
95 (I: 49; C: 46) | 120 min | Effective |
| 4 | Oliveira et al, 2019, Brazil [45] | Change in skill level | Significant differences from the specialists’ reference standards: Int: Conditions 4 and 10 (P<0.001); Cont: Conditions 1, 4,6, 7, 8, and 10 (P<0.05) | 20 (C: 10; I: 10) | 1 month | Effective |
| 5 | Martínez et al, 2017, Chile* [9] | Change in skill level |
Increase in score: Int: 16.2 ± 8.3 points (P < 0.001); Cont: 10.6 ± 11.7 points (P < 0.001) Difference in score between the groups: 3.5points (P = 0.22). |
80 (I: 40; C: 40) | 4 weeks | Effective |
| 6 | Naveed et al, 2018, England [52] | Change in skill level | Average OSATS Score (Max score: 5): Int: 3.53±0.39; Cont: 2.58±0.71; P = 0.0139 | 20 (C: 10; I: 10); Final evaluation (C: 7; I: 8) | Int: 1 hour; Cont: 2 hours | Effective |
| 7 | Kim et al, 2018, South Korea [53] | Change in skill level |
Improvement in nursing skill performance (Out of 378): Int: 205.35 ± 24.01 to 363.62 ± 9.07; Cont: 202.94 ± 22.95 to 328.22 ± 27.76 Mean Difference in Pre-post Skills: Int: 158.26±25.61; Cont: 125.28±33.502; P<0.001 |
72 (C: 36; I: 36); Final evaluation: 66 (C: 32, I: 34) | 1 week | Effective |
| 8 | Kang et al, 2020, South Korea [61] | Change in skill level |
Mean Difference in Pre-post Skills: Cont: 0.52 ± 0.56; Exp 1: 0.62 ± 0.73; Exp 2: 0.95 ± 0.46; P = 0.014 |
86 (Exp 1: 26; Exp 2: 32; Cont: 28) | 2 weeks | Effective |
| 9 | Bayram et al, 2019, Turkey [54] | Change in skill level |
Median Skill score: Pre test:Int: 53 (40–57); Cont: 53 (37–57); P = 0.997 Post test:Int: 55 (46–57); Cont: 54 (46–57); P = 0.017 Median OSCE time (Seconds): Pre test: Int: 330 (162–360); Cont: 340 (228–360); P = 0.022 Post test:Int: 260 (180–360); Cont: 260 (190–360); P = 0.723 |
118 (C: 59; I:59) | 1 week | Not effective |
| 10 | Fernández-Lao et al, 2016, Spain [55] | Change in skill level |
Global OSCE Scores: Ultrasound skills: Int:12.000 ± 2.572; Cont:9.000 ± 2.943; P = 0.000 Palpation skills: 12.038 ± 3.155; Cont:9.833 ± 3.963; P = 0.034 |
49 (I: 25; C: 24) | 2 weeks | Effective |
| 11 | Lozano-Lozano et al, 2020, Spain [56] | Change in skill level |
OSCE exam score: Int:7.3 ± 1.5; Cont: NA; P<0.001 |
110 (C: 55; I: 55); Final Evaluation: 105 (C: 55; I: 50) | 2 weeks | Effective |
| 12 | Strandell-Laine et al, 2018, Finland [46] | Change in skill level |
Mean Overall improvement in competence score: Int: 10.11±2.22; Cont: 11.67±2.30 (P = 0.57) Mean Improvement in self-efficacy: Int: 1.77±0.17; Cont: 1.51± 0.20 (P = 0.37) |
102 (I = 52; C = 50) | Three periods of 5 weeks | Not effective |
| 13 | Bartlett et al, 2017, UK [47] | Change in skill level |
Mean baseline score to post intervention score: Group 1: 28.7 (62.3%) to 32.7 (71.1%); P = 0.003 Group 2: 27.0 (58.7%) to 36.1 (78.5%); P = 0.001 Group 3: 27.6 (59.8%) to 34.9 (75.7%); P = 0.001 Mean score change from baseline (95% CI): Group 1: 4.0 (1.8–6.2); Group 2:9.1 (4.7–13.5); Group 3: 7.3 (4.3–10.4) |
27 (Group 1: 9; Group 2: 9; Group 3: 9) | 1 hour | Effective |
| 14 | Bunogerane et al, 2017, Rwanda [57] | Change in skill level |
Difference in cognitive skills (percentage change in pre test & post test): Int: 38.6% (P<0.001); Cont: 15.9% (P = 0.304) Overall simulation test score: Int: 22.43 (89.71%); Cont: 15.85 (63.4%); P <0.001 |
27 (C: 13; I: 14) | Till post-test completion | Effective |
| 15 | Low et al, 2011, UK [48] | Change in skill level | Overall cardiac arrest simulation test score Median (IQR): Int: 84.5(75.5–92.5); Cont: 72(62–87); P = 0.02 | 31 (I: 16; C: 15) | Till completion of test | Effective |
| 16 | Miriam McMullan, 2018, UK [49] | Change in skill level |
Drug Calculation Ability (Mean±SD): Pre: 47.6±23.4; Post: 56.7±24.7; P = 0.004 Drug Calculation Self-Efficacy (Mean±SD): Pre: 20.4±18.0; Post: 49.6±19.9; P<0.001 |
60 (Paramedics: 41; ODP: 19) | 8 weeks | Effective |
| 17 | Kang et al, 2018, South Korea [58] | Change in skill level |
Mean HTN self-efficacy Pre test: Int:72.2±9.6;Cont:68.1±13.6; Post test: Int:78.0±10.3;Cont:66.4±13.6; P = 0 .002 Mean DM self-efficacy Pre test: Int:67.8±9.9;Cont: 62.2±14.1; Post test: Int:72.0±12.2;Cont: 65.8±12.6; P = 0.043 |
92 [I: 49 (HTN: 21; DM: 28); C: 43 (HTN: 20; DM: 23)] | 1 week | Effective |
| 18 | Young Yoo et al, 2015, South Korea [59] | Change in skill level |
Clinical assessment skill for lung practice:Int:29.0 ± 1.1; Cont: 28.4 ± 0.8 (P = 0.258) Clinical assessment skill for Heart practice: Int: 37.0 ± 2.4; Cont: 38.3 ± 1.3 (P = 0.258) |
22 (11 each cross over) | 4 weeks | Not effective |
| 19 | Kim et al, 2017, South Korea [60] | Change in skill level | Difference in the mean scores for skills: Int: 11.97 ± 5.07; Cont: 6.71 ± 4.34 (P<0.001) | 80 (I: 40; C: 40); Final evaluation: 73 (I: 35; C:38) | 1 month | Effective |
| 20 | Shore et al, 2018, USA [62] | Change in skill level | Median simulation test score: 89 (IQR, 81 to 92) | 53 (single group) | 3 weeks | Effective |
| 21 | Meyer et al, 2018, USA [50] | Change in skill level |
Mean accuracy in testing/ diagnostic decisions: Int: 82.6%; Cont: 70.2%; P<0.001 Mean confidence in testing/diagnostic decisions (out of 10): Int: 7.5; Cont: 6.3; P<0.001 |
46 | 30 to 60 minutes | Effective |
| 22 | Quezada et al, 2019, Chile [51] | Change in skill level |
Improvement in GRS (5–25) score: Int: 15(6–17) to 23(20–25); P<0.05; Cont: 15(10–19) to 24(22–5); P<0.05 Improvement in SRS (4–20) score: Int: 12(11–15) to 18(15–20); P<0.05; Cont: 12(8–15) to 19(16–20); P<0.05 Change in Operative time (min): Int: 39(10.47) to 22(3.37); P<0.05; Cont: 42(12.58) to 22(3.35); P <0.05 |
55 (C: 25; I: 30) | 72 hours for single video | Effective |
| 23 | Ebner et al, 2019, Germany [63] | Change in skill level |
Longitudinal kidney measurements (mm) Right kidney (Median[IQR]): Int: 105.3(86.1 to 127.1); Cont: 92(50.4 to 112.2); P<0.001 Left kidney (Median[IQR]):Int: 100.3(81.7 to 118.6); Cont: 85.3(48.3 to 113.4); P<0.001 Median Measuring time (in seconds): Int: 351 (155–563); Cont: 302 (103–527) P = 0.26 |
66 (I: 33; C: 33) | 1 week | Effective |
AMD: Age-related Macular Degeneration; CRVO: Central retinal vein occlusion; DM: Diabetes Mellitus; GRS: Global rating scale; HTN: Hypertension; ODP: Operating Department Practice; OSATS: Objective Structured Assessment of Technical Skills; OSCE: Objective structured clinical evaluation; PDR: Pre-proliferative diabetic retinopathy; RCT: Randomized controlled trial; SD: Standard Deviation; SRS: Specific rating scale; UK: United Kingdom; USA: United States of America.
* Indicates that the study reported final score of EUNACOM (theoretical practical exam of general medicine) as combined knowledge and skill score. So the same result is repeated in skill domain also