JMIR Publications

ABSTRACT

Background:

Medical schools in low- and middle-income countries are facing a shortage of staff, learning infrastructure as well as access to fast and reliable Internet. Offline digital education may be an alternative solution for these issues allowing medical students to learn at their own time and pace, without the need for a network connection.

Objective:

The primary objective of this systematic review was to assess the effectiveness of offline digital education compared with traditional learning or a different form of offline digital education in improving knowledge, skills, attitudes, and satisfaction of medical students. The secondary objectives was to assess the cost-effectiveness, changes in accessibility and/or availability of education, and the unintended/adverse-effects of the interventions on students.

Methods:

We carried out a systematic review of the literature by following the Cochrane methodology. We searched seven major electronic databases from January 1990 to August 2017 for randomized controlled trials (RCTs) or cluster RCTs (cRCTs). Two authors independently screened studies, extracted data and assessed risk of bias. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Results:

We included 36 studies with 3,325 medical students. Thirty-three of the studies were RCTs and three were cRCTs. The interventions consisted of software programs, Compact Disc Read-Only Memory (CD-ROMs), PowerPoint presentations, computer-based videos and other computer-based interventions. The pooled estimate of 19 studies (1,717 participants) showed equivalent effectiveness between offline digital education and traditional learning groups in terms of students’ post-intervention knowledge scores (standardized mean difference (SMD) = 0.11, 95% confidence interval (CI): -0.11, 0.32, small effect size, low quality evidence). Meta-analysis of four studies found that, compared with traditional learning, offline digital education improved medical students' post-intervention skills (SMD = 1.05, 95% CI: 0.15, 1.95, large effect size, low quality evidence). We are uncertain about the effects of offline digital education on students’ attitudes and satisfaction due to missing or incomplete outcome data. Only four studies estimated the costs of offline digital education; and none reported changes in accessibility and/or availability of education, or adverse-effects. The risk of bias was predominantly high in more than half of the included studies. The overall quality of the evidence was low (for knowledge, skills, attitudes and satisfaction) due to the study limitations and inconsistency across the studies.

Conclusions:

Our findings suggest that offline digital education is as effective as traditional learning in terms of medical students’ knowledge and more effective than traditional learning in terms of medical students’ skills. However, there is a need to further investigate students’ attitudes and satisfaction with offline digital education as well as its cost-effectiveness, changes in accessibility and/or availability of education, and any unintended/adverse-effects of the interventions.