۱- Introduction

۲- Background

۳- Methods

۴- Results

۵- Discussion

۶- Conclusions

References

Abstract

In low- and middle-income countries (LMICs), e-learning for medical education may alleviate the burden of severe health worker shortages and deliver affordable access to high quality medical education. However, diverse challenges in infrastructure and adoption are encountered when implementing e-learning within medical education in particular. Understanding what constitutes successful e-learning is an important first step for determining its effectiveness. The objective of this study was to systematically review e-learning interventions for medical education in LMICs, focusing on their evaluation and assessment methods. Nine databases were searched for publications from January 2007 to June 2017. We included 52 studies with a total of 12,294 participants. Most e-learning interventions were pilot studies (73%), which mainly employed summative assessments of study participants (83%) and evaluated the e-learning intervention with questionnaires (45%). Study designs, evaluation and assessment methods showed considerable variation, as did the study quality, evaluation periods, outcome and effectiveness measures. Included studies mainly utilized subjective measures and custom-built evaluation frameworks, which resulted in both low comparability and poor validity. The majority of studies self-concluded that they had had an effective e-learning intervention, thus indicating potential benefits of e-learning for LMICs. However, MERSQI and NOS ratings revealed the low quality of the studies’ evidence for comparability, evaluation instrument validity, study outcomes and participant blinding. Many e-learning interventions were small-scale and conducted as short-termed pilots. More rigorous evaluation methods for e-learning implementations in LMICs are needed to understand the strengths and shortcomings of e-learning for medical education in low-resource contexts. Valid and reliable evaluations are the foundation to guide and improve e-learning interventions, increase their sustainability, alleviate shortages in health care workers and improve the quality of medical care in LMICs.

Introduction

To achieve the 2030 Sustainable Development Goals (SDGs) for health–specifically, goal 3 (Good Health and Well-Being) and goal 4 (Quality Education)–low- and middle-income countries (LMICs) need effective and affordable education strategies to address critical health worker shortages (Al-Shorbaji, Majeed, & Wheeler, 2015, p. 156; Bollinger et al., 2013). This is particularly crucial considering the significant challenges most LMICs face with limited health care budgets (World Health Organization, 2014), insufficient qualified health workers (Mills, 2014), limited access to equipment and infrastructure, and a lack of continuing professional development and continuing medical education programs (Mack, Golnik, Murray, & Filipe, 2017). Training facilities and resources for health workers in LMICs are insufficient, and a substantial number of the few trained professionals are subject to “brain drain” when regularly recruited to high-income countries (Aluttis, Bishaw, & Frank, 2014). E-learning interventions for medical education could be of great benefit for targeting good health and well-being and quality education, especially in low-resource settings (Al-Shorbaji, Atun, Car, Majeed, & Wheeler, 2015; Dawson, Walker, Campbell, & Egede, 2016; Liu et al., 2016; World Health Organization, 2016a,b).