The efficacy and acceptance of online learning vs. offline learning in medical student education: a systematic review and meta-analysis

ABSTRACT

Background: To maintain the continuity of medical education during the COVID-19 epidemic, online learning has replaced traditional face-to-face learning. But the efficacy and acceptance of online learning for medical education remains unknown. This meta-analysis aimed to assess whether online learning improves learning outcomes and is more acceptable to medical students compared to offline learning. Methods: Four databases were searched for randomized controlled trials (RCTs) and comparative studies (non-RCTs) involving online learning published from January 1900 to October 2020. A total of twenty-seven studies comparing online and offline learning in medical students were included. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework and Newcastle-Ottawa Scale (NOS) were used to assess the methodological quality of RCTs and non-RCTs respectively. The data of knowledge and skills scores and course satisfaction were synthesized using a random effects model for the meta-analysis. Results: Twenty-one RCTs that were judged to be of high quality according to the GRADE framework and six non-RCTs studies which ranged from 6 to 8 (NOS) and can be considered high-quality were included in this meta-analysis. The revealed that the online learning group had significantly higher post-test scores (SMD =0.58, 95% CI 0.25 to 0.91;P=0.0006) and pre-and post-test score gains than the offline group (SMD =1.12, 95% CI 0.14 to 2.11, P=0.02). In addition, online education was more satisfactory to participants than the offline learning (OR 2.02;95% CI 1.16 to 3.52;P=0.01). Subgroup analysis was performed on knowledge and skill scores at the post-test level. The selected factors included study outcome, study design and type, participants, course type and country. No significant factors were observed in the subgroup analysis except for course type subgroup analysis. Discussion: Online learning in medical education could lead to higher post-test knowledge and skill scores than offline learning. It also has higher satisfaction ratings than offline education. In conclusion, online learning can be considered as a potential educational method during the COVID-19 pandemic. However, given the risk of bias of included studies such as the inclusion of non-randomized comparative studies, the conclusion should be made with cautions. Trial Registration CRD42020220295. © Journal of Xiangya Medicine. All rights reserved.