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Logo of bmcmeduBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Medical Education
BMC Med Educ. 2009; 9: 21.
Published online May 12, 2009. doi:  10.1186/1472-6920-9-21
PMCID: PMC2688004
The effectiveness of a clinically integrated e-learning course in evidence-based medicine: A cluster randomised controlled trial
Regina Kulier,corresponding author1 Sjors FPJ Coppus,2,3 Javier Zamora,4,14 Julie Hadley,5 Sadia Malick,5 Kausik Das,6 Susanne Weinbrenner,7 Berrit Meyerrose,7 Tamas Decsi,8 Andrea R Horvath,9 Eva Nagy,9 Jose I Emparanza,10 Theodoros N Arvanitis,1 Amanda Burls,1 Juan B Cabello,10 Marcin Kaczor,11 Gianni Zanrei,12 Karen Pierer,13 Katarzyna Stawiarz,11 Regina Kunz,13 Ben WJ Mol,2,3 and Khalid S Khan1,5
1The University of Birmingham, Edgbaston, Birmingham B15 2TG, UK
2Academic Medical Center, University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
3Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology and Biostatistics, Meibergdreef 9, 1105 AZ Amsterdam, Amsterdam, the Netherlands
4Clinical Biostatistics Unit, Hospital Ramon y Cajal, Ctra Colmenar, km 9.100 28034, Madrid, Spain
5Birmingham Women's Hospital, Metchley Park Road, Edgbaston, Birmingham, B15 2TG, UK
6Heart of England NHS Foundation Trust, Solihull Hospital, Lode Lane, Solihull, B91 2JL, UK
7Agency for Quality in Medicine, Weglelystrasse 3, 10623 Berlin, Germany
8University of Pécs, Department of Paediatrics, József Attila u. 7, Pécs, H-7623, Hungary
9TUDOR, University of Szeged, Albert Szent-Gyorgyi Medical and Pharmacological Centre, Somogyi Bela ter 1, Szeged, H-6725, Hungary
10CASPe (CASP Espana), Joaquin Orozco 6, 1°-F, 03006 Alicante, Spain
11CASPolska, 30–347 Krakow, ul. Wadowicka 3, Poland
12Universitá Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29100 Piacenza, Italy
13Basel Institute for Clinical Epidemiology, Hebelstrasse 10, CH 4031 Basel, Switzerland
14CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
corresponding authorCorresponding author.
Regina Kulier: r.kulier/at/; Sjors FPJ Coppus: s.f.coppus/at/; Javier Zamora: javier.zamora/at/; Julie Hadley: j.a.hadley/at/; Sadia Malick: malicks1/at/; Kausik Das: kausik.das/at/; Susanne Weinbrenner: weinbrenner/at/; Berrit Meyerrose: meyerrose/at/; Tamas Decsi: tamas.decsi/at/; Andrea R Horvath: Horvath/at/; Eva Nagy: neva/at/; Jose I Emparanza: joseignacio.emperanza/at/; Theodoros N Arvanitis: t.arvanitis/at/; Amanda Burls: a.j.burls/at/; Juan B Cabello: jbcabello/at/; Marcin Kaczor: katarzyna.stawiarz/at/; Gianni Zanrei: gianni.zanrei/at/; Karen Pierer: piererk/at/; Katarzyna Stawiarz: katarzyna.stawiarz/at/; Regina Kunz: Rkunz/at/; Ben WJ Mol: b.w.mol/at/; Khalid S Khan: k.s.khan/at/
Received December 10, 2008; Accepted May 12, 2009.
To evaluate the educational effects of a clinically integrated e-learning course for teaching basic evidence-based medicine (EBM) among postgraduates compared to a traditional lecture-based course of equivalent content.
We conducted a cluster randomised controlled trial in the Netherlands and the UK involving postgraduate trainees in six obstetrics and gynaecology departments. Outcomes (knowledge gain and change in attitude towards EBM) were compared between the clinically integrated e-learning course (intervention) and the traditional lecture based course (control). We measured change from pre- to post-intervention scores using a validated questionnaire assessing knowledge (primary outcome) and attitudes (secondary outcome).
There were six clusters involving teaching of 61 postgraduate trainees (28 in the intervention and 33 in the control group). The intervention group achieved slightly higher scores for knowledge gain compared to the control, but these results were not statistically significant (difference in knowledge gain: 3.5 points, 95% CI -2.7 to 9.8, p = 0.27). The attitudinal changes were similar for both groups.
A clinically integrated e-learning course was at least as effective as a traditional lecture based course and was well accepted. Being less costly than traditional teaching and allowing for more independent learning through materials that can be easily updated, there is a place for incorporating e-learning into postgraduate EBM curricula that offer on-the-job training for just-in-time learning.
Trial registration
Trial registration number: ACTRN12609000022268.
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