The Effectiveness And Related Influencing Factors Of Blended Learning In The Health Professions

Background: Blended learning has grown rapidly and is now widely used in medical education. Concerns about the effectiveness of blended learning have led to an increasing number of studies on this topic. However, there has yet to be a quantitative synthesis to evaluate the effectiveness of blended learning on knowledge acquisition in health professions.Objective: We aimed to assess the effectiveness of blended learning for health professional learners compared with no intervention and with non-blended learning. We also aimed to explore factors that could explain differences in learning effects. Moreover, in order to verify the effectiveness of blended learning in the health professions, we conducted two blended learning cases in quasi-experiment with the intervention course of Epidemiology, Advanced Statistics, Randomized Controlled Trials, Environment and Health, and Demography.Methods:(1)We conducted a search of citations in Medline, CINAHL, Science Direct, Ovid Embase, Web of Science, CENTRAL, and ERIC. Studies in any language that compared blended learning with no intervention or non-blended learning among health professional learners and assessed knowledge acquisition were included. Then we made meta-analysis.(2) In addition, we conducted two blended learning cases with quasi-experiment, and we collect data and information from post-test, questionnaires, and focus group discussions. We compared the post-test scores between intervention group and control group with t-test, explored the association betwwen learning timr and post-test scores with Sprearman rank correlation, conducted Logistic regression for the satisfaction and the potential factors, and performed thematic analysis on results of the interviews with grounded threory.Results: In the meta-analysis, fifty-six eligible articles were identified. Heterogeneity across studies was large(I2 ?93.3) in all analyses. For studies comparing knowledge gained from blended learning versus no intervention, the pooled effect size was 1.40(95% CI: 1.04–1.77; P<0.001; n=20 interventions) with no significant publication bias, and exclusion of any single study did not change the overall result. For studies comparing blended learning with non-blended learning(pure e-learning or pure traditional face-to-face learning), the pooled effect size was 0.81(95%CI: 0.57–1.05; P<.001; n=56 interventions), and exclusion of any single study did not change the overall result. Although significant publication bias was found, the trim and fill method showed that the effect size changed to 0.26(95%CI:-0.01–0.54) after adjustment. In the subgroup analyses, pre-posttest study design, presence of exercises, and objective outcome assessment yielded larger effect sizes. In the Case One, the final score of the students in intervention group was 83.59(±8.48), while that for control group was 80.57(±8.80), and there was no statistical difference between the two groups(t=1.077, P=0.284>0.05). In the intervention group, there is significant positive correlation between the post-test scores and total study time(rs=0.651,P=0.030). In the Case Two, the results of Logistic regression on satisfaction showed that the institution(P=0.009), “better access to the learning materials”(P=0.033), “e-learning platform is helpful”(P=0.023) and “learning was more independent”(P=0.048) were the factors influencing students' satisfaction on blending learning. In the focus group discussion, it was found that most of the students were satisfied with blended learning, and they prefer blended learning compared with pure e-learning and traditional face-to-face learning. The participants consider “course content”, “communication and discussion with teachers and other students”, “the design of e-learning platform” and “learners' computer skills” to be the factors influencing the effectiveness of blended learning.Conclusions: Blended learning appears to have a consistent positive effect in comparison with no intervention, and to be more effective than or at least as effective as non-blended instruction for knowledge acquisition in health professions. Compared with pure traditional learning and e-learning, students are more satisfied with blended learning.Thus, Blended learning is promising and worthwhile for further application in medical education. Due to the large heterogeneity, the conclusion should be treated with caution. With using well-designed e-learning platform, providing useful and abundant course materials, increasing the communication between students with teachers and with other students, and providing training on computer skills if essential, the effectiveness of blended learning could be facilitated and improved.