title: Teaching tools in evidence based practice: evaluation of reusable learning objects (RLOs) for learning about meta-analysis.
abstract: BACKGROUND
  All healthcare students are taught the principles of evidence based practice on their courses. The ability to understand the procedures used in systematically reviewing evidence reported in studies, such as meta-analysis, are an important element of evidence based practice. Meta-analysis is a difficult statistical concept for healthcare students to understand yet it is an important technique used in systematic reviews to pool data from studies to look at combined effectiveness of treatments. In other areas of the healthcare curricula, by supplementing lectures, workbooks and workshops with pedagogically designed, multimedia learning objects (known as reusable learning objects or RLOs) we have shown an improvement in students' perceived understanding in subjects they found difficult. In this study we describe the development and evaluation of two RLOs on meta-analysis. The RLOs supplement associated lectures and aim to improve students' understanding of meta-analysis in healthcare students.
  
  
  METHODS
  Following a quality controlled design process two RLOs were developed and delivered to two cohorts of students, a Master in Public Health course and Postgraduate diploma in nursing course. Students' understanding of five key concepts of Meta-analysis were measured before and after a lecture and again after RLO use. RLOs were also evaluated for their educational value, learning support, media attributes and usability using closed and open questions.
  
  
  RESULTS
  Students rated their understanding of meta-analysis as improved after a lecture and further improved after completing the RLOs (Wilcoxon paired test, p < 0.01 in all cases) Whilst the media components of the RLOs such as animations helped most students (86%) understand concepts including for example Forest plots, 93% of students rated usability and control as important to their learning. A small number of students stated they needed the support of a lecturer alongside the RLOs (7% 'Agreed' and 21% 'Neutral').
  
  
  CONCLUSIONS
  Meta-analysis RLOs that are openly accessible and unrestricted by usernames and passwords provide flexible support for students who find the process of meta-analysis difficult.
authors.affiliation: School of Nursing, Midwifery & Physiotherapy, University of Nottingham, Nottingham, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Bath-Hextall
authors.forename: Heather
authors.initials: H
authors.lastname: Wharrad
authors.forename: Jo
authors.initials: J
authors.lastname: Leonardi-Bee
mesh_terms: D003194:Computer-Assisted Instruction; D040381:Education, Public Health Professional / Q000379:methods; D055317:Evidence-Based Practice / Q000193:education*; D006801:Humans; D015201:Meta-Analysis as Topic; D013338:Students, Nursing; D011795:Surveys and Questionnaires; D013663:Teaching / Q000379:methods*