title: A methodological quality synthesis of systematic reviews on computer-mediated continuing education for healthcare providers.
abstract: BACKGROUND
  Healthcare providers use continuing education (CE) to meet professional development requirements and to ensure optimal patient care. There has been a dramatic increase in computer-mediated CE (CMCE) programs.
  
  
  OBJECTIVE
  To synthesize the literature regarding the current state of the science on the efficacy of CMCE for healthcare professionals, particularly as it relates to provider learning and patient outcomes. Specifically, this review assesses the methodological quality of existing systematic reviews and meta-analyses.
  
  
  METHODS
  A literature search was conducted using Cochrane Library, PubMed, and CINAHL. Review articles evaluating the efficacy of CMCE for healthcare providers were included. Publications were searched between 2002 and 2013 and limited to those printed in English. An objective measurement tool, AMSTAR, was used to assess the methodological quality of each review. AMSTAR is an 11-item instrument, in which individual criteria were evaluated and a composite score of all 11 components was determined for each review. Outcomes of each review were also categorized based on Kirkpatrick's levels for summative evaluation: (i) Learner satisfaction, (ii) Learning outcomes, (iii) Performance improvement, (iv) Patient/health outcomes.
  
  
  RESULTS
  Starting with 231 articles, 11 met the inclusion criteria for this evaluation. AMSTAR quality scores of the reviews ranged from 7 to 11, with 11 indicating the strongest quality. Although weak research design of many studies and heterogeneous topics covered make summative evaluations difficult, there were some common themes covered in the articles reviewed. Healthcare providers were largely satisfied with using CMCE programs. Overall, the studies comparing CMCE to traditional CE methods found the impact on learning outcomes to be comparable, with neither method necessarily superior. Additionally, all reviews lacked evaluation of practice outcomes.
  
  
  CONCLUSIONS
  While results of this review show promise for CMCE, further evaluation and more rigorously conducted research is necessary. Particular focus is needed to determine the effects of CMCE on health outcomes.
authors.affiliation: Hearst Predoctoral Fellow, Arizona State University, Aurora, CO, USA.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Militello
authors.forename: Bonnie
authors.initials: B
authors.lastname: Gance-Cleveland
authors.forename: Heather
authors.initials: H
authors.lastname: Aldrich
authors.forename: Rabah
authors.initials: R
authors.lastname: Kamal
mesh_terms: D003194:Computer-Assisted Instruction / Q000592:standards* / Q000639:trends; D004502:Education, Medical, Continuing / Q000592:standards* / Q000639:trends; D004509:Education, Nursing, Continuing / Q000592:standards* / Q000639:trends; D019317:Evidence-Based Medicine / Q000592:standards / Q000639:trends; D055318:Evidence-Based Nursing / Q000592:standards* / Q000639:trends; D006801:Humans
keywords: computer; computer-mediated; continuing education; continuing medical education