title: Online eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction.
abstract: BACKGROUND
  Health systems worldwide are facing shortages in health professional workforce. Several studies have demonstrated the direct correlation between the availability of health workers, coverage of health services, and population health outcomes. To address this shortage, online eLearning is increasingly being adopted in health professionals' education. To inform policy-making, in online eLearning, we need to determine its effectiveness.
  
  
  METHODS
  We performed a systematic review of the effectiveness of online eLearning through a comprehensive search of the major databases for randomised controlled trials that compared online eLearning to traditional learning or alternative learning methods. The search period was from January 2000 to August 2013. We included articles which primarily focused on students' knowledge, skills, satisfaction and attitudes toward eLearning and cost-effectiveness and adverse effects as secondary outcomes. Two reviewers independently extracted data from the included studies. Due to significant heterogeneity among the included studies, we presented our results as a narrative synthesis.
  
  
  RESULTS
  Fifty-nine studies, including 6750 students enrolled in medicine, dentistry, nursing, physical therapy and pharmacy studies, met the inclusion criteria. Twelve of the 50 studies testing knowledge gains found significantly higher gains in the online eLearning intervention groups compared to traditional learning, whereas 27 did not detect significant differences or found mixed results. Eleven studies did not test for differences. Six studies detected significantly higher skill gains in the online eLearning intervention groups, whilst 3 other studies testing skill gains did not detect differences between groups and 1 study showed mixed results. Twelve studies tested students' attitudes, of which 8 studies showed no differences in attitudes or preferences for online eLearning. Students' satisfaction was measured in 29 studies, 4 studies showed higher satisfaction for online eLearning and 20 studies showed no difference in satisfaction between online eLearning and traditional learning. Risk of bias was high for several of the included studies.
  
  
  CONCLUSIONS
  The current evidence base suggests that online eLearning is equivalent, possibly superior to traditional learning. These findings present a potential incentive for policy makers to cautiously encourage its adoption, while respecting the heterogeneity among the studies.
authors: Health Services and Outcomes Research, National Healthcare Group, Singapore ; Joint first authors.
authors: Pradeep Paul
authors: PP
authors: George
authors: Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK ; Joint first authors.
authors: Nikos
authors: N
authors: Papachristou
authors: Health Services and Outcomes Research, National Healthcare Group, Singapore.
authors: José Marcano
authors: JM
authors: Belisario
authors: Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Chaoyang District Beijing, P.R. China.
authors: Wei
authors: W
authors: Wang
authors: Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors: Petra A
authors: PA
authors: Wark
authors: Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors: Ziva
authors: Z
authors: Cotic
authors: Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors: Kristine
authors: K
authors: Rasmussen
authors: Department of Health Evidence, Radboud University Nijmegen, Nijmegen, The Netherlands.
authors: René
authors: R
authors: Sluiter
authors: Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors: Eva
authors: E
authors: Riboli-Sasco
authors: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors: Lorainne
authors: L
authors: Tudor Car
authors: Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors: Eve Marie
authors: EM
authors: Musulanov
authors: Health Services and Outcomes Research, National Healthcare Group, Singapore.
authors: Joseph Antonio
authors: JA
authors: Molina
authors: Health Services and Outcomes Research, National Healthcare Group, Singapore.
authors: Bee Hoon
authors: BH
authors: Heng
authors: Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Chaoyang District Beijing, P.R. China.
authors: Yanfeng
authors: Y
authors: Zhang
authors: Knowledge, Ethics and Research, World Health Organization, Geneva, Switzerland.
authors: Erica Lynette
authors: EL
authors: Wheeler
authors: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors: Najeeb
authors: N
authors: Al Shorbaji
authors: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors: Azeem
authors: A
authors: Majeed
authors: Health Services and Outcomes Research, National Healthcare Group, Singapore ; Health Services and Outcomes Research Programme, Lee Kong Chian School of Medicine, Imperial College & Nanyang Technological University, Singapore.
authors: Josip
authors: J
authors: Car