title: Enhancing Education Activities for Health Care Trainees and Professionals Using Audience Response Systems: A Systematic Review.
abstract: BACKGROUND
  This review examines the effect of incorporating clickers within practice-based education sessions on educational outcomes of health care trainees and professionals.
  
  
  METHODS
  A systematic literature review was conducted on primary research studies published up until August 2014. Studies were identified by database searching (Ovid MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and PsychInfo), citation searching, and reference list checking. Studies were restricted to those evaluating the use of clickers as part of the provision of postgraduate education or continuing education programs and were evaluated according to Kirkpatrick's four levels of training evaluation (reaction, learning, behavior, and results).
  
  
  RESULTS
  Seventeen studies met the eligibility criteria. Twelve studies assessed learner and/or speaker reactions, with feedback overwhelmingly positive in all studies. Reported learner benefits included increased attentiveness, engagement, and enjoyment of presentations. Speakers reported that using clickers engaged the audience and assisted in assessing audience comprehension. Eight studies assessed learning outcomes. Higher level evidence obtained from four randomized studies demonstrated significant improvements in knowledge with the use of clickers compared with traditional didactic presentations, but no differences when clickers were compared with an interactive lecture with integrated questions. No studies adequately assessed higher level educational outcomes (behavior and results).
  
  
  CONCLUSIONS
  Although the use of clickers improves learning environment and learner satisfaction, the limited high-quality data for improvements in learning and behavior outcomes make it uncertain whether the acceptance and implementation of clickers within routine practice-based education programs are warranted at this stage.
authors.affiliation: Dr. Grzeskowiak: Postdoctoral Research Fellow, The Robinson Research Institute, The University of Adelaide, Adelaide, Australia; Pharmacist, SA Pharmacy, Flinders Medical Centre, Bedford Park, South Australia, Australia. Ms. Thomas: Pharmacist, SA Pharmacy, Repatriation General Hospital, Adelaide, Australia. Ms. To: Lecturer, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia. Mr. Phillips: Pharmacist, Good Health Choices, Chemplus Pty Ltd, Adelaide, Australia. Ms. Reeve: PhD Candidate, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia; Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Luke E
authors.initials: LE
authors.lastname: Grzeskowiak
authors.forename: Alicia E
authors.initials: AE
authors.lastname: Thomas
authors.forename: Josephine
authors.initials: J
authors.lastname: To
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Phillips
authors.forename: Emily
authors.initials: E
authors.lastname: Reeve
mesh_terms: D004496:Education, Continuing; D004500:Education, Graduate; D004521:Educational Measurement; D018961:Educational Technology / Q000639:trends*; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007858:Learning