title: Conventional vs. e-learning in nursing education: A systematic review and meta-analysis.
abstract: BACKGROUND
  By and large, in health professions training, the direction of the effect of e-learning, positive or negative, strongly depends on the learning outcome in question as well as on learning methods which e-learning is compared to. In nursing education, meta-analytically generated knowledge regarding the comparisons between conventional and e-learning is scarce.
  
  
  OBJECTIVE
  The aim of this review is to discover the size of the effect of e-learning on learning outcomes in nursing education and to assess the quality of studies in which e-learning has been compared to conventional learning.
  
  
  METHODS
  A systematic search of six electronic databases, PubMed, Ovid MEDLINE®, CINAHL (EBSCOhost), Cochrane Library, PsycINFO, and ERIC, was conducted in order to identify relevant peer-reviewed English language articles published between 2011 and 2015. The quality of the studies included as well as the risk of bias in each study was assessed. A random-effects meta-analysis was performed to generate a pooled mean difference in the learning outcome.
  
  
  RESULTS
  Altogether, 10 studies were eligible for the quality assessment and meta-analysis. Nine studies were evaluated as good quality studies, but not without a risk of bias. Performance bias caused a high risk in nearly all the studies. In the meta-analysis, an e-learning method resulted in test scores that were, on average, five points higher than a conventional method on a 0-100 scale. Heterogeneity between the studies was very large.
  
  
  CONCLUSIONS
  The size and direction of the effect of a learning method on learning outcomes appeared to be strongly situational. We suggest that meta-regressions should be performed instead of basic meta-analyses in order to reveal factors that cause variation in the learning outcomes of nursing education. It might be necessary to perform separate meta-analyses between e-learning interventions aimed at improving nursing knowledge and those aimed at improving nursing skills.
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1C, Kuopio, Finland. Electronic address: ari.voutilainen@uef.fi.
authors.forename: Ari
authors.initials: A
authors.lastname: Voutilainen
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1C, Kuopio, Finland.
authors.forename: Terhi
authors.initials: T
authors.lastname: Saaranen
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1C, Kuopio, Finland.
authors.forename: Marjorita
authors.initials: M
authors.lastname: Sormunen
mesh_terms: D020375:Education, Distance / Q000379:methods*; D004506:Education, Nursing; D004521:Educational Measurement / Q000379:methods; D006801:Humans; D007858:Learning; D013338:Students, Nursing
keywords: Conventional learning; E-learning; Meta-analysis; Nursing education; Nursing knowledge; Nursing skills; Systematic review