Elsevier

Computers & Education

Volume 69, November 2013, Pages 199-215
Computers & Education

Exploring the use of asynchronous online discussion in health care education: A literature review

https://doi.org/10.1016/j.compedu.2013.07.005Get rights and content

Highlights

  • More research needed comparing online discussion with and without an intervention.

  • Online discussion may help students learn from experience when in clinical practice.

  • Factors such as group size, length of time and framework used may affect learning.

  • Factors such as peer moderation and use of clinical scenarios may affect learning.

Abstract

This paper highlights the different options associated with asynchronous online discussion (AOD) use in health care education which may have an impact on their effectiveness. The review was carried out following a search of specific databases, websites, key journals, references and key authors. All studies published between 2006 and 2012 that met specific inclusion/exclusion criteria were subject to quality appraisal. Fourteen studies met the quality appraisal criteria: six qualitative, four quasi-experimental, one observational and three mixed methods. Data extraction coupled with narrative synthesis enabled the description of options that emerged and exploration of the relationships within and between studies. Study design as well as methodological quality was mixed. However, several useful factors emerged which may impact on effectiveness. These include (a) the mode of e-moderation (b) provision of AOD for participants in the clinical setting to critically reflect, analyse and resolve clinical issues and (c) increased amount of time spent reading the AOD (but not the number of discussion ‘hits’). Research in this area appears to be in its infancy and one of the main recommendations is that further studies are required which focus on comparing the same type of AOD with and without a specific intervention in order to make any robust conclusions.

Section snippets

Introduction & background

Several systematic reviews on e-learning for the health professions show that it is just as effective as classroom learning (e.g. Cook et al., 2008, Lewis et al., 2005). The question now is to ascertain which components of e-learning can lead to greater effectiveness. Cook et al. (2010a) have succeeded in this quest to some extent with a systematic review comparing different e-learning methods for health professionals. They concluded that the most effective are those that include interactivity,

Methods

Although the gold standard for reviews is to consider only randomised controlled trials (RCTs), these appear to be rare within educational research. It is difficult to undertake RCTs in education due to both practical and ethical issues, particularly meeting student expectations/demands (Campbell, Gibsen, Hall, Richards, & Callery, 2008). Therefore, this present review includes quasi-experimental studies as well as all types of qualitative research and mixed method studies.

Results

The 14 selected studies consisted of six qualitative, five quantitative (four quasi-experimental and one observational) and three using a mixed methods approach. They were found from a wide variety of sources mostly from the US, UK and Canada. Seven (50%) were focused on practicing professionals, and seven focused on undergraduates of which four were on practice placement. There was an even mix of nursing (5) medical (5) and other health professions (6).

Discussion

All studies in the review had positive outcomes in terms of demonstrating learning through AOD, although they were all were small except for Plack et al.'s (2008) study. All the quantitative results relevant to the review research question were significant except for Markewitz's (2007) study.

The majority of studies in this review (12/14) used e-moderated AOD, all with positive learning outcomes of varying degrees. At first, this appears to be a similar result to Johnson's review,6

Conclusion

Many factors/options have emerged that may have an effect on learning (Table 4) but the heterogeneity of study design, type of intervention and measure of learning, makes it difficult to generalise these findings. Whilst the overall results are positive, the lack of controls (i.e. AOD without the intervention) and the general small increases in learning mean that the results in terms of effectiveness are not particularly robust. However, there are numerous implications for future research,

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