E-learning in orthopedic surgery training: A systematic review

Abstract

E-learning is the use of internet-based resources in education. In the field of surgical education, this definition includes the use of virtual patient cases, digital modeling, online tutorials, as well as video recordings of surgical procedures and lectures. In recent years, e-learning has increasingly been considered a viable alternative to traditional teaching within a number of surgical fields. Here we present (1) a systematic review of literature assessing the efficacy of e-learning modules for orthopedic education and (2) a discussion of their relevance. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted according to the guidelines defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). The search yielded a total of 255 non-duplicate citations that were screened using predetermined inclusion/exclusion criteria. A total of 9 full text articles met inclusion criteria, which included the use of an objective outcome measure to evaluate an orthopedic e-learning module. Six studies assessed knowledge using a multiple-choice test and 4 assessed skills using a clinical exam. All studies showed positive score improvement pre- to post-intervention, and a majority showed greater score improvement than standard teaching methods in both knowledge (4/6 studies) and clinical skills (3/4 studies). E-learning represents an effective supplement or even alternative to standard teaching techniques within orthopedic education for both medical students and residents. Future work should focus on validating specific e-learning programs using standardized outcome measures and assessing long-term knowledge retention using e-learning platforms.

Introduction

The goal of medical education is to prepare students for the rigors of residency training. Despite this objective, lack of medical knowledge ranks among the top struggles of fourth year medical students from the viewpoint of residency program directors.¹ Traditionally, surgical sub-internship programs lack a uniform procedural curriculum.² One analysis, performed by Lindeman et al. in 2013 stated that nearly 80% of the surgical sub-internship programs were “devoid of technical and procedural skill laboratories.”³ This sentiment is likely shared among physician educators across a variety of surgical specialties, including orthopedic surgery.

One approach to addressing this problem has been implementation of e-learning. In its most rudimentary form, e-learning is the use of internet-based resources for teaching and learning. In surgical specialties, e-learning encompasses the use of virtual patient cases, digital modeling, online tutorials, and standardized videos and images.⁴ Furthermore, developers may incorporate a variety of updated education strategies such as spaced-repetition learning and “blended-learning”, which combines online and face-to-face instruction.⁵

The advantages of e-learning in the surgical setting are well-established. In addition to being easily accessed and updated, e-learning platforms accommodate a wide variety of learning styles and effectively teach a broad array of surgically relevant information. Interactive, web-based media significantly improves surgical skill and reduces error rates and operative time in both general surgery and plastic surgery resident operations.6, 7 Furthermore, the use of case-based e-learning software by medical students has significantly improved retention of clinical and theoretical knowledge over three weeks after use of the software ceased.⁸ A number of studies indicate that both surgical residents and medical students who use e-learning programs are more satisfied with their learning experience compared to those who use traditional teaching methods.9, 10, 11

Technological advances and sophisticated applications have increased the acceptance and widespread use of internet-based teaching methods.¹² While use of e-learning platforms in surgical training has expanded over recent years, the role of this technology within orthopedic surgery remains unclear. We present a review of current literature regarding e-learning methods related to training orthopedic surgeons. Given the innate propensity for rapid technological change within the field, we focus on relevant literature from the past 10 years specific to orthopedic surgery.