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JMIR Res Protoc. 2017 Jul 5;6(7):e128. doi: 10.2196/resprot.8085.

Effectiveness of Adaptive E-Learning Environments on Knowledge, Competence, and Behavior in Health Professionals and Students: Protocol for a Systematic Review and Meta-Analysis.

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Montreal Heart Institute Research Center, Montreal, QC, Canada.
Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.
Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
Center for Innovation in Nursing Education, Université de Montréal, Montreal, QC, Canada.
School of Librarianship and Information Science, Université de Montréal, Montreal, QC, Canada.



Adaptive e-learning environments (AEEs) can provide tailored instruction by adapting content, navigation, presentation, multimedia, and tools to each user's navigation behavior, individual objectives, knowledge, and preferences. AEEs can have various levels of complexity, ranging from systems using a simple adaptive functionality to systems using artificial intelligence. While AEEs are promising, their effectiveness for the education of health professionals and health professions students remains unclear.


The purpose of this systematic review is to assess the effectiveness of AEEs in improving knowledge, competence, and behavior in health professionals and students.


We will follow the Cochrane Collaboration and the Effective Practice and Organisation of Care (EPOC) Group guidelines on systematic review methodology. A systematic search of the literature will be conducted in 6 bibliographic databases (CINAHL, EMBASE, ERIC, PsycINFO, PubMed, and Web of Science) using the concepts "adaptive e-learning environments," "health professionals/students," and "effects on knowledge/skills/behavior." We will include randomized and nonrandomized controlled trials, in addition to controlled before-after, interrupted time series, and repeated measures studies published between 2005 and 2017. The title and the abstract of each study followed by a full-text assessment of potentially eligible studies will be independently screened by 2 review authors. Using the EPOC extraction form, 1 review author will conduct data extraction and a second author will validate the data extraction. The methodological quality of included studies will be independently assessed by 2 review authors using the EPOC risk of bias criteria. Included studies will be synthesized by a descriptive analysis. Where appropriate, data will be pooled using meta-analysis by applying the RevMan software version 5.1, considering the heterogeneity of studies.


The review is in progress. We plan to submit the results in the beginning of 2018.


Providing tailored instruction to health professionals and students is a priority in order to optimize learning and clinical outcomes. This systematic review will synthesize the best available evidence regarding the effectiveness of AEEs in improving knowledge, competence, and behavior in health professionals and students. It will provide guidance to policy makers, hospital managers, and researchers in terms of AEE development, implementation, and evaluation in health care.


adaptive learning environments; e-learning; intelligent tutoring systems; interactive learning environments; medical education; meta-analysis; nursing education; systematic review

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