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Objectives It remains unclear whether computer-assisted instruction (CAI)
is more effective than other teaching methods in acquiring and retaining
ECG competence amongst medical students and residents. Design This
systematic review and meta-analysis followed the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources
Electronic literature searches of PubMed, databases via EBSCOhost, Scopus,
Web of Science, Google Scholar and grey literature were conducted on 28
November 2017. We subsequently reviewed the citation indexes of articles
identified by the search. Eligibility criteria Studies were included if a
comparative research design was used to evaluate the efficacy of CAI
versus other methods of ECG instruction, as determined by the acquisition
and/or retention of ECG competence of medical students and/or residents.
Data extraction and synthesis Two reviewers independently extracted data
from all eligible studies and assessed the risk of bias. After duplicates
were removed, 559 papers were screened. Thirteen studies met the
eligibility criteria. Eight studies reported sufficient data to be
included in the meta-analysis. Results In all studies, CAI was compared to
face-to-face ECG instruction. There was a wide range of computer-assisted
and face-to-face teaching methods. Overall, the meta-analysis found no
significant difference in acquired ECG competence between those who
received computer-assisted or face-to-face instruction. However,
sub-analyses showed that CAI in a blended learning context was better than
face-to-face teaching alone, especially if trainees had unlimited access
to teaching materials and/or deliberate practice with feedback. There was
no conclusive evidence that CAI was better than face-to-face teaching for
longer-term retention of ECG competence. Conclusion CAI was not better
than face-to-face ECG teaching. However, this meta-analysis was
constrained by significant heterogeneity amongst studies. Nevertheless,
the finding that blended learning is more effective than face-to-face ECG
teaching is important in the era of increased implementation of
e-learning. PROSPERO registration number CRD42017067054
154 views reported since publication in 2019.