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1 Cover sheet Title:

Use of online communication to create learning communities of healthcare professionals: What works, when and in whom? Review Group (in alphabetical order): Dr Steve Arnott Avon and Wiltshire

Mental Health Partnership NHS Trust

Director of Medical Education

Dr Razan Halawa An-Najah National University

Medical Education Fellow

Dr Kim Humby Avon and Wiltshire Mental Health Partnership NHS Trust

Specialty Trainee in Psychiatry

Dr Amy Manley Avon and Wiltshire Mental Health Partnership NHS Trust University of Bristol

ST6 Liaison Psychiatry Teaching unit developer, Teaching and Learning for Healthcare Professionals

Ms Lara Skinner Avon and Wiltshire Mental Health Partnership NHS Trust

Systematic Reviewer, Research and Development

Catherine Trimble Avon and Wiltshire Mental Health Partnership NHS Trust

Clinical Teaching Fellow

Louisa Wilson Avon and Wiltshire Mental Health Partnership NHS Trust

Core Trainee in Psychiatry

Lead Reviewer: Amy Manley [email protected]

2 Background to the topic: Online learning in Healthcare eLearning provides universities and healthcare organisations with an effective method of delivering educational materials which overcomes geographical boundaries and issues of availability. However this any-time any-place approach has been criticised for creating a sense of isolation in its users (Reid, Thomson, & Mcglade, 2016). Research into the impact of eLearning in healthcare professionals often focuses on knowledge outcomes, however the impact of reducing face-to-face teaching time on inter-professional networking opportunities, a sense of belonging to the organisation’s community and social learning from others in that community is overlooked (Berge, 2002). Such isolation not only contributes to non-participation in the learning process but may have disadvantages for users and the wider organisation in terms of morale, motivation and personal investment in the organisation (Ali & Smith, 2015; Porima, 2006; Reid et al., 2016). Connecting healthcare professionals online Online communication and collaboration has been facilitated by the emergence of “web 2.0”. Web 2.0 refers to changes in the way websites are designed to allow users to take a more active role, interacting with content and other users, being able to generate content themselves and being able to access information in a way that is tailored to them. The term was first used in 1999, with a great expansion in such websites and the use of these websites since then (O’Reilly & Battelle, 2009). Social media, blogs and discussion boards have enabled people without vast technical skills to engage in online discussion. Digital literacy and time spent online have risen in all age groups and use of social media continues to increase with 63% of adults having a social media profile, a figure which reaches 89% in 16-24 year olds. These increases are accompanied by changes in the way we access the internet from desktop computers to laptops and now smartphones leading the way as the UKs most common way of getting online (Office For National Statistics, 2016). This greater mobile connectivity results from better and cheaper mobile internet and WiFi access, making any-time, any-place internet access more of a reality and facilitating peoples’ ability to communicate online. In contrast to the concerns around digital technologies creating isolation in users, online groups of learners are being established to support collaboration and inter-professional problem solving (Li et al., 2009; Verstegen et al., 2016). Encouraging online communication between students on placement can reduce isolation, support reflection and aid retention (Jisc, 2008; Wisker, Robinson, & Shacham, 2007). Connectivist MOOCs successfully support global inter-professional collaboration on healthcare topics and dissemination of good practice (Liyanagunawardena & Williams, 2014). However many top-down initiatives to implement digital solutions to community building are unsuccessful (Sandars, 2007). Collaborative learning Social constructivism theorises that people do not absorb knowledge as individuals in isolation, but rather they construct it through their communication and interaction with

others. Collaborative learning methods apply this principle, moving away from the idea that knowledge can be transferred from expert to novice, and emphasising the importance of personal interactions to support each other’s learning (Oxford, 1997). Harasim's (2012) Online Collaberative Learning model suggests learners in pass through three phases, namely idea generation (sharing divergent thoughts and ideas), idea organising (analysis and structuring of ideas), and intellectual convergence (reaching a shared understanding or outcome). The emphasis of the model is on the learners who collaborate to generate learning outcomes, with a role for a moderator or teacher in facilitating these stages. Garrison, Anderson and Archer (2010) argue that discourse can occur in the absence of a teaching presence, but that this presence is required to set climate, content and allow turn the discourse into a learning experience. However this model assumes learning content is externally set (e.g. a university course). Whereas professional learners tend to identify their own learning goals (Garrison, 1997). This, along with an intrinsic motivation to learn, and experience which can be shared, places a lesser onus on a facilitator to turn discourse into an educational experience. This is supported by studies in healthcare professionals where learning and research outcomes are achieved despite a lack of external facilitation (Frisch et al., 2014). Therefore Dillenbourg's (1999 p1) broader definition of collaborative learning as any “situation in which two or more people learn or attempt to learn something together” may be more applicable to professional learners, whilst also encompassing learning experiences as described by Garrison, Anderson and Archer (2010). This definition focuses on learning arising from the actions of and interactions between two individuals with a similar level of knowledge, as opposed to a transfer of information from an expert to a learner. For such collaboration to occur the learners must be able to communicate, though this communication can be synchronous or asynchronous (Harasim, 2012).

Palloff and Pratt (2010) suggest online collaborative learning supports critical thinking, research skills, reflection and lead to the social construction of knowledge and meaning as well as transformative learning. Much of their work is in undergraduates, however similar benefits have been identified in professionals engaging in continuing professional development activities, where no expert exists and learning occurs between peers (Frisch et al., 2014; Nicholson & Bond, 2003; Wisker et al., 2007). In addition to the educational outcomes, collaborative learning can also foster a sense of connectedness with peers (Boulos, Maramba, & Wheeler, 2006). Supporting collaborative learning in an online setting may therefore overcome the sense of isolation users report with other online learning methods.

Learning as part of a learning community

The definition of a learning community and whether these can exist online has been the source of much debate. The term “online learning community” is commonly used to describe groups of people who communicate online for the purpose of learning together. This can be seen as an extension of Dillenbourg’s broad definition of collaborative learning above, but where the interaction exists between three or more individuals. Such a definition has received criticism as such groups do not necessarily meet the criteria for a

“community” as described by McMillan and Chavis (1986) i.e. that members have a sense of membership, influence, need fulfilment and emotional connectedness. However Bruckman (2005) argues that communities are by their nature amorphous, being better recognised by their members than by a pre-defined set of attributes, with more specific definitions impeding research. Preece and Maloney-Krichmar (2005) concur arguing that a broad definition “may encourage us to concentrate on more substantive issues such as how communities are created, evolve or cease to exist online”. On this basis we will be using this broad definition for the purpose of the review, whilst considering whether there are attributes of such communities which relate to specific outcomes. There is some evidence that online communities are able to confer benefits ascribed to learning communities offline, with one example in healthcare showing how good practice may be shared, transitions in healthcare supported and research capacity enhanced through a (broadly defined) online community of nursing professionals (Frisch et al., 2014). Research has also suggested that connecting professionally online can reduce drop-out and increase feelings of being supported (Boulos, Maramba, & Wheeler, 2006).

A sense of belonging to a learning community is not only advantageous in terms of promoting participation, morale and motivation, but Cruess, Cruess, & Steinert (2016) argue that engagement with the one’s professional community it is vital to professional identity formation and the development of tacit knowledge. They draw on Lave and Wenger's work (1991) on communities of practice to emphasise the importance of learning from others within your profession, with whom you practice, in your development from novice to expert.

Communities of Practice

The term “community of practice” (CoP) was first coined by Lave and Wenger in 1991, stemming from their work on situated learning. It is used to describe a group of people with a shared interest, who interact regularly to learn about and construct shared knowledge around that interest, based on shared experience, practice and resources. The defining features of a community of practice are (Wenger, 1999):

1- Joint enterprise: A shared interest in which participants wish to develop their expertise

2- Mutual engagement: Regular interactions between members in the community 3- Shared Repertoire: Shared resources and mutual understanding (whether explicit or

tacit) on which to base practice

Learning in this way aids professional development, facilitates the development of new knowledge, increases resilience to change and enhances trust and sense of being valued (Hart et al., 2013). Within healthcare communities of practice have additionally been shown to support the implementation of evidence based medicine and enhance clinical practice (Ranmuthugala et al., 2011).

Significant debate exists as to whether true communities of practice can be established online. Sharma, Smith, Rooksby and Gerry (2006) argue that their online community meets this definition, with a joint enterprise (reducing critical incidents in anaesthetics), mutual

engagement (anaesthetists from ten hospitals) and shared repertoire (revised anaesthetic practice based on shared learning). However others argue that interactions between people online lack the richness required for substantial community learning (Kling and Courtwright 2004 p.91). It is clear that the majority of online communities of healthcare professionals would not meet the definition of a community of practice. Engagement may be sporadic and varied with some individuals purely observing, whilst others contribute regularly. There may not be a single common interest and understanding, meaning and practice may vary significantly. None-the-less the degree to which these features are present in online communities may influence their outcome.

Other reviews in this area Previous and ongoing systematic reviews have evaluated the role of online learning in healthcare settings (Childs, Blenkinsopp, Hall, & Walton, 2005; George et al., 2014; Means, Murphy, & Baki, 2013). However these have a far wider scope than online communications technologies, from information provision to interactive virtual patients to online communication. They focus on knowledge and satisfaction outcomes, as opposed to considering the impact of the online learning community, making drawing conclusions about the effect of any one type of online learning on sense of community difficult. A further review considers the role of social media in medical student education (Cheston, Flickinger, & Chisolm, 2013). Social media has a focus on communication and therefore would be relevant to the scope of this review. However social media platforms are not the only online method of communication and therefore may not offer a full representation of methods to support online communities of healthcare professionals. It was also restricted to a single professional group. When we consider the role these technologies could play in connecting healthcare professionals from multiple backgrounds, it would be valuable to review online communications technologies without limiting this to a single professional group. This review aims to add to the previous reviews in the following ways. Firstly it includes all healthcare professional groups as one application of such technologies could be supporting inter-professional working and collaboration. Secondly it provides an update to the previous reviews. The digital landscape is changing rapidly with increasing internet connectivity, changes to how we access the internet and communicate online and improving digital literacy. Finally, given the increasing use of online communications to connect healthcare professionals, the breadth of approaches and the conflicting arguments around the risk of isolation versus benefits of collaboration, a narrative synthesis of the evidence in this area, it would be extremely useful to provide educators with guidance as to how best to support those in the healthcare community to connect and learn together online.

3 Review question(s), objectives and key words This systematic review aims to review the literature around the development and value of online learning communities of healthcare professionals and healthcare students. We aim to provide guidance to educators as to the impact of learning communities on professional development, the reasons behind their success or failure and the circumstances in which they are effective. Our primary research question is: In healthcare professionals and students, what helps online learning communities thrive, what value do they have and in what circumstances? Within this there are a number of review objectives: In healthcare professionals and students this review will:

1. describe the breadth of online communication methods used to support the development of online learning communities.

2. identify the effects online learning communities have on users (e.g. knowledge, skills, attitudes and wellbeing) and institutions (e.g. research capacity).

3. describe how, when and in whom online learning communities thrive and exert their effects including identifying barriers and facilitators to use and the influence of design on outcome

4. Determine whether sense of community (McMillan and Chavis 1986) or community of practice domains (Wenger, 1999) arise from online learning communities and whether they influence outcome

Keywords: Computer Mediated Communication Social Networks Blogging Communities of practice Collaboration

4 Study selection criteria Inclusion Criteria: Studies which meet all of the following criteria will be eligible for inclusion:

• Population: Healthcare professionals or students studying to become healthcare professionals.

• Intervention: Interventions which facilitate asynchronous communication between a group of people, over the internet, for the primary purpose of supporting collaborative learning from the interaction between learners. Collaborative learning is defined according to Dillenbourg's (1999 p1) definition as any “situation in which two or more people learn or attempt to learn something together”.

• Outcome: Any measured outcome related to the asynchronous communication component of the intervention, whether assessed qualitatively or quantitatively.

• English language studies • Studies published during or after 2012

Exclusion criteria: The following will be excluded from the review:

• Studies which are purely descriptive in nature, which do not report the outcome of a specific intervention.

• Studies which use online communication about specific patient cases which have the primary purpose of accessing advice around treating that individual patient.

• Studies which facilitate online communication but not for the purpose of learning e.g. use of social networking for non-education related purposes.

• Studies which use online communication primarily to facilitate the transfer of knowledge from expert to learner, as opposed to facilitating the interaction between learners.

• Studies which facilitate learning through synchronous online communication only e.g. online videocalling or synchronous text discussion where students are expected to log on simultaneously to participate.

• Studies which include asynchronous communication as part of a wider educational intervention, but which do not evaluate this asynchronous collaborative component either quantitatively or qualitatively e.g. use of YouTube but with no description of the associated discussion board.

• Studies which are not English language • Studies published prior to 2012

Justification of study selection criteria: Our population includes all healthcare professional groups and students as online platforms to support learning offer an opportunity for multi-professional communication and learning between people at different stages of training. Although collaborative learning tends to

occur between people with a common goal, with similar knowledge and of similar status, an individual may share these in relation to a specific interest despite different professional backgrounds. For example a consultant surgeon and a nursing student with a keen interest in education may have very different clinical knowledge and professional background, but share a common interest and level of ability when it comes to their aim of developing their skills in facilitating problem-based learning (PBL) sessions, and thus be able to learn collaboratively. Our definition of collaborative learning i.e. is intentionally broad but emphasises “learning together”. This excludes information sharing in a single direction for example where one person is teaching, mentoring or coaching another, where an information repository is being created (unless the platform supports discussion of the resource between participants) or where social networks are used with the primary intention of providing information. We have also only included studies of specific circumscribed interventions involving asynchronous communication, as opposed to those which evaluate perceptions of or outcomes associated with general use of a platform. Studies of patterns of use do not provide information about how to implement an online platform and studies of the effects of generic platforms are biased by focusing on outcomes in self-selecting users. For example the creation of a twitter hashtag to facilitate discussion between mental health nurses about schizophrenia would be included, whereas mental health nurses patterns of use or perceptions of twitter as a potential learning tool, would be excluded. “Any place, any time” is one of the significant benefits of online communication over face-to-face learning, as well as being a potential barrier to the development of communities. We have chosen to include studies which evaluate asynchronous communication to ensure it carries this advantage and to reduce heterogenetity between study interventions. We have excluded studies which only utilize synchronous communication. There are studies which evaluate platforms with the potential for generating discussion e.g. twitter or youtube, but where the discussion element is not detailed or where evaluation is focused on elements unrelated to the discussion. These do not offer an understanding of whether learning occurred as a result of the interaction between individuals and whether this would have had an association with the evaluation outcomes. Therefore they will be excluded. Given the exploratory nature of this review we have not limited the scope to any specific outcome measure. This will allow an evaluation of the potential outcomes of online communication to promote learning in an online community. This is particularly important given that many studies into online learning overlook potential negative consequences, e.g. increased isolation, by only evaluating intended consequences e.g. learning. We will exclude purely descriptive studies which lack any evaluation these study designs will not support our aims by providing evidence about effect of online communication interventions or how the effect arises. This systematic review specifically focuses on the use of internet enabled communication to connect people. In 2012 the 4G mobile network was introduced to the UK, allowing greater internet access and functionality whilst “on the go” and precipitating changes to how and when the internet is accessed. We have also seen ongoing increases in access to the

internet, social media use and improving digital literacy over this time in the UK (Office For National Statistics, 2016), with parallel trends worldwide. We have chosen to limit our search to studies since 2012. This is a relatively short timespan, however given these rapid changes in internet use which have a direct effect on uptake and use of online communication tools, we agreed that studies prior to this may not reflect current practice.

5 Search sources and strategies The following databases will be searched to identify eligible papers:

• Medline • Psycinfo • Embase • CINHAL • ERIC • British Education Index • Web of Knowledge (core collection) • Cochrane database

The search strategies are shown in appendix 1. References of selected papers will be reviewed in order to identify any additional papers which meet our eligibility criteria. References of included studies will additionally be screened for further studies meeting our inclusion criteria and not identified by our search. The contents of the following journals (since 2012) will be screened to identify any further papers:

• Journal of Medical Internet Research • British Journal of Educational Technology • Computers and Education

Search results will be screened for eligibility by two reviewers independently. Results of the pilot search: The initial search was piloted in MEDLINE and ERIC only. It combined search terms related to the internet (e.g. social networks, blogging, internet) with those related to healthcare professionals / students (e.g. Medical Student, Health Personnel) and those related to education or collaboration (e.g. medical education, curriculum, learn*, collaborat*). This search returned 6,664 results. The first 500 were screened for relevance. Of these 486 were excluded based on title and abstract. Due to the large number of irrelevant results within the first 500 papers returned, we chose to focus the terms we used to describe the internet, to those which referred specifically to online communication. These included types of online communication (e.g. social media, blogging, computer mediated communication, videoconferencing, online discussion).

Refining the search in this way did not lead to loss of any of the relevant papers within the papers initially screened. It was therefore agreed to use this as our search strategy for the main review (see figure 1). In our pilot review we restricted the search to papers published since 1999. This date was chosen as it marked the start of web 2.0. Although this was a very inclusive approach, we found that earlier online communication methods such as email lists did not reflect the current digital communication environment. We were also concerned that the results would be less applicable to current practice due to dramatic changes in who uses online communication and how we use and integrate it into our lives over this timespan. For example with increasing use of online sites for personal purposes, a lack of digital literacy or access presents less of a problem, however separating the personal and professional online may present more of a challenge. We decided to limit our search to papers since 2012 as any earlier work is unlikely to be reflective of current online communication.

Figure 1 – Results of the revised search strategy (see appendix 1 for search terms):

Records identified through database searching Medline = 1782 PsycInfo = 640 EMBASE = 3374 CINHAL = 881 ERIC = 75 BEA = 20 Web of Knowledge = 1945 Cochrane = 465

Records identified through other methods Journal Screening: Reference screening: Not yet complete

Records after duplicates removed electronically n = 5461

Records screened by title and abstract n = 5461

Full text articles to be screened for eligibility n = 389

Studies included in the narrative synthesis Not yet complete – Estimated to be around 20% of papers eligible for full text screening, based on screening of first 50 full-text papers (10 eligible for inclusion).

Records excluded (did not meet inclusion criteria): n = 5072

Records excluded: Not yet complete

6 Procedure for Extracting Data Eligible papers will be catalogued and a pro forma will be used to extract study data (see appendix 2). Each paper will be appraised independently by two reviewers. Extracted data will be compared to ensure consistency. All papers will be reviewed by the lead reviewer to ensure consistency across reviewers.

7. Appraisal of Studies The data extraction pro forma is based on the EQUATOR Network reporting guidelines (CONSORT, STROBE, SRQR) and includes two assessments of study quality specifically designed for medical education literature - the Medical Education Research Quality Instrument (MERQI - for quantitative studies only) and the BEME Global Scale (for all studies). Results of the pilot review: Data extraction and appraisal of papers has been piloted with all reviewers reviewing 5 papers in order to:

1- Further refine the search strategy, inclusion and exclusion criteria (see above) 2- Refine the proforma and resolve uncertainties 3- Ensure calibration of appraisal between reviewers

Following the pilot data extraction the proforma was revised to reduce repetition data being extracted. Information extracted by reviewers and scoring of papers was similar between reviewers. We discussed limiting the review to comparative studies only but agreed that this may result in loss of valuable information from qualitative analyses as to how online communication can exert its effects. Therefore we decided to continue including all papers with an evaluative component. Revisions following peer review: Following peer review the proforma was further revised to extract information as to whether the intervention would meet the criteria for a community as defined by McMillan and Chavis (1986) i.e. sense of membership, influence, need fulfilment and emotional connectedness) or a community of practice (joint enterprise, mutual engagement, shared repertoire). Should this information be present, we will be able to discuss the role these aspects may play in the outcome of the interventions. Ensuring consistency of appraisal: Each paper will be appraised independently by two reviewers. Any disagreement will be discussed by the two reviewers, if this is not resolved then the input of a third reviewer will be sought.

8- Synthesis of extracted evidence Narrative synthesis will be undertaken to synthesise the evidence from papers included in the study. It is unlikely that any statistical synthesis will be possible due to the breath of outcome measures. The narrative synthesis will follow the stages of a segregated mixed-methodology review as described by Sandelowski (2006). This segregated approach involves the extraction and analysis of qualitative and quantitative data separately, thus not compromising data quality. This is followed by configuration of findings from both these approaches in order to drive the development of theories related to our objectives. The conclusions will be broken down into a series of data-driven themes and justified in the context of the original studies.

9. Project timetable Clarify scope of review September - November 2016 Pilot literature search, December 2017 – April 2017 refine date extraction and search strategy Full literature search May - September 2017 Protocol submission September 2017 Revised literature search April 2018 – August 2018 Revised Protocol Submission September 2018 Data abstraction September 2018 – December 2018 Draft report February 2019 Final Report May 2019

10. Conflict of interest statement No funding has been sought to support the undertaking of this review. Although some researchers have an interest in the areas of online communication, none have received funding or published studies which would be included within the remit of this review.

11. Plans for updating the review The review team would be interested in updating the review in future as needed and depending on availability.

12. Changes to the protocol This protocol may be updated in response to our findings with the expressed agreement of the review group. Any major revision will be resubmitted to BEME for approval.

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Appendix 1: Search Strategies Medline Search

1 exp Students, Dental/ 5670 2 exp Students, Medical/ 27994 3 exp Students, Premedical/ 172 4 exp Students, Nursing/ 21131 5 exp Students, Pharmacy/ 2289 6 exp Students, Health Occupations/ 58335 7 exp Health Personnel/ 453598 8 exp Faculty, Medical/ 11801 9 exp Allied Health Personnel/ 46330

10 (physician* or doctor* or clinician* or therapist* or dentist* or psychiatrist* or surgeon* or nurs*).ab,ti,kf.

1204683

11 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 1480174 12 exp Education, Medical/ 149903 13 exp Education, Continuing/ 61046 14 exp curriculum/ or exp education, distance/ or exp education,

predental/ or exp education, premedical/ or exp inservice training/ 104782

15 exp Education, Nursing/ 80678 16 exp Education, Continuing/ 61046 17 (education* or train* or learn* or teach* or collaborat* or

course*).ti,ab,kf. 1713751

18 12 or 13 or 14 or 15 or 16 or 17 1825337 19 exp Social Media/ 3785 20 exp Blogging/ 813 21 exp Blogs/ 0 22 exp Webcasts/ 500 23 exp Videoconferencing/ 1489 24 (web adj "2.0").ti,ab,kf. 572 25 (skype or (google adj hangout*) or facetime or facebook or twitter or

whatsapp or youtube or Instagram or linkedin or "google+" or pintrest).ti,ab,kf.

14795

26 ((online adj2 discussion) or ((online or internet) and (forum or (discussion adj board))) or blog* or weblog* or vlog*).ti,ab,kf.

2674

27 (mooc or (massive adj open adj online adj course*) or ted-ed or futurelearn or edx or Coursera).ti,ab,kf.

4665

28 (((internet or online or virtual) adj3 (communicat* or collaborat*)) or ((virtual or online) adj (communit* or (social adj network))) or (social adj media) or hypermedia or webcast* or podcast*).ti,ab,kf.

7774

29 ((online or internet) and messenger).ti,ab,kf. 75 30 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 30626 31 11 and 18 and 30 2628 32 (2012* or 2013* or 2014* or 2015* or 2016* or 2017*).yr,ed. 6626977 33 31 and 32 1782

Pscyinfo Search 1 exp Dental Students/ 233 2 exp Medical Students/ 12171 3 exp Nursing Students/ 4474 4 exp Health Personnel/ 121605 5 exp Medical Personnel/ 73508 6 exp Allied Health Personnel/ 4534 7 exp therapists/ 30150 8 exp Mental Health Personnel/ 47499 9 (physician* or doctor* or clinician* or therapist* or dentist* or

psychiatrist* or surgeon* or nurs*).ab,ti,id,tm. 339633

10 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 392834 11 exp Medical Education/ 21848 12 exp Continuing Education/ 4500 13 exp CURRICULUM/ 105343 14 exp inservice training/ 3023 15 exp Distance Education/ 3846 16 exp Nursing Education/ 5182 17 dental education/ 163 18 exp graduate psychology education/ 7186 19 (education* or train* or learn* or teach* or

course*).ti,ab,id,tm. 1124155

20 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 1143495 21 exp Social Media/ 8997 22 exp BLOG/ 323 23 exp Computer Mediated Communication/ 5884 24 exp Social Media/ 8997 25 (web adj "2.0").ti,ab,id,tm. 1205 26 (skype or (google adj hangout*) or facetime or facebook or

twitter or whatsapp or youtube or Instagram or linkedin or "google+" or pintrest).ti,ab,id,tm.

7521

27 ((online adj2 discussion) or ((online or internet) and (forum or (discussion adj board))) or blog* or weblog* or vlog*).ti,ab,id,tm.

4790

28 (mooc or (massive adj open adj online adj course*) or ted-ed or futurelearn or edx or Coursera).ti,ab,id,tm.

288

29 (((internet or online or virtual) adj3 (communicat* or collaborat*)) or ((virtual or online) adj (communit* or (social adj network))) or (social adj media) or hypermedia or webcast* or podcast*).ti,ab,id,tm.

12333

30 ((online or internet) and messenger).ti,ab,id,tm. 82 31 exp teleconferencing/ 818 32 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 28460 33 10 and 20 and 32 1002 34 (2012* or 2013* or 2014* or 2015* or 2016* or 2017*).yr. 1033887 35 33 and 34 640

EMBASE Search

1 exp health student/ 87190 2 exp health care personnel/ 1238097 3 (physician* or doctor* or clinician* or therapist* or dentist* or psychiatrist* or

surgeon* or nurs*).ab,ti. 1520909

4 1 or 2 or 3 2229819 5 exp medical education/ 287047 6 exp health education/ or exp in service training/ or exp paramedical education/ 377348 7 (train* or education* or learn* or teach* or course* or collaborat*).ti,ab. 2158293 8 5 or 6 or 7 2493732 9 exp questionnaire/ 549343

10 exp interview/ 213102 11 (evaluat* or assess* or survey* or attitude or feedback or view* or opinion*).ti,ab. 7072720 12 9 or 10 or 11 7341119 13 exp social media/ 8992 14 exp blogging/ 137 15 exp hypermedia/ 368 16 exp webcast/ 269 17 (web adj "2.0").ti,ab. 649 18 exp Videoconferencing/ 2533 19 (skype or google hangout* or facetime or facebook or twitter or whatsapp or

youtube or Instagram or linkedin or "google+" or pintrest).ti,ab. 19417

20 ((online adj2 discussion) or ((online or internet) and (forum or (discussion adj board))) or blog* or weblog* or vlog*).ti,ab.

3889

21 (mooc or (massive adj open adj online adj course*) or ted-ed or futurelearn or edx or Coursera).ti,ab.

5255

22 (((internet or online or virtual) adj3 (communicat* or collaborat*)) or ((virtual or online) adj (communit* or (social adj network))) or (social adj media) or hypermedia or webcast* or podcast*).ti,ab.

10216

23 ((online or internet) and messenger).ti,ab. 110 24 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 41397 25 4 and 8 and 11 and 24 3683 26 (2012* or 2013* or 2014* or 2015* or 2016* or 2017*).yr,em. 30733866 27 25 and 26 3374

ERIC Search S40 S14 AND S27 AND S38 Limiters - Date Published: 20120101-20171231 75 S39 S14 AND S27 AND S38 169 S38 (S28 OR S29 OR S30 OR S31 OR S32 OR S33 OR S34 OR S35 OR S36 OR

S37) 17,199

S37 SU "Videoconferencing" 353 S36 kw((online or internet) and messenger) or ti((online or internet) and messenger) or

ab((online or internet) and messenger) 3

S35 TI("virtual communit*" or "online communit*" or "virtual social network" or "online social network" or "social media" or hypermedia or webcast* or podcast*) or ab("virtual communit*" or "online communit*" or "virtual social network" or "online social network" or "social media" or hypermedia or webcast* or podcast*) or kw("virtual communit*" or "online communit*" or "virtual social network" or "online social network" or "social media" or hypermedia or webcast* or podcast*)

1,720

S34 kw(mooc or ("massive open online course*") or ted-ed or futurelearn or edx or Coursera) or ti(mooc or ("massive open online course*") or ted-ed or futurelearn or edx or Coursera) or ab(mooc or ("massive open online course*") or ted-ed or futurelearn or edx or Coursera)

380

S33 ab(("online discussion") or ((online or internet) and (forum or ("discussion board"))) or blog* or weblog* or vlog*) or ti(("online discussion") or ((online or internet) and (forum or ("discussion board"))) or blog* or weblog* or vlog*) or kw(("online discussion") or ((online or internet) and (forum or ("discussion board"))) or blog* or weblog* or vlog*)

952

S32 ti("web 2.0") or ab("web 2.0") or kw("web 2.0") 465 S31 KW(skype or facetime or "google hangout*" or facebook or twitter or whatsapp or

youtube or Instagram or linkedin or "google+" or pintrest) or ti(skype or facetime or "google hangout*" or facebook or twitter or whatsapp or youtube or Instagram or

911

linkedin or "google+" or pintrest) or ab(skype or facetime or "google hangout*" or facebook or twitter or whatsapp or youtube or Instagram or linkedin or "google+" or pintrest)

S30 SU computer mediated communication 11,458 S29 Web 2.0 Technologies 1,661 S28 Social Media 3,018 S27 S15 OR S16 OR S17 OR S18 OR S19 OR S20 OR S21 OR S22 OR S23 OR S24

OR S25 OR S26 290,356

S26 TI ( education* or train* or learn* or teach* or course* ) AND KW ( education* or train* or learn* or teach* or course* ) AND AB ( education* or train* or learn* or teach* or course* )

45,112

S25 continuing education 20,263 S24 inservice training 6,162 S23 distance education 18,258 S22 curriculum 207,359 S21 su "Allied Health Occupations Education" 820 S20 SU health professions education 819 S19 SU Pharmaceutical Education 1,400 S18 SU Nursing Education 4,855 S17 SU Allied Health Occupations Education 4,594 S16 SU Graduate Medical Education 1,233 S15 SU Medical Education 10,209 S14 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11

OR S12 OR S13 54,630

S13 TI ( physician* or doctor* or clinician* or therapist* or dentist* or psychiatrist* or surgeon* or nurse* ) OR AB ( physician* or doctor* or clinician* or therapist* or dentist* or psychiatrist* or surgeon* or nurse* ) OR KW ( physician* or doctor* or clinician* or therapist* or dentist* or psychiatrist* or surgeon* or nurse* )

36,227

S12 SU allied health students 507 S11 SU health occupations students 513 S10 SU Medical Students 4,508 S9 SU Allied Health Occupations 5,246 S8 SU Health Personnel 4,794 S7 SU dentistry 868 S6 SU Health Occupations 6,219 S5 SU Psychologists 5,814 S4 SU Physicians 5,033 S3 SU Nurses 4,524 S2 SU Mental Health Workers 647 S1 SU Allied Health Personnel 1,954

CINHAL S21 S4 AND S9 AND S19 Limiters - Date Published: 20120101-20171231 881 S20 S4 AND S9 AND S19 1,672 S19 S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18 20,337 S18 (MH "Telehealth+") 9,777 S17 kw((online or internet) and messenger) or ti((online or internet) and messenger) or

ab((online or internet) and messenger) 19


2,106


30


1,186

S13 ti("web 2.0") or ab("web 2.0") or kw("web 2.0") 259

S12 KW(skype or facetime or "google hangout*" or facebook or twitter or whatsapp or youtube or Instagram or linkedin or "google+" or pintrest) or ti(skype or facetime or "google hangout*" or facebook or twitter or whatsapp or youtube or Instagram or linkedin or "google+" or pintrest) or ab(skype or facetime or "google hangout*" or facebook or twitter or whatsapp or youtube or Instagram or linkedin or "google+" or pintrest)

2,295

S11 (MH "Videoconferencing+") 812 S10 (MH "Social Media") OR (MH "Social Networking") or (MH "Blogs") or (MH

"Webcasts+") 6,782

S9 S5 OR S6 OR S7 OR S8 583,948 S8 TI ( education* or train* or learn* or teach* or course* or communicat* or

collaborat*) or KW ( education* or train* or learn* or teach* or course* or communicat* or collaborat*) or AB ( education* or train* or learn* or teach* or course* or communicat* or collaborat*)

454,548

S7 (MH "Education, Premedical") OR (MH "Education, Competency-Based") OR (MH "Faculty Development") OR (MH "Learning Environment") OR (MH "Learning Methods") OR (MH "Preceptorship") OR (MH "Program Development")

31,562

S6 (MH "Education, Clinical+") 12,463 S5 (MH "Education, Health Sciences+") 192,057 S4 S1 OR S2 OR S3 678,620 S3 TI ( physician* or doctor* or clinician* or therapist* or dentist* or psychiatrist* or

surgeon* or nurse* ) OR AB ( physician* or doctor* or clinician* or therapist* or dentist* or psychiatrist* or surgeon* or nurse* ) OR KW ( physician* or doctor* or clinician* or therapist* or dentist* or psychiatrist* or surgeon* or nurse* )

413,297

S2 (MH "Health Manpower+") 362,851 S1 (MH "Students, Allied Health+") OR (MH "Students, Dental") OR (MH "Students,

Medical") OR (MH "Students, Midwifery") OR (MH "Students, Nursing+") OR (MH "Students, Nursing, Practical") OR (MH "Students, Pharmacy") OR (MH "Students, Podiatry") OR (MH "Students, Health Occupations+") OR (MH "Students, Chiropractic")

41,441

British Education Abstracts

S40 S39 Limiters - Publication Date: 20120101-20171231 20 S39 S14 AND S27 AND S38 30 S38 S 28 OR S29 OR S30 OR S31 OR S32 OR S33 OR S34 OR S35 OR S36

OR S37 1,634

S37 SU "Videoconferencing" 149 S36 kw((online or internet) and messenger) or ti((online or internet) and

messenger) or ab((online or internet) and messenger) 0


399


87


259

S32 ti("web 2.0") or ab("web 2.0") or kw("web 2.0") 105 S31 KW(skype or facetime or "google hangout*" or facebook or twitter or

whatsapp or youtube or Instagram or linkedin or "google+" or pintrest) or ti(skype or facetime or "google hangout*" or facebook or twitter or whatsapp or youtube or Instagram or linkedin or "google+" or pintrest) or ab(skype or facetime or "google hangout*" or facebook or twitter or whatsapp or youtube or Instagram or linkedin or "google+" or pintrest)

300

S30 SU computer mediated communication 0

S29 Web 2.0 Technologies 78 S28 Social Media 608 S27 S15 OR S16 OR S17 OR S18 OR S19 OR S20 OR S21 OR S22 OR S23

OR S24 OR S25 OR S26 40,754

S26 TI ( education* or train* or learn* or teach* or course* ) AND KW ( education* or train* or learn* or teach* or course* ) AND AB ( education* or train* or learn* or teach* or course* )

13,312

S25 continuing education 3,604 S24 inservice training 129 S23 distance education 2,740 S22 curriculum 20,146 S21 su "Allied Health Occupations Education" 0 S20 SU health professions education 0 S19 SU Pharmaceutical Education 9 S18 SU Nursing Education 24 S17 SU Allied Health Occupations Education 0 S16 SU Graduate Medical Education 2 S15 SU Medical Education 5,163 S14 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR

S11 OR S12 OR S13 8,044

S13 TI ( physician* or doctor* or clinician* or therapist* or dentist* or psychiatrist* or surgeon* or nurse* ) OR AB ( physician* or doctor* or clinician* or therapist* or dentist* or psychiatrist* or surgeon* or nurse* ) OR KW ( physician* or doctor* or clinician* or therapist* or dentist* or psychiatrist* or surgeon* or nurse* )

3,645

S12 SU allied health students 0 S11 SU health occupations students 58 S10 SU Medical Students 2,819 S9 SU Allied Health Occupations 0 S8 SU Health Personnel 472 S7 SU dentistry 89 S6 SU Health Occupations 59 S5 SU Psychologists 1,121 S4 SU Physicians 1,180 S3 SU Nurses 304 S2 SU Mental Health Workers 1 S1 SU Allied Health Personnel 453

Web of Science Search

# 5 #4 Timespan=2012-2017

1,945

# 4 #1 and #2 and #3

3,269

# 3 TS=(("Social Media" or weblog* or vlog* or Blog* or Webcast* or Videoconferenc*) or ((online or internet) near/2 (forum or discussion)) or ((internet or online or virtual) near/2 communicat*) or ((internet or online or virtual) near/3 collaborat*) or ((internet or virtual or online) near/2 communit*) or ((internet or online or virtual) near/2 messenger))

71,256

# 2 TS=(education* or train* or learn* or teach* or collaborat* or course* or curriculum)

3,222,860

# 1 TS=(dental or medical or premedical or pharmac* or physician* or doctor* or clinician* or therapist* or dentist* or psychiatrist* or surgeon* or nurs* or "health profession*")

2,676,614

http://apps.webofknowledge.com/summary.do?product=WOS&doc=1&qid=8&SID=E4txqqtDx6NXjoqW8Nj&search_mode=AdvancedSearch&update_back2search_link_param=yes




Cochrane Search

ID Search Hits #1 MeSH descriptor: [Students, Dental] explode all trees 128 #2 MeSH descriptor: [Students, Medical] explode all trees 858 #3 MeSH descriptor: [Students, Premedical] explode all trees 1 #4 MeSH descriptor: [Students, Nursing] explode all trees 350 #5 MeSH descriptor: [Students, Pharmacy] explode all trees 43 #6 MeSH descriptor: [Students, Health Occupations] explode all trees 1417 #7 MeSH descriptor: [Health Personnel] explode all trees 7642 #8 MeSH descriptor: [Faculty, Medical] explode all trees 98 #9 MeSH descriptor: [Allied Health Personnel] explode all trees 1000 #10 physician* or doctor* or clinician* or therapist* or dentist* or

psychiatrist* or surgeon* or nurs* 125478

#11 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 128834 #12 MeSH descriptor: [Education, Continuing] explode all trees 1117 #13 MeSH descriptor: [Curriculum] explode all trees 1617 #14 MeSH descriptor: [Education, Distance] explode all trees 119 #15 MeSH descriptor: [Education, Professional] explode all trees 4289 #16 MeSH descriptor: [Inservice Training] explode all trees 741 #17 education* or train* or learn* or teach* or collaborat* or course* 200924 #18 #12 or #13 or #14 or #15 or #16 or #17 201079 #19 MeSH descriptor: [Blogging] explode all trees 13 #20 MeSH descriptor: [Social Media] explode all trees 90 #21 MeSH descriptor: [Blogging] explode all trees 13 #22 MeSH descriptor: [Webcasts] explode all trees 0 #23 MeSH descriptor: [Videoconferencing] explode all trees 171 #24 skype or "google hangout" or facetime or "google+" 1232 #25 facebook or twitter or whatsapp or youtube or Instagram or

linkedin or pintrest 471

#26 "online discussion" or "online forum" or "internet discussion" or "internet forum" or blog* or weblog* or vlog* or "internet messenger" or "online messenger"

353

#27 "social media" or mooc or "massive open online course" or "ted-ed" or futurelearn or coursera

591

#28 #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 2482 #29 #11 and #18 and #28 895 #30 #29 with Cochrane Library publication date between Jan 2012 and

Dec 2017 586

#31 #30 in Cochrane Reviews and Trials 465

Appendix 2 – Data extraction proforma

Study Type Introduction Aims / Objectives Methodology Summary of study design and rationale Number of institutions studied Educational intervention(s), implementation, duration Control condition (if applicable) Selection methods, eligibility criteria and rationale How was sample size determined Randomisation Methods (if applicable) Objectivity measures / Blinding Outcome recording, measures and instruments (? validity, ? reliability) Internal structure of instrument used Content validity of instrument Criterion validity (Relationship with other variables) Follow up method and duration Quantitative Studies Data analysis (grouping of participants, analysis of subgroups, statistical analyses) Management of loss to follow up Confounders / sources of bias Qualitative Studies Coding and analysis method Techniques to enhance coding integrity / trustworthiness / credibility Results Number of participants (at each stage of study, in each group, in analysis) Response rate category Summarise characteristics of participants Level of participation in educational intervention Description of the results Appropriateness of analysis Quantitative Studies Effect size or other measure of effect (and p value) and precision (confidence interval) for primary outcome Effect size or other measure of effect (and p value) and precision for secondary outcomes Statistical adjustments made for confounders / multiple measures Other analyses (subgroups, interaction) Category boundaries when continuous variables were categorized Qualitative Studies Links of main findings (e.g., interpretations, inferences, and themes) to empirical data (include quote if illustrates key point)

Describe any Theory developed from main finidings Limitations and Conclusions Conclusions drawn by authors Findings in the context of previous work Limitations of study Application and Generalizability of results Context or researcher characteristics which may have influenced outcome Review Aims

Extent to which learners meet definition of community (comment on sense of membership, influence, need fulfilment and emotional connectedness)

Extent to which learners are a CoP (describe joint enterprise, mutual engagement, shared repertoire) Any further observations of relevance to the review Summary of key themes which this paper adds to the review Scores BEME Review Score Strength of Evidence (select one) Outcomes (select one) MERSQI Review Score

Documents

Use of online communication to create learning communities ... of...Social media, blogs and discussion boards have enabled people without vast technical skills to engage in online