The technology-enhanced learning revolution in paediatrics, what do we know, what do we need to know: A scoping review

The technology-enhanced learning revolution in paediatrics, what do we know, what do we need to know: A scoping review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The technology-enhanced learning revolution in paediatrics, what do we know, what do we need to know: A scoping review Clodagh S O'Gorman, Mary F Higgins, Patsy Walsh, Evelyn Murphy, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7613680/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Introduction The use of technology-enhanced learning in medicine has expanded rapidly in recent years in response to emerging needs. This scoping review aims to synthesise and evaluate studies on the use of e-learning in undergraduate and postgraduate medical education in paediatrics. Methods A scoping review was conducted following the principles of the PRISMA tool, to synthesise and evaluate studies according to population, intervention and outcomes, both qualitative and quantitative. Studies were identified by systematic searching of EMBASE, Medline, Scopus, Cochrane and Thesis Proquest, and citation searching (N=547). Studies published between 2017 and April 2023 were included. Twenty studies met eligibility criteria and are included. Results Of the 20 studies, seven referred to undergraduate students, twelve to postgraduate trainees and one included both. Eight studies measured only qualitative outcomes, six measured both qualitative and quantitative and 6 only quantitative outcomes. One study focussed on educators. Heterogeneity between studies was significant. There was an increase in published studies following 2019, coinciding with increased e-learning due to the Covid-19 pandemic. No study measured patient outcome changes related to e-learning. Discussion With increased global use of technology-enhanced learning in paediatrics there is an urgent need for well conducted studies that provide credible and transferable evaluations detailing effects on learning and achievement. Further research could inform the development of a standard set of outcome measures for technology-enhanced learning in paediatrics. Scoping review paediatrics child health technology enhanced learning digital learning e-learning undergraduate postgraduate internet-based learning. Figures Figure 1 Figure 2 Figure 3 Introduction There are numerous e-learning instructional designs in use in clinical medicine, including but not limited to those described in a 2008 paper as: “ online and offline computer-based programmes, massive open online courses, virtual reality environments, virtual patients, mobile learning, digital-game based learning and psychomotor skills trainers ”(1). With the advent of the era of virtual reality and artificial intelligence, digital transformation is set to further disrupt medical education providing new opportunities for innovative teaching methods, personalised learning experiences and enhanced accessibility. For the purposes of this paper, we will refer to e-learning and its tools as technology-enhanced learning (TEL), It is an imperative that TEL is studied systematically, to ensure the quality of the content and to improve knowledge acquisition and learner engagement related to TEL. Since the Covid-19 pandemic, the use of TEL in healthcare has increased significantly. Social distancing limitations were implemented internationally as a public health measure to control the spread of the virus. These also placed limitations on traditional methods of teaching for undergraduate students and postgraduate trainees in medicine, including in paediatrics. Individual organisations and institutions had to develop and implement innovations very quickly, to try to continue clinical teaching(2-4). TEL might meet the needs of a newer generation of medical learners, conversant with other technology, but it may require educators to build a specific skillset in TEL. Scoping reviews (ScR) describing TEL in response to Covid-19 have identified 127(4), 769(5) and 55(6) studies in medical education. Other systematic reviews have identified advances in TEL in clinical medicine including pre-Covid-19 (7), which was one of the largest systematic reviews, but it identified and included only 2 studies in Paediatrics out of 42 included studies. To our knowledge, no ScR studying e-learning in paediatric medicine for undergraduates or postgraduates has yet been published. Thus, ScR is an appropriate methodology for this study. The objective of this ScR was to identify and describe studies in the published literature on the use of e-learning activities in paediatric medicine for undergraduate medical students and postgraduate trainees, following the structured framework set out by Arksey and O’Malley (8). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist was used in the conduct and reporting of this scoping review (9). (Table 1) The 5 stages in the framework of Arksey and O’Malley(8) were followed. Stage 1: Identify the research question To identify and describe published studies on the use of e-learning in paediatric medicine for undergraduate medical students and postgraduate trainees. Stage 2: Identifying relevant studies Search Strategy The MeSH terms for the search strategy included “pediatrics” AND “medical student” and “doctor” and “technology enhanced learning”. The following databases were searched in April 2023: Ovid Embase, Ovid Medline, EBSCO Medline, Cochrane central database, EBSCO Eric, Thesis proquest and Scopus. Citation searching was conducted. A university medical librarian supported this extensive search. Inclusion and Exclusion Criteria Only studies published in the English language in peer-reviewed journals were included. Abstract reports and conference proceedings were excluded. Study populations eligible for inclusion were undergraduate medical students in paediatric medicine or postgraduate paediatric doctors in training. Only TEL interventions focussed on undergraduate or postgraduate medical educational e-interventions were included. Studies using the following methodologies were eligible for inclusion, including pre/post intervention assessments, historical cohorts or control groups, as well as qualitative assessments. Mixed methods studies were eligible for inclusion. Only studies published between 2017 and April 2023 were included. Only study populations with > 50% paediatric undergraduate medical students or postgraduate paediatric doctors in training were included. Corresponding authors were contacted for additional information as required. TEL interventions for non-paediatric medicine disciplines were excluded. Citation pearl indexing was conducted. The search strategy was executed in April 2023. Retrieved papers were imported into Rayyaan ( https://rayyan.ai/ ). Figure 1 shows the number of studies retrieved. Stage 3: Study Selection Each title and abstract were reviewed independently (blindly) by 2 researchers for inclusion in scoping review, using the pre-defined inclusion and exclusion criteria. When the 2 reviewers disagreed, the study was discussed and if necessary, a third reviewer was invited to mediate to achieve consensus. Studies were selected for full text review when the 2 independent reviewers agreed on inclusion. Stage 4: Charting the data The data extraction sheet (DES) was developed, tested on pilot data and refined accordingly (Appendix 4). Data were extracted from each of the individual selected studies using the DES, entered directly into an excel file, collated and summarised. One author reviewed all the studies for data extraction. Data extraction was conducted to address the following: 1. TEL activities employed; 2. methodologies used; 3. outcomes assessed. Kirkpatrick's levels of evaluation were used to categorise the forms of evaluation used in each of the included studies (10, 11). Stage 5: Collating, summarizing and reporting the results The data were collated, summarized and reported by analysis of the completed excel file. The findings of the analysis of the selected literature are summarised in the results section. Results Study Selection The search strategy identified 547 studies, of which 453 met the year of publication criterion. There was initial agreement on 449/453 papers and consensus achieved by discussion between two reviewers on 4 further papers. Following title and abstract review, 73 full papers were retrieved and reviewed. Twenty studies were included in the final review (Fig. 2 ). Year of publication This included eight between 2017–2019 (12–19); and 12 between 2020-April 2023(20–31). The expanding volume of studies in later years is likely due to increased e-learning during the Covid-19 pandemic. Country(ies) of origin Twelve studies were published from groups based in North America (13–15, 17, 19, 20, 22, 24, 27–30); two from Africa (23, 31); three from Europe(12, 18, 26), one from Asia(25) & two were inter-continental, one from South & North America (21) and one from Europe & Canada(16). Four papers, all from low-middle income countries, cited the uses and benefits of medical e-learning in these countries (21, 23, 25, 31). Paediatrics Of the twenty included studies, eleven focused on paediatrics as a discipline (N = 11) (12, 14–16, 19–21, 23, 25, 26, 29), paediatric cardiology (N = 3) (24, 28, 31), one neonatology (27), one paediatric radiology (17) and one paediatric resuscitation (18). Three study populations included majority paediatrics with another (adult) discipline: one paediatric cardiology / internal medicine (30); one paediatric neurology/ adult neurology (22); and one paediatric emergency medicine with adult emergency medicine (13). Undergraduate versus Postgraduate Paediatric Medicine Seven studies focussed exclusively on paediatrics medical students (12, 14, 17, 20, 26, 29, 31); eleven on postgraduate paediatric doctors (13, 15, 16, 19, 21, 23–25, 27, 28, 30); one included paediatric trainees and some faculty (18); and one focussed on both paediatrics undergraduate and postgraduate students and trainees (22). Ethics Twelve studies stated they received ethics approval (12–16, 18, 20, 22, 26, 28–30). Four specified ethics exemptions (19, 21, 23, 27). Four provided no ethics statements (17, 24, 25, 31). TEL interventions & Learning Theories The TEL intervention was synchronous in four studies (20, 23, 29, 31); asynchronous in fifteen (12–19, 21, 22, 24, 25, 27, 28, 30) and combined-synchronous-asynchronous in one study (26). The TEL intervention was compulsory to the respective curriculum in four studies, 2 for students (17, 26) and 1 for just trainees (19) & one for trainees, including some faculty (18). In the remaining sixteen studies, the TEL intervention was not compulsory within the curriculum. The four synchronous TEL interventions included three on-line lectures (20, 23, 31) and one pilot study of virtual reality assessment of an infant with respiratory distress, led by educator (29). The asynchronous TEL interventions included thirteen studies that described various recorded or narrated lectures or videos or modules, without any clear opportunities for student-led interactions with the tool (12, 13, 15, 17–19, 21, 22, 24, 25, 27, 28, 30). Two studies, both RCTs, described interactive cases, delivered asynchronously, within which students have decision points (14, 16). One study included synchronous and asynchronous components; the learning tool in this RCT was a blended learning, flipped classroom with on-line lectures and case-based discussions, which used qualitative follow-up guided by a learning environment framework. This was the only study that referenced the learning theory underpinning its construct, specifically citing social constructivism.(26) Methodologies Eleven studies specified mixed methods (13–16, 20, 22, 26–28, 30, 31). The remaining nine studies, included six quasi-experimental, studies (19, 21, 23–25, 29) and three randomised controlled trials (RCTs) (12, 17, 18). Outcome measures Three mixed methods studies used qualitative feedback and thematic analysis (20, 26, 27). Three quasi-experimental studies used qualitative feedback (21, 23, 29) and 2 used qualitative feedback with thematic analysis(24, 25). Only one/20 studies performed qualitative analysis of feedback from educators (24). Two RCTs measured qualitative outcomes (14, 16), and one of these also included quantitative measurement of skill performance (oral case presentation)(14). One mixed methods study utilised qualitative and quasi-experimental methodologies to measure change in attitudes of paediatrics trainees following e-learning and subsequently monitored trainees’ on-line interactions for evidence of change in attitudes and intent to change behaviour following e-learning, thus equivalent to Kirkpatrick levels 2&3 (14). This study used a flipped classroom approach, with 1 week of lectures followed by on-line case-based discussions (14). One quasi-experimental study, using blended learning and flipped classroom (one week of lectures and then case-based discussions) conducted qualitative thematic feedback analysis on participants, also using Colles’ learning environment framework. The authors also monitored Moodle (monitored on-line forum) activity of participants and identified an anticipated change in decision-making with students’ expressing that they would make different decisions in future, based on their learning. While this study did not fulfil criteria for Kirkpatrick level 3, this study deserves particular mention (26) . Four studies measured both qualitative outcomes and pre-test/post-test MCQs following an intervention, using RCT methodology in two (15, 22) and quasi-experimental observational methodology in two (13, 30). Four additional studies used pre-test/post-test MCQs as their outcome, including two quasi-experimental studies (28, 31) and one RCT (17). Other quantitative skills-based outcomes included clinical examination skills following a non-controlled observational study (19) and in two studies, objective structured clinical examination (OSCE) skills assessments were conducted following RCTs to evaluate the practical competencies gained by trainees and the translation of e-learning into clinical practice (12, 18). Numbers of Participants The minimum participant number was seven (27, 28) and the maximum 789 (14). In total, studies on 2742 paediatric participants were included in this scoping review. (See Fig. 3 ) Duration of TEL Intervention Eleven of 20 included studies did not provide information on the duration of the TEL intervention. Nine/20 studies described the duration of e-learning intervention, ranging from 12 minutes (12) to 5 hours 40 minutes (13). Three were synchronous and 6 asynchronous. Future studies should report the duration of the TEL intervention in more detail. (See Fig. 3 ) Duration of Follow-up This was defined by twelve studies; four described four weeks (18), 3months(30), four months (28) and eight months follow-up (15); ten indicated that follow-up was completed within the relevant clinical rotation (12, 13, 15, 17, 19, 24, 25, 27, 28), one of which defined this as four months (28). Role of Facilitator Where stated, the facilitator role was most commonly in the development of the resource (12, 13, 17, 18, 24, 28, 31) with some facilitators involved in facilitating case-based discussions (25, 26) and assessment (14, 22, 30). Facilitators were also involved in leading virtual reality TEL interventions for paediatrics medical students(29). Facilitators were faculty members in 11 studies (13, 15, 18, 20, 22, 23, 25, 26, 28–30), senior trainees in two studies (14, 27) and near-peer trainees in one study (12). Evaluation measures Three/20 studies measured Kirkpatrick 2 alone (12, 17, 18). One study measured Kirkpatrick 1,2 & 3 (14). All sixteen other studies measured Kirkpatrick 1 and 2. Only one study directly measured Kirkpatrick 3 outcomes (14). Another study assessed an intention to change behaviour by monitoring students’ on-line contributions to virtual cases following the e-learning activity; however, actual change in behaviour was outside the scope of that study (26). No study evaluated outcomes at Kirkpatrick Level 4. Discussion In this scoping review, we have demonstrated that there has been significant content creation in Paediatrics TEL, but few studies demonstrate high quality evaluation and adequate follow-up. It is possible that due to restrictions during the Covid-19 pandemic, there has been a focus on content transfer from face-to-face to virtual learning (2–4) but without a concomitant commitment to assessing the effects on learning and learners. Future studies should address these deficiencies. There is significant heterogeneity of methodology and outcomes in studies in this scoping review. This level of heterogeneity is problematic in this scoping review, as it is challenging to synthesise the findings of studies with very different methodological frameworks. Future research would benefit from greater standardisation of approach and outcome reporting. For examples, only one study did each of the following: collected qualitative feedback from educators (24); cited the learning theory underpinning its methodology (26) cited the framework for learning environment analysis in its qualitative analysis from learners feedback (26). Because 8/20 papers included did not have research ethics approval, further work is required to explore if this is representative of TEL in paediatrics and to standardise the inclusion of an appropriate ethics statement in published papers. There are several reasons why TEL should benefit learners: different learners with different styles will respond better to different educational opportunities. Currently, TEL interventions are not designed to replace but to supplement other pre-existing tools for clinical learning. When educators provide the appropriate tools in the right learning environment, learners can select and integrate tools to match their individual learning needs. Given the digital engagement of young learners and the focus on digital disruption in this scoping review, a discussion on connectivism is appropriate. There are significant potential economic benefits to TEL interventions in clinical paediatrics (32). Potential economic benefits were not explored by many included studies. Studies which addressed economic benefits included studies focussed on TEL in low-to-middle income countries (21, 23, 25, 31) and those with internationally available tools (22). Sharing resources would support all clinical educators and learners internationally, with the caveat that clinical conditions and management vary with geography and economic resources, as documented specifically in one study (21). It is clear from this study that future paediatric TEL studies would benefit from adherence to a structured approach to their conduct, and reporting of their paediatric TEL in a format that would allow future researchers to complete the required categories for scoping review, using the PRISMA-ScR framework (9). One approach to achieve this goal would be for paediatric educators to work alongside pedagogists in conducting and reporting education research and in developing a core outcomes set. This would allow more detail and robust data in future ScR and systematic reviews. It is time-critical to promote the standardisation and quality of measured and reported outcomes; the potential exponential increase in TEL interventions due to the use of artificial intelligence is hard to predict. Governance of both clinical practice and clinical education within the domain of TEL will be essential to ensure the quality, efficacy and safety of medical training programs establishing that future TEL translate into improvements in medical training and healthcare delivery. To our knowledge, this is the first scoping review of TEL interventions in paediatric medicine for undergraduate medical students in paediatrics or for post-graduate medical trainees in paediatrics. There are limitations to this study. Firstly, only one reviewer extracted data from the included studies. This is not unusual; in 2016, 70% of scoping reviews used 1 reviewer for data extraction (33). Secondly, this search was limited to paediatrics; it is possible that there are unidentified studies. However, a recent systematic review of e-learning in undergraduate medicine identified only 2 paediatrics studies (7). Citation pearl searching failed to identify additional relevant studies. Future Directions Studies of e-learning interventions in paediatric medicine for undergraduates and postgraduates should be encouraged to follow standardised frameworks for conduct and reporting, with clinician educators and education methodologists collaborating. Such a potential structured approach must include comments on ethics; time spent on the TEL and core outcome measures. While challenging, it is important to design and fund long-term studies which can focus on outcomes, specifically any potential change in student or physician behaviour and/or change in patient outcomes due to the TEL. Qualitative feedback from e-learning educators should be encouraged to guide curriculum development, monitor outcomes and uphold professional accountability in a rapidly evolving educational environment. Evidence-based studies should assess outcomes including changes in clinical practice, decision-making and quality of care wherever feasible. Future scoping reviews, and perhaps systematic reviews can play a crucial role in drawing practical and clinically relevant conclusions. Declarations Consent to participate was not required for this scoping review. Consent to Publish declarations: not applicable. Author Contribution COG, YF, PW contributed substantially to the conception and design of the work. COG and PW contributed substantially to the acquisition of data. COG, MFH, EM and YF contributed substantially to the analysis and interpretation of data. COG wrote the first draft, with substantial contrinutions from Each author has approved the submitted version. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7613680","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":539578104,"identity":"4ea6de09-d35f-4404-8bcb-0c83877ab5a5","order_by":0,"name":"Clodagh S 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04:19:49","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":80823,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow sheet of included studies.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"F2.png","url":"https://assets-eu.researchsquare.com/files/rs-7613680/v1/d6eaf63ee591a3dbb1e3d66c.png"},{"id":95260576,"identity":"3a9b8e2a-101e-4b6c-b939-9796abb20614","added_by":"auto","created_at":"2025-11-06 04:19:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":513381,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDetails of included studies\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7613680/v1/2e4edb3fcaecaa200f6b1959.png"},{"id":95315705,"identity":"aa667d13-2a83-43ad-b29e-3c2739b0ea8a","added_by":"auto","created_at":"2025-11-06 15:56:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1811862,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7613680/v1/13646ed7-bee5-41fc-9d15-f05642f11ae9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The technology-enhanced learning revolution in paediatrics, what do we know, what do we need to know: A scoping review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThere are numerous e-learning instructional designs in use in clinical medicine, including but not limited to those described in a 2008 paper as: “\u003cem\u003eonline and offline computer-based programmes, massive open online courses, virtual reality environments, virtual patients, mobile learning, digital-game based learning and psychomotor skills trainers\u003c/em\u003e”(1). With the advent of the era of virtual reality and artificial intelligence, digital transformation is set to further disrupt medical education providing new opportunities for innovative teaching methods, personalised learning experiences and enhanced accessibility. For the purposes of this paper, we will refer to e-learning and its tools as technology-enhanced learning (TEL), It is an imperative that TEL is studied systematically, to ensure the quality of the content and to improve knowledge acquisition and learner engagement related to TEL.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSince the Covid-19 pandemic, the use of TEL in healthcare has increased significantly. Social distancing limitations were implemented internationally as a public health measure to control the spread of the virus. These also placed limitations on traditional methods of teaching for undergraduate students and postgraduate trainees in medicine, including in paediatrics. Individual organisations and institutions had to develop and implement innovations very quickly, to try to continue clinical teaching(2-4). TEL \u0026nbsp;might meet the needs of a newer generation of medical learners, conversant with other technology, but it may require educators to build a specific skillset in TEL. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eScoping reviews (ScR) describing TEL in response to Covid-19 have identified 127(4), 769(5) and 55(6) studies in medical education. Other systematic reviews have identified advances in TEL in clinical medicine including pre-Covid-19 (7), which was one of the largest systematic reviews, but it identified and included only 2 studies in Paediatrics out of 42 included studies. To our knowledge, no ScR \u0026nbsp;studying e-learning in paediatric medicine for undergraduates or postgraduates has yet been published. Thus, ScR is an appropriate methodology for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe objective of this ScR was to identify and describe studies in the published literature on the use of e-learning activities in paediatric medicine for undergraduate medical students and postgraduate trainees, following the structured framework set out by Arksey and O’Malley (8).\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist was used in the conduct and reporting of this scoping review (9). (Table\u0026nbsp;1)\u003c/p\u003e\u003cp\u003eThe 5 stages in the framework of Arksey and O\u0026rsquo;Malley(8) were followed.\u003c/p\u003e\n\u003ch3\u003eStage 1: Identify the research question\u003c/h3\u003e\n\u003cp\u003eTo identify and describe published studies on the use of e-learning in paediatric medicine for undergraduate medical students and postgraduate trainees.\u003c/p\u003e\n\u003ch3\u003eStage 2: Identifying relevant studies\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSearch Strategy\u003c/h2\u003e\u003cp\u003eThe MeSH terms for the search strategy included \u0026ldquo;pediatrics\u0026rdquo; AND \u0026ldquo;medical student\u0026rdquo; and \u0026ldquo;doctor\u0026rdquo; and \u0026ldquo;technology enhanced learning\u0026rdquo;. The following databases were searched in April 2023: Ovid Embase, Ovid Medline, EBSCO Medline, Cochrane central database, EBSCO Eric, Thesis proquest and Scopus. Citation searching was conducted. A university medical librarian supported this extensive search.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eOnly studies published in the English language in peer-reviewed journals were included. Abstract reports and conference proceedings were excluded. Study populations eligible for inclusion were undergraduate medical students in paediatric medicine or postgraduate paediatric doctors in training. Only TEL interventions focussed on undergraduate or postgraduate medical educational e-interventions were included. Studies using the following methodologies were eligible for inclusion, including pre/post intervention assessments, historical cohorts or control groups, as well as qualitative assessments. Mixed methods studies were eligible for inclusion. Only studies published between 2017 and April 2023 were included.\u003c/p\u003e\u003cp\u003eOnly study populations with \u0026gt;\u0026thinsp;50% paediatric undergraduate medical students or postgraduate paediatric doctors in training were included. Corresponding authors were contacted for additional information as required. TEL interventions for non-paediatric medicine disciplines were excluded. Citation pearl indexing was conducted.\u003c/p\u003e\u003cp\u003eThe search strategy was executed in April 2023. Retrieved papers were imported into Rayyaan (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://rayyan.ai/\u003c/span\u003e\u003cspan address=\"https://rayyan.ai/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the number of studies retrieved.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eStage 3: Study Selection\u003c/h3\u003e\n\u003cp\u003eEach title and abstract were reviewed independently (blindly) by 2 researchers for inclusion in scoping review, using the pre-defined inclusion and exclusion criteria. When the 2 reviewers disagreed, the study was discussed and if necessary, a third reviewer was invited to mediate to achieve consensus. Studies were selected for full text review when the 2 independent reviewers agreed on inclusion.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eStage 4: Charting the data\u003c/h2\u003e\u003cp\u003eThe data extraction sheet (DES) was developed, tested on pilot data and refined accordingly (Appendix 4). Data were extracted from each of the individual selected studies using the DES, entered directly into an excel file, collated and summarised. One author reviewed all the studies for data extraction. Data extraction was conducted to address the following: 1. TEL activities employed; 2. methodologies used; 3. outcomes assessed. Kirkpatrick's levels of evaluation were used to categorise the forms of evaluation used in each of the included studies (10, 11).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eStage 5: Collating, summarizing and reporting the results\u003c/h2\u003e\u003cp\u003eThe data were collated, summarized and reported by analysis of the completed excel file. The findings of the analysis of the selected literature are summarised in the results section.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eStudy Selection\u003c/h2\u003e\u003cp\u003eThe search strategy identified 547 studies, of which 453 met the year of publication criterion. There was initial agreement on 449/453 papers and consensus achieved by discussion between two reviewers on 4 further papers. Following title and abstract review, 73 full papers were retrieved and reviewed. Twenty studies were included in the final review (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eYear of publication\u003c/h2\u003e\u003cp\u003eThis included eight between 2017\u0026ndash;2019 (12\u0026ndash;19); and 12 between 2020-April 2023(20\u0026ndash;31). The expanding volume of studies in later years is likely due to increased e-learning during the Covid-19 pandemic.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eCountry(ies) of origin\u003c/h2\u003e\u003cp\u003eTwelve studies were published from groups based in North America (13\u0026ndash;15, 17, 19, 20, 22, 24, 27\u0026ndash;30); two from Africa (23, 31); three from Europe(12, 18, 26), one from Asia(25) \u0026amp; two were inter-continental, one from South \u0026amp; North America (21) and one from Europe \u0026amp; Canada(16). Four papers, all from low-middle income countries, cited the uses and benefits of medical e-learning in these countries (21, 23, 25, 31).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003ePaediatrics\u003c/h2\u003e\u003cp\u003eOf the twenty included studies, eleven focused on paediatrics as a discipline (N\u0026thinsp;=\u0026thinsp;11) (12, 14\u0026ndash;16, 19\u0026ndash;21, 23, 25, 26, 29), paediatric cardiology (N\u0026thinsp;=\u0026thinsp;3) (24, 28, 31), one neonatology (27), one paediatric radiology (17) and one paediatric resuscitation (18). Three study populations included majority paediatrics with another (adult) discipline: one paediatric cardiology / internal medicine (30); one paediatric neurology/ adult neurology (22); and one paediatric emergency medicine with adult emergency medicine (13).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eUndergraduate versus Postgraduate Paediatric Medicine\u003c/h2\u003e\u003cp\u003eSeven studies focussed exclusively on paediatrics medical students (12, 14, 17, 20, 26, 29, 31); eleven on postgraduate paediatric doctors (13, 15, 16, 19, 21, 23\u0026ndash;25, 27, 28, 30); one included paediatric trainees and some faculty (18); and one focussed on both paediatrics undergraduate and postgraduate students and trainees (22).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eEthics\u003c/h2\u003e\u003cp\u003eTwelve studies stated they received ethics approval (12\u0026ndash;16, 18, 20, 22, 26, 28\u0026ndash;30). Four specified ethics exemptions (19, 21, 23, 27). Four provided no ethics statements (17, 24, 25, 31).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eTEL interventions \u0026amp; Learning Theories\u003c/h2\u003e\u003cp\u003eThe TEL intervention was synchronous in four studies (20, 23, 29, 31); asynchronous in fifteen (12\u0026ndash;19, 21, 22, 24, 25, 27, 28, 30) and combined-synchronous-asynchronous in one study (26).\u003c/p\u003e\u003cp\u003eThe TEL intervention was compulsory to the respective curriculum in four studies, 2 for students (17, 26) and 1 for just trainees (19) \u0026amp; one for trainees, including some faculty (18). In the remaining sixteen studies, the TEL intervention was not compulsory within the curriculum.\u003c/p\u003e\u003cp\u003eThe four synchronous TEL interventions included three on-line lectures (20, 23, 31) and one pilot study of virtual reality assessment of an infant with respiratory distress, led by educator (29).\u003c/p\u003e\u003cp\u003eThe asynchronous TEL interventions included thirteen studies that described various recorded or narrated lectures or videos or modules, without any clear opportunities for student-led interactions with the tool (12, 13, 15, 17\u0026ndash;19, 21, 22, 24, 25, 27, 28, 30). Two studies, both RCTs, described interactive cases, delivered asynchronously, within which students have decision points (14, 16). One study included synchronous and asynchronous components; the learning tool in this RCT was a blended learning, flipped classroom with on-line lectures and case-based discussions, which used qualitative follow-up guided by a learning environment framework. This was the only study that referenced the learning theory underpinning its construct, specifically citing social constructivism.(26)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eMethodologies\u003c/h2\u003e\u003cp\u003eEleven studies specified mixed methods (13\u0026ndash;16, 20, 22, 26\u0026ndash;28, 30, 31).\u003c/p\u003e\u003cp\u003eThe remaining nine studies, included six quasi-experimental, studies (19, 21, 23\u0026ndash;25, 29) and three randomised controlled trials (RCTs) (12, 17, 18).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eOutcome measures\u003c/h2\u003e\u003cp\u003eThree mixed methods studies used qualitative feedback and thematic analysis (20, 26, 27). Three quasi-experimental studies used qualitative feedback (21, 23, 29) and 2 used qualitative feedback with thematic analysis(24, 25). Only one/20 studies performed qualitative analysis of feedback from educators (24). Two RCTs measured qualitative outcomes (14, 16), and one of these also included quantitative measurement of skill performance (oral case presentation)(14).\u003c/p\u003e\u003cp\u003eOne mixed methods study utilised qualitative and quasi-experimental methodologies to measure change in attitudes of paediatrics trainees following e-learning and subsequently monitored trainees\u0026rsquo; on-line interactions for evidence of change in attitudes and intent to change behaviour following e-learning, thus equivalent to Kirkpatrick levels 2\u0026amp;3 (14). This study used a flipped classroom approach, with 1 week of lectures followed by on-line case-based discussions (14). One quasi-experimental study, using blended learning and flipped classroom (one week of lectures and then case-based discussions) conducted qualitative thematic feedback analysis on participants, also using Colles\u0026rsquo; learning environment framework. The authors also monitored Moodle (monitored on-line forum) activity of participants and identified an anticipated change in decision-making with students\u0026rsquo; expressing that they would make different decisions in future, based on their learning. While this study did not fulfil criteria for Kirkpatrick level 3, this study deserves particular mention (26) .\u003c/p\u003e\u003cp\u003eFour studies measured both qualitative outcomes and pre-test/post-test MCQs following an intervention, using RCT methodology in two (15, 22) and quasi-experimental observational methodology in two (13, 30). Four additional studies used pre-test/post-test MCQs as their outcome, including two quasi-experimental studies (28, 31) and one RCT (17).\u003c/p\u003e\u003cp\u003eOther quantitative skills-based outcomes included clinical examination skills following a non-controlled observational study (19) and in two studies, objective structured clinical examination (OSCE) skills assessments were conducted following RCTs to evaluate the practical competencies gained by trainees and the translation of e-learning into clinical practice (12, 18).\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eNumbers of Participants\u003c/h2\u003e\u003cp\u003eThe minimum participant number was seven (27, 28) and the maximum 789 (14). In total, studies on 2742 paediatric participants were included in this scoping review. (See Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eDuration of TEL Intervention\u003c/h2\u003e\u003cp\u003eEleven of 20 included studies did not provide information on the duration of the TEL intervention. Nine/20 studies described the duration of e-learning intervention, ranging from 12 minutes (12) to 5 hours 40 minutes (13). Three were synchronous and 6 asynchronous. Future studies should report the duration of the TEL intervention in more detail. (See Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eDuration of Follow-up\u003c/h2\u003e\u003cp\u003eThis was defined by twelve studies; four described four weeks (18), 3months(30), four months (28) and eight months follow-up (15); ten indicated that follow-up was completed within the relevant clinical rotation (12, 13, 15, 17, 19, 24, 25, 27, 28), one of which defined this as four months (28).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eRole of Facilitator\u003c/h2\u003e\u003cp\u003eWhere stated, the facilitator role was most commonly in the development of the resource (12, 13, 17, 18, 24, 28, 31) with some facilitators involved in facilitating case-based discussions (25, 26) and assessment (14, 22, 30). Facilitators were also involved in leading virtual reality TEL interventions for paediatrics medical students(29). Facilitators were faculty members in 11 studies (13, 15, 18, 20, 22, 23, 25, 26, 28\u0026ndash;30), senior trainees in two studies (14, 27) and near-peer trainees in one study (12).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eEvaluation measures\u003c/h2\u003e\u003cp\u003eThree/20 studies measured Kirkpatrick 2 alone (12, 17, 18). One study measured Kirkpatrick 1,2 \u0026amp; 3 (14). All sixteen other studies measured Kirkpatrick 1 and 2. Only one study directly measured Kirkpatrick 3 outcomes (14). Another study assessed an intention to change behaviour by monitoring students\u0026rsquo; on-line contributions to virtual cases following the e-learning activity; however, actual change in behaviour was outside the scope of that study (26). No study evaluated outcomes at Kirkpatrick Level 4.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e In this scoping review, we have demonstrated that there has been significant content creation in Paediatrics TEL, but few studies demonstrate high quality evaluation and adequate follow-up. It is possible that due to restrictions during the Covid-19 pandemic, there has been a focus on content transfer from face-to-face to virtual learning (2\u0026ndash;4) but without a concomitant commitment to assessing the effects on learning and learners. Future studies should address these deficiencies.\u003c/p\u003e\u003cp\u003e There is significant heterogeneity of methodology and outcomes in studies in this scoping review. This level of heterogeneity is problematic in this scoping review, as it is challenging to synthesise the findings of studies with very different methodological frameworks. Future research would benefit from greater standardisation of approach and outcome reporting. For examples, only one study did each of the following: collected qualitative feedback from educators (24); cited the learning theory underpinning its methodology (26) cited the framework for learning environment analysis in its qualitative analysis from learners feedback (26). Because 8/20 papers included did not have research ethics approval, further work is required to explore if this is representative of TEL in paediatrics and to standardise the inclusion of an appropriate ethics statement in published papers.\u003c/p\u003e\u003cp\u003eThere are several reasons why TEL should benefit learners: different learners with different styles will respond better to different educational opportunities. Currently, TEL interventions are not designed to replace but to supplement other pre-existing tools for clinical learning. When educators provide the appropriate tools in the right learning environment, learners can select and integrate tools to match their individual learning needs. Given the digital engagement of young learners and the focus on digital disruption in this scoping review, a discussion on connectivism is appropriate.\u003c/p\u003e\u003cp\u003eThere are significant potential economic benefits to TEL interventions in clinical paediatrics (32). Potential economic benefits were not explored by many included studies. Studies which addressed economic benefits included studies focussed on TEL in low-to-middle income countries (21, 23, 25, 31) and those with internationally available tools (22). Sharing resources would support all clinical educators and learners internationally, with the caveat that clinical conditions and management vary with geography and economic resources, as documented specifically in one study (21).\u003c/p\u003e\u003cp\u003e It is clear from this study that future paediatric TEL studies would benefit from adherence to a structured approach to their conduct, and reporting of their paediatric TEL in a format that would allow future researchers to complete the required categories for scoping review, using the PRISMA-ScR framework (9). One approach to achieve this goal would be for paediatric educators to work alongside pedagogists in conducting and reporting education research and in developing a core outcomes set. This would allow more detail and robust data in future ScR and systematic reviews.\u003c/p\u003e\u003cp\u003eIt is time-critical to promote the standardisation and quality of measured and reported outcomes; the potential exponential increase in TEL interventions due to the use of artificial intelligence is hard to predict. Governance of both clinical practice and clinical education within the domain of TEL will be essential to ensure the quality, efficacy and safety of medical training programs establishing that future TEL translate into improvements in medical training and healthcare delivery.\u003c/p\u003e\u003cp\u003e To our knowledge, this is the first scoping review of TEL interventions in paediatric medicine for undergraduate medical students in paediatrics or for post-graduate medical trainees in paediatrics. There are limitations to this study. Firstly, only one reviewer extracted data from the included studies. This is not unusual; in 2016, 70% of scoping reviews used 1 reviewer for data extraction (33). Secondly, this search was limited to paediatrics; it is possible that there are unidentified studies. However, a recent systematic review of e-learning in undergraduate medicine identified only 2 paediatrics studies (7). Citation pearl searching failed to identify additional relevant studies.\u003c/p\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eFuture Directions\u003c/h2\u003e\u003cp\u003eStudies of e-learning interventions in paediatric medicine for undergraduates and postgraduates should be encouraged to follow standardised frameworks for conduct and reporting, with clinician educators and education methodologists collaborating. Such a potential structured approach must include comments on ethics; time spent on the TEL and core outcome measures. While challenging, it is important to design and fund long-term studies which can focus on outcomes, specifically any potential change in student or physician behaviour and/or change in patient outcomes due to the TEL. Qualitative feedback from e-learning educators should be encouraged to guide curriculum development, monitor outcomes and uphold professional accountability in a rapidly evolving educational environment. Evidence-based studies should assess outcomes including changes in clinical practice, decision-making and quality of care wherever feasible. Future scoping reviews, and perhaps systematic reviews can play a crucial role in drawing practical and clinically relevant conclusions.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConsent to participate\u003c/h2\u003e\u003cp\u003ewas not required for this scoping review.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConsent to Publish\u003c/h2\u003e\u003cp\u003edeclarations: not applicable.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eCOG, YF, PW contributed substantially to the conception and design of the work. COG and PW contributed substantially to the acquisition of data. COG, MFH, EM and YF contributed substantially to the analysis and interpretation of data. COG wrote the first draft, with substantial contrinutions from Each author has approved the submitted version. Each author has agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEllaway R, Masters K. AMEE Guide 32: e-Learning in medical education Part 1: Learning, teaching and assessment. Med Teach. 2008;30(5):455–73.\u003c/li\u003e\n\u003cli\u003eGrafton-Clarke C, Uraiby H, Gordon M, Clarke N, Rees E, Park S, et al. Pivot to online learning for adapting or continuing workplace-based clinical learning in medical education following the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 70. Med Teach. 2022;44(3):227–43.\u003c/li\u003e\n\u003cli\u003eStojan J, Haas M, Thammasitboon S, Lander L, Evans S, Pawlik C, et al. Online learning developments in undergraduate medical education in response to the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 69. Med Teach. 2022;44(2):109–29.\u003c/li\u003e\n\u003cli\u003eDaniel M, Gordon M, Patricio M, Hider A, Pawlik C, Bhagdev R, et al. An update on developments in medical education in response to the COVID-19 pandemic: A BEME scoping review: BEME Guide No. 64. Med Teach. 2021;43(3):253–71.\u003c/li\u003e\n\u003cli\u003ePark H, Shim S, Lee YM. A scoping review on adaptations of clinical education for medical students during COVID-19. Prim Care Diabetes. 2021;15(6):958–76.\u003c/li\u003e\n\u003cli\u003eGrafton-Clarke C, Uraiby H, Gordon M, Clarke N, Rees E, Park S, et al. Pivot to online learning for adapting or continuing workplace-based clinical learning in medical education following the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 70. 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San Francisco : Berrett-Koehler ; Emeryville, CA : Publishers Group West [distributor], [1994] ©1994; 1994.\u003c/li\u003e\n\u003cli\u003eStephan F, Groetschel H, Büscher AK, Serdar D, Groes KA, Büscher R. Teaching paediatric basic life support in medical schools using peer teaching or video demonstration: A prospective randomised trial. Journal of Paediatrics and Child Health. 2018;54(9):981–6.\u003c/li\u003e\n\u003cli\u003eLittle-Wienert K, Hsu D, Torrey S, Lemke D, Patel B, Turner T, et al. Pediatric Emergency Medicine Online Curriculum Improves Resident Knowledge Scores, but Will They Use It? Pediatric Emergency Care. 2017;33(11):713–7.\u003c/li\u003e\n\u003cli\u003eSox CM, Tenney-Soeiro R, Lewin LO, Ronan J, Brown M, King M, et al. Efficacy of a Web-Based Oral Case Presentation Instruction Module: Multicenter Randomized Controlled Trial. Acad Pediatr. 2018;18(5):535–41.\u003c/li\u003e\n\u003cli\u003eShah NH, Bhansali P, Barber A, Toner K, Kahn M, MacLean M, et al. Children With Medical Complexity: A Web-Based Multimedia Curriculum Assessing Pediatric Residents Across North America. Academic Pediatrics. 2018;18(1):79–85.\u003c/li\u003e\n\u003cli\u003ePetit LM, Le Pape P, Delestras S, Nguyen C, Marchand V, Belli D, et al. E-Learning Training to Improve Pediatric Parenteral Nutrition Practice: A Pilot Study in Two University Hospitals. J Parenter Enter Nutr. 2020;44(6):1089–95.\u003c/li\u003e\n\u003cli\u003eEl-Ali A, Kamal F, Cabral CL, Squires JH. Comparison of Traditional and Web-Based Medical Student Teaching by Radiology Residents. J Am Coll Radiol. 2019;16(4):492–5.\u003c/li\u003e\n\u003cli\u003eAksoy ME, Guven F, Sayali ME, Kitapcıoglu D. The effect of web-based learning in pediatric basic life support (P-BLS) training. Comput Hum Behav. 2019;94:56–61.\u003c/li\u003e\n\u003cli\u003eBenjamin J, Groner J, Walton J, Noritz G, Gascon GM, Mahan JD. Learning in a Web-Based World: An Innovative Approach to Teach Physical Examination Skills in Patients with Neurodisability. Academic Pediatrics. 2018;18(6):714–6.\u003c/li\u003e\n\u003cli\u003eLissinna B, Rashid M, Foulds JL, Forbes KL. Embracing uncertainty: medical student perceptions of a pediatric bootcamp developed in response to mandated changes during the pandemic. BMC Medical Education. 2022;22(1).\u003c/li\u003e\n\u003cli\u003eShemwell K, Jun-Ihn E, Pithia N, Strobel KM, Bacca Pinto LA, Chang NR, et al. Video simulation to learn pediatric resuscitation skills tailored to a low resource setting: A pilot program in Iquitos, Peru. SAGE Open Med. 2022;10:20503121221077584.\u003c/li\u003e\n\u003cli\u003eCurry B, Buttle S, McMillan HJ, Webster R, Reddy D, Karir A, et al. Does E-learning Facilitate Medical Education in Pediatric Neurology? Can J Neurol Sci. 2023:1–7.\u003c/li\u003e\n\u003cli\u003eMahfud M, Jones M, Fader T, Hause E. A virtual pediatric rheumatology teaching initiative for physicians in Somaliland. Pediatr Rheumatol Online J. 2023;21(1):1.\u003c/li\u003e\n\u003cli\u003eKailin JA, Kyle WB, Altman CA, Wood AC, Schlingmann TS. Online Learning and Echocardiography Boot Camp: Innovative Learning Platforms Promoting Blended Learning and Competency in Pediatric Echocardiography. Pediatr Cardiol. 2021;42(2):389–96.\u003c/li\u003e\n\u003cli\u003eLee YK, Wattanapisit A, Ng CJ, Boey CCM, Ahmad Kamar A, Choo YM, et al. Tailoring an online breastfeeding course for Southeast Asian paediatric trainees- A qualitative study of user experience from Malaysia and Thailand. BMC Medical Education. 2022;22(1).\u003c/li\u003e\n\u003cli\u003eKidszun A, Forth FA, Matheisl D, Busch F, Kaltbeitzel L, Kurz S. Ethics education in pediatrics: Implementation and evaluation of an interactive online course for medical students. GMS Journal for Medical Education. 2022;39(5).\u003c/li\u003e\n\u003cli\u003eGisondo CM, Weiner G, Stanley K. A Video and Case-Based Transport Curriculum for Neonatal-Perinatal Medicine Trainees Using a Flipped Classroom Methodology. MedEdPORTAL : the journal of teaching and learning resources. 2021;17:11097.\u003c/li\u003e\n\u003cli\u003eAlshengeti A, Slayter K, Black E, Top K. On-line virtual patient learning: A pilot study of a new modality in antimicrobial stewardship education for pediatric residents. BMC Res Notes. 2020;13(1).\u003c/li\u003e\n\u003cli\u003eYoung D, Real FJ, Sahay RD, Zackoff M. Remote Virtual Reality Teaching: Closing an Educational Gap During a Global Pandemic. Hosp Pediatr. 2021;11(10):e258–e62.\u003c/li\u003e\n\u003cli\u003eMotonaga KS, Sacks L, Olson I, Balasubramanian S, Chen S, Peng L, et al. The development and efficacy of a paediatric cardiology fellowship online preparatory course. Cardiol Young. 2022:1–6.\u003c/li\u003e\n\u003cli\u003eRusingiza E, Alizadeh F, Wolbrink T, Mutamba B, Vinci S, Profita EL, et al. An e-learning pediatric cardiology curriculum for Pediatric Postgraduate trainees in Rwanda: implementation and evaluation. BMC Medical Education. 2022;22(1).\u003c/li\u003e\n\u003cli\u003eMeinert E, Eerens J, Banks C, Maloney S, Rivers G, Ilic D, et al. Exploring the Cost of eLearning in Health Professions Education: Scoping Review. JMIR Med Educ. 2021;7(1):e13681.\u003c/li\u003e\n\u003cli\u003eTricco AC, Lillie E, Zarin W, O'Brien K, Colquhoun H, Kastner M, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2016;16:15.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Scoping review, paediatrics, child health, technology enhanced learning, digital learning, e-learning, undergraduate, postgraduate, internet-based learning.","lastPublishedDoi":"10.21203/rs.3.rs-7613680/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7613680/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe use of technology-enhanced learning in medicine has expanded rapidly in recent years in response to emerging needs. This scoping review aims to synthesise and evaluate studies on the use of e-learning in undergraduate and postgraduate medical education in paediatrics. \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods \u0026nbsp; A scoping review was conducted following the principles of the PRISMA tool, to synthesise and evaluate studies according to population, intervention and outcomes, both qualitative and quantitative. Studies were identified by systematic searching of EMBASE, Medline, Scopus, Cochrane and Thesis Proquest, and citation searching (N=547). Studies published between 2017 and April 2023 were included. Twenty studies met eligibility criteria and are included. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Of the 20 studies, seven referred to undergraduate students, twelve to postgraduate trainees and one included both. Eight studies measured only qualitative outcomes, six measured both qualitative and quantitative and 6 only quantitative outcomes. One study focussed on educators. Heterogeneity between studies was significant. There was an increase in published studies following 2019, coinciding with increased e-learning due to the Covid-19 pandemic. No study measured patient outcome changes related to e-learning. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDiscussion \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWith increased global use of technology-enhanced learning in paediatrics there is an urgent need for well conducted studies that provide credible and transferable evaluations detailing effects on learning and achievement. Further research could inform the development of a standard set of outcome measures for technology-enhanced learning in paediatrics.\u003c/p\u003e","manuscriptTitle":"The technology-enhanced learning revolution in paediatrics, what do we know, what do we need to know: A scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-06 04:19:43","doi":"10.21203/rs.3.rs-7613680/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-16T21:57:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"98916408482509588345023804616883305604","date":"2025-11-05T13:28:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"276095515605124843387475740277492847316","date":"2025-11-04T06:01:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288838870518565324579183338497378351827","date":"2025-10-24T12:26:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-24T09:49:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-30T10:47:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-30T08:40:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-30T08:39:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-09-14T15:46:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"46c4c86e-dfdc-4e26-a4f0-293753290f78","owner":[],"postedDate":"November 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-06T04:19:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-06 04:19:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7613680","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7613680","identity":"rs-7613680","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}