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14 Evidence based medicine in low-middle income countries; online or face-to-face teaching method?
  1. Iman El Sayed1,
  2. Sherif Abdelmonem2
  1. 1Bio-Medical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
  2. 2Critical Care Medicine Department, Alexandria University, Alexandria, Egypt


Objectives Weak points of clinical practice in most low middle income (LMIC) countries involve shortage of resources and limited budget that necessitate the need of evidence based health care.1 One of Obstacles for EBM learning is lack of time in attending standalone face to face lectures, Limited access to literature databases and unfeasible educational facilities at teaching theatre in many LMIC.2 Online learning permits physicians to maintain learning in clinical settings. We aim to study differences in post graduate students’ achievement if they are taught EBM by face-to-face or by online learning.

Method We assessed the performance of eleven post-graduate students who completed face-to-face learning module and twelve students accomplished online learning. The teaching materials including lectures, assignments and educational videos were the same in both courses so that any performance difference would be due to the teaching method. Both modules consist of eleven topics discussing EBM cycle for decision making. Clinical scenarios are taught through problem based approach either face to face or by accessing the e-learning discussion forum. Grading involved continuous student activities all over the semester (15%), midterm (25%), oral (15%) and final (30%) exams. Students were evaluated by a project submitted by the end of the semester (15%) that examined student’s perception from formulating a clinical question either therapeutic or diagnostic till decision making. Percentage of students satisfaction was calculated about course content evaluation, teaching materials, lecturer evaluation, students’ assessment process and finally, fair practices among students.

Results Mean midterm and final exam scores didn’t differ significantly between the two groups (p.759, 721 respectively). Students from both groups achieved almost the same mean score on oral discussion exam (p.31). Students who attended the online learning module had a significantly higher median project score compared to those who attended the face-to-face teaching (p<0.001). Median continuous assessment scores of students that completed face-to–face learning was slightly higher with borderline significance than online teaching score (p0.062). In general, Students from both modules were similarly satisfied about course contents, lecturers and students’ assessment process although one third of students felt non-equality and unfair instructors’ practice towards them in face-to-face teaching method.

Conclusions E-learning proved better achievement of postgraduate students. A strong emphasis should be paid towards further dissemination of E-learning of EBM to support the developing era of evidenced based practice in low middle income countries.


  1. Kabene SM, Orchard C, Howard JM, et al. The importance of human resources management in health care: A global context. Human Resources for Health2006;4:20. doi:10.1186/1478-4491-4-20

  2. Gagnon MP, Legare F, Labrecque M, et al. Perceived barriers to completing an e-learning program on evidence-based medicine. Informatics in Primary Care 2007;15(2):83−91.

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