Effectiveness of E-learning in Pharmacy Education

Sandra M. Salter, BPharm, PhD Candidate; Ajay Karia, BSc Hons Pharm; Frank M. Sanfilippo, PhD; Rhonda M. Clifford, PhD


Am J Pharm Educ. 2014;78(4) 

In This Article

Abstract and Introduction


Over the past 2 decades, e-learning has evolved as a new pedagogy within pharmacy education. As learners and teachers increasingly seek e-learning opportunities for an array of educational and individual benefits, it is important to evaluate the effectiveness of these programs. This systematic review of the literature examines the quality of e-learning effectiveness studies in pharmacy, describes effectiveness measures, and synthesizes the evidence for each measure. E-learning in pharmacy education effectively increases knowledge and is a highly acceptable instructional format for pharmacists and pharmacy students. However, there is limited evidence that e-learning effectively improves skills or professional practice. There is also no evidence that e-learning is effective at increasing knowledge long term; thus, long-term follow-up studies are required. Translational research is also needed to evaluate the benefits of e-learning at patient and organizational levels.


The fundamental purpose of pharmacy education is to provide pharmacy students with the knowledge and skills to become pharmacists, and then to enable pharmacists to remain competent in the profession. The traditional pedagogy involving face-to-face instruction has evolved alongside the maturation of the Internet. Increasingly, pharmacists, pharmacy students, and pharmacy educators encounter teaching and learning opportunities beyond the classroom, with more and more content delivered online.[1–5] Historically, online learning (using information and communication technologies) represented one facet of e-learning, while computer-based learning (using standalone multimedia such as a CD-ROM) represented another. Now e-learning is defined as learning conducted through an Internet process.[6,7]

E-learning programs are truly ubiquitous, and for this reason they offer attractive solutions to educating large numbers of geographically diverse populations. They allow standardized educational content to be easily distributed and updated. Learners gain control over time and place of learning, while programs provide automated real-time feedback for teachers and learners. Moreover, rather than move away from teacher-centered pedagogy, educators enhance and extend existing curriculums with e-learning opportunities, and learners embrace this.[4,7–10] However as e-learning becomes a common feature in pharmacy education, the need to demonstrate its effectiveness increases.

Measuring and defining effectiveness of complex interventions, such as e-learning is difficult.[11–13] In 1959, Donald Kirkpatrick proposed a 4-level model for evaluation of training programs.[14] Further in 2009, the Best Evidence Medical Education (BEME) Collaboration adopted (and termed the levels) "Kirkpatrick's hierarchy," as a grading standard for literature reviews.[15] In both instances, the levels may be simply defined as (1) reaction, (2) learning, (3) behavior, and (4) results. Reaction is a measure of program satisfaction. Learning is a measure of attitudes, knowledge, or skills change as a result of the program. Behavior is represented by the transfer of learning to the workplace. Finally, results are a measure of how the learning has changed organizational practice or patient outcomes.

Several reviews have evaluated the effectiveness of e-learning in the health professions, some with and others without applying the concepts of Kirkpatrick's hierarchy.[8,9,16–22] However, there are no reviews of the effectiveness of e-learning in pharmacy education. We conducted a systematic review to identify and evaluate the literature on effectiveness of e-learning in pharmacy education. We used Kirkpatrick's hierarchy to guide outcome measures. Our primary aim was to determine effectiveness in terms of learning, behavior, and results. Our secondary aim was to assess effectiveness as reactions to e-learning programs.