Introduction
Objective
Methods
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Not empirical (e.g., reviews and commentaries).
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About training patients to manage their own chronic disease.
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About digital health solutions (e-health, m-health, apps, etc.)
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Not related to NCD prevention, treatment, or care.
Author/s (year) | Study Title | Objective |
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Bermejo-Caja et al. (2019) [20] | Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment: a qualitative pilot study | To pilot the acceptability and feasibility of a virtual community of practice aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions |
Block et al.(2018) [21] | Promoting sustainability in quality improvement: an evaluation of a web-based continuing education program in blood pressure measurement | To evaluate whether a web-based continuing education program in blood pressure measurement reinforced knowledge and skills among clinical staff and promoted sustainability of an existing quality improvement program |
Conte et al. (2017) [22] | Development of A Platform For E-Training/E-Learning for Echocardiography Practitioners | To present a platform for e-training, specifically addressed to echocardiography practitioners, aiming at improving effectiveness in the clinical interpretation of echocardiography images. |
De Silva et al. (2022) [23] | Utilization of an Online Education Module and Standardized Patient Simulation Experience to Improve Nursing Student Learning Outcomes with Heart Failure Patients | To examine whether nursing students ‘participation in an online comprehensive heart failure educational module enhances their knowledge and ability to apply heart failure education skills in a simulated standardized nurse-patient interaction. |
Engelman et al. (2017) [24] | Evaluation of Computer-Based Training for Health Workers in Echocardiography for RHD | To measure the change in the knowledge and confidence of a group of health workers after a computer-assisted training intervention in basic echocardiography for rheumatic heart disease |
Franchi et al. (2019) [25] | Simulation-Based Education for Physicians to Increase Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation | To determine whether a simulation-based education addressed to physicians was able to increase the proportion of hospitalized elderly with atrial fibrillation prescribed with oral anticoagulants compared with the usual practice |
Fuchs et al. (2018) [26] | Self-learning of point-of-care cardiac ultrasound, can medical students teach themselves? | To evaluate if the training process of Point-of-care ultrasonography can be simplified by allowing medical students self-train themselves with a web-based cardiac ultrasound software |
Gorchs-Molist et al. (2020) [27] | An Online Training Intervention on Prehospital Stroke Codes in Catalonia to Improve the Knowledge, Pre-Notification Compliance and Time Performance of Emergency Medical Services Professionals | To evaluate if the training process of Point-of-care ultrasonography can be simplified by allowing medical students self-train themselves with a web-based cardiac ultrasound software |
Hayer et al. (2022) [28] | Using web-based training to improve accuracy of blood pressure measurement among health care professionals: A randomized trial | To evaluate the effectiveness of the e-Learning module in changing blood pressure measurement knowledge and clinical skills |
Herbert et al. (2021) [29] | Developing a Smartphone App with Augmented Reality to Support Virtual Learning of Nursing Students on Heart Failure | To develop an Augmented Reality (AR) app on heart failure for remote training of nursing students and compare it against recorded video lecture using a quasi-experimental study using pre-test- post-test design with junior nursing students. |
Hicks and Murano(2017) [30] | Online nutrition and T2DM continuing medical education course launched on state-level medical association | To determine whether a 1-hour online continuing medical education (CME) course focused on nutrition for type 2 diabetes would result in a gain in nutrition knowledge by practicing physicians. |
Hjorth-Johansen et al. (2019) [31] | E-learning or lectures to increase knowledge about congenital heart disease in infants: A comparative interventional study | To create, implement and evaluate an e-learning course on nursing infants with congenital heart disease (CHD) and to measure its efficacy com‐pared with classroom learning |
Jameison (2020) [32] | Cardiac physiology: comparison of an e-learning and classroom-based resource for first-year medical students. | To assess the efficacy and enjoyability of an e-learning resource (ELR) and a classroom-based lesson (CBL) aimed at increasing students’ understanding of cardiovascular disease by using ‘patient’-centred activities. |
Kailin et al. (2021) [33] | Online Learning and Echocardiography Boot Camp: Innovative Learning Platforms Promoting Blended Learning and Competency in Paediatric Echocardiography | To evaluate the impact of online learning combined with lecture-based and hands-on teaching on the acquisition of paediatric echocardiography knowledge and confidence in paediatric cardiology and paediatric critical care fellows. |
Lombardi et al. (2018) [34] | Raising Awareness of Acute Kidney Injury: A Latin American Experience | To describe the design, implementation, and results of two different online courses about acute kidney injury (AKI) targeting nephrologists and related specialists and primary care physicians. To evaluate the impact that this educational tool has had on medical knowledge. |
Lukaschek et al. (2019) [35] | Applicability of Motivational Interviewing for Chronic Disease Management in Primary Care Following a Web-Based E-Learning Course: Cross-Sectional Study | To report participants’ opinion on the practicality of Motivational Interviewing for chronic disease management in primary care as learned in a web-based E-learning course, stratified by the level of education. |
Okuroğlu and Alpar (2019) [36] | Effect of web-based diabetes training program on diabetes related knowledge, attitudes, and skills of health professionals: A randomized controlled trial | To determine the effect of a Web-Based Diabetes Training Program (WB–DTP) on the diabetes-related knowledge, attitudes, and skills of health professionals. |
Padilha et al. (2021) [37] | Easiness, usefulness and intention to use a MOOC in nursing | To assess students and nurses’ easiness, usefulness and intention to use a Massive Open Online Course (MOOC) as an educational resource to enhance self-management intervention skills in Chronic Obstructive Pulmonary Disease patients. |
Paul et al. (2017) [38] | Poor uptake of an online intervention in a cluster randomized controlled trial of online diabetes education for rural general practitioners | To describe the uptake of a continuing medical education intervention targeting diabetes management for rural general practitioners and its impact on the viability of a cluster randomised controlled trial of the effects of continuing medical education on whole-town diabetes monitoring and control. |
Phuangngoenmak et al. (2019) [39] | Effectiveness of the Strengthening Diabetes Care Program: A Randomized Controlled Trial with Thai Nurse Practitioners | To examine the effects of a strengthening diabetes care program among Thai nurse practitioners working in a diabetic clinic at primary care units in a province in northern Thailand |
Piya et al. (2022) [40] | The impact of nursing staff education on diabetes inpatient glucose management: a pilot cluster randomized controlled trial | To compare diabetes outcomes in medical wards where nursing staff were offered one face-to-face (F2F) session followed by access to online education (online), F2F education only, or standard care (control). |
Rhodes et al. (2019) [41] | Rapid E-Learning for professional development in school-based diabetes management. | To assess the effectiveness of a rapid e-learning module for school nurse professional development in school-based diabetes management |
Santiago et al.(2021) [42] | Digital educational technology for care management of diabetes mellitus people’s feet | To develop and validate a distance learning course aimed at the pillars of care management of diabetes mellitus people’s feet. |
Siddiqui et al. (2018) [43] | Facebook as a Learning Tool: Perception of Stroke Unit Nurses in a Tertiary Care Hospital in Islamabad | To obtain the perception of nurses on the use of Facebook as a learning tool. |
Suppan et al. (2021) [44] | Asynchronous distance learning of the National Institutes of Health Stroke Scale during the COVID-19 pandemic (e-learning vs. video): Randomized controlled trial | To determine whether an e-learning module could improve asynchronous distance knowledge acquisition of the National Institutes of Health Stroke Scale (NIHSS) in senior medical students compared to the traditional didactic video. |
Tseng et al. (2021) [45] | Effectiveness of applying clinical simulation scenarios and integrating information technology in medical-surgical nursing and critical nursing courses | To determine the impact of combining clinical simulation scenario training and Information Technology Integrated Instruction (ITII) on the teaching of nursing skills. |
Walker et al. (2021) [46] | Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D | To demonstrate the feasibility of an Extension for Community Healthcare Outcomes (ECHO) program focused on Type 1 Diabetes and improve primary care providers’ abilities to manage patients with Type 1 Diabetes. |
Wewer Albrechsten et al. (2017) [47] | Health care professionals from developing countries report educational benefits after an online diabetes course | To investigate if participation in a 6-week open online course in the prevention and treatment of diabetes and obesity had any impact on the knowledge, skills, and career of health care professionals contrasting participants from developing countries versus developed countries. |
Results
Description of studies
Author/s (year) | Study Location | Target Population | Study Design | Health Focus |
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Bermejo-Caja et al. [20] | Spain (HIC) | Doctors and nurses | Observational | Chronic conditions |
Block et al. [21] | USA (HIC) | Medical assistants, nurses | Evaluation | Hypertension |
Conte et al. [22] | Italy (HIC) | Doctors | Observational | Cardiovascular disease |
De Silva et al. (2022) | USA (HIC) | Nursing students | Experimental | Cardiovascular disease |
Engelman et al. [24] | Uganda (LMIC) | Health workers, nursing students, and nurses | Experimental | Cardiovascular disease |
Franchi et al. [25] | Italy (HIC) | Doctors | Randomized Control Trial | Cardiovascular disease |
Fuchs et al. (2018) | Israel (HIC) | Medical students | Experimental | Cardiovascular disease |
Gorchs-Molist et al. [27] | Spain (HIC) | Emergency technicians, nurses, and doctors | Observational | Cerebrovascular |
Hayer et al. [28] | USA (HIC) | Doctors, nurses, physician assistants, and medical assistants | Randomized Control Trial | Hypertension |
Herbert et al. [29] | USA (HIC) | Nursing students | Experimental | Cardiovascular disease |
Hicks and Murano [30] | USA (HIC) | Doctors | Experimental | Diabetes |
Hjorth-Johansen et al. [31] | Norway (HIC) | Nursing students and nurses | Randomized Control Trial | Cardiovascular disease |
Jameison [32] | UK (HIC) | Medical students | Experimental | Cardiovascular disease |
Kailin et al. [33] | USA (HIC) | Medical students | Evaluation | Cardiovascular disease |
Lombardi et al. [34] | Latin America (LMIC) | Doctors | Experimental | Renal |
Lukaschek et al. [35] | Germany (HIC) | Doctors | Observational | Cardiovascular disease |
Okuroğlu and Alpar [36] | Türkiye (LMIC) | Nurses, midwives | Randomized Control Trial | Diabetes |
Padilha et al. [37] | Portugal (HIC) | Nursing students and nurses | Observational | Chronic Obstructive Pulmonary Disease |
Paul et al. [38] | Australia (HIC) | Doctors | Randomized Control Trial | Diabetes |
Phuangngoenmak et al. [39] | Thailand (LMIC) | Nurses | Randomized Control Trial | Diabetes |
Piya et al. (2022) | Australia (HIC) | Nurses | Randomized Control Trial | Diabetes |
Rhodes et al. [41] | USA (HIC) | School nurses | Observational | Diabetes |
Santiago et al. [42] | Brazil (LMIC) | Nurses | Observational | Diabetes |
Siddiqui et al. [43] | Pakistan (LMIC) | Nurses | Observational | Cerebrovascular |
Suppan et al. (2021) | Switzerland (HIC) | Medical students | Randomized Control Trial | Cerebrovascular |
Tseng et al. [45] | Taiwan (HIC) | Nursing and medical students | Experimental | Cardiovascular disease |
Walker et al. [46] | USA (HIC) | Doctors | Observational | Diabetes |
Wewer Albrechsten et al. (2017) | Various “developing countries” (LMIC) | Doctors, nurses, midwives, and medical students | Observational | Diabetes |
Assessment of digital educational intervention
Blended learning
Author/s (Year) | Online Learning Tool | Findings |
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De Silva et al. (2022) | Web based LMS (HFEM) | The findings from this research indicate that large gains can be made in both student knowledge attainment and knowledge application if educators move beyond normal classroom/lecture teaching techniques. The total mean of 17.99 (SD = 1.37) for the experimental group on the heart failure posttest was significantly higher, F (1,142) = 408.74, p < 0.01, than the control group total mean score of 12.69 (SD = 1.77). |
Kailin et al. (2021) | Web based LMS (pedecho) | Benefits to online learning modules was demonstrated for the short and medium-term retention of echocardiographic learning content. The online learning group demonstrated improvement in exam scores following online learning (PRE 49.1 ± 15.3 vs. POST 67.8 ± 17%; p ≤ 0.01). Medical learners from around the world who had not been previously exposed to echocardiographic learning content exhibited a clear benefit from this online platform and learning materials |
Okuroğlu and Alpar (2019) | Web based LMS | It was determined that the Web based distance training program was effective at increasing the diabetes-related knowledge and skills of the healthcare professionals. The scores of the achievement test post-test (P < 0.001) and follow-up test (P < 0.001) were significantly higher in the intervention group, compared to the control group that receiving face-to-face education from a diabetes nurse. However, the program was not adequate for enhancing the diabetes-related attitudes of health professionals, as the diabetes-related attitudes were similarly positive (> 3) for both groups with no significant difference. |
Phuangngoenmak et al. (2019) | Web based LMS | The findings showed the effectiveness of the program in strengthening competency in diabetes care among nurses. In the experiment group, this program significantly increased perceived self-efficacy, outcome expectancy, knowledge and skills in Diabetes Mellitus care at Weeks 4 and 8, compared to the baseline (all p < 0.003). In addition, when compared to the control group, the levels of perceived self-efficacy, outcome expectancy, knowledge and skills in Diabetes Mellitus care were statistically and significantly higher at Weeks 4 and 8 (all p < 0.02). |
Piya et al. (2022) | Web based LMS | The online ward, but not the Face-to-Face (F2F) or control wards (control group) showed increased number of good diabetes days (GDD). In the online ward, GDD improved from 4.7(2.7–7.0) to 6.0(2.3–7.0) days; p = 0.038. However, there was no difference in length of stay (LOS) change between online [Median (IQR) 5 (2–8) to 4 (2–7) days], F2F [7 (4–14) to 5 (3–13) days] or control wards [5 (3–9) to 5 (3–7) days]. |
Siddiqui et al. (2018) | Facebook | Facebook enabled participants to study the material when their schedule permitted it. The online teaching and facilitation were ideal for our full-time working nurses as reflected by their improved post-course test results. The post-course test showed that nine of 10 candidates passed with scores > 70% compared to only two candidates getting scores > 50% in the pre-course test. |
Walker et al. (2021) | Web based LMS (ECHO T1D) | Following the pilot study, there was statistically significant improvement in primary care providers’ diabetes knowledge (p ≤ 0.01) as well as in diabetes confidence (p ≤ 0.01). The results of this pilot study demonstrate that the blended learning addresses the gaps by equipping more practitioners with the knowledge and resources to support patients with Type 1 diabetes who may not otherwise receive adequate or routine specialty care. |
Online learning with instructor
Author/s (Year) | Online Learning Tool | Findings |
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Conte et al. (2017) | Web based LMS & Smartphone App | The authors present the E-Learning part as its useful to introduce the E-Training and is considered, as a real innovation of the overall tool. The E-Training represents a challenging way to update knowledge also in expert users, to improve their skills and to compare their opinion with the whole peer-community and with the coordination team over frequently updated tricky clinical cases |
Gorchs-Molist et al. (2020) | Web based LMS (Moodle) | An interprofessional online training intervention on strokes in the Catalonian Emergency Medical Services was effective in increasing the participant’s knowledge on cerebrovascular medical emergencies. There was a significant increase in 80% of the questions regarding recognition of signs and symptoms of a stroke (p < 0.05), and a significant increase in all questions regarding stroke code, prehospital management and stroke assessment, with most scores above 85% (p < 0.001). Both strengths and areas for improvement were detected for future training opportunities. These results encouraged the Catalonian Emergency Medical Services to maintain this training intervention in their continuous education program, which, starting back in 2015, is delivered twice a year. |
Hicks and Murano (2017) | Web based LMS | This research study demonstrated that online continuing medical education courses launched on state-level medical association platforms improved subject matter knowledge significantly between the pre- and post-scores (P < 0.0001). Ultimately, doctors who couple knowledge basics with practical application tools may more successfully integrate these into their practices. |
Paul et al. (2017) | Web based LMS | Given that the number of doctors completing the online learning module was too few to expect an intervention effect, the intervention trial was discontinued, that is, no follow-up data were collected. |
Santiago et al. (2021) | Web based LMS (Moodle) | It was possible to develop a digital educational technology for care management of Diabetes Mellitus people’s feet. |
Tseng et al. (2021) | Web based LMS | For student performance, there was no significant difference between the experimental and control groups before the course, demonstrating their similarities, but student performance for the knowledge component in the experimental group (innovative instruction) was better than the control group (conventional instruction) after the courses. The Objective structure clinical examinations (OSCE) total score for the experimental group was M = 230.18, SD = 26.89 vs. M = 194.97, SD = 21.66 for the control group (p < 0.001). This, demonstrating the effectiveness of innovative instruction to boost knowledge-based learning within a short amount of time. |
Online learning as self-study
Author (Year) | Online Learning Tool | Findings |
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Bermejo-Caja et al. (2019) | Web based LMS (e MPODERA) | The results from this pilot study show qualitatively that primary care professionals considered the e-learning application useful for learning how to empower patients. However, attention needs to be paid to technological issues, and the time demands on professionals. |
Block et al. (2018) | Web based LMS (Learnshare) | Direct observation data revealed that completing the online training program was associated with improvement in certain steps in the blood pressure protocol, including explaining the protocol to patients, providing a rest period, use of average mode, and recording the average reading in the EMR. Prior to the module, the participants answered 80.6% of questions correctly and after the module, they answered 93.4% correctly (p < 0.01), and improvements were significant for staff from all job types. |
Engelman et al. (2017) | Web based LMS | In this evaluation of computer-assisted training materials for Rheumatic Heart Disease screening, strong evidence was reported for an increase in knowledge across all required learning areas. They reported an increase in the mean total score on knowledge tests from 44.8–85.4% (mean difference: 40.6%, 95% confidence interval: 35.4 to 45.8%). Additionally, increased confidence in core competencies for a group of health workers without previous training in ultrasonography was also reported with a significant increase in confidence scores clinical science, echocardiography and overall (p < 0.001 for all three scales). Use of the training modules may reduce face-to-face teaching times and therefore the human resource requirements for busy clinicians and faculty. |
Franchi et al. (2019) | Web based LMS (Dr Sim) | In this trial conducted in internal medicine and geriatric wards, an educational course based on a computer-based simulation did not succeed in obtaining an increase in the proportion of patients with Atrial Fibrillation prescribed with any Oral Anti Coagulants at hospital discharge with respect to the usual practice (odds ratio, 1.46; 95% confidence interval, 0.81–2.64). However, in the intervention arm, there was a greater increase, compared to the control arm, in the proportion of patients prescribed with Oral Anti Coagulants (15.1%; 95% Confidence interval, 0-31.5%) and with direct oral anticoagulants (20%; 95% confidence interval, 0-39.8%). |
Fuchs et al. (2018) | Web based LMS (eMedical Academy) | This study shows that medical students were able to independently learn how to acquire cardiac ultrasound views by using an e-learning platform in combination with self-practice. Students who trained on their own, with no bedside teaching, combining an e-learning module and self-cardiac ultrasound practice, were overall as good as students who received an already validated, bedside, frontal cardiac ultrasound course with no significant difference between the two groups (p = 0.508). |
Hayer et al. (2022) | Web based LMS | Across all four sites, participants in the intervention group demonstrated significant improvement in both their knowledge and skills after completing the 30-minute e-Learning module. Following the e-Learning module, the intervention group performed on average 3.4 more objective structured clinical examination items and 1.7 more knowledge questions correctly vs. 1.4 and 0.5 in the control group following a test-rest approach (P < 0.01). The intervention group also had a 17.1% increase in the obtainment of accurate systolic and diastolic blood pressure measurement compared to a 6.1% decline in the control group (p < 0.01). The results confirm the need for BP measurement retraining and the ability to improve provider’s knowledge and skills with a brief 30-minute e-Learning module. |
Herbert et al. (2021) | Smartphone Augmented Reality (AR) App | When comparing the overall HFA pre-test and post test results, no key learning differences were identified for either the experimental or recorded video lecture control groups in both the assessment completion time (t [3] = 1.626, p = 0.114) and overall % test accuracy (t [30] = 1.846, p = 0.075). Overall performance across groups was not as high as the authors expected. |
Hjorth-Johansen et al. (2019) | Web based LMS | While the scores between the control group (face-to-face learning) and the intervention group (e-learning) did not differ significantly, both groups improved their scores significantly. The score of the face-to‐face learning group (control) increased significantly from 22.9–36.5 (p < 0.001), while that of the e‐learning group increased from 27.8–38.0 (p < 0.001). The fact that e-learning was the less time-consuming learning method and that traditional learning was the preferred learning method may imply that blended learning, mixing traditional learning and e-learning may be the most effective learning method. This may address both the need for time effectiveness and the need for interaction with a teacher or an expert. |
Jameison (2020) | Web based LMS (SoftChalk) | The study met its initial aims and significantly improved participant’s confidence in their understanding of cardiovascular disease, with a greater mean increase in confidence across all topics from the e-learning resources than the classroom lessons (Scores of 2.46 vs. 1.80). The study suggests e-learning and student led classroom-based learning are effective methods of teaching, with students commenting that both were engaging and enjoyable. |
Lombardi et al. (2018) | Web based LMS | Before and after the online course for nephrologists, the mean number of right answers was 5.87 and 8.01, respectively (P < 0.05). The pretest and posttest scores for the primary care physicians were not reported. The interactive, asynchronous, online courses are a valuable and successful tool for continuing medical education in Latin America, reducing heterogeneity in access to training across countries. Reliable information is lacking regarding the impact of these courses on long-term knowledge retention and the ultimate benefit on quality of health. |
Lukaschek et al. (2019) | Web based LMS (EQuiP) | The knowledge and skills obtained by the Web-based motivational interviewing course were assessed by the participants as being beneficial and appropriate for use in primary care practice. Regarding the perceived applicability of skills and knowledge from the course, the groups rated the following: medical students: 94% [79/84] good; Physicians in specialist training: 88.6% [109/123] excellent; and General practitioners: 51.3% [182/355] excellent. |
Padilha et al. (2021) | Massive Open Online Courses (MOOC) | This study shows that independently of age, nurses consider MOOC useful for education and lifelong learning, expressing usefulness and intention to use this educational strategy in the future. Two dimensions presented average scores near the maximum scale value, the dimension 1 (F1) - Easiness and global quality of the course (M = 4.70, SD = 0.314) and dimension 2 (F2) - Usefulness and intention to use in the future this type of course (M = 4.73, SD = 0.346). Regarding the easiness of use and global quality of the MOOC, specialised nurses, who are older and with expertise in this field, scored higher than nurses and students. These data show that the MOOC is not only directed to younger generations but most importantly are highly beneficial to those who need access to education and lifelong learning to keep up to date. |
Rhodes et al. (2019) | Web based LMS | The results of the present study suggest that these modules can be an effective method for educating school nurses in a time- and cost-sensitive manner. The independent sample t-test revealed a statistically significant (p < 0.001) difference between pre-test (M = 12.79, SD = 2.05) and post-test (M = 17.15, SD = 2.00) scores (t (1125) = − 35.19, p = 0.00). |
Suppan et al. (2021) | Web based LMS | Asynchronous distance learning using a highly interactive e-learning module yielded better results than following the traditional didactic video on the web (38 correct answers, 95% CI 37–39, vs. 35 correct answers, 95% CI 34–36, P < 0.001). |
Wewer Albrechsten et al. (2017) | MOOC (Coursera) | Over 80% of the health care participants report educational benefits, improved knowledge about the prevention and treatment therapies of diabetes and furthermore improved professional life and practice. Participants from developing countries gained more impact on their clinical practice (94%) compared to health care professionals from developed regions (88%) (Mean of differences = 6%, P = 0.03. The results indicate that a 6-week internet-based course in diabetes and obesity treatment may serve as an important resource in postgraduate education for medical doctors as well other health care professionals. |