The review, led by Hanieh Asgharian of Tehran University of Medical Sciences and colleagues at Tabriz University of Medical Sciences in Iran, was published on 19 October 2026. The team searched nine major databases, including PubMed, Scopus, ProQuest, Web of Science, the Cochrane Library, ERIC, MEDLINE, and the Iranian databases SID and Magiran, covering literature from inception to June 2025. They supplemented these searches with systematic-review databases, Google Scholar, and grey-literature sources, a strategy designed to capture unpublished and hard-to-find studies that often go missing in conventional reviews.

After independent screening by two reviewers, the researchers included sixteen interventional studies. These spanned randomized controlled trials, quasi-experimental designs, and before-and-after studies, giving a broad picture of how digital education has been tested in maternal and neonatal settings. The interventions themselves were strikingly diverse: web-based modules, instructional videos, simulation programs, serious games, mobile applications, and blended learning approaches that combine online content with face-to-face teaching.

The headline finding concerns clinical skills. In controlled studies, the pooled effect favored e-learning with a standardized mean difference of 0.43, with a 95 percent confidence interval running from 0.05 to 0.82 and a p-value of 0.03. In plain terms, learners trained with digital tools performed measurably better on practical skills assessments than those taught by conventional means, and the statistical heterogeneity across studies was relatively modest at an I² of 38 percent, meaning the studies were reasonably consistent with one another. The certainty of this evidence was graded as low using the GRADE framework, but the direction and consistency of the effect give the finding real weight.

Knowledge outcomes told a different story. Across controlled studies, e-learning showed a favorable but statistically non-significant effect on knowledge scores, with a standardized mean difference of 0.89 and a wide confidence interval spanning from −0.22 to 1.99. The p-value of 0.12 fell short of conventional significance thresholds, and the heterogeneity estimate was a striking 93 percent, indicating that the included studies varied enormously in their designs, populations, and outcome measures. The certainty of evidence for this outcome was rated very low, meaning any conclusion about knowledge acquisition should be treated with considerable caution.

Two uncontrolled before-and-after studies added a further layer of evidence. In these, knowledge improved after e-learning interventions, with a standardized mean difference of 1.108 and a confidence interval from 0.273 to 1.943, though heterogeneity was again high at 88 percent. The authors are careful to note that without a control group, and given the substantial variability between studies, these results cannot support causal interpretation. Learners may simply have improved because they took the same test twice, or because of concurrent educational experiences unrelated to the digital intervention.

Why would digital education sharpen hands-on skills more reliably than it broadens knowledge? One plausible explanation lies in the nature of the interventions themselves. Simulation-based modules, serious games, and interactive videos allow learners to rehearse procedures, such as neonatal resuscitation or chest compressions, repeatedly and in a risk-free environment. Procedural skills benefit from deliberate, repeated practice with immediate feedback, which digital platforms can deliver at scale. Knowledge, by contrast, is often measured with multiple-choice tests, and traditional lectures or printed materials may be equally effective at conveying factual content, leaving little room for e-learning to demonstrate an advantage.

The methodological rigor of the review is worth noting. The team assessed risk of bias using the RoB 2.0 tool for randomized controlled trials and the Joanna Briggs Institute quasi-experimental checklist for non-randomized studies. Meta-analyses were conducted in RevMan 5.4 and Comprehensive Meta-Analysis version 4, and the certainty of evidence for each outcome was formally graded with GRADE. This transparent architecture allows readers to see exactly how much confidence to place in each pooled estimate, rather than treating all findings as equally solid.

The authors are candid about the limitations. Interpretation is constrained by substantial heterogeneity, incomplete outcome reporting, risk of bias in the underlying studies, and the small number of studies contributing to each meta-analysis. With only sixteen included studies spread across a wide range of intervention types, learner populations, and outcome measures, the pooled estimates rest on thin foundations. The very low certainty attached to the knowledge findings reflects these weaknesses, and the authors explicitly caution against overreading the results.

Even so, the review arrives at a consequential moment. Maternal and neonatal mortality remains a global health priority, and the World Health Organization has long emphasized that trained, competent birth attendants and neonatal caregivers are among the most effective interventions available. If digital education can reliably build procedural competence in nurses, midwives, and physicians, it offers a scalable way to extend high-quality training to settings where expert instructors are scarce. The evidence here suggests that promise is real for skills, but the field now needs larger, better-designed trials, standardized outcome measures, and fuller reporting before e-learning can be declared a definitive substitute for conventional teaching in maternal and neonatal health education.

Subject of Research: Effectiveness of e-learning interventions on knowledge and clinical skills in maternal and neonatal health education

Article Title: The effectiveness of e-learning in maternal and neonatal health education: a systematic review and meta-analysis

Article References: Asgharian, H., Ghanbari-Homaie, S., Salehi-Pourmehr, H., Ghojazadeh, M., & Pourabbas, A. (2026). The effectiveness of e-learning in maternal and neonatal health education: a systematic review and meta-analysis. BMC Medical Education. https://doi.org/10.1186/s12909-026-10633-9

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10633-9

Keywords: e-learning, maternal health, neonatal care, medical education, systematic review, meta-analysis, clinical skills, digital education, simulation, blended learning, health professions education, GRADE