“…In three articles, digital learning approaches were claimed to be more effective than no intervention in improving knowledge [43,44,48] or at least as effective as traditional learning [48]; yet one systematic review suggested that e-learning may make little or no difference in patient outcomes or health professionals' behaviours, skills or knowledge [49]. Moreover, knowledge level was also examined by two crosssectional studies conducted in Germany, and Italy, one case study in Portugal, and one evaluation of a massive open online course (MOOC) [9,[52][53][54]. Authors reported an improvement of knowledge level [53,54] as well as participants of these interventions reported utilization of the knowledge [31], and skills gained in their professional lives frequently [9].…”