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In medical and clinical education, creating critical thinking and promoting clinical reasoning abilities are the highest aims and results of education. The main aim of this study was to assess the efficacy of digital case scenarios versus print/paper case scenarios on clinical reasoning in problem-based learning (PBL). If a study used the multimedia scenario case interventions, video case scenarios and online-guided scenarios as digital case PBL, we would consider it eligible.  Method: The study was a systematic review and meta-analysis. A comprehensive search for all randomized controlled trials, systematic reviews and meta-analyses for digital case scenarios versus paper case scenarios in PBL were conducted using Medline (Ovid), Scopus, ISI Web of Science and CINAHL. Google Scholar was used to follow the bibliographies of the related papers to create an exhaustive data set. Search results were limited to the years 2003-2013.  Results: Our searches yielded 65 hits. After initial screenings of the titles and abstracts, we assessed the full texts of studies. Five eligible studies with 222 students were included in the meta-analysis. The meta-analysis showed that both of the digital and paper-based scenarios have similar impacts on clinical reasoning. But the review of papers showed that 73% of students are more satisfied with digital scenarios in comparison with paper-based scenarios and found that digital scenarios are 90% more time saving than paper-based scenarios.  Conclusion: According to the results of meta-analysis, efficacy of digital-based scenarios is similar to the efficacy of paper-based scenarios while simultaneously creating more satisfaction and saving the time of students and teachers; therefore, it is suggested that electronic PBL be used rather than paper-based in all levels of medical education.

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The Efficacy of Digital Case Scenario versus Paper Case Scenario on Clinical Reasoning in Problem Based Learning: A Systematic Review and Meta-Analysis