e-Learning in Reproductive Health : Dr. Naira Roland Matevosyan

Although open access to the reproductive health (RH) literature accelerates the recognition/dissemination of the research findings, its actual effects are often controversial. e-Learning creates new and emerging paradigms in RH education like self-directed learning, limitations of which can defocus the endpoint selection in clinical and experimental trials.

Nowadays, the citation of the open-for-access (OFA) RH research papers, are gradually dominating upon the citation of fundamental not-open-for-access (NOFA) literature and solid innovative conclusions. The researchers, clinicians, and policymakers must confront the question of whether or not the OFA literature accelerates scientific advancement and knowledge translation of research into practice. Overall, the citation ethics and policy in RH research need to be enforced-catalyzing the scholarly process of bringing the evidence into the action, and helping the clinicians to act on the evidence.

Making RH Open for Access

The unique characteristics of e-Learning lies in its ability to enable a truly interactive learning environment and create communities of learners like KOALA (Computerized Obstetrics and Gynecology Automated Learning Analysis), OMNI (Organizing Medical Networked Information), and MORE OB (Managing Obstetrical Risk Efficiently). The ubiquitous use and a quick deployment of e-Learning RH materials (connectivity, accessibility, mobility, multi-media capability, dynamic feedbacks), create new and emerging paradigms in education, and self-directed learning.  Meantime, a collection of evidence that demonstrates a personal learning strategy, may result in the expansion of competencies beyond the expertise, and iatrogenic malpractice. The discipline of reproductive medicine has not been immune to these effects.

Open for access (OFA) to the RH literature assumes the removal of the barriers (financial, academic, timing) from accessing the scholarly work. OFA considers two possibilities: e-Journals (freely available articles in the journal websites, a model mostly paid by the author usually through a research grant), and self-archiving (published papers in traditional journals, where only the subscribed members may have immediate access, but are available in their personal or institutional website repositories or archives).

Among the arguments of OFA proponents is that the ‘open’ work is more quickly recognized, cited, and utilized. This raise some ethical, practical, and policy questions for scholars, clinicians, and RH policymakers, like whether or not the OFA literature accelerates scientific advancement and knowledge translation of research into practice. Also, an economical issue rears up a debate. That is, what the return on investment is when paying for publishing an article in an OFA journal, or whether investments into institutional repositories should be made, or if self-archiving should be mandatory, as contemplated by some funding entities.

The Objective

We have attempted to compare the bibliometric impact of OFA and NOFA through citation topology, in a cohort of articles in a journal (Birth: Issues in Perinatal Care). Here we locate citation patterns through mapping the results of a longitudinal quasi-baseline biblio-metric (citatory-metric) study of 27 (33 percent) OFA scholarly e-articles and 55 (67percent) OFA papers in RH (a total of 82).

Here it deserves a mention that Birth: Issues in Perinatal Care is a multidisciplinary, refereed journal, devoted to the issues and practices in the care of childbearing women, infants, and families. The aims of Birth are:

 To publish original, well-designed, peer-reviewed research on issues in pregnancy and childbirth, featuring physical, psychological, and social aspects of care;

 To provide review articles on topics of major importance in perinatal care;

 To present a forum for discussing current issues in maternal and new born care;

 To underline the importance of evidence-based research in changing clinical practices.

Free online access to this journal is available within institutions in the developing world through the Health InterNetwork Access to Research Initiative [HINARI], with the World Health Organization (WHO).

A longitudinal quasi-baseline citatory-metric analysis of a cohort of OFA and NOFA articles were published in the journal ‘Birth: Issues in Perinatal Care’, between March 2005 and June 2006. Article characteristics were extracted; potentially confounding variables, including the number of authors, authors` lifetime publication count, submission track, country of corresponding author were adjusted for in logistic and linear multiple regression models. A total of 82 original research articles were analyzed, among which 27 (33 percent) were OFA articles and 55 (67 percent) were NOFA articles.

The average number of citations of OFA articles was slightly lower as compared to NOFA articles. With a logistic regression model, controlling over the submission track and potential confounders, the NOFA articles, as compared to OFA, remained likely to be more cited (odds ratio = 1.7 [1.2-2.2] ). In the crude citation analyses, the mean number of citations, as well as the proportion of the articles cited at least once, was higher in the NOFA group (RR- 95 percent CI).

Study Limitations

However, the study, despite being scientific and exhaustive, is characterized by some limitations. Since this was an observational and not a randomized study, it statistically enabled to control only over the known confounders.

There may be a possibility of selection bias among authors judging the importance of their work, with quality differences between the articles contributing to citation differences.

Also, this study offers mainly a short-term (one year) glimpse at what happens in the long-term citation curve. The study used the citations as proxy for impact, and may bring an argument whether and how the scientific atmosphere in RH can benefit by increased citation rates.

But notwithstanding the limitations, the findings do lead us to important conclusions. The findings suggest that:

1) The solid reputation and scientific recognition of the journal ‘Birth: Issues in Perinatal Care’ is truly deserved, as the works published in the journal illustrate longitudinal research that is endorsed with scientific evidence.

2) Overall, in RH, research needs to be reviewed, catalyzing the scholarly process of bringing the evidence into action, and helping the clinicians to act on the evidence.

Footnote: The author has no relations to ‘Birth: Issues in Perinatal Care’ or its editorial cabinet.


1) Carayannis EG, Campbell D. [2006]. Knowledge Creation, Diffusion and Use in Innovation Networks and Knowledge Clusters: A Comparative Systems Approach across the United States, Europe, and Asia. GWU School of Business, Praeger, 2006;

2) Consumer Reports Questions Cesarean Frequency, International Cesarean Awareness Network; https://www.medicalnewstoday.com

3) Fung MF, Walker M, Fung KF, et al [2000]. An internet-based learning portfolio in resident education the KOALA multicentre programme. Med Educ; 34: 4749;

4) Fung KFM, Walker M, Fung KFK. [1999]. The KOALA continuous professional development programme: an integral part of the lifelong learning continuum. J Soc Obstet Gynaecol Can 1999; 21: 106575;

5) Fung Kee Fung M, Temple L, Walker M, et al [1998]. Medical education in the new millennium. Medical informatics, evidence-based medi-cine, self-directed learning and the KOALA programme. J Soc Obstet Gynaecol Can 1998; 20:9991006;

6) Eysenbach G [2006]. Citation advantage of open access articles, PloS Biol 4(5): e157, Centre for Global eHealth Innovation;

7) https://www.blackwellpublishing.com/journal.asp;

8) Management and Leadership of Life Sciences Research in Canada: A Snapshot and Some Questions, On Management Health Group, 2005;

9) Roy M [2003]. Self-directed workteams and safety: a winning combination? Safety Sci.2003;41(4): 359-376;

10) Rubeor K [2003]. Role of risk management in maternal-child health. J Perinat Neonat Nurs. 2003;17(2):94-100;

11) Wenger E [1998]. Communities
of practice, learning, meaning and identity. New York: Cambridge University Press;

12) Wenger E [2002]. Supporting communities of practice: a survey of community-oriented technology. Overview of technologies with a potential to support communities of practice.www.ewenger.com/tech/index.htm


Follow and connect with us on Facebook, Twitter, LinkedIn, Elets video