Table 2 Kirkpatrick level 1 learning outcomes from studies included in the scoping review

Positive

Convenient and efficient method of learning and solving difficult clinical problems [10, 19, 23, 29, 32]

Enables learning by numerous means;

 - By revision [17, 31]

 - By Q&A problem solving strategy [17]

 - By preplanned curriculum [23, 30] or by adapting to an evolving curriculum [31]

 - By using multimedia tools to explain complex concepts [31]

 - By teacher-learner and learner-learner model [23]

 - By learning in a legitimate, collaborative, social, online group space [23, 25, 31]

 - By deconstructing hierarchy, reducing inhibitions and encouraging active involvement by all grades of learner [21, 26, 31]

 - By obtaining links to relevant learning material [10, 23, 26]

Enables assessment;

 - Formative assessment within discussions [21, 24, 30]

 - Summative assessment tool, especially as a method for measuring learner engagement/participation in discussions [17, 31]

Negative

 Intrusiveness and interference with routine clinical work [24, 31]

 Large volume of learning material can impede learning [23, 25]

 Concerns about breaching patient confidentiality [24, 26]

 Effective learning depends on “completion” of a discussion topic which does not always happen [26]