BACKGROUND: It is necessary to train a large number of healthcare workers (HCW) within a limited time to ensure adequate human resources during an epidemic. There remains an urgent need for best practices on development and implementation of training programmes.

OBJECTIVE: To explore published literature in relation to training and education for viral epidemics as well as the effect of these interventions to inform training of HCW.

DATA SOURCES: Systematic searches in five databases performed between 1 January 2000 and 24 April 2020 for studies reporting on educational interventions in response to major viral epidemics.

STUDY ELIGIBILITY CRITERIA: All studies on educational interventions developed, implemented and evaluated in response to major global viral outbreaks from 2000 to 2020.

PARTICIPANTS: Healthcare workers.

INTERVENTIONS: Educational or training interventions.

STUDY APPRAISAL AND SYNTHESIS METHODS: Descriptive information were extracted and synthesised according to content, competency category, educational methodology, educational effects and level of educational outcome. Quality appraisal was performed using a criterion-based checklist.

RESULTS: A total of 15 676 records were identified and 46 studies were included. Most studies were motivated by the Ebola virus outbreak with doctors and nurses as primary learners. Traditional didactic methods were commonly used to teach theoretical knowledge. Simulation-based training was used mainly for training of technical skills, such as donning and doffing of personal protective equipment. Evaluation of the interventions consisted mostly of surveys on learner satisfaction and confidence or tests of knowledge and skills. Only three studies investigated transfer to the clinical setting or effect on patient outcomes.

CONCLUSIONS AND IMPLICATIONS OF FINDINGS: The included studies describe important educational experiences from past epidemics with a variety of educational content, design and modes of delivery. High-level educational evidence is limited. Evidence-based and standardised training programmes that are easily adapted locally are recommended in preparation for future outbreaks.

Original languageEnglish
Article numbere044111
JournalBMJ Open
Issue number5
Pages (from-to)e044111
Publication statusPublished - 28 May 2021


  • Disease Outbreaks
  • Epidemics
  • Health Personnel
  • Humans
  • Personal Protective Equipment
  • COVID-19
  • education & training (see medical education & training)
  • medical education & training


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