Veremu, MunasheJiang, ZhilinGillespie, ConorRoman, ElenaCook, WilliamChauhan, RohilFard, AmirToumbas, GeorgiosBaig, ShehlaZipser, CarlStacpoole, SybilTetreault, LindsayDeakin, NaomiBateman, AntonyBenjamin, Davies2025-12-052025-12-052025-11-07BMJ Open, ISSN: 2044-6055 (Print); 2044-6055 (Online), BMJ Publishing Group, 15(11), e107475-. doi: 10.1136/bmjopen-2025-1074752044-60552044-6055http://hdl.handle.net/10292/20278OBJECTIVES: To assess the comparative effectiveness of educational interventions in neurological disease for healthcare workers and students. DESIGN: Systematic review. DATA SOURCES: Medline, Embase and Cochrane through to 1 June 2025. ELIGIBILITY CRITERIA: Studies evaluating neurological disease educational interventions with a comparator group (observational cohort/randomised controlled trial (RCT)) were included. DATA EXTRACTION AND SYNTHESIS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted (PROSPERO: CRD42023461838). Knowledge acquisition and educational methodologies were collected from each study. Study outcomes were classified using the Kirkpatrick and Kirkpatrick four-level model (learner reaction, knowledge acquisition, behavioural change, clinical outcome).1 Risk of bias was assessed using the Newcastle-Ottawa scale for non-randomised studies and the Cochrane Risk of Bias tool for RCTs.2 3 RESULTS: A total of 67 studies involving 4728 participants were included. Of these, 36 were RCTs, and 31 were observational studies. Virtual interventions were the most common (67.2%, n=45 studies), primarily targeting either medical students (46.3%, n=31 studies) or specialists (40.3%, n=27 studies). Overall, 70.1% (n=47) of studies demonstrated outcomes in favour of the intervention. However, few studies used K&K level 3/4 outcomes, with two studies evaluating behaviour change (level 3) and three assessing clinical outcomes (level 4 combined with other levels). No study exclusively assessed level 4 outcomes. Meta-analysis of 22 RCTs with calculable standardised mean differences (SMDs) (n=1748) showed a significant benefit of interventions (SMD 0.75, 95% CI 0.22 to 1.27, p=0.0056). CONCLUSIONS: This review highlights a growing body of research particularly focusing on virtual techniques, specialist audiences and treatment-oriented content. Few studies assessed changes in practice or patient care. Non-specialists remain underrepresented. Future studies should prioritise assessing the clinical impact of educational interventions within non-specialist audiences.© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made.https://creativecommons.org/licenses/by/4.0/Health EducationMEDICAL EDUCATION & TRAININGNeurologyNeurosurgery4203 Health Services and Systems42 Health SciencesClinical Trials and Supportive ActivitiesComparative Effectiveness ResearchClinical ResearchHealth Services1103 Clinical Sciences1117 Public Health and Health Services1199 Other Medical and Health Sciences32 Biomedical and clinical sciences42 Health sciences52 PsychologyHumansHealth PersonnelNervous System DiseasesComparative Effectiveness ResearchHumansHealth PersonnelNervous System DiseasesComparative Effectiveness ResearchJournal ArticleOpenAccess10.1136/bmjopen-2025-107475