Online Learning Efficacy Research Database

BACKGROUND AND OBJECTIVES: Medical education experts have called for improved training in evidence-based medicine (EBM) and the increased use of e-learning technologies in medical education. In response, we developed an interactive, Web-based curriculum on key aspects of EBM in family medicine.

METHODS: Students participating in a 6-week family medicine clerkship (n=238) were randomly assigned to intervention (n=134) or control (n=104) groups. Both groups participated in the traditional clerkship experience, but intervention group students received additional training via an on-line curriculum that included learning modules in MEDLINE searching skills, EBM skills, and the calculation of the number needed to treat (NNT) statistic. The on-line curriculum was evaluated using a case-control design with a test case at the clerkship's end.

RESULTS: Results suggested that the on-line curriculum was effective, with experimental group students outperforming control group participants on a variety of measures, including the number of MEDLINE searches conducted during the clerkship (13 searches versus 3 searches) and the quality of literature search strategies on an evaluation patient case study (2.9 versus 2.1 on a 1=poor to 4=excellent scale). Intervention group students reported greater confidence and enjoyment in searching the biomedical journal literature via MEDLINE and were more likely to identify the best articles (randomized controlled trials or meta-analyses) for the evaluation case from among those retrieved (60% versus 34%). In addition, intervention group students' abilities to correctly calculate the NNT were significantly higher than those of control group participants (73% versus 27%). Intervention group students were more likely than control subjects to report learning from other students during the clerkship.

CONCLUSIONS: This study demonstrates that an e-learning approach to educating medical students to effectively search MEDLINE for articles meeting the criteria for evidence-based practice can result in higher-quality literature search strategies, identification of higher-quality evidence, and improved confidence in information retrieval and analysis skills. 
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Background: Little evidence exists to guide the selection of methods for teaching clinical diagnosis.

Purpose: To compare the efficacy, student preference, and cost of a Web-based (WB) program versus a standardized patient (SP) encounter for teaching clinical diagnosis skills to 2nd-year medical students.

Methods: Randomized, controlled, crossover study comparing WB versus SP-based teaching for the clinical diagnosis of abdominal pain and headache. Outcome measures were performance on a 2-case SP examination (scored on the basis of a checklist completed by a faculty observer and an objective score on a postencounter subjective-objective assessment plan [SOAP] note), format preferences as assessed by end-of-course evaluations, and cost.

Results: Thirty students consented to participate. WB and SP training produced similar scores on both the Abdominal Pain checklist (66% vs. 62%; p =. 17) and Headache checklist (56% vs. 63%; p =. 07). WB training produced a higher score on the Abdominal Pain SOAP note (69% vs. 47%; p =. 006), but not the Headache SOAP note (69% vs. 67%; p =. 85). Students rated the SP format higher than the WB format on all 7 preference measures. Start-up costs were estimated at $2,190 for the SP format and $2,250 for the WB format. Ongoing costs per case per student were estimated to be $45 for the SP format and $30 for the WB format.

Conclusions: WB and SP learning outcomes were comparable, but students preferred the SP format. Start-up costs were comparable, but the ongoing costs of the WB format were less expensive, suggesting that WB teaching may be a viable strategy. 
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Interactive video in an e-learning system allows proactive and random access to video content. Our empirical study examined the influence of interactive video on learning outcome and learner satisfaction in e-learning environments. Four different settings were studied: three were e-learning environments—with interactive video, with non-interactive video, and without video. The fourth was the traditional classroom environment. Results of the experiment showed that the value of video for learning effectiveness was contingent upon the provision of interactivity. Students in the e-learning environment that provided interactive video achieved significantly better learning performance and a higher level of learner satisfaction than those in other settings. However, students who used the e-learning environment that provided non-interactive video did not improve either. The findings suggest that it may be important to integrate interactive instructional video into e-learning systems. 
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OBJECTIVE: To compare the effectiveness of traditional and online teaching methods for educating anesthesiology residents in the principles and practice of difficult airway management.

DESIGN: Prospective, randomized, controlled trial.

SETTING: University hospital.

PARTICIPANTS: Two randomly selected groups, each containing 28 physicians enrolled from among residents in Anesthesiology and Intensive Care Medicine in Italy.

INTERVENTIONS: Residents in Group 1 took a traditional 5-h course on the principles and practice of airway management, which included lectures, slide projection, and dummy demonstrations. The same material was presented to Group 2 in an exclusively online format, which could be individually accessed for a period of 36 h. In the online course, student-instructor interaction was provided through threaded discussion forums during three 30-min real-time question-and-answer sessions.

MEASUREMENTS AND RESULTS: Differences in baseline and post-course scores on written tests and practical skills tests were measured. Knowledge gains in Group 2 were slightly, but not significantly, greater compared with Group 1 both in written (P=0.228) and practical skills (P=0.376) tests. Semi-quantitative ratings of learner satisfaction were significantly higher in the online group (P=0.014). Almost all online students (93%) were logged in for at least 45 of the 90 min of real-time question-and-answer sessions. The four instructors spent an average of 144+/-10 min preparing answers and interacting with online students.

CONCLUSIONS: Online teaching formats may be a valid alternative for teaching residents the principles and practice of difficult airway management. Interaction with instructors seems to be an important element, but it may require substantial time commitments by instructors. 
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Purpose: To determine whether internal medicine residents prefer learning from Web-based (WB) modules or printed material, and to compare the effect of these teaching formats on knowledge.

Method: The authors conducted a randomized, controlled, crossover study in the internal medicine resident continuity clinics of the Mayo School of Graduate Medical Education during the 2002–03 academic year. Participants studied two topics of ambulatory medicine using WB modules and two topics using paper practice guidelines in randomly assigned sequences. Primary outcomes were format preference (assessed by an end-of-course questionnaire) and score changes from pre- to postintervention tests of knowledge.

Results: A total of 109 consented and 75 (69%) completed the postintervention test. Fifty-seven of 73 (78% “95% CI, 67–86%”) preferred the WB format (p < .001). Test scores improved for both formats (67.7% to 75.0% for WB, 66.0% to 73.3% for paper), but score change was not different between formats both before (p = .718) and after (p = .080) adjusting for topic, clinic site, study group, postgraduate year, and gender. Residents spent less time on WB modules (mean = 47 ± 26 minutes) than paper (mean = 59 ± 35, p = .024). Difficulties with passwords limited their use of WB modules for 71% (59–80%) of residents.

Conclusion: No difference was found between WB and paper-based formats in knowledge-test score change, but residents preferred learning with WB modules and spent less time doing so. Passwords appeared to impede use of WB modules. WB learning is effective, well accepted, and efficient. Research should focus on aspects of WB instruction that will enhance its power as a learning tool and better define its role in specific settings. 
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A graduate level research methods and statistics course offered on the World-Wide Web was evaluated relative to the traditional lecture version of the course. With their consent, course members were randomly assigned to the two versions of the course for the first block of sessions. For the second block of sessions the groups crossed over to access the alternative version of the course. Quantitative and qualitative outcome data were collected to sample cognitive and affective domains. Improvements in knowledge and reductions in anxiety were apparent following both versions, with no significant differences between versions being detected. Analysis of course member comments indicated less satisfaction with the teaching input on the web-based version but more satisfaction with the peer collaboration that was stimulated. An activity theory framework is applied in conceptualising the findings and generating recommendations for further course development and evaluation. 
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This study examined the effects of a Web-based teaching method (versus a traditional lecture method) on undergraduate nursing students' learning of electrocardiography (ECG). The Web-based learning program was developed by the authors and implemented for 4 weeks. The study used a pretest-posttest experimental design. A total of 105 senior nursing students were recruited at a university in Korea. Fifty-four students were assigned to an experimental group in 2002, and 51 were assigned to a control group in 2003. Knowledge about ECG among students in the Web-based group was significantly lower than that of students in the control group (p < .01). Conversely, the ability to interpret ECG recordings was significantly higher among students in the Web-based group (p < .05). No significant differences were found between the two groups in level of motivation or satisfaction with learning. The self-directed, Web-based ECG learning program appears to be effective in helping nursing students to interpret ECG recordings. 
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Current literature suggests that a hybrid model of distance education supports student learning more effectively than any other format. It also seems likely that the hybrid format can be used in most courses. The purpose of our study was to examine the strength of these assertions. This study examined the outcomes of two introductory courses in teacher education and health services employing similar pedagogical methods within three delivery formats (face-to-face, internet-based, and hybrid) in an effort to compare each of these modes of instruction. Results demonstrate that significant differences exist among the various formats and that the internet-based format could possibly lead to better student outcomes compared to face-to-face and hybrid formats. 
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We developed a hybrid course format (part online, part face-to-face) to deliver a high-enrollment, introductory environmental biology course to resident (living on or near campus), non-science majors at a large, public university. The hybrid course was structured to include bi-weekly online assignments and weekly meetings in the lecture hall focused on active-learning exercises. To evaluate the effectiveness of the web-based component of the hybrid course, we taught the hybrid course simultaneously with a traditional course in which we used passive lectures to cover material in the online assignments. Both courses received the same active-learning activities in class. Students in the hybrid course reported that the quality of interaction with the instructor was high, that they read the text more often and studied in groups more frequently. Performance on a post-course assessment test indicated that the hybrid course format was better or equivalent to the traditional course. Specifically, online assignments were equivalent to or better than passive lectures, and that active-learning exercises were more effective when coupled with online activities. Performance gains were greater for upperclassmen than for freshmen, indicating that hybrid course formats might be a superior option for upperclassmen when satisfying general science requirements. 
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In a series of 5 experiments in 2000 and 2001, several hundred students at two different universities with three different professors and six different teaching assistants took a semester long course on causal and statistical reasoning in either traditional lecture/recitation or online/recitation format. In this article we compare the pre-post test gains of these students, we identify features of the online experience that were helpful and features that were not, and we identify student learning strategies that were effective and those that were not. Students who entirely replaced going to lecture with doing online modules did as well and usually better than those who went to lecture. Simple strategies like incorporating frequent interactive comprehension checks into the online material (something that is difficult to do in lecture) proved effective, but online students attended face-to-face recitations less often than lecture students and suffered because of it. Supporting the idea that small, interactive recitations are more effective than large, passive lectures, recitation attendance was three times as important as lecture attendance for predicting pre-test to post-test gains. For the online student, embracing the online environment as opposed to trying to convert it into a traditional print-based one was an important strategy, but simple diligence in attempting “voluntary” exercises was by far the most important factor in student success. 
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