Online Learning Efficacy Research Database

Aims and objectives: To detect problems when classifying pressure ulcers and to examine whether an e-learning program is able to increase the classification skills of qualified nurses and nursing students.

Background: Both the distinction between pressure ulcer grades and the differentiation between moisture lesions is difficult. Misclassification and incorrect identification of the lesions results in inadequate preventive and therapeutic measures. Education and training are important for spreading evidence-based insights about this topic. Design: Repeated measure design, consisting of one pretest and three posttests.

Methods: The experimental intervention consisted of a one-hour session during which the participants independently went over an e-learning program. The control intervention consisted of a one-hour lecture. Both interventions had the same learning contents. A convenience sample of 212 qualified nurses and 214 final-year nursing students was randomly assigned to an experimental-and a control group.

Results: In the pretest, the classification skills were low. After the intervention, these skills improved significantly in both groups. The nursing students achieved better results when using the e-learning program. Among the qualified nurses, there was no difference between the learning methods. Although the classification skills decreased in the posttests, they did not drop under the level of the pretest.

Conclusion: The actual classification system does not provide the necessary information about the severity of a pressure ulcer. The differential diagnosis between a moisture lesion was complicated. The classification skills of the qualified nurses and nursing students increased by both learning methods. Repetition remains, however, necessary.

Relevance to clinical practice: Both instruction methods are adequate to acquire the knowledge about the differences between moisture lesions and pressure ulcers. E-learning allows studying in one's own time and place, and could therefore be very suitable for repetition of the training. How to organise this training could be a subject for further research. 
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Objectives/Hypothesis: To compare the pass rate of residents performing the Particle Repositioning Maneuver (PRM) after one of three interventions: 1) small group PRM instruction (SG); 2) standard classroom instruction (CI); and 3) Web-based learning module (WM). We hypothesize that our Web-based learning module is more effective than CI and as effective as SG.

Study Design: Prospective randomized control trial.

Methods: The study population includes all family medicine residents at the University of Western Ontario. On day 0, all subjects were tested. Residents were then randomized to one of three intervention groups: 1) SG, 2) CI, or 3) WM. On day 7, the residents were again tested. Observers were blinded to the intervention type. Testing (day 0 and day 7) was performed using the DizzyFIX (Clearwater Clinical Ltd., London, Ontario, Canada), a pass/fail test, and evaluation by a trained observer (correct or incorrect).

Results: There were no statistically significant differences in pass rates between the three groups before the interventions (DizzyFIX: P = .2096, observer: P = .3710). After the interventions, DizzyFIX testing pass rates were 50.0% SG, 60.0% CI and 100.0% WM (P = .3564). Observer testing pass rates were 85.7% SG, 28.6% CI, and 83.3% WM (P = .0431).

Conclusions: This study demonstrated that our Web-based learning module for the PRM is comparable to small-group clinical instruction, and superior to standard classroom instruction for teaching the PRM when evaluated by a trained observer. 
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Background
Web-based technologies are increasingly being used to create modes of online learning for nurses but their effect has not been assessed in nurse education.

Objectives
Assess whether participation in face-to-face discussion seminars or online asynchronous discussion groups had different effects on educational attainment in a web-based course.

Design
Non-randomised or quasi-experimental design with two groups-students choosing to have face-to-face discussion seminars and students choosing to have online discussions.

Setting
The Core Methods module of a postgraduate research methods course.

Participants
All 114 students participating in the first 2 yr during which the course teaching material was delivered online.

Outcome
Assignment mark for Core Methods course module.

Methods
Background details of the students, their choices of modules and assignment marks were collected as part of the routine course administration. Students’ online activities were identified using the student tracking facility within WebCT. Regression models were fitted to explore the association between available explanatory variables and assignment mark.

Results
Students choosing online discussions had a higher Core Methods assignment mark (mean 60.8/100) than students choosing face-to-face discussions (54.4); the difference was statistically significant (t=3.13, df=102, p=0.002), although this ignores confounding variables. Among online discussion students, assignment mark was significantly correlated with the numbers of discussion messages read (Kendall's tb=0.22, p=0.050) and posted (Kendall's tb=0.27, p=0.017); among face-to-face discussion students, it was significantly associated with the number of non-discussion hits in WebCT (Kendall's tb=0.19, p=0.036). In regression analysis, choice of discussion method, whether an M.Phil./Ph.D. student, number of non-discussion hits in WebCT, number of online discussion messages read and number posted were associated with assignment mark at the 5% level of significance when taken singly; in combination, only whether an M.Phil./Ph.D. student (p=0.024) and number of non-discussion hits (p=0.045) retained significance.

Conclusions
This study demonstrates that a research methods course can be delivered to postgraduate healthcare students at least as successfully by an entirely online method in which students participate in online discussion as by a blended method in which students accessing web-based teaching material attend face-to-face seminar discussions. Increased online activity was associated with higher assignment marks. The study highlights new opportunities for educational research that arise from the use of virtual learning environments that routinely record the activities of learners and tutors. 
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Objective. Determine whether lectures by national experts and a publicly available online program with similar educational objectives can improve knowledge, attitudes, and beliefs (KAB) important to chronic pain management.

Design. A pretest–posttest randomized design with two active educational interventions in two different physician groups and a third physician group that received live education on a different topic to control for outside influences, including retesting effects, on our evaluation.

Participants. A total of 136 community-based primary care physicians met eligibility criteria. All physicians attended the educational program to which they were assigned. Ninety-five physicians (70%) provided complete data for evaluation.

Measurements. Physician responses to a standardized 50-item pain management KAB survey before, immediately after, and 3 months following the interventions.

Results. The study groups and the 41 physicians not providing outcomes information were similar with respect to age, sex, race, percent engaged in primary care, and number of patients seen per week. Physician survey scores improved immediately following both pain education programs (live: 138.0→150.6, P < 0.001; online: 143.6→150.4, P = 0.007), but did not change appreciably in the control group (139.2→142.5, P > 0.05). Findings persisted at 3 months. Satisfaction measures were high (4.00–4.72 on 1–5 scale) and not significantly different (P = 0.072–0.893) between groups.

Conclusions. When used under similar conditions, national speakers and a publicly available online CME program were associated with improved pain management KAB in physicians. The benefits lasted for 3 months. These findings support the continued use of these pain education strategies. 
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Background
Within a clinical context e-learning is comparable to traditional approaches of continuing medical education (CME). However, the occupational health context differs and until now the effect of postgraduate e-learning among occupational physicians (OPs) has not been evaluated.

Aim
To evaluate the effect of e-learning on knowledge on mental health issues as compared to lecture-based learning in a CME programme for OPs.

Methods
Within the context of a postgraduate meeting for 74 OPs, a randomized controlled trial was conducted. Test assessments of knowledge were made before and immediately after an educational session with either e-learning or lecture-based learning.

Results
In both groups, a significant gain in knowledge on mental health care was found (P < 0.05). However, there was no significant difference between the two educational approaches.

Conclusion
The effect of e-learning on OPs' mental health care knowledge is comparable to a lecture-based approach. Therefore, e-learning can be beneficial for the CME of OPs. 
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The technology known as virtual microscopy is now widely available to medical students. A number of medical school histology and pathology course directors, including those at the Eastern Virginia Medical School, are exploring the question of how best to make use of this new tool. The current study compared the efficacy of teaching and testing one unit of histology, bone and cartilage, using two technologies, namely, virtual microscopy and traditional microscopy. Additionally, the study examined whether low, moderate, high moderate, or high achieving students perform more effectively in any of the learning/testing formats. In a completely randomized block design, 96 first semester, first-year medical students were grouped by previous exam quartiles then subsequently randomly assigned to one of four groups. Using identical laboratory exercises with highly comparable slides for each experimental group, half of the subjects learned the exercise with traditional microscopy and half learned with virtual microscopy. Subjects were further randomly subdivided into virtual or actual testing groups. The authors found no significant differences in test scores when they examined effects by learning group or by testing group, nor were there significant interaction effects. Student performance evaluated by previous exam quartile was significant (P < 0.001). That is, students who had scored in a particular quartile on a previous test tended to score in the same quartile on the bone and cartilage test regardless of learning or testing method. In a short opinion survey, students were polled to evaluate their experience. Student preferences for both learning and testing method varied widely. 
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Background
Previous research has shown that internet education can lead to short-term improvements in clinicians' knowledge, confidence and communication practices. We wished to better understand the duration of these improvements and whether different curriculum delivery strategies differed in affecting these improvements.

Methods
As previously described, we conducted a randomized control trial comparing four different strategies for delivering an e-curriculum about herbs and other dietary supplements (HDS) to clinicians. The four strategies were delivering the curriculum by: a) email over 10 weeks; b) email within one week; c) web-site over 10 weeks; d) web-site within one week. Participants were surveyed at baseline, immediately after the course and 6–10 months after completing the course (long-term). Long-term outcomes focused on clinicians' knowledge, confidence and communication practices.

Results
Of the 780 clinicians who completed the course, 385 (49%) completed the long-term survey. Completers and non-completers of the long-term survey had similar demographics and professional characteristics at baseline. There were statistically significant improvements from baseline to long-term follow-up in knowledge, confidence and communication practices; these improvements did not differ by curriculum delivery strategy. Knowledge scores improved from 67.7 ± 10.3 at baseline to 78.8 ± 12.3 at long-term follow-up (P < 0.001). Confidence scores improved from 53.7 ± 17.8 at baseline to 66.9 ± 12.0 at long term follow-up (P < 0.001); communication scores improved from 2.6 ± 1.9 at baseline to 3.6 ± 2.1 (P < 0.001) at long-term follow-up.

Conclusion
This e- curriculum led to significant and sustained improvements in clinicians' expertise about HDS regardless of the delivery strategy. Future studies should compare the impact of required vs. elective courses and self-reported vs. objective measures of behavior change. 
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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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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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