A practical guide to developing effective web-based learning

Effective learning environments - the process of creating and maintaining an online continuing education tool

Continuing medical education (CME) is an indispensable part of maintaining physicians' competency. Since attending conferences requires clinical absenteeism and is not universally available, online learning has become popular. The purpose of this study is to conduct a retrospective analysis examining the creation process of an anesthesia website for adherence to the published guidelines and, in turn, provide an illustration of developing accredited online CME. Using Kern's guide to curriculum development, our website analysis confirmed each of the six steps was met. As well, the technical design features are consistent with the published literature on efficient online educational courses. Analysis of the database from 3937 modules and 1628 site evaluations reveals the site is being used extensively and is effective as demonstrated by the participants' examination results, content evaluations and reports of improvements in patient management. Utilizing technology to enable distant learning has become a priority for many educators. When creating accredited online CME programs, course developers should understand the educational principles and technical design characteristics that foster effective online programs. This study provides an illustration of incorporating these features. It also demonstrates significant participation in online CME by anesthesiologists and highlights the need for more accredited programs.

E-learning programs in oncology: a nationwide experience from 2005 to 2014

Background

E-learning is an established concept in oncological education and training. However, there seems to be a scarcity of long-term assessments of E-learning programs in oncology vis-á-vis their structural management and didactic value. This study presents descriptive, nationwide data from 2005 to 2014. E-learning oncology programs in chemotherapy, general oncology, pain management, palliative care, psycho-social-oncology, and radiotherapy, were reviewed from our databases. Questionnaires of self-perceived didactic value of the programs were examined 2008–2014.

Results

The total number of trainees were 4693, allocated to 3889 individuals. The trainees included medical doctors (MDs; n = 759), registered nurses (RNs; n = 2359), radiation therapy technologists (n = 642), and, social and health care assistants (SHCAs; n = 933). The E-learning covered 29 different program classifications, comprising 731 recorded presentations, and covering 438 themes. A total of 490 programs were completed by the trainees. The European Credit Transfer and Accumulation System (ECTS; 1 ECTS point equals 0.60 US College Credit Hours) points varied across the educational programs from 0.7 to 30.0, corresponding to a duration of full-time studies ranging between 15 to 900 h (0.4–24 weeks) per program. The total number of ECTS points for the trainee cohort, was 20,000 corresponding to 530,000 full-time academic hours or 324.0 standard academic working years. The overall drop-out rate, across professions and programs, was 10.6% (499/4693). The lowest drop-out rate was seen for RNs (4.3%; P < 0.0001). Self-reported evaluation questionnaires (2008–2014) were completed by 72.1% (2642/3666) of the trainees. The programs were overall rated, on a 5-categorical scale (5 = excellent; 1 = very inferior), as excellent by 68.6% (MDs: 64.9%; RNs: 66.8%; SHCAs: 77.7%) and as good by 30.6% (MDs: 34.5%; RNs: 32.4%; SHCAs: 21.5%) of the responders.

Conclusions

This descriptive study, performed in a lengthy timeframe, presents high-volume data from multi-professional, oncological E-learning programs. While the E-learning paradigm, across professions, seems to have been well received, it is imperative that prospective studies, benchmarking against traditional training methods, are carried out, examining the hypothesized didactic value of our E-programs.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-017-2372-8) contains supplementary material, which is available to authorized users.

E-learning for grass-roots emergency public health personnel: Preliminary lessons from a national program in China

In China, grass-roots emergency public health personnel have relatively limited emergency response capabilities and they are constantly required to update their professional knowledge and skills due to recurring and new public health emergencies. However, professional training, a principal solution to this problem, is inadequate because of limitations in manpower and financial resources at grass-roots public health agencies. In order to provide a cost-effective and easily expandable way for grass-roots personnel to acquire knowledge and skills, the National Health Planning Commission of China developed an emergency response information platform and provided trial access to this platform in Anhui and Heilongjiang provinces in China. E-learning was one of the modules of the platform and this paper has focused on an e-learning pilot program. Results indicated that e-learning had satisfactorily improved the knowledge and ability of grass-roots emergency public health personnel, and the program provided an opportunity to gain experience in e-course design and implementing e-learning. Issues such as the lack of personalized e-courses and the difficulty of evaluating the effectiveness of e-learning are topics for further study.

Quality specifications in postgraduate medical e-learning: an integrative literature review leading to a postgraduate medical e-learning model

BACKGROUND

E-learning is driving major shifts in medical education. Prioritizing learning theories and quality models improves the success of e-learning programs. Although many e-learning quality standards are available, few are focused on postgraduate medical education.

METHODS

We conducted an integrative review of the current postgraduate medical e-learning literature to identify quality specifications. The literature was thematically organized into a working model.

RESULTS

Unique quality specifications (n = 72) were consolidated and re-organized into a six-domain model that we called the Postgraduate Medical E-learning Model (Postgraduate ME Model). This model was partially based on the ISO-19796 standard, and drew on cognitive load multimedia principles. The domains of the model are preparation, software design and system specifications, communication, content, assessment, and maintenance.

CONCLUSION

This review clarified the current state of postgraduate medical e-learning standards and specifications. It also synthesized these specifications into a single working model. To validate our findings, the next-steps include testing the Postgraduate ME Model in controlled e-learning settings.

Informing Patients About Placebo Effects: Using Evidence, Theory, and Qualitative Methods to Develop a New Website

Background

According to established ethical principles and guidelines, patients in clinical trials should be fully informed about the interventions they might receive. However, information about placebo-controlled clinical trials typically focuses on the new intervention being tested and provides limited and at times misleading information about placebos.

Objective

We aimed to create an informative, scientifically accurate, and engaging website that could be used to improve understanding of placebo effects among patients who might be considering taking part in a placebo-controlled clinical trial.

Methods

Our approach drew on evidence-, theory-, and person-based intervention development. We used existing evidence and theory about placebo effects to develop content that was scientifically accurate. We used existing evidence and theory of health behavior to ensure our content would be communicated persuasively, to an audience who might currently be ignorant or misinformed about placebo effects. A qualitative ‘think aloud’ study was conducted in which 10 participants viewed prototypes of the website and spoke their thoughts out loud in the presence of a researcher.

Results

The website provides information about 10 key topics and uses text, evidence summaries, quizzes, audio clips of patients’ stories, and a short film to convey key messages. Comments from participants in the think aloud study highlighted occasional misunderstandings and off-putting/confusing features. These were addressed by modifying elements of content, style, and navigation to improve participants’ experiences of using the website.

Conclusions

We have developed an evidence-based website that incorporates theory-based techniques to inform members of the public about placebos and placebo effects. Qualitative research ensured our website was engaging and convincing for our target audience who might not perceive a need to learn about placebo effects. Before using the website in clinical trials, it is necessary to test its effects on key outcomes including patients’ knowledge and capacity for making informed choices about placebos.

Cognitive Load and Self-Determination Theories Applied to E-Learning: Impact on Students' Participation and Academic Performance

BACKGROUND

Emergency clerkships expose students to a stressful environment that require multiple tasks, which may have a direct impact on cognitive load and motivation for learning. To address this challenge, Cognitive Load Theory and Self Determination Theory provided the conceptual frameworks to the development of a Moodle-based online Emergency Medicine course, inspired by real clinical cases.

METHODS

Three consecutive classes (2013-2015) of sixth-year medical students (n = 304) participated in the course, during a curricular and essentially practical emergency rotation. "Virtual Rounds" provided weekly virtual patients in narrative format and meaningful schemata to chief complaints, in order to simulate real rounds at Emergency Unit. Additional activities such as Extreme Decisions, Emergency Quiz and Electrocardiographic challenge offered different views of emergency care. Authors assessed student´s participation and its correlation with their academic performance. A survey evaluated students´ opinions. Students graduating in 2015 answered an online questionnaire to investigate cognitive load and motivation.

RESULTS

Each student produced 1965 pageviews and spent 72 hours logged on. Although Clinical Emergency rotation has two months long, students accessed the online course during an average of 5.3 months. Virtual Rounds was the most accessed activity, and there was positive correlations between the number of hours logged on the platform and final grades on Emergency Medicine. Over 90% of students felt an improvement in their clinical reasoning and considered themselves better prepared for rendering Emergency care. Considering a Likert scale from 1 (minimum load) to 7 (maximum load), the scores for total cognitive load were 4.79±2.2 for Virtual Rounds and 5.56±1.96 for real medical rounds(p<0,01).

CONCLUSIONS

A real-world inspired online course, based on cognitive and motivational conceptual frameworks, seems to be a strong tool to engage students in learning. It may support them to manage the cognitive challenges involved in clinical care and increase their motivation for learning.

Creating a National HIV Curriculum

In recent years, the HIV care provider workforce has not kept pace with an expanding HIV epidemic. To effectively address this HIV workforce shortage, a multipronged approach is needed that includes high-quality, easily accessible, up-to-date HIV education for trainees and practicing providers. Toward this objective, the University of Washington, in collaboration with the AIDS Education and Training Center National Coordinating Resource Center, is developing a modular, dynamic curriculum that addresses the entire spectrum of the HIV care continuum. Herein, we outline the general principles, content, organization, and features of this federally funded National HIV Curriculum, which allows for longitudinal, active, self-directed learning, as well as real-time evaluation, tracking, and feedback at the individual and group level. The online curriculum, which is in development, will provide a free, comprehensive, interactive HIV training and resource tool that can support national efforts to expand and strengthen the United States HIV clinical care workforce.

Web-Based Learning for Emergency Airway Management in Anesthesia Residency Training

Introduction. Web-based learning (WBL) is increasingly used in medical education; however, residency training programs often lack guidance on its implementation. We describe how the use of feasibility studies can guide the use of WBL in anesthesia residency training. Methods. Two case-based WBL emergency airway management modules were developed for self-directed use by anesthesia residents. The feasibility of using this educational modality was assessed using a single cohort pretest/posttest design. Outcome measures included user recruitment and retention rate, perceptions of educational value, and knowledge improvement. The differences between pre- and postmodule test scores and survey Likert scores were analysed using the paired t test. Results. Recruitment and retention rates were 90% and 65%, respectively. User-friendliness of the modules was rated highly. There was a significant improvement in perceptions of the value of WBL in the postsurvey. There was a significant knowledge improvement of 29% in the postmodule test. Conclusions. Feasibility studies can help guide appropriate use of WBL in curricula. While our study supported the potential feasibility of emergency airway management modules for training, collaboration with other anesthesia residency programs may enable more efficient development, implementation, and evaluation of this resource-intensive modality in anesthesia education and practice.

A Web simulation of medical image reconstruction and processing as an educational tool

Web educational resources integrating interactive simulation tools provide students with an in-depth understanding of the medical imaging process. The aim of this work was the development of a purely Web-based, open access, interactive application, as an ancillary learning tool in graduate and postgraduate medical imaging education, including a systematic evaluation of learning effectiveness. The pedagogic content of the educational Web portal was designed to cover the basic concepts of medical imaging reconstruction and processing, through the use of active learning and motivation, including learning simulations that closely resemble actual tomographic imaging systems. The user can implement image reconstruction and processing algorithms under a single user interface and manipulate various factors to understand the impact on image appearance. A questionnaire for pre- and post-training self-assessment was developed and integrated in the online application. The developed Web-based educational application introduces the trainee in the basic concepts of imaging through textual and graphical information and proceeds with a learning-by-doing approach. Trainees are encouraged to participate in a pre- and post-training questionnaire to assess their knowledge gain. An initial feedback from a group of graduate medical students showed that the developed course was considered as effective and well structured. An e-learning application on medical imaging integrating interactive simulation tools was developed and assessed in our institution.

Defining the learning curve of point-of-care ultrasound for confirming endotracheal tube placement by emergency physicians

Background

Unrecognized esophageal intubations are associated with significant patient morbidity and mortality. No single confirmatory device has been shown to be 100 % accurate at ruling out esophageal intubations in the emergency department. Recent studies have demonstrated that point-of-care ultrasound (POCUS) may be a useful adjunct for confirming endotracheal tube placement; however, the amount of practice required to become proficient at this technique is unclear. The purpose of this study is to determine the amount of practice required by emergency physicians to become proficient at interpreting ultrasound video clips of esophageal and endotracheal intubations.

Methods

Emergency physicians and emergency medicine residents completed a baseline interpretation test followed by a 10 min online tutorial. They then interpreted POCUS clips of esophageal and endotracheal intubations in a randomly selected order. If an incorrect response was provided, the participant completed another practice session with feedback. This process continued until they correctly interpreted ten consecutive ultrasound clips. Descriptive statistics were used to summarize the data.

Results

Of the 87 eligible physicians, 66 (75.9 %) completed the study. The mean score on the baseline test was 42.9 % (SD 32.7 %). After the tutorial, 90.9 % (60/66) of the participants achieved proficiency after one practice attempt and 100 % achieved proficiency after two practice attempts. Six intubation ultrasound clips were misinterpreted, for a total error rate of 0.9 % (6/684). Overall, the participants had a sensitivity of 98.3 % (95 % CI 96.3–99.4 %) and specificity of 100 % (95 % CI 98.9–100 %) for detecting correct tube location. Scans were interpreted within an average of 4 s (SD 2.9 s) of the intubation.

Conclusions

After a brief online tutorial and only two practice attempts, emergency physicians were able to quickly and accurately interpret ultrasound intubation clips of esophageal and endotracheal intubations.

Electronic supplementary material

The online version of this article (doi:10.1186/s13089-015-0031-7) contains supplementary material, which is available to authorized users.

Formation of a New Entity to Support Effective Use of Technology in Medical Education: The Student Technology Committee

BACKGROUND

As technology in medical education expands from teaching tool to crucial component of curricular programming, new demands arise to innovate and optimize educational technology. While the expectations of today's digital native students are significant, their experience and unique insights breed new opportunities to involve them as stakeholders in tackling educational technology challenges.

OBJECTIVE

The objective of this paper is to present our experience with a novel medical student-led and faculty-supported technology committee that was developed at Vanderbilt University School of Medicine to harness students' valuable input in a comprehensive fashion. Key lessons learned through the initial successes and challenges of implementing our model are also discussed.

METHODS

A committee was established with cooperation of school administration, a faculty advisor with experience launching educational technologies, and a group of students passionate about this domain. Committee membership is sustained through annual selective recruitment of interested students.

RESULTS

The committee serves 4 key functions: acting as liaisons between students and administration; advising development of institutional educational technologies; developing, piloting, and assessing new student-led educational technologies; and promoting biomedical and educational informatics within the school community. Participating students develop personally and professionally, contribute to program implementation, and extend the field's understanding by pursuing research initiatives. The institution benefits from rapid improvements to educational technologies that meet students' needs and enhance learning opportunities. Students and the institution also gain from fostering a campus culture of awareness and innovation in informatics and medical education. The committee's success hinges on member composition, school leadership buy-in, active involvement in institutional activities, and support for committee initiatives.

CONCLUSIONS

Students should have an integral role in advancing medical education technology to improve training for 21st-century physicians. The student technology committee model provides a framework for this integration, can be readily implemented at other institutions, and creates immediate value for students, faculty, information technology staff, and the school community.

Engaging Physician Learners Through a Web-Based Platform: Individualized End-of-Life Education

BACKGROUND

Web-based modules provide a convenient and low-cost education platform, yet should be carefully designed to ensure that learners are actively engaged. In order to improve attitudes and knowledge in end-of-life (EOL) care, we developed a web-based educational module that employed hyperlinks to allow users access to auxiliary resources: clinical guidelines and seminal research papers.

METHODS

Participants took pre-test evaluations of attitudes and knowledge regarding EOL care prior to accessing the educational module, and a post-test evaluation following the module intervention. We recorded the type of hyperlinks (guideline or paper) accessed by learners, and stratified participants into groups based on link type accessed (none, either, or both). We used demographic and educational data to develop a multivariate mixed-effects regression analysis to develop adjusted predictions of attitudes and knowledge.

RESULTS

114 individuals participated. The majority had some professional exposure to EOL care (prior instruction 62%; EOL referral 53%; EOL discussion 56%), though most had no family (68%) or personal experience (51%). On bivariate analysis, non-partnered (p = .04), medical student training level (p = .03), prior palliative care referral (p = .02), having a family member (p = .02) and personal experience of EOL care (p < .01) were all associated with linking to auxiliary resources via hyperlinks. When adjusting for confounders, β coefficient estimates and least squares estimation demonstrated that participants clicking on both hyperlink types were more likely to score higher on all knowledge and attitude items, and demonstrate increased score improvements.

CONCLUSION

Auxiliary resources accessible by hyperlink are an effective adjunct to web-based learning in end-of-life care.

Evaluating technology-enhanced learning: A comprehensive framework

BACKGROUND

The absence of a standard, comprehensive approach to evaluating technology-enhanced learning (TEL) limits the utility of individual evaluations, and impedes the integration and synthesis of results across studies.

PURPOSE

To outline a comprehensive framework for approaching TEL evaluation in medical education, and to develop instruments for measuring the perceptions of TEL learners and instructors.

METHODS AND RESULTS

Using both theoretical constructs of inquiry in education and a synthesis of existing models and instruments, we outlined a general model for evaluation that links utility, principles, and practices. From this we derived a framework for TEL evaluation that identifies seven data collection activities: needs analysis; documentation of processes, decisions, and final product; usability testing; observation of implementation; assessment of participant experience; assessment of learning outcomes; and evaluation of cost, reusability, and sustainability. We then used existing quality standards and approaches to develop instruments for assessing the experiences of learners and instructors using TEL.

CONCLUSIONS

No single evaluation is likely to collect all of this information, nor would any single audience likely find all information elements equally useful. However, consistent use of a common evaluation framework across different courses and institutions would avoid duplication of effort and allow cross-course comparisons.

Using innovative instructional technology to meet training needs in public health: a design process

Technology and distance learning can potentially enhance the efficient and effective delivery of continuing education to the public health workforce. Public Health Training Centers collaborate with instructional technology designers to develop innovative, competency-based online learning experiences that meet pressing training needs and promote best practices. We describe one Public Health Training Center's online learning module design process, which consists of five steps: (1) identify training needs and priority competencies; (2) define learning objectives and identify educational challenges; (3) pose hypotheses and explore innovative, technology-based solutions; (4) develop and deploy the educational experience; and (5) evaluate feedback and outcomes to inform continued cycles of revision and improvement. Examples illustrate the model's application. These steps are discussed within the context of design practices in the fields of education, engineering, and public health. They incorporate key strategies from across these fields, including principles of programmatic design familiar to public health professionals, such as backward design. The instructional technology design process we describe provides a structure for the creativity, collaboration, and systematic strategies needed to develop online learning products that address critical training needs for the public health workforce.

The value of online learning and MRI: finding a niche for expensive technologies

BACKGROUND

The benefits of online learning come at a price. How can we optimize the overall value?

AIMS

Critically appraise the value of online learning.

METHODS

Narrative review.

RESULTS

Several prevalent myths overinflate the value of online learning. These include that online learning is cheap and easy (it is usually more expensive), that it is more efficient (efficiency depends on the instructional design, not the modality), that it will transform education (fundamental learning principles have not changed), and that the Net Generation expects it (there is no evidence of pent-up demand). However, online learning does add real value by enhancing flexibility, control and analytics. Costs may also go down if disruptive innovations (e.g. low-cost, low-tech, but instructionally sound "good enough" online learning) supplant technically superior but more expensive online learning products. Cost-lowering strategies include focusing on core principles of learning rather than technologies, using easy-to-learn authoring tools, repurposing content (organizing and sequencing existing resources rather than creating new content) and using course templates.

CONCLUSIONS

Online learning represents just one tool in an educator's toolbox, as does the MRI for clinicians. We need to use the right tool(s) for the right learner at the right dose, time and route.

A pilot randomized control trial to evaluate the feasibility of an Internet-based self-management and transitional care program for youth with haemophilia

Adolescents with haemophilia must assume responsibility for their health and management of their disease. An online self-management program was developed to support adolescents during this transition. To determine the feasibility of the program using a randomized control trial (RCT) design in terms of accrual/attrition rates, willingness to be randomized, compliance with the program/outcome measures and satisfaction. Adolescents, ages 13-18, were enrolled in a pilot RCT (NCT01477437) and randomized to either the intervention (8-week program with telephone coaching) or the control arm (no access to the website, weekly telephone call as attention-strategy). All participants completed pre/post-outcome measures. Twenty-nine teens participated (intervention n = 16, control n = 13). Participants in the intervention arm spent an average of 50 min on the website per week and completed the modules in an average of 14 weeks (SD = 4.9). Attrition was higher in the control group compared to the intervention group (54% vs. 25%). 17/18 (94%) who completed the program also completed the poststudy measures. Teens on the intervention arm showed significant improvement in disease-specific knowledge (P = 0.004), self-efficacy (P = 0.007) and transition preparedness (P = 0.046). There was a statistically significant improvement in knowledge in the intervention group when compared to the control group (P = 0.01). Overall, the teens found the website to be informative, comprehensive and easy to use and were satisfied with the program. This pilot RCT study suggests benefit to the program and indicates an RCT design to be feasible with minor adjustments to the protocol.

Virtual patients: the influence of case design and teamwork on students' perception and knowledge - a pilot study

BACKGROUND

Virtual patient (VP) cases are an effective teaching method, although little is known about how to design and implement them for maximum effectiveness. The aim of this study was to explore the effect of case design and teamwork on students' learning outcome.

METHODS

One hundred forty-six undergraduate medical students participated in a mandatory medical computer science course consisting of five seminars. At the end of each seminar, they worked on one VP case, either in teams of two or individually. Each student filled out an introductory and a final survey and a feedback sheet after completing each case. Additionally, there was a surprise multiple choice (MC) test after the last seminar with three questions regarding each case.

RESULTS

Students with more clinical experience and students who had worked in a team performed significantly better on MC questions. Students with less clinical experience more frequently used information which had been positioned less prominently on the case material. Certain aspects of case design were rated more positively by students who had an interest in e-learning. In general, students preferred to work on cases for less than 15 minutes.

CONCLUSIONS

Clinically more advanced students and students working with a partner seem to benefit most from short VP cases with prominently presented information.

The Picmonic(®) Learning System: enhancing memory retention of medical sciences, using an audiovisual mnemonic Web-based learning platform

BACKGROUND

Medical students are required to retain vast amounts of medical knowledge on the path to becoming physicians. To address this challenge, multimedia Web-based learning resources have been developed to supplement traditional text-based materials. The Picmonic(®) Learning System (PLS; Picmonic, Phoenix, AZ, USA) is a novel multimedia Web-based learning platform that delivers audiovisual mnemonics designed to improve memory retention of medical sciences.

METHODS

A single-center, randomized, subject-blinded, controlled study was conducted to compare the PLS with traditional text-based material for retention of medical science topics. Subjects were randomly assigned to use two different types of study materials covering several diseases. Subjects randomly assigned to the PLS group were given audiovisual mnemonics along with text-based materials, whereas subjects in the control group were given the same text-based materials with key terms highlighted. The primary endpoints were the differences in performance on immediate, 1 week, and 1 month delayed free-recall and paired-matching tests. The secondary endpoints were the difference in performance on a 1 week delayed multiple-choice test and self-reported satisfaction with the study materials. Differences were calculated using unpaired two-tailed t-tests.

RESULTS

PLS group subjects demonstrated improvements of 65%, 161%, and 208% compared with control group subjects on free-recall tests conducted immediately, 1 week, and 1 month after study of materials, respectively. The results of performance on paired-matching tests showed an improvement of up to 331% for PLS group subjects. PLS group subjects also performed 55% greater than control group subjects on a 1 week delayed multiple choice test requiring higher-order thinking. The differences in test performance between the PLS group subjects and the control group subjects were statistically significant (P<0.001), and the PLS group subjects reported higher overall satisfaction with the material.

CONCLUSION

The data of this pilot site demonstrate marked improvements in the retention of disease topics when using the PLS compared with traditional text-based materials. The use of the PLS in medical education is supported.

Computer-based teaching module design: principles derived from learning theories

CONTEXT

The computer-based teaching module (CBTM), which has recently gained prominence in medical education, is a teaching format in which a multimedia program serves as a single source for knowledge acquisition rather than playing an adjunctive role as it does in computer-assisted learning (CAL). Despite empirical validation in the past decade, there is limited research into the optimisation of CBTM design. This review aims to summarise research in classic and modern multimedia-specific learning theories applied to computer learning, and to collapse the findings into a set of design principles to guide the development of CBTMs.

METHODS

Scopus was searched for: (i) studies of classic cognitivism, constructivism and behaviourism theories (search terms: 'cognitive theory' OR 'constructivism theory' OR 'behaviourism theory' AND 'e-learning' OR 'web-based learning') and their sub-theories applied to computer learning, and (ii) recent studies of modern learning theories applied to computer learning (search terms: 'learning theory' AND 'e-learning' OR 'web-based learning') for articles published between 1990 and 2012. The first search identified 29 studies, dominated in topic by the cognitive load, elaboration and scaffolding theories. The second search identified 139 studies, with diverse topics in connectivism, discovery and technical scaffolding. Based on their relative representation in the literature, the applications of these theories were collapsed into a list of CBTM design principles.

RESULTS

Ten principles were identified and categorised into three levels of design: the global level (managing objectives, framing, minimising technical load); the rhetoric level (optimising modality, making modality explicit, scaffolding, elaboration, spaced repeating), and the detail level (managing text, managing devices).

CONCLUSIONS

This review examined the literature in the application of learning theories to CAL to develop a set of principles that guide CBTM design. Further research will enable educators to take advantage of this unique teaching format as it gains increasing importance in medical education.

Point-of-care ultrasound education: the increasing role of simulation and multimedia resources

This article reviews the current technology, literature, teaching models, and methods associated with simulation-based point-of-care ultrasound training. Patient simulation appears particularly well suited for learning point-of-care ultrasound, which is a required core competency for emergency medicine and other specialties. Work hour limitations have reduced the opportunities for clinical practice, and simulation enables practicing a skill multiple times before it may be used on patients. Ultrasound simulators can be categorized into 2 groups: low and high fidelity. Low-fidelity simulators are usually static simulators, meaning that they have nonchanging anatomic examples for sonographic practice. Advantages are that the model may be reused over time, and some simulators can be homemade. High-fidelity simulators are usually high-tech and frequently consist of many computer-generated cases of virtual sonographic anatomy that can be scanned with a mock probe. This type of equipment is produced commercially and is more expensive. High-fidelity simulators provide students with an active and safe learning environment and make a reproducible standardized assessment of many different ultrasound cases possible. The advantages and disadvantages of using low- versus high-fidelity simulators are reviewed. An additional concept used in simulation-based ultrasound training is blended learning. Blended learning may include face-to-face or online learning often in combination with a learning management system. Increasingly, with simulation and Web-based learning technologies, tools are now available to medical educators for the standardization of both ultrasound skills training and competency assessment.

Perspectives on the enablers of e-heath adoption: an international interview study of leading practitioners

Studies examining the application of information technology to the delivery of health-care services often highlight the anticipated benefits. In consequence, the benefits of health-care information technology adoption, often referred to as 'e-health', are widely reported yet there is limited empirical evidence as to how such benefits can be realized. Design and implementation guidelines have been considered from a socio-technical perspective and there is support for the successful application of these principles. There are also some global surveys on the topic, but these often report only statistical data and lack richness of content. This study draws on existing literature to examine whether the principles of health-care information technology adoption are currently applied in practice. The paper presents a timely international analysis of the drivers, critical enablers and successful deployment strategies for e-health from the perspective of leading practitioners. The study considers the adoption of e-health in 15 countries. A qualitative research design was used and semistructured interviews were conducted with 38 thought leaders with expertise in health-care information systems and technology. The study presents a comparative analysis of the lessons learned from implementing, integrating and embedding e-health in practice, and presents a four-phase approach from the perspective of practitioners for the accelerated deployment of e-health systems: (i) develop a strategic approach, (ii) engage the workforce, (iii) capitalize on information technology and (iv) partner with the patient/citizen.

Online learning for faculty development: a review of the literature

BACKGROUND

With the growing presence of computers and Internet technologies in personal and professional lives, it seems prudent to consider how online learning has been and could be harnessed to promote faculty development.

AIMS

Discuss advantages and disadvantages of online faculty development, synthesize what is known from studies involving health professions faculty members, and identify next steps for practice and future research.

METHOD

We searched MEDLINE for studies describing online instruction for developing teaching, leadership, and research skills among health professions faculty, and synthesized these in a narrative review.

RESULTS

We found 20 articles describing online faculty development initiatives for health professionals, including seven quantitative comparative studies, four studies utilizing defined qualitative methods, and nine descriptive studies reporting anecdotal lessons learned. These programs addressed diverse topics including clinical teaching, educational assessment, business administration, financial planning, and research skills. Most studies enrolled geographically-distant learners located in different cities, provinces, or countries. Evidence suggests that online faculty development is at least comparable to traditional training, but learner engagement and participation is highly variable. It appears that success is more likely when the course addresses a relevant need, facilitates communication and social interaction, and provides time to complete course activities.

CONCLUSIONS

Although we identified several practical recommendations for success, the evidence base for online faculty development is sparse and insubstantial. Future research should include rigorous, programmatic, qualitative and quantitative investigations to understand the principles that govern faculty member engagement and success.

Development and validation of a tool to evaluate the quality of medical education websites in pathology

BACKGROUND

The exponential use of the internet as a learning resource coupled with varied quality of many websites, lead to a need to identify suitable websites for teaching purposes.

AIM

The aim of this study is to develop and to validate a tool, which evaluates the quality of undergraduate medical educational websites; and apply it to the field of pathology.

METHODS

A tool was devised through several steps of item generation, reduction, weightage, pilot testing, post-pilot modification of the tool and validating the tool. Tool validation included measurement of inter-observer reliability; and generation of criterion related, construct related and content related validity. The validated tool was subsequently tested by applying it to a population of pathology websites.

RESULTS AND DISCUSSION

Reliability testing showed a high internal consistency reliability (Cronbach's alpha = 0.92), high inter-observer reliability (Pearson's correlation r = 0.88), intraclass correlation coefficient = 0.85 and κ =0.75. It showed high criterion related, construct related and content related validity. The tool showed moderately high concordance with the gold standard (κ =0.61); 92.2% sensitivity, 67.8% specificity, 75.6% positive predictive value and 88.9% negative predictive value. The validated tool was applied to 278 websites; 29.9% were rated as recommended, 41.0% as recommended with caution and 29.1% as not recommended.

CONCLUSION

A systematic tool was devised to evaluate the quality of websites for medical educational purposes. The tool was shown to yield reliable and valid inferences through its application to pathology websites.

Canadian Otolaryngology - Head and Neck Surgery clerkship curricula: evolving toward tomorrow's learners

Background

Increasing focus is being placed on Clerkship curriculum design and implementation in light of new undergraduate medical education research and accreditation standards. Canadian Otolaryngology-Head and Neck Surgery (OTOHNS) Clerkship programs are continually but independently evolving towards a common goal of improving Clerkship curriculum.

Methods

An electronic survey was sent to undergraduate OTOHNS directors at all Canadian medical schools (n = 17) examining their Clerkship curricula. Themes included Clerkship format, teaching methods, faculty support and development, program strengths, and barriers.

Results

Survey response rate was 76%. All responding schools had OTOHNS Clerkship programs ranging in type (mandatory, selective or elective) and length (<1 to 4 weeks). Learning modalities varied. Electronic learning tools were identified as increasingly important to curriculum delivery. Common strengths included wide clinical exposure and one-on-one mentoring. Multiple challenges were identified in curriculum implementation and evaluation. All schools expressed interest in developing national standards, objectives and e-learning resources.

Conclusions

Significant variation exists in OTOHNS Clerkship experiences between Canadian medical schools. Many schools perceive barriers of insufficient time, space and curriculum standardization. Interested Canadian OTOHNS educators are eager to collaborate to improve the collective OTOHNS Clerkship experience.

Developing web-based training for public health practitioners: what can we learn from a review of five disciplines?

During a time when governmental funding, resources and staff are decreasing and travel restrictions are increasing, attention to efficient methods of public health workforce training is essential. A literature review was conducted to inform the development and delivery of web-based trainings for public health practitioners. Literature was gathered and summarized from five disciplines: Information Technology, Health, Education, Business and Communications, following five research themes: benefits, barriers, retention, promotion and evaluation. As a result, a total of 138 articles relevant to web-based training design and implementation were identified. Key recommendations emerged, including the need to conduct formative research and evaluation, provide clear design and layout, concise content, interactivity, technical support, marketing and promotion and incentives. We conclude that there is limited application of web-based training in public health. This review offers an opportunity to learn from other disciplines. Web-based training methods may prove to be a key training strategy for reaching our public health workforce in the environment of limited resources.

Leadership's role in support of online academic programs: implementing an administrative support matrix

The proliferation of online education programs creates a myriad of challenges for those charged with implementation and delivery of these programs. Although creating and sustaining quality education is a shared responsibility of faculty, staff, and academic leaders, this article focuses on the pivotal role of leadership in securing the necessary resources, developing the organizational structures, and influencing organizational culture. The vital foundation for a successful outcome when implementing online education programs is the role of leadership in providing adequate and appropriate support. Abundant literature extols the roles of leadership in project management; however, there is a dearth of models or systematic methods for leaders to follow regarding how to implement and sustain online programs. Research conducted by the authors culminated in the development of an Administrative Support Matrix, thus addressing the current gap in the literature.

Developing a comprehensive, effective patient-friendly website to enhance decision making in predictive testing for Huntington disease

PURPOSE

Predictive testing for Huntington disease is a complex decision, requiring in-depth counseling, education, and evaluation. Despite the growth in Web-based decision aids and educational resources, such tools for those considering Huntington disease testing are not available. The main objective of this project was to develop a patient-friendly, comprehensive, accessible Web-based tool to provide accurate information about testing for Huntington disease.

METHODS

A semistructured interview study was conducted to determine the informational, educational, and support needs of those considering Huntington disease testing. A dedicated predictive testing website was subsequently developed and pilot tested.

RESULTS

The interview study revealed that an effective website should include interactive diagrams, video documentaries, and personal stories of others who had considered testing. The pilot test revealed that the multidimensional site was easy to navigate and understand and provided an accurate, unbiased overview of the important factors to be considered before undergoing predictive testing.

CONCLUSION

This project demonstrates the use of a mixed-method approach to develop the first tailored website dedicated to predictive testing for Huntington disease. Such an approach enabled the development of a comprehensive, accurate, and effective educational tool that supports informed decision making for people considering predictive testing for Huntington disease in an accessible, nonthreatening manner.

Developing an interactive web-based learning program on skin cancer: the learning experiences of clinical educators

Web-based learning in medical education is rapidly growing. However, there are few firsthand accounts on the rationale for and development of web-based learning programs. We present the experience of clinical educators who developed an interactive online skin cancer detection and management course in a time-efficient and cost-efficient manner without any prior skills in computer programming or technical construction of web-based learning programs. We review the current state of web-based learning including its general advantages and disadvantages as well as its specific utility in dermatology. We then detail our experience in developing an interactive online skin cancer curriculum for primary care clinicians. Finally, we describe the main challenges faced and lessons learned during the process. This report may serve medical educators who possess minimal computer programming and web design skills but want to employ the many strengths of web-based learning without the huge costs associated with hiring a professional development team.

Available, intuitive and free! Building e-learning modules using web 2.0 services

BACKGROUND

E-learning is part of the mainstream in medical education and often provides the most efficient and effective means of engaging learners in a particular topic. However, translating design and content ideas into a useable product can be technically challenging, especially in the absence of information technology (IT) support. There is little published literature on the use of web 2.0 services to build e-learning activities.

AIM

To describe the web 2.0 tools and solutions employed to build the GP Synergy evidence-based medicine and critical appraisal online course.

METHODS

We used and integrated a number of free web 2.0 services including: Prezi, a web-based presentation platform; YouTube, a video sharing service; Google Docs, a online document platform; Tiny.cc, a URL shortening service; and Wordpress, a blogging platform.

RESULTS

The course consisting of five multimedia-rich, tutorial-like modules was built without IT specialist assistance or specialised software. The web 2.0 services used were free. The course can be accessed with a modern web browser.

CONCLUSIONS

Modern web 2.0 services remove many of the technical barriers for creating and sharing content on the internet. When used synergistically, these services can be a flexible and low-cost platform for building e-learning activities. They were a pragmatic solution in our context.

Learner feedback and educational outcomes with an internet-based ambulatory curriculum: a qualitative and quantitative analysis

BACKGROUND

Online medical education curricula offer new tools to teach and evaluate learners. The effect on educational outcomes of using learner feedback to guide curricular revision for online learning is unknown.

METHODS

In this study, qualitative analysis of learner feedback gathered from an online curriculum was used to identify themes of learner feedback, and changes to the online curriculum in response to this feedback were tracked. Learner satisfaction and knowledge gains were then compared from before and after implementation of learner feedback.

RESULTS

37,755 learners from 122 internal medicine residency training programs were studied, including 9437 postgraduate year (PGY)1 residents (24.4 % of learners), 9864 PGY2 residents (25.5 %), 9653 PGY3 residents (25.0 %), and 6605 attending physicians (17.0 %). Qualitative analysis of learner feedback on how to improve the curriculum showed that learners commented most on the overall quality of the educational content, followed by specific comments on the content. When learner feedback was incorporated into curricular revision, learner satisfaction with the instructive value of the curriculum (1 = not instructive; 5 = highly instructive) increased from 3.8 to 4.1 (p < 0.001), and knowledge gains (i.e., post test scores minus pretest scores) increased from 17.0 % to 20.2 % (p < 0.001).

CONCLUSIONS

Learners give more feedback on the factual content of a curriculum than on other areas such as interactivity or website design. Incorporating learner feedback into curricular revision was associated with improved educational outcomes. Online curricula should be designed to include a mechanism for learner feedback and that feedback should be used for future curricular revision.

Implementation outcomes of a multiinstitutional web-based ethical, legal, and social implications genetics curriculum for primary care residents in three specialties

PURPOSE

Medical genetics lends itself to disseminated teaching methods because of mismatches between numbers of physicians having patients with genetic disorders and availability of genetic specialists.

METHOD

During 3 years, we implemented an interactive, web-based curriculum on ethical, legal, and social implications in medical genetics for primary care residents in three specialties at three institutions. Residents took five (of 10) cases and three (of five) tutorials that varied by specialty. We assessed changes in self-efficacy (primary outcome), knowledge, application, and viewpoints.

RESULTS

Overall enrollment was 69% (279/403). One institution did not complete implementation and was dropped from pre-post comparisons. We developed a six-factor ethical, legal, and social implications self-efficacy scale (Cronbach α = 0.95). Baseline self-efficacy was moderate (71/115; range: 23-115) and increased 15% after participation. Pre-post knowledge scores were high and unchanged. Residents reported that this curriculum covered ethical, legal, and social implications/genetics better than their usual curricula. Most (68-91%) identified advantages, especially in providing flexibility and stimulating self-directed learning. After participation, residents reported creating learning goals (66%) and acting on those goals (62%).

CONCLUSIONS

Ethical, legal, and social implications genetics curricular participation led to modest self-efficacy gains. Residents reported that the curriculum covered unique content areas, had advantages over traditional curriculum, and that they applied ethical, legal, and social implications content clinically. We share lessons from developing and implementing this complex web-based curriculum across multiple institutions.

Technology-assisted education in graduate medical education: a review of the literature

Studies on computer-aided instruction and web-based learning have left many questions unanswered about the most effective use of technology-assisted education in graduate medical education.

Developing effective web-based regional anesthesia education: a randomized study evaluating case-based versus non-case-based module design

BACKGROUND AND OBJECTIVES

Little is known about the use of Web-based education in regional anesthesia training. Benefits of Web-based education include the ability to standardize learning material quality and content, build appropriate learning progressions, use interactive multimedia technologies, and individualize delivery of course materials. The goals of this investigation were (1) to determine whether module design influences regional anesthesia knowledge acquisition, (2) to characterize learner preference patterns among anesthesia residents, and (3) to determine whether learner preferences play a role in knowledge acquisition. Direct comparison of knowledge assessments, learning styles, and learner preferences will be made between an interactive case-based and a traditional textbook-style module design.

METHODS

Forty-three Mayo Clinic anesthesiology residents completed 2 online modules, a knowledge pretest, posttest, an Index of Learning Styles assessment, and a participant satisfaction survey. Interscalene and lumbar plexus regional techniques were selected as the learning content for 4 Web modules constructed using the Blackboard Vista coursework application. One traditional textbook-style module and 1 interactive case-based module were designed for each of the interscalene and lumbar plexus techniques.

RESULTS

Participants scored higher on the postmodule knowledge assessment for both of the interscalene and lumbar plexus modules. Postmodule knowledge performance scores were independent of both module design (interactive case-based versus traditional textbook style) and learning style preferences. However, nearly all participants reported a preference for Web-based learning and believe that it should be used in anesthesia resident education. Participants did not feel that Web-base learning should replace the current lecture-based curriculum.

CONCLUSIONS

All residents scored higher on the postmodule knowledge assessment, but this improvement was independent of the module design and individual learning styles. Although residents believe that online learning should be used in anesthesia training, the results of this study do not demonstrate improved learning or justify the time and expense of developing complex case-based training modules. While there may be practical benefits of Web-based education, educators in regional anesthesia should be cautious about developing curricula based on learner preference data.

A comparison of online versus on-site training in health research methodology: a randomized study

BACKGROUND

Distance learning may be useful for building health research capacity. However, evidence that it can improve knowledge and skills in health research, particularly in resource-poor settings, is limited. We compared the impact and acceptability of teaching two distinct content areas, Biostatistics and Research Ethics, through either on-line distance learning format or traditional on-site training, in a randomized study in India. Our objective was to determine whether on-line courses in Biostatistics and Research Ethics could achieve similar improvements in knowledge, as traditional on-site, classroom-based courses.

SUBJECTS

Volunteer Indian scientists were randomly assigned to one of two arms.

INTERVENTION

Students in Arm 1 attended a 3.5-day on-site course in Biostatistics and completed a 3.5-week on-line course in Research Ethics. Students in Arm 2 attended a 3.5-week on-line course in Biostatistics and 3.5-day on-site course in Research Ethics. For the two course formats, learning objectives, course contents and knowledge tests were identical.

MAIN OUTCOME MEASURES

Improvement in knowledge immediately and 3-months after course completion, compared to baseline.

RESULTS

Baseline characteristics were similar in both arms (n = 29 each). Median knowledge score for Biostatistics increased from a baseline of 49% to 64% (p < 0.001) 3 months after the on-site course, and from 48% to 63% (p = 0.009) after the on-line course. For the on-site Research Ethics course, median score increased from 69% to 83% (p = 0.005), and for the on-line Research Ethics course from 62% to 80% (p < 0.001). Three months after the course, median gains in knowledge scores remained similar for the on-site and on-line platforms for both Biostatistics (16% vs. 12%; p = 0.59) and Research Ethics (17% vs. 13%; p = 0.14).

CONCLUSION

On-line and on-site training formats led to marked and similar improvements of knowledge in Biostatistics and Research Ethics. This, combined with logistical and cost advantages of on-line training, may make on-line courses particularly useful for expanding health research capacity in resource-limited settings.

Improving quality through multidisciplinary education

Multidisciplinary education (MDE) is perceived as the next means of implementing major improvements in the quality and cost-effectiveness of patient care. In this article, the authors discuss various definitions of MDE, evaluate how MDE might be implemented in clinical arenas relevant to the anesthesiologist, and describe several implementations of MDE within their hospital and the anesthesiology department.

E-Medical Education

The World Wide Web has made available a large variety of medical information and education resources only dreamed of two decades ago. This review discusses a number of Web-based e-Medical education concepts and resources likely to be of interest to the medical education community as well as a number of other groups. The resources described focus especially on those that are free and those that have an interactive component. The importance of interactivity and its role in the “constructivist” approach to education is emphasized. Problem-based learning in medical education is also discussed. In addition, the importance of “Web 2.0” and related developments is discussed, along with an overview of Web-based medical simulation software that can complement medical education programs. The importance of podcasts and videocasts as an educational resource are also emphasized. Other concepts such as mashups and the semantic Web are briefly described. Intellectual property issues are also discussed, such as Creative Commons license arrangements, as well as the concept of “information philanthropy”. Finally, the importance of peer-review and technology evaluation for online educational materials is discussed.

How we develop and sustain innovation in medical education technology: Keys to success

The use of information technology to support the educational mission of academic medical centers is nearly universal; however, the scope and methods employed vary greatly (Souza et al. 2008 ). This article reviews the methods, processes, and specific techniques needed to conceive, develop, implement, and assess technology-based educational programs across healthcare disciplines. We discuss the core concepts, structure, and techniques that enable growth, productivity, and sustainability within an academic setting. Herein are specific keys to success with examples including project selection, theory-based design, the technology development process, implementation, and evaluation that can lead to broad participation and positive learning outcomes. Most importantly, this article shares methods to involve students, faculty, and stakeholders in technology design and the development process that fosters a sustainable culture of educational innovation.

Relevance of CONSORT reporting criteria for research on eHealth interventions

OBJECTIVE

In 1996, 2001, and 2010, the Consolidated Standards of Reporting Trials (CONSORT) group released criteria for reporting critical information about randomized clinical trials [1,2]. These criteria were intended to improve the quality and completeness of reporting of RCTs in health care research. This paper discusses the relevance of the CONSORT recommendations for the reporting and design of eHealth research.

METHODS

We reviewed the CONSORT recommendations and discussed their particular relevance to eHealth (electronic information, support and/or communication resources designed to promote health) research. This review focuses on such issues as recruitment and screening of participants, description of treatment elements, and reporting of outcome data and adverse events.

RESULTS

eHealth research presents special challenges regarding the comprehensive and effective reporting of research information. However, the strategic application of CONSORT recommendations holds great promise for improving the quality and informativeness of eHealth research.

CONCLUSION

Investigators need to consider CONSORT recommendations at all stages of the research enterprise, including planning, execution and reporting in order to increase the informativeness of their research efforts.

PRACTICE IMPLICATIONS

The recommendations contained in this paper have the potential to enhance the public health and scientific value of eHealth research.

Time and learning efficiency in Internet-based learning: a systematic review and meta-analysis

Authors have claimed that Internet-based instruction promotes greater learning efficiency than non-computer methods.

OBJECTIVES

determine, through a systematic synthesis of evidence in health professions education, how Internet-based instruction compares with non-computer instruction in time spent learning, and what features of Internet-based instruction are associated with improved learning efficiency.

DATA SOURCES

we searched databases including MEDLINE, CINAHL, EMBASE, and ERIC from 1990 through November 2008. STUDY SELECTION AND DATA ABSTRACTION we included all studies quantifying learning time for Internet-based instruction for health professionals, compared with other instruction. Reviewers worked independently, in duplicate, to abstract information on interventions, outcomes, and study design.

RESULTS

we identified 20 eligible studies. Random effects meta-analysis of 8 studies comparing Internet-based with non-Internet instruction (positive numbers indicating Internet longer) revealed pooled effect size (ES) for time -0.10 (p = 0.63). Among comparisons of two Internet-based interventions, providing feedback adds time (ES 0.67, p =0.003, two studies), and greater interactivity generally takes longer (ES 0.25, p = 0.089, five studies). One study demonstrated that adapting to learner prior knowledge saves time without significantly affecting knowledge scores. Other studies revealed that audio narration, video clips, interactive models, and animations increase learning time but also facilitate higher knowledge and/or satisfaction. Across all studies, time correlated positively with knowledge outcomes (r = 0.53, p = 0.021).

CONCLUSIONS

on average, Internet-based instruction and non-computer instruction require similar time. Instructional strategies to enhance feedback and interactivity typically prolong learning time, but in many cases also enhance learning outcomes. Isolated examples suggest potential for improving efficiency in Internet-based instruction.

The role of medical museums in contemporary medical education

From the early 19th century until the most recent two decades, open-space and satellite museums featuring anatomy and pathology collections (collectively referred to as "medical museums") had leading roles in medical education. However, many factors have caused these roles to diminish dramatically in recent years. Chief among these are the great advances in information technology and web-based learning that are currently at play in every level of medical training. Some medical schools have abandoned their museums while others have gradually given away their museums' contents to devote former museum space to new classrooms, lecture halls, and laboratories. These trends have accelerated as medical school enrollment has increased and as increasing interest in biological and biomedical research activities have caused medical schools to convert museum space into research facilities. A few medical schools, however, have considered the contents of their museums as irreplaceable resources for modern medicine and medical education and the space these occupy as great environments for independent and self-directed learning. Consequently, some medical schools have updated their medical museums and equipped them with new technologies. The Anatomical Museum of Leiden University Medical Center in The Netherlands and the Medical Museum of Kawasaki Medical School in Kurashiki, Okayama, Japan, are two examples of such upgraded museums. Student surveys at Leiden University have indicated that all students (100%) found audio-guided museum tours to be useful for learning and majorities of them found guided tours to be clinically relevant (87%). However, 69% of students felt that museum visits should be optional rather than compulsory within the medical training curriculum.

What do we mean by web-based learning? A systematic review of the variability of interventions

OBJECTIVES

Educators often speak of web-based learning (WBL) as a single entity or a cluster of similar activities with homogeneous effects. Yet a recent systematic review demonstrated large heterogeneity among results from individual studies. Our purpose is to describe the variation in configurations, instructional methods and presentation formats in WBL.

METHODS

We systematically searched MEDLINE, EMBASE, ERIC, CINAHL and other databases (last search November 2008) for studies comparing a WBL intervention with no intervention or another educational activity. From eligible studies we abstracted information on course participants, topic, configuration and instructional methods. We summarised this information and then purposively selected and described several WBL interventions that illustrate specific technologies and design features.

RESULTS

We identified 266 eligible studies. Nearly all courses (89%) used written text and most (55%) used multimedia. A total of 32% used online communication via e-mail, threaded discussion, chat or videoconferencing, and 9% implemented synchronous components. Overall, 24% blended web-based and non-computer-based instruction. Most web-based courses (77%) employed specific instructional methods, other than text alone, to enhance the learning process. The most common instructional methods (each used in nearly 50% of courses) were patient cases, self-assessment questions and feedback. We describe several studies to illustrate the range of instructional designs.

CONCLUSIONS

Educators and researchers cannot treat WBL as a single entity. Many different configurations and instructional methods are available for WBL instructors. Researchers should study when to use specific WBL designs and how to use them effectively.