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Academic Medicine:
IT in Medical Education

A Multi-Institutional Randomized Controlled Trial of Adjuvant Web-Based Teaching to Medical Students

Kerfoot, B Price MD, EdM; Baker, Harley EdD; Jackson, Thomas L. MD; Hulbert, William C. MD; Federman, Daniel D. MD; Oates, Robert D. MD; DeWolf, William C. MD

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Abstract

Purpose: To investigate the impact of an adjuvant Web-based teaching program on medical students’ learning during clinical rotations.

Method: From April 2003 to May 2004, 351 students completing clinical rotations in surgery–urology at four U.S. medical schools were invited to volunteer for the study. Web-based teaching cases were developed covering four core urologic topics. Students were block randomized to receive Web-based teaching on two of the four topics. Before and after a designated duration at each institution (ranging one to three weeks), students completed a validated 28-item Web-based test (Cronbach’s alpha = .76) covering all four topics. The test was also administered to a subset of students at one school at the conclusion of their third-year to measure long-term learning.

Results: Eighty-one percent of all eligible students (286/351) volunteered to participate in the study, 73% of whom (210/286) completed the Web-based program. Compared to controls, Web-based teaching significantly increased test scores in the four topics at each medical school (p < .001, mixed analysis of variance), corresponding to a Cohen’s d effect size of 1.52 (95% confidence interval [CI], 1.23–1.80). Learning efficiency was increased three-fold by Web-based teaching (Cohen’s d effect size 1.16; 95% CI 1.13–1.19). Students who were tested a median of 4.8 months later demonstrated significantly higher scores for Web-based teaching compared to non-Web-based teaching (p = .007, paired t-test). Limited learning was noted in the absence of Web-based teaching.

Conclusions: This randomized controlled trial provides Class I evidence that Web-based teaching as an adjunct to clinical experiences can significantly and durably improve medical students’ learning.

© 2006 Association of American Medical Colleges

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