Cook David A
Division of General Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Acad Med. 2005 Jun;80(6):541-8. doi: 10.1097/00001888-200506000-00005.
Media-comparative research-that is, the comparison of computer-based learning (CBL) to noncomputer instruction-is logically impossible because there are no valid comparison groups. Results from media-comparative studies are thus confounded and difficult to meaningfully interpret. In 1994, Friedman proposed that such research be supplanted by investigations into CBL designs, usage patterns, assessment methods, and integration. His proposal appears to have largely been ignored. In this article, the author updates the agenda for research in CBL (including Web-based learning). While media-comparative studies are confounded, CBL-CBL comparisons are often not. CBL instructional designs vary in configuration (e.g., discussion board or tutorial), instructional method (e.g., case-based learning, personalized feedback, or simulation), and presentation (e.g., screen layout, hyperlinks, or multimedia). Comparisons within one level (for example, comparing two instructional methods) facilitate evidence-based improvements, but comparisons between levels are confounded. Additional research questions within the CBL-CBL framework might include: Does adaptation of CBL in response to individual differences such as prior knowledge, computer experience, or learning style improve learning outcomes? Will integrating CBL with everyday clinical practice facilitate learning? How can simulations augment clinical training? And, how can CBL be integrated within and between institutions? In addressing these questions it is important to remember the most important outcome-effect on patients and practice-and outcomes specific to CBL including costs, cognitive structuring, and learning unique to the computer-based environment. CBL is not a panacea, but holds great promise. Realization of this potential requires that media-comparative studies be replaced by rigorous, theory-guided comparisons of CBL interventions.
媒介比较研究——即基于计算机的学习（CBL）与非计算机教学的比较——在逻辑上是不可能的，因为不存在有效的对照组。因此，媒介比较研究的结果相互混淆，难以进行有意义的解读。1994年，弗里德曼提议用对CBL设计、使用模式、评估方法及整合的调查来取代此类研究。他的提议似乎在很大程度上被忽视了。在本文中，作者更新了CBL（包括基于网络的学习）的研究议程。虽然媒介比较研究相互混淆，但CBL与CBL之间的比较通常并非如此。CBL教学设计在配置（如讨论板或辅导教程）、教学方法（如基于案例的学习、个性化反馈或模拟）和呈现方式（如屏幕布局、超链接或多媒体）方面各不相同。同一层面内的比较（例如，比较两种教学方法）有助于基于证据的改进，但不同层面之间的比较则相互混淆。CBL - CBL框架内的其他研究问题可能包括：根据诸如先验知识、计算机经验或学习风格等个体差异对CBL进行调整是否能提高学习效果？将CBL与日常临床实践相结合是否有助于学习？模拟如何增强临床培训？以及，CBL如何在机构内部和机构之间进行整合？在解决这些问题时，重要的是要记住最重要的结果——对患者和实践的影响——以及CBL特有的结果，包括成本、认知结构和基于计算机环境的独特学习方式。CBL并非万灵药，但前景广阔。要实现这一潜力，需要用对CBL干预措施进行严格的、理论指导的比较来取代媒介比较研究。
