Kerfoot B Price, Baker Harley, Jackson Thomas L, Hulbert William C, Federman Daniel D, Oates Robert D, DeWolf William C
VA Boston Healthcare System, 150 South Huntington Avenue, 151DIA, Jamaica Plain, MA 02130, USA.
Acad Med. 2006 Mar;81(3):224-30. doi: 10.1097/00001888-200603000-00004.
To investigate the impact of an adjuvant Web-based teaching program on medical students' learning during clinical rotations.
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.
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.
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.
探讨基于网络的辅助教学计划对医学生临床实习期间学习的影响。
2003年4月至2004年5月，邀请了在美国四所医学院完成外科 - 泌尿外科临床实习的351名学生自愿参与该研究。开发了涵盖四个核心泌尿外科主题的基于网络的教学案例。学生被整群随机分组，接受四个主题中两个主题的网络教学。在每个机构指定的时间段（一至三周）前后，学生完成了一项经过验证的包含28个项目的网络测试（克朗巴哈系数α = 0.76），涵盖所有四个主题。在一所学校的部分学生三年级结束时也进行了该测试，以衡量长期学习效果。
所有符合条件的学生中有81%（286/351）自愿参与研究，其中73%（210/286）完成了基于网络的课程。与对照组相比，基于网络的教学显著提高了每所医学院四个主题的测试成绩（p < 0.001，混合方差分析），对应的科恩d效应量为1.52（95%置信区间[CI]，1.23 - 1.80）。基于网络的教学使学习效率提高了三倍（科恩d效应量1.16；95% CI 1.13 - 1.19）。在中位时间为4.8个月后接受测试的学生中，基于网络教学的成绩显著高于非网络教学（p = 0.007，配对t检验）。在没有基于网络教学的情况下，学习效果有限。
这项随机对照试验提供了I类证据，表明基于网络的教学作为临床经验的辅助手段可以显著且持久地提高医学生的学习效果。
