Chenkin Jordan, Lee Shirley, Huynh Thien, Bandiera Glen
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Acad Emerg Med. 2008 Oct;15(10):949-54. doi: 10.1111/j.1553-2712.2008.00231.x. Epub 2008 Sep 5.
Web-based learning has several potential advantages over lectures, such as anytime-anywhere access, rich multimedia, and nonlinear navigation. While known to be an effective method for learning facts, few studies have examined the effectiveness of Web-based formats for learning procedural skills. The authors sought to determine whether a Web-based tutorial is at least as effective as a didactic lecture for learning ultrasound-guided vascular access (UGVA).
Participating staff emergency physicians (EPs) and junior emergency medicine (EM) residents with no UGVA experience completed a precourse test and were randomized to either a Web-based or a didactic group. The Web-based group was instructed to use an online tutorial and the didactic group attended a lecture. Participants then practiced on simulators and live models without any further instruction. Following a rest period, participants completed a four-station objective structured clinical examination (OSCE), a written examination, and a postcourse questionnaire. Examination results were compared using a noninferiority data analysis with a 10% margin of difference.
Twenty-one residents and EPs participated in the study. There were no significant differences in mean OSCE scores (absolute difference = -2.8%; 95% confidence interval [CI] = -9.3% to 3.8%) or written test scores (absolute difference = -1.4%; 95% CI = -7.8% to 5.0%) between the Web group and the didactic group. Both groups demonstrated similar improvements in written test scores (26.1% vs. 25.8%; p = 0.95). Ninety-one percent (10/11) of the Web group and 80% (8/10) of the didactic group participants found the teaching format to be effective (p = 0.59).
Our Web-based tutorial was at least as effective as a traditional didactic lecture for teaching the knowledge and skills essential for UGVA. Participants expressed high satisfaction with this teaching technology. Web-based teaching may be a useful alternative to didactic teaching for learning procedural skills.
基于网络的学习相较于讲座具有若干潜在优势，如随时随地可访问、丰富的多媒体资源以及非线性导航。虽然已知其是学习事实性知识的有效方法，但很少有研究考察基于网络的形式在学习操作技能方面的有效性。作者试图确定基于网络的教程在学习超声引导下血管穿刺术（UGVA）方面是否至少与讲授式讲座一样有效。
参与研究的无UGVA经验的急诊科工作人员（EPs）和急诊医学（EM）初级住院医师完成课前测试，并随机分为网络组或讲授组。网络组被指导使用在线教程，讲授组参加讲座。然后，参与者在模拟器和活体模型上练习，不再接受任何进一步指导。休息一段时间后，参与者完成四站式客观结构化临床考试（OSCE）、笔试和课后问卷。使用非劣效性数据分析比较考试结果，差异幅度为10%。
21名住院医师和EPs参与了研究。网络组和讲授组在平均OSCE分数（绝对差异=-2.8%；95%置信区间[CI]=-9.3%至3.8%）或笔试分数（绝对差异=-1.4%；95%CI=-7.8%至5.0%）方面无显著差异。两组在笔试分数上都有类似的提高（26.1%对25.8%；p=0.95）。网络组91%（10/11）的参与者和讲授组80%（8/10）的参与者认为教学形式有效（p=0.59）。
我们的基于网络的教程在教授UGVA所需的知识和技能方面至少与传统讲授式讲座一样有效。参与者对这种教学技术表示高度满意。基于网络的教学可能是学习操作技能的讲授式教学的有用替代方法。
