Research Department of Open Learning, Division of Medical Education, UCL, 4th Floor, Holborn Union Building, Whittington Campus, Highgate Hill, London N19 5LW, UK.
BMC Med Educ. 2010 Feb 2;10:12. doi: 10.1186/1472-6920-10-12.
Educational courses for doctors and medical students are increasingly offered via the Internet. Despite much research, course developers remain unsure about what (if anything) to offer online and how. Prospective learners lack evidence-based guidance on how to choose between the options on offer. We aimed to produce theory driven criteria to guide the development and evaluation of Internet-based medical courses.
Realist review - a qualitative systematic review method whose goal is to identify and explain the interaction between context, mechanism and outcome. We searched 15 electronic databases and references of included articles, seeking to identify theoretical models of how the Internet might support learning from empirical studies which (a) used the Internet to support learning, (b) involved doctors or medical students; and (c) reported a formal evaluation. All study designs and outcomes were considered. Using immersion and interpretation, we tested theories by considering how well they explained the different outcomes achieved in different educational contexts.
249 papers met our inclusion criteria. We identified two main theories of the course-in-context that explained variation in learners' satisfaction and outcomes: Davis's Technology Acceptance Model and Laurillard's model of interactive dialogue. Learners were more likely to accept a course if it offered a perceived advantage over available non-Internet alternatives, was easy to use technically, and compatible with their values and norms. 'Interactivity' led to effective learning only if learners were able to enter into a dialogue - with a tutor, fellow students or virtual tutorials - and gain formative feedback.
Different modes of course delivery suit different learners in different contexts. When designing or choosing an Internet-based course, attention must be given to the fit between its technical attributes and learners' needs and priorities; and to ways of providing meaningful interaction. We offer a preliminary set of questions to aid course developers and learners consider these issues.
医生和医学生的教育课程越来越多地通过互联网提供。尽管进行了大量研究，但课程开发者仍然不确定在网上提供什么（如果有的话）以及如何提供。潜在的学习者缺乏关于如何在提供的选项之间进行选择的循证指导。我们旨在制定理论驱动的标准，以指导基于互联网的医学课程的开发和评估。
真实审查 - 一种定性系统审查方法，其目的是识别和解释背景、机制和结果之间的相互作用。我们搜索了 15 个电子数据库和包含文章的参考文献，试图从实证研究中识别出互联网如何支持学习的理论模型，这些研究（a）使用互联网支持学习，（b）涉及医生或医学生；并（c）报告了正式评估。考虑了所有研究设计和结果。通过沉浸式和解释性方法，我们通过考虑它们在不同教育背景下如何解释不同结果来检验理论。
有 249 篇论文符合我们的纳入标准。我们确定了两种主要的课程情境理论，它们解释了学习者满意度和结果的变化：戴维斯的技术接受模型和劳里拉德的互动对话模型。如果课程提供了相对于可用的非互联网替代方案的感知优势、易于使用且与他们的价值观和规范兼容，那么学习者更有可能接受该课程。只有当学习者能够进行对话 - 与导师、同学或虚拟教程 - 并获得形成性反馈时，“互动”才会导致有效的学习。
不同的课程交付模式适合不同背景下的不同学习者。在设计或选择基于互联网的课程时，必须注意其技术属性与学习者的需求和优先级之间的契合度；以及提供有意义的互动方式。我们提供了一组初步问题，以帮助课程开发者和学习者考虑这些问题。
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