Office of Education Research, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Acad Med. 2010 May;85(5):909-22. doi: 10.1097/ACM.0b013e3181d6c319.
A recent systematic review (2008) described the effectiveness of Internet-based learning (IBL) in health professions education. A comprehensive synthesis of research investigating how to improve IBL is needed. This systematic review sought to provide such a synthesis.
The authors searched MEDLINE, CINAHL, EMBASE, Web of Science, Scopus, ERIC, TimeLit, and the University of Toronto Research and Development Resource Base for articles published from 1990 through November 2008. They included all studies quantifying the effect of IBL compared with another Internet-based or computer-assisted instructional intervention on practicing and student physicians, nurses, pharmacists, dentists, and other health professionals. Reviewers working independently and in duplicate abstracted information, coded study quality, and grouped studies according to inductively identified themes.
From 2,705 articles, the authors identified 51 eligible studies, including 30 randomized trials. The pooled effect size (ES) for learning outcomes in 15 studies investigating high versus low interactivity was 0.27 (95% confidence interval, 0.08-0.46; P = .006). Also associated with higher learning were practice exercises (ES 0.40 [0.08-0.71; P = .01]; 10 studies), feedback (ES 0.68 [0.01-1.35; P = .047]; 2 studies), and repetition of study material (ES 0.19 [0.09-0.30; P < .001]; 2 studies). The ES was 0.26 (-0.62 to 1.13; P = .57) for three studies examining online discussion. Inconsistency was large (I(2) >or=89%) in most analyses. Meta-analyses for other themes generally yielded imprecise results.
Interactivity, practice exercises, repetition, and feedback seem to be associated with improved learning outcomes, although inconsistency across studies tempers conclusions. Evidence for other instructional variations remains inconclusive.
最近的一项系统评价（2008 年）描述了基于互联网的学习（IBL）在医疗专业教育中的有效性。需要对研究如何提高 IBL 的效果进行全面综合分析。本系统评价旨在提供这样的综合分析。
作者检索了 MEDLINE、CINAHL、EMBASE、Web of Science、Scopus、ERIC、TimeLit 和多伦多大学研究与开发资源库，以获取 1990 年至 2008 年 11 月期间发表的关于 IBL 效果的文章。他们包括所有定量评估 IBL 与另一种基于互联网或计算机辅助教学干预对执业和学生医师、护士、药剂师、牙医和其他卫生专业人员影响的研究。评审员独立并重复地提取信息、编码研究质量，并根据归纳出的主题对研究进行分组。
从 2705 篇文章中，作者确定了 51 项符合条件的研究，其中包括 30 项随机试验。在 15 项研究中，高交互性与低交互性相比，学习效果的汇总效应大小（ES）为 0.27（95%置信区间，0.08-0.46；P=0.006）。与更高的学习效果相关的还有实践练习（ES 0.40 [0.08-0.71；P=0.01]；10 项研究）、反馈（ES 0.68 [0.01-1.35；P=0.047]；2 项研究）和重复学习材料（ES 0.19 [0.09-0.30；P<.001]；2 项研究）。三项关于在线讨论的研究的 ES 为 0.26（-0.62 至 1.13；P=0.57）。大多数分析中存在较大的不一致性（I²≥89%）。对于其他主题的元分析通常产生不精确的结果。
交互性、实践练习、重复和反馈似乎与学习效果的提高有关，但研究之间的不一致性削弱了结论的可信度。关于其他教学变化的证据仍然不确定。
