Abstract
BackgroundEducational 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.MethodsRealist 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.Results249 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.ConclusionsDifferent 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.
Highlights
Educational courses for doctors and medical students are increasingly offered via the Internet
Complex interventions consist of multiple human components that interact in a non-linear fashion to produce outcomes which are highly context dependent [9,10,11]
Our rationale for using the realist review method is explained in the Methods section below
Summary
Educational courses for doctors and medical students are increasingly offered via the Internet. Cook et al.’s 2008 meta-analysis addressed efficacy, and concluded that, on average, Internet formats were equivalent to non-Internet formats in terms of learner satisfaction and changes in knowledge, skills and behaviour [8]. Their findings indicated that substantial heterogeneity existed and their meta-analysis was unable to account for the complexity of the interactions within their included studies. Complex interventions consist of multiple human components (teachers, learners etc.) that interact in a non-linear fashion to produce outcomes which are highly context dependent [9,10,11]. Our rationale for using the realist review method is explained in the Methods section below
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