title: A multi-institutional randomized controlled trial of adjuvant Web-based teaching to medical students.
abstract: OBJECTIVE
  To investigate the impact of an adjuvant Web-based teaching program on medical students' learning during clinical rotations.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: VA Boston Healthcare System, 150 South Huntington Avenue, 151DIA, Jamaica Plain, MA 02130, USA. drskerfoot@msn.com
authors.forename: B Price
authors.initials: BP
authors.lastname: Kerfoot
authors.forename: Harley
authors.initials: H
authors.lastname: Baker
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Jackson
authors.forename: William C
authors.initials: WC
authors.lastname: Hulbert
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Federman
authors.forename: Robert D
authors.initials: RD
authors.lastname: Oates
authors.forename: William C
authors.initials: WC
authors.lastname: DeWolf
mesh_terms: D004501:Education, Medical / Q000379:methods*; D005260:Female; D013502:General Surgery / Q000193:education; D006801:Humans; D020407:Internet; D007858:Learning; D008297:Male; D012577:Schools, Medical; D013337:Students, Medical; D014572:Urology / Q000193:education