title: Uniform instruction using web-based, asynchronous technology in a geographically distributed clinical clerkship: analysis of osteopathic medical student participation and satisfaction.
abstract: BACKGROUND
  As medical schools in the United States increase their class sizes, many institutions are forced to extend their teaching affiliations outside of their immediate communities. Geographic distribution threatens the ability to provide the uniform learning opportunities that students need and accrediting bodies require.
  
  
  OBJECTIVE
  To determine if a Web-based, asynchronous learning module can provide an effective, uniform learning opportunity for osteopathic medical students enrolled in clinical clerkship.
  
  
  METHODS
  Third-year osteopathic medical students enrolled in an 8-week core clinical clerkship in surgery were required to participate in a Web-based, asynchronous, interactive instructional module designed to provide opportunities for higher-order thinking through analysis, synthesis, and reflective learning. The quantity and content of students' online course interactions were analyzed to determine quantitative and qualitative features of their course participation. At the completion of the clerkship, students completed a 10-item Likert-type survey of their experience to determine the most helpful attributes of the Web-based learning module. Responses were assigned numerical values from 1 (strongly disagree) to 5 (strongly agree) to obtain a mean score for each question.
  
  
  RESULTS
  Sixty-three students completed the Web-based module. The content of their discussions, as determined by message coding, identified the critical thinking needed to acquire abstract conceptualization of the problems presented in a typical surgery clerkship. Students found the content of the module relevant to the clerkship (mean score, 4.18) and valued facilitator feedback (4.00). Although they did not prefer Web-based instruction of classroom lecture (2.66), students indicated that the Web-based module enhanced their overall learning experience in the clerkship (3.30).
  
  
  CONCLUSIONS
  Web-based technology in the clinical education of third-year osteopathic medical students appears to afford an acceptable teaching alternative when face-to-face instruction cannot be provided. Further study of the impact of instructional design on the quality of higher-order thinking in this domain is needed, as is an appreciation for the dynamics of group learning in a virtual environment.
authors.affiliation: MEd, 3500 Camp Bowie Blvd, Fort Worth, TX 76107-2644, USA. dpeska@hsc.unt.edu
authors.forename: Don N
authors.initials: DN
authors.lastname: Peska
authors.forename: Kadriye O
authors.initials: KO
authors.lastname: Lewis
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002982:Clinical Clerkship / Q000379:methods*; D002983:Clinical Competence; D003258:Consumer Behavior; D003479:Curriculum; D020375:Education, Distance; D018961:Educational Technology; D005260:Female; D013502:General Surgery / Q000193:education; D005843:Geography; D006801:Humans; D020407:Internet; D008297:Male; D017145:Models, Educational; D010021:Osteopathic Medicine / Q000193:education*; D013337:Students, Medical; D013781:Texas; D055815:Young Adult