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<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/"><meta name="dc.Title" content="Computer-based learning versus practical course in pre-clinical education: Acceptance and knowledge retention"><meta name="dc.Creator" content="Klaus-Dietrich Kröncke"><meta name="dc.Description" content="Background: Computer-based learning is a tool that, when designed appropriately, can be used to effectively meet worthy educational goals. Aims: This study aimed to compare acceptance and effectiveness of a tutored computer-based practical course (CPC) with a traditional biochemical laboratory experiment in pre-clinical medical education. Method: Under quasi-randomised conditions two cohorts of second-year medical students performed either a CPC or a laboratory experiment. Students’ perceptions were obtained by assessment questionnaires, knowledge retention was investigated by post test. Results: The students evaluated the CPC highly significantly better than the laboratory experiment. Students performing the CPC demonstrated a statistically significant greater knowledge retention compared to students who performed the laboratory experiment. Conclusions: These findings show that learning objectives concerning basic biochemical knowledge can be acquired in a CPC and that medical students accept such a CPC ..."><meta name="dc.Publisher" content=" Informa UK Ltd UK "><meta name="dc.Date" scheme="WTN8601" content="2010-04-27"><meta name="dc.Type" content="research-article"><meta name="dc.Format" content="text/HTML"><meta name="dc.Identifier" scheme="doi" content="10.3109/01421590903394611"><meta name="dc.Identifier" scheme="publisher-id" content="439639"><meta name="dc.Source" content="http://dx.doi.org/10.3109/01421590903394611"><meta name="dc.Language" content="en"><meta name="dc.Coverage" content=" UK "><meta name="dc.Rights" content="© 2010 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted">
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<!-- Start full text content -->
<!-- abstract content --><div class="arttitle">Computer-based learning versus practical course in pre-clinical education: Acceptance and knowledge retention</div><p class="fulltext"></p><div>
2010, Vol. 32, No. 5
,
Pages 408-413
(doi:10.3109/01421590903394611)
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</a></li><li><a href="http://informahealthcare.com/page/publishingservices/reprints">Reprints</a></li><li><a href="http://comms.informahealthcare.com/our_services_and_products/permissions">Permissions</a></li></ul></div><contrib-group xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"> <a class="entryAuthor" href="http://informahealthcare.com/action/doSearch?action=runSearch&type=advanced&result=true&prevSearch=%2Bauthorsfield%3A%28Kr%25C3%25B6ncke%252C%2BKlaus%255C-Dietrich%29">Klaus-Dietrich Kröncke</a><a class="ref" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=end-a1&doi=10.3109/01421590903394611"></a><a class="ref" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=cn1&doi=10.3109/01421590903394611"><sup>*</sup></a><div class="NLM_bio"><p class="first last">KLAUS-DIETRICH
KRÖNCKE, PhD, is professor at the Institute of Biochemistry and
Molecular Biology I at the Medical Faculty of the
Heinrich-Heine-University of Düsseldorf. The work described here is part
of his master thesis of the german postgraduate course ‘Master of
Medical Education’.</p></div> <p class="fulltext">Medical Department of the Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany</p> </contrib-group><div class="NLM_author-notes"> <div class="NLM_corresp"><sup>*</sup><i>Correspondence</i>:
Klaus-Dietrich Kröncke, Institute of Biochemistry and Molecular Biology
I, Heinrich-Heine-University of Düsseldorf, Universitätsstr. 1, D-40225
Düsseldorf, Germany <span class="phone">+49-211-81-15695</span> <span class="fax">+49-211-81-13029</span> <a href="mailto:kroencke@uni-duesseldorf.de">kroencke@uni-duesseldorf.de</a></div> </div><p class="fulltext"></p><br clear="all"><a name="abstract"></a><br clear="right"><table class="sectionHeading" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><th align="left" valign="middle" width="95%">ABSTRACT</th><td class="sectionHeading" width="62" height="16" nowrap="nowrap"><span class="fulltext">Section:</span></td><td class="sectionHeading" align="right" valign="middle" width="92" height="16" nowrap="nowrap"><form style="margin-bottom: 0pt;"><select name="select23" class="fulltextdd" onchange="GoTo(this, 'self')"><option selected="selected">Choose</option><option value="#">Top of page</option><option value="">ABSTRACT <<</option><option value="#h1">Introduction</option><option value="#h2">Methods</option><option value="#h10">Results</option><option value="#h14">Discussion</option><option value="#h15">Conclusions</option><option value="#h16">Acknowledgements</option><option value="#h17">References</option></select></form></td><td class="sectionHeading" align="right" valign="middle" width="10" height="16" nowrap="nowrap"><img src="Computer-basedLearning_files/10x10_spacer.gif" alt="" width="10" height="10"></td><td bgcolor="#ffffff" width="16" height="16" nowrap="nowrap"><a href="#h1"><img src="Computer-basedLearning_files/arrow_down.gif" alt="Next section" border="0" width="11" height="9" hspace="5"></a></td></tr></tbody></table><p class="fulltext"></p><div class="abstractSection"> <p class="first"><b>Background:</b> Computer-based learning is a tool that, when designed appropriately, can be used to effectively meet worthy educational goals.</p> <p><b>Aims:</b>
This study aimed to compare acceptance and effectiveness of a tutored
computer-based practical course (CPC) with a traditional biochemical
laboratory experiment in pre-clinical medical education.</p> <p><b>Method:</b>
Under quasi-randomised conditions two cohorts of second-year medical
students performed either a CPC or a laboratory experiment. Students’
perceptions were obtained by assessment questionnaires, knowledge
retention was investigated by post test.</p> <p><b>Results:</b> The
students evaluated the CPC highly significantly better than the
laboratory experiment. Students performing the CPC demonstrated a
statistically significant greater knowledge retention compared to
students who performed the laboratory experiment.</p> <p class="last"><b>Conclusions:</b>
These findings show that learning objectives concerning basic
biochemical knowledge can be acquired in a CPC and that medical students
accept such a CPC as a substitute for a real laboratory experiment.</p></div><!-- /abstract content --><!-- fulltext content --><div id="ss1" class="NLM_sec NLM_sec_level_1"><a name="h1"><!-- title --></a><br clear="right"><table class="sectionHeading" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><th align="left" valign="middle" width="95%">Introduction</th><td class="sectionHeading" width="62" height="16" nowrap="nowrap"><span class="fulltext">Section:</span></td><td class="sectionHeading" align="right" valign="middle" width="92" height="16" nowrap="nowrap"><form style="margin-bottom: 0pt;"><select name="select23" class="fulltextdd" onchange="GoTo(this, 'self')"><option selected="selected">Choose</option><option value="#">Top of page</option><option value="#abstract">ABSTRACT</option><option value="">Introduction <<</option><option value="#h2">Methods</option><option value="#h10">Results</option><option value="#h14">Discussion</option><option value="#h15">Conclusions</option><option value="#h16">Acknowledgements</option><option value="#h17">References</option></select></form></td><td class="sectionHeading" align="right" valign="middle" width="10" height="16" nowrap="nowrap"><img src="Computer-basedLearning_files/10x10_spacer.gif" alt="" width="10" height="10"></td><td bgcolor="#ffffff" width="16" height="16" nowrap="nowrap"><a href="#abstract"><img src="Computer-basedLearning_files/arrow_up.gif" alt="Previous section" border="0" width="11" height="9" hspace="5"></a><a href="#h2"><img src="Computer-basedLearning_files/arrow_down.gif" alt="Next section" border="0" width="11" height="9" hspace="5"></a></td></tr></tbody></table> <p>Electronic
learning tools offer an exciting potential for improving student
learning, either as an aid to or as a replacement for traditional
teaching methods. Particularly in medical education there is a rapid
expansion of e-learning tools (Ellaway & Masters <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b7&doi=10.3109/01421590903394611">2008</a>; Masters & Ellaway <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b12&doi=10.3109/01421590903394611">2008</a>), and computer-based applications are now part of modern medical curricula all over the world (Ruiz et al. <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b16&doi=10.3109/01421590903394611">2006</a>). Most of these e-learning applications are web-based learning or teaching programs (e.g. Colsman et al. <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b2&doi=10.3109/01421590903394611">2006</a> and websites cited therein; see also the webside ‘The Multimedia Educational Resource for Learning and Online Teaching’: <a class="ref" href="http://www.merlot.org/" target="url">http://www.merlot.org</a>).
To date implementation or evaluation of only a few e-learning
practicals for medical students have been published (Dwyer et al. <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b6&doi=10.3109/01421590903394611">1997</a>; Hughes <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b9&doi=10.3109/01421590903394611">2001</a>; Levine <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b11&doi=10.3109/01421590903394611">2002</a>; Hoa et al. <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b8&doi=10.3109/01421590903394611">2006</a>; Dantas & Kemm <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b5&doi=10.3109/01421590903394611">2008</a>).</p> <p>We
recently have implemented a tutor-supported computer-based practical
biochemistry course ‘Polymerase Chain Reaction (PCR)’ in our curriculum.
Second-year medical students learn essential features of the PCR with
the aid of embedded text and audiovisual animations, respectively,
search for specific PCR-relevant data in PubMed, and finally solve
medical-related PCR tasks. The students have evaluated this
computer-based practical course (CPC) very positively (Kröncke &
Becher <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b10&doi=10.3109/01421590903394611">2008</a>). We therefore decided to devise further tutor-supported CPCs.</p> <p class="last">In
one of our compulsory biochemical laboratory experiments pre-clinical
medical students measure the oxygen consumption of isolated rat liver
mitochondria under various conditions. Learning objective is to get a
deeper insight into the biochemical mechanism of respiration and energy
generation in the human body. Here the implementation of a tutored CPC
containing an interactive computer software virtually simulating the
oxygen consumption of mitochondria is described. This new devised
learning unit also contains textual information, embedded images and
visual animations about ‘energy generation in humans and poisoning with
cyanide, carbon monoxide, and uncouplers of the respiratory chain’ for
self-studies as well as formative self-tests. This study aimed to
investigate student acceptance of the CPC and to investigate whether
students performing CPC demonstrate greater knowledge retention compared
to students performing the ‘wet’ laboratory experiment.</p><center class="fulltext"><table id="_e1" border="0" cellpadding="0" cellspacing="0" width="95%"><tbody><tr bgcolor="#e1e1e1"><td><table cellpadding="2" cellspacing="2"><tbody><tr bgcolor="#e1e1e1"><td align="center" bgcolor="#ffffff" valign="top"><a class="ref" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=_e1&doi=10.3109/01421590903394611"><img src="Computer-basedLearning_files/dummy_table_thumb.gif" alt="Data table" align="bottom" border="1" width="150" height="100"></a></td><td align="left" valign="top"><p class="fulltext" align="left">Table</p></td></tr></tbody></table></td></tr></tbody></table></center></div><div id="ss2" class="NLM_sec NLM_sec_level_1"><a name="h2"><!-- title --></a><br clear="right"><table class="sectionHeading" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><th align="left" valign="middle" width="95%">Methods</th><td class="sectionHeading" width="62" height="16" nowrap="nowrap"><span class="fulltext">Section:</span></td><td class="sectionHeading" align="right" valign="middle" width="92" height="16" nowrap="nowrap"><form style="margin-bottom: 0pt;"><select name="select23" class="fulltextdd" onchange="GoTo(this, 'self')"><option selected="selected">Choose</option><option value="#">Top of page</option><option value="#abstract">ABSTRACT</option><option value="#h1">Introduction</option><option value="">Methods <<</option><option value="#h10">Results</option><option value="#h14">Discussion</option><option value="#h15">Conclusions</option><option value="#h16">Acknowledgements</option><option value="#h17">References</option></select></form></td><td class="sectionHeading" align="right" valign="middle" width="10" height="16" nowrap="nowrap"><img src="Computer-basedLearning_files/10x10_spacer.gif" alt="" width="10" height="10"></td><td bgcolor="#ffffff" width="16" height="16" nowrap="nowrap"><a href="#h1"><img src="Computer-basedLearning_files/arrow_up.gif" alt="Previous section" border="0" width="11" height="9" hspace="5"></a><a href="#h10"><img src="Computer-basedLearning_files/arrow_down.gif" alt="Next section" border="0" width="11" height="9" hspace="5"></a></td></tr></tbody></table> <div id="ss3" class="NLM_sec NLM_sec_level_2"><span class="title2" id="d3277414e300">Study design and participants</span> <p>The study was designed as an experimental field study (<a class="ref" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=F0001&doi=10.3109/01421590903394611">Figure 1</a>). Ethical approval to the study was given by the ethics committee of the Heinrich-Heine-University of Düsseldorf. <a name="F0001"><!-- FIG --></a></p><p class="fulltext"></p><br clear="right"><center><table cellpadding="0" cellspacing="0" width="95%"><tbody><tr bgcolor="#e1e1e1"><td><table cellpadding="5" cellspacing="5"><tbody><tr bgcolor="#e1e1e1"><td align="center" bgcolor="#ffffff" valign="top"><a class="ref" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=F0001&doi=10.3109/01421590903394611"><img src="Computer-basedLearning_files/01421590903394611f0001g.gif" alt="" align="bottom" border="1"><br><strong>View larger version</strong> (54K)<br><br></a></td><td align="left" valign="top" width="100%"><div class="short-legend"> <p class="first last"><span class="captionLabel">Figure 1.</span> Study flow chart.</p></div><br clear="left"></td></tr></tbody></table></td></tr></tbody></table></center><br> <p>The
grouping of all second-year medical students into 21 groups (maximum:
16 students) in the winter semester 2007/08 was adopted from the
previous semester. Neither students nor lecturers of the Institute of
Biochemistry and Molecular Biology I had any influence on that.</p> <p>In
Düsseldorf medical students perform a biochemical practical training in
the third semester. A written description of the laboratory experiments
including workflows and theoretical background information is always
available for the students in the intranet of the university. In
30-minute introductory seminars prior to each laboratory experiment
lecturers discuss the topic with the student groups. Student knowledge
about the theoretical background of the respective experiment is audit
tested by the lecturers, and ill preparation leads to exclusion from the
respective practical course. Thus, all students have a similar
theoretical knowledge prior to performing the laboratory experiments.</p> <p>Groups
with odd numbers carried out the traditional laboratory experiment and
groups with even numbers the CPC, but this was not announced. To avoid
any lecturer bias the same 2 lecturers A and B contemporaneously
performed the introductory seminars in turns with respect to groups with
odd or even numbers using the same PowerPoint slides. To evaluate the
students’ motivation to perform the subsequent learning unit the
students were asked to respond to an anonymous questionnaire containing 5
rating-type questions with a 6-point Likert scale (1 = ‘strongly agree’
or ‘very high’ to 6 = ‘strongly disagree’ or ‘very low’). After
completion of the motivation questionnaire the groups were told to
perform the laboratory experiment or the CPC.</p> <div id="ss4" class="NLM_sec NLM_sec_level_3"><span class="title3" id="d3277414e327">Laboratory course</span> <p class="last">Students
in groups of 4 measured the oxygen consumption of isolated rat liver
mitochondria under various conditions, e.g. after addition of
dinitrophenole (DNP; uncoupler of the respiratory chain) and cyanide,
respectively. Results were recorded and printed, and the students
calculated the respiratory control index Q as well as the P:O ratio. Two
educational assistants supervised the students. No formative feedback
test was performed. Including the calculations, the laboratory course
lasted about 2 hours.</p></div> <div id="ss5" class="NLM_sec NLM_sec_level_3"><span class="title3" id="d3277414e335">Computer-based practical course (CPC)</span> <p class="last">Students
in twos in their own time and at their own pace measured with an
interactive computer software the simulated oxygen consumption of
mitochondria under various conditions. Resulting graphs were printed and
the students calculated Q and P:O similar as the students performing
the laboratory experiment. Including the calculations the students
needed about 1 h for the virtual experiment. Three educational
assistants supervised and helped the students with the calculations.
After completing the calculations the student teams left the room for a
10–15 minute break. The students in twos then performed self-studies on
the generation of ATP in humans under aerobic, anaerobic and fasting
conditions as well as on symptoms and therapies of poisonings with
cyanide, carbon monoxide, and DNP. The self-study consisted of a
learning path containing text (e.g. a real-life intoxication case with
DNP) with keywords linked to images and flash animations. Finally the
students in twos performed 2 formative self-tests on the computer. After
filling out 15 cloze deletion test questions they automatically got
their own answers presented together with a predefined ‘optimal’ answer.
They then answered 2 × 10 multiple-choice (MC) test questions by
selecting one correct out of 5 items. At the end the results were
automatically shown to them. During the self-study and the self-tests
only 1 educational assistant was present to answer questions. The whole
computer-based learning unit including the break lasted about 2–2.5
hours.</p></div> <div id="ss6" class="NLM_sec NLM_sec_level_3"><span class="title3" id="d3277414e342">Contentment evaluation</span> <p class="last">Immediately
after the laboratory courses or the CPCs the students were asked to
respond to an anonymous contentment questionnaire containing 12
rating-type questions with a 6-point Likert scale (1 = ‘strongly agree’
or ‘very good/school grade 1’ to 6 = ‘strongly disagree’ or ‘very
bad/school grade 6’) and 3 free text questions (‘what was very good?’,
‘what was very bad?’, ‘what should be improved?’). The questionnaires
were electronically scanned and statistically analysed using SPSS. Free
text comments were transcribed and thematically analysed to determine
the number of students who made similar comments.</p></div> <div id="ss7" class="NLM_sec NLM_sec_level_3"><span class="title3" id="d3277414e349">Randomisation verification</span> <p class="last">The
compulsory biochemical MC test written about 2 weeks after the teaching
sessions was used to verify the randomisation of the study
participants. The test contained 40 questions but no specific questions
from the self-studies or self-tests of the CPC.</p></div> <div id="ss8" class="NLM_sec NLM_sec_level_3"><span class="title3" id="d3277414e356">Knowledge test</span> <p class="last">At
the beginning of seminars in biochemistry or physiology about 3 months
after the teaching sessions the students were unannounced asked to
voluntarily fill out a knowledge questionnaire. Students were assured
that the test results were treated confidentially. To improve
motivation, 3 book coupons (100.- EURO each) were advertised to be drawn
by lot under all students participating under their name. To make it
more difficult to copy answers from a neighbour, 3 versions of the
questionnaire were distributed which differed only in the sequences of
the 5 free text and the 5 cloze deletion test questions. The students
needed about 15–20 min for the test with no imposed time limit. The
questionnaires were numbered and copied twice without the students’
names. Two lecturers of the Institute of Biochemistry and Molecular
Biology I, which otherwise were not involved in the study, independently
assessed the copied and blinded questionnaires. With an assessment
template they both scored the answers to the free text questions (0–4/5
points) and to the cloze deletion test questions (0–1 points).
Assignment of 0.5 points was permissible. In case of significant score
differences (>1.5 points for a free text answer or >0.5 points for
a cloze test answer), the 2 referees were asked to discuss their
different scores with each other and to eventually modify them.
Subsequently the scores were averaged and unblinded.</p></div></div> <div id="ss9" class="NLM_sec NLM_sec_level_2"><span class="title2" id="d3277414e363">Statistical analysis</span> <p class="last">Analysis was performed using Students’ <i>t</i> test (two tailed for independent samples) with <i>p</i> < 0.05 considered as significant.</p></div></div><div id="ss10" class="NLM_sec NLM_sec_level_1"><a name="h10"><!-- title --></a><br clear="right"><table class="sectionHeading" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><th align="left" valign="middle" width="95%">Results</th><td class="sectionHeading" width="62" height="16" nowrap="nowrap"><span class="fulltext">Section:</span></td><td class="sectionHeading" align="right" valign="middle" width="92" height="16" nowrap="nowrap"><form style="margin-bottom: 0pt;"><select name="select23" class="fulltextdd" onchange="GoTo(this, 'self')"><option selected="selected">Choose</option><option value="#">Top of page</option><option value="#abstract">ABSTRACT</option><option value="#h1">Introduction</option><option value="#h2">Methods</option><option value="">Results <<</option><option value="#h14">Discussion</option><option value="#h15">Conclusions</option><option value="#h16">Acknowledgements</option><option value="#h17">References</option></select></form></td><td class="sectionHeading" align="right" valign="middle" width="10" height="16" nowrap="nowrap"><img src="Computer-basedLearning_files/10x10_spacer.gif" alt="" width="10" height="10"></td><td bgcolor="#ffffff" width="16" height="16" nowrap="nowrap"><a href="#h2"><img src="Computer-basedLearning_files/arrow_up.gif" alt="Previous section" border="0" width="11" height="9" hspace="5"></a><a href="#h14"><img src="Computer-basedLearning_files/arrow_down.gif" alt="Next section" border="0" width="11" height="9" hspace="5"></a></td></tr></tbody></table> <p>In
the winter semester 2007/08, within 2 weeks 162 students (64.8% female,
35.2% male) in 11 groups went through the computer-based practical
e-learning course (E) and 133 students (60.9% female, 39.1% male) in 10
groups through the laboratory course (L). To verify the motivation of
the students to do these learning units, an anonymous motivation
evaluation was carried out directly after the introductory seminars and
prior to the announcement, which group will perform E and which will
perform L. The questionnaires were completed by 162 E-students (100%)
and by 132 L-students (99.3%). With the exception of question 1, no
statistically significant differences were found between the motivations
and expectations of the students who subsequently performed E or L (<a class="ref" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=T0001&doi=10.3109/01421590903394611">Table 1</a> </p><center class="fulltext"><table id="T0001" border="0" cellpadding="0" cellspacing="0" width="95%"><tbody><tr bgcolor="#e1e1e1"><td><table cellpadding="2" cellspacing="2"><tbody><tr bgcolor="#e1e1e1"><td align="center" bgcolor="#ffffff" valign="top"><a class="ref" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=T0001&doi=10.3109/01421590903394611"><img src="Computer-basedLearning_files/dummy_table_thumb.gif" alt="Data table" align="bottom" border="1" width="150" height="100"></a></td><td align="left" valign="top"><div class="short-legend"> <p class="first last"><span class="captionLabel">Table 1.<img src="Computer-basedLearning_files/2003.gif" alt="" class="entityA" align="bottom"></span> Means (standard deviations) for the ratings* on the survey questions from the students' motivation evaluation</p></div></td></tr></tbody></table></td></tr></tbody></table></center>).
Subgroup analysis for question 1 shows that there were no statistically
significant differences between E and L with respect to the lecturers A
or B. This indicates that the students did not know, whether they would
go to do E or L. In addition, it appears as if there was no lecturer
bias. <div id="ss11" class="NLM_sec NLM_sec_level_2"><span class="title2" id="d3277414e482">Learner satisfaction</span> <p>Directly
after completion of the laboratory courses or the CPCs the students
were asked to fill out an anonymous contentment questionnaire. Of the
E-students, 156 (96.3%) completed the questionnaire, of the L-students
only 117 students (88.0%), because unfortunately in one L-group the
evaluation questionnaires were not distributed. <a class="ref" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=F0002&doi=10.3109/01421590903394611">Figure 2</a>
shows the ratings on selected questions from the students’ survey. All
questions shown were highly significantly better rated by the E-students
showing that the students liked the CPC better. <a name="F0002"><!-- FIG --></a></p><p class="fulltext"></p><br clear="right"><center><table cellpadding="0" cellspacing="0" width="95%"><tbody><tr bgcolor="#e1e1e1"><td><table cellpadding="5" cellspacing="5"><tbody><tr bgcolor="#e1e1e1"><td align="center" bgcolor="#ffffff" valign="top"><a class="ref" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=F0002&doi=10.3109/01421590903394611"><img src="Computer-basedLearning_files/01421590903394611f0002g.gif" alt="" align="bottom" border="1"><br><strong>View larger version</strong> (39K)<br><br></a></td><td align="left" valign="top" width="100%"><div class="short-legend"> <p class="first last"><span class="captionLabel">Figure 2.</span>
Results of the survey questions from the students’ contentment
evaluation. Values are Likert ratings showing the percentages of
students responding in each of 6 levels together with average ratings ±
standard deviations (SD) and <i>p</i> values. TU = teaching unit.</p></div><br clear="left"></td></tr></tbody></table></td></tr></tbody></table></center><br> <p class="last">In
the E-groups 81 students (51.9%) and in the L-groups 53 students
(45.3%) answered at least one free text question. In both E- and
L-groups the introductory seminar (8.3% of all E-students vs. 14.5% of
all L-students) and the helpful educational assistants (6.4% vs. 9.4%)
were most frequently mentioned positively. In the E-groups, 10 students
(6.4%) appreciated that the experiment was performed via computer, 9
students (5.8%) liked the cloze and the MC self-tests, respectively, and
6 students (3.8%) appreciated, that the experiment could be repeated by
pressing a ‘reset’ button. Only 2 students (1.3%) mentioned that they
did not like the working on a computer. All other clustered commentaries
were given by less than 3.8% of the students. Particularly noticeable,
no clustered improvement proposals were given by more than 4 students.</p></div> <div id="ss12" class="NLM_sec NLM_sec_level_2"><span class="title2" id="d3277414e506">Randomisation verification</span> <p class="last">About
2 weeks after the teaching sessions, 139 E-students (85.5% of those who
had performed the CPC) and 109 L-students (82.0% of those who had
performed the laboratory experiment), respectively, participated in the
compulsory biochemical MC test. Mean test scores for the E-students
(63.6% female, 36.4 male) were 45.6 ± 14.9 and for the L-students (60.7%
female, 39.3% male) 48.6 ± 13.5 (maximum = 80). The difference of 3
scores was found to be not statistically significant (<i>p</i> = 0.099). This shows that the quasi-randomisation of the students into E- or L-groups had been successful.</p></div> <div id="ss13" class="NLM_sec NLM_sec_level_2"><span class="title2" id="d3277414e516">Learning outcomes</span> <p>About
3 months after the practical courses all students who participated in
seminars of biochemistry or physiology were unannounced asked to
voluntarily fill out a knowledge questionnaire. Of the 292 seminar
participants 246 (84.2%) completed the knowledge questionnaires. Marked
with names were 214 questionnaires (71.2%), while 32 (13.0%) were
completed anonymously.</p> <p class="last">Students were divided into E (e-learning group; <i>n</i> = 87; 63.2% female, 36.8% male), L (laboratory experiment group; <i>n</i> = 87; 59.8% female, 40.2% male), and C (control group = students which neither had participated in E or L; <i>n</i>
= 40; 57.5% female, 42.5% male). E-students were 22.8 ± 2.4, L-students
23.7 ± 4.1, and C-students 24.8 ± 5.4 years old with only the
difference between E and C being statistically significant (<i>p</i> = 0.032). In <a class="ref" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=F0003&doi=10.3109/01421590903394611">Figure 3</a>
total test scores (maximum = 28) as well as the sum of the scores of
the free text and of the cloze test questions are shown including
minimum and maximum scores achieved. Students of the E-groups scored
better than students of the L- and of the C-groups. The differences were
small but statistically significant, with the exception of the
difference between E and L concerning the cloze test results. <a name="F0003"><!-- FIG --></a></p><p class="fulltext"></p><br clear="right"><center><table cellpadding="0" cellspacing="0" width="95%"><tbody><tr bgcolor="#e1e1e1"><td><table cellpadding="5" cellspacing="5"><tbody><tr bgcolor="#e1e1e1"><td align="center" bgcolor="#ffffff" valign="top"><a class="ref" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=F0003&doi=10.3109/01421590903394611"><img src="Computer-basedLearning_files/01421590903394611f0003g.gif" alt="" align="bottom" border="1"><br><strong>View larger version</strong> (28K)<br><br></a></td><td align="left" valign="top" width="100%"><div class="short-legend"> <p class="first last"><span class="captionLabel">Figure 3.</span>
Students’ scores of the knowledge test. Shown are average scores ±
standard deviations of students performing the e-learning unit (E), the
laboratory experiment (L) or neither of them (C = control group).
Numbers above the brackets represent <i>p</i>-values. Minimum and maximum scores achieved are given in the columns.</p></div><br clear="left"></td></tr></tbody></table></td></tr></tbody></table></center><br> </div></div><div id="ss14" class="NLM_sec NLM_sec_level_1"><a name="h14"><!-- title --></a><br clear="right"><table class="sectionHeading" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><th align="left" valign="middle" width="95%">Discussion</th><td class="sectionHeading" width="62" height="16" nowrap="nowrap"><span class="fulltext">Section:</span></td><td class="sectionHeading" align="right" valign="middle" width="92" height="16" nowrap="nowrap"><form style="margin-bottom: 0pt;"><select name="select23" class="fulltextdd" onchange="GoTo(this, 'self')"><option selected="selected">Choose</option><option value="#">Top of page</option><option value="#abstract">ABSTRACT</option><option value="#h1">Introduction</option><option value="#h2">Methods</option><option value="#h10">Results</option><option value="">Discussion <<</option><option value="#h15">Conclusions</option><option value="#h16">Acknowledgements</option><option value="#h17">References</option></select></form></td><td class="sectionHeading" align="right" valign="middle" width="10" height="16" nowrap="nowrap"><img src="Computer-basedLearning_files/10x10_spacer.gif" alt="" width="10" height="10"></td><td bgcolor="#ffffff" width="16" height="16" nowrap="nowrap"><a href="#h10"><img src="Computer-basedLearning_files/arrow_up.gif" alt="Previous section" border="0" width="11" height="9" hspace="5"></a><a href="#h15"><img src="Computer-basedLearning_files/arrow_down.gif" alt="Next section" border="0" width="11" height="9" hspace="5"></a></td></tr></tbody></table> <p>Very
few medical students will ever need biochemical laboratory skills, and
undergraduate biochemical laboratory experiments are primarily performed
to illustrate and to reinforce theoretical biochemical knowledge. A
tutor-supported lesson combining a virtual and interactive simulation of
a biochemical experiment with text, images, animations, and a learner
control via questions and immediate feedback was devised and
implemented. Data handling and interpretation was similar as in the
parallel performed laboratory experiment. It was evaluated whether the
students accepted this computer-based learning unit as a substitute for a
real laboratory experiment and whether graduation from this
computer-based learning resulted in greater knowledge retention compared
to graduation from the ‘wet’ laboratory practical.</p> <p>The study
participants were not randomised due to the rigid schedule of lessons in
the third semester, but the results of the compulsory biochemical MC
test showed that the study was performed under quasi-randomised
conditions. The students evaluated the CPC significantly better than the
laboratory experiment, although a positive amplification effect due to
cross-communication cannot be excluded. In an unannounced knowledge test
concerning the topic of the teaching sessions 3 months later the
E-students scored better than the L-students, although the 2 cohorts had
a similar theoretical knowledge before the learning units and despite
the fact that the students had learned for the compulsory biochemistry
test which was performed between the teaching sessions and the post
test. This may explain why the scoring differences were small, although
they were statistically significant.</p> <p>It is thought that active exchanges with others enhances student performance and satisfaction (e.g. Michael <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b13&doi=10.3109/01421590903394611">2006</a>; Braeckman et al. <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b1&doi=10.3109/01421590903394611">2008</a>).
With regard to activities, engagement, guidance, feedback, and repeated
and individualised practice the implemented CPC offers a range of
advantages. Students doing the CPC benefit from being more active, as
they perform the virtual experiment in twos compared to 4 students
performing the laboratory experiment, and as they additionally perform
self-studies and self-tests about the medical relevance and the
theoretical background of the biochemical experiment. In addition, the
E-students spent more time in the e-learning than in the laboratory
course (2–2.5 h versus 2 h), and their attention was directed towards
the specific learning objectives without distraction of laboratory
manipulations required in the real experiment. Moreover, the more
positive educational climate in a team of 2 compared to a team of 4, and
the more flexible options of computers compared to the quite rigid
scheduled environment in a laboratory may have also positively
influenced the learning outcome. Furthermore we noticed that the
E-students discussed a lot during the virtual experiment, the
self-studies and the self-tests, either in their teams but also between
the teams. This is in line with findings that students like to do
e-learning with a partner (Rawson & Quinlan <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b15&doi=10.3109/01421590903394611">2002</a>).
In the laboratory, where 4 students work together, individual students
can hide and not reveal their weakness. In contrast, in the CPC the
students are under higher social pressure to collaborate and to
understand the content of the learning unit. It is therefore not
surprising that in the unannounced knowledge test the E-students scored
significantly better than the L- or the C-students. This indicates that
the computer-based learning unit is more effective than the laboratory
experiment with respect to knowledge retention, although duration of the
teaching sessions as well as supervision expenses all in all are
comparable.</p> <p>With 8.0 ± 2.8 and 6.7 ± 2.8 (maximum score: 28),
respectively, the knowledge test results appear to be not very
satisfactory. So the question is allowed whether we really can talk
about knowledge retention. However, the students were totally unprepared
to perform the knowledge test, and it was a formative test with a low
motivation to score well. In addition, free text questions (maximum
score: 23) are always rather challenging for students. The results of
the cloze deletion test questions (maximum score: 5) were much better,
because these kind of questions are quite easy to answer. Furthermore,
the E-students scored nearly twice as high as the C-students (4.1 ± 2.8
scores) which had performed neither E nor L and thus served as a control
group. This indicates that really knowledge retention and not just
recall was measured.</p> <p class="last">A recent meta-analysis showed
that internet-based learning is associated with large positive effects
compared with no intervention, but that effects compared with
non-internet instructional methods are heterogeneous and generally
small, thus suggesting effectiveness similar to traditional methods
(Cook et al. <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b3&doi=10.3109/01421590903394611">2008</a>).
David Cook in this journal stated that e-learning research to date has
done little to inform educational practice and that further
no-intervention-controlled studies or comparisons with traditional
instructional methods are not needed (Cook <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b4&doi=10.3109/01421590903394611">2009</a>).
This may indeed be true for web-based, but not for other computer-based
learning units, e.g. tutor-supported computer-based practicals. To date
only few studies have been published which describe the implementation
of e-learning practicals in medical education, and only some of these
papers contain measurements of knowledge retention compared to
traditional laboratory practicals (Hughes <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b9&doi=10.3109/01421590903394611">2001</a>; Sancho <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b17&doi=10.3109/01421590903394611">2006</a>; Dantas & Kemm <a class="ref NLM_xref-bibr" href="http://informahealthcare.com/action/showPopup?citid=citart1&id=b5&doi=10.3109/01421590903394611">2008</a>).
However, summative tests in form of MC test questions were used, and no
active knowledge in form of unannounced free text questions was
inspected. Also differences in the study design and the quality of the
e-learning courses make it difficult to compare the here described
results with results from the above cited studies.</p></div><div id="ss15" class="NLM_sec NLM_sec_level_1"><a name="h15"><!-- title --></a><br clear="right"><table class="sectionHeading" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><th align="left" valign="middle" width="95%">Conclusions</th><td class="sectionHeading" width="62" height="16" nowrap="nowrap"><span class="fulltext">Section:</span></td><td class="sectionHeading" align="right" valign="middle" width="92" height="16" nowrap="nowrap"><form style="margin-bottom: 0pt;"><select name="select23" class="fulltextdd" onchange="GoTo(this, 'self')"><option selected="selected">Choose</option><option value="#">Top of page</option><option value="#abstract">ABSTRACT</option><option value="#h1">Introduction</option><option value="#h2">Methods</option><option value="#h10">Results</option><option value="#h14">Discussion</option><option value="">Conclusions <<</option><option value="#h16">Acknowledgements</option><option value="#h17">References</option></select></form></td><td class="sectionHeading" align="right" valign="middle" width="10" height="16" nowrap="nowrap"><img src="Computer-basedLearning_files/10x10_spacer.gif" alt="" width="10" height="10"></td><td bgcolor="#ffffff" width="16" height="16" nowrap="nowrap"><a href="#h14"><img src="Computer-basedLearning_files/arrow_up.gif" alt="Previous section" border="0" width="11" height="9" hspace="5"></a><a href="#h16"><img src="Computer-basedLearning_files/arrow_down.gif" alt="Next section" border="0" width="11" height="9" hspace="5"></a></td></tr></tbody></table> <p class="last">This
study shows that a computer-based practical course can provide a
learning tool that is more effective than a ‘wet’ laboratory experiment
for developing knowledge retention and understanding that does not
involve practical details of the experimental methods used, and that
medical students accept such a CPC as a substitute for a real laboratory
experiment.</p></div><div class="NLM_sec NLM_sec_level_1"><a name="h16"><!-- title --></a><br clear="right"><table class="sectionHeading" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><th align="left" valign="middle" width="95%">Acknowledgements</th><td class="sectionHeading" width="62" height="16" nowrap="nowrap"><span class="fulltext">Section:</span></td><td class="sectionHeading" align="right" valign="middle" width="92" height="16" nowrap="nowrap"><form style="margin-bottom: 0pt;"><select name="select23" class="fulltextdd" onchange="GoTo(this, 'self')"><option selected="selected">Choose</option><option value="#">Top of page</option><option value="#abstract">ABSTRACT</option><option value="#h1">Introduction</option><option value="#h2">Methods</option><option value="#h10">Results</option><option value="#h14">Discussion</option><option value="#h15">Conclusions</option><option value="">Acknowledgements <<</option><option value="#h17">References</option></select></form></td><td class="sectionHeading" align="right" valign="middle" width="10" height="16" nowrap="nowrap"><img src="Computer-basedLearning_files/10x10_spacer.gif" alt="" width="10" height="10"></td><td bgcolor="#ffffff" width="16" height="16" nowrap="nowrap"><a href="#h15"><img src="Computer-basedLearning_files/arrow_up.gif" alt="Previous section" border="0" width="11" height="9" hspace="5"></a><a href="#h17"><img src="Computer-basedLearning_files/arrow_down.gif" alt="Next section" border="0" width="11" height="9" hspace="5"></a></td></tr></tbody></table> <p>I
thank the students who responded to the questionnaires, Thomas Becher
for installing the software and helping to analyse data, Dr. Judith de
Bruin for generating and analysing the questionnaires, Luka Peters for
creating the flash animations used in the CPC, Dr. Gunter Wagner and Dr.
Sibylle Soboll for rating the knowledge test, Dr. Wim Gijselaers, Dr.
Martin Fischer, Dr. Stefan Herzig, and Dr. Christoph Stosch for their
advices with the study design, and Dr. Wilhelm Stahl for supporting this
study in word and deed. I also thank the Educational Dean of the
Medical Faculty of the Heinrich-Heine-University of Düsseldorf for
funding the 3 book coupons.</p> <p class="last"><b><i>Declaration of interest:</i></b> The author reports no conflict of interest. The author alone is responsible for the content and writing of the paper.</p></div><a name="h17"><!-- title --></a><br clear="right"><table class="sectionHeading" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><th align="left" valign="middle" width="95%">References</th><td class="sectionHeading" width="62" height="16" nowrap="nowrap"><span class="fulltext">Section:</span></td><td class="sectionHeading" align="right" valign="middle" width="92" height="16" nowrap="nowrap"><form style="margin-bottom: 0pt;"><select name="select23" class="fulltextdd" onchange="GoTo(this, 'self')"><option selected="selected">Choose</option><option value="#">Top of page</option><option value="#abstract">ABSTRACT</option><option value="#h1">Introduction</option><option value="#h2">Methods</option><option value="#h10">Results</option><option value="#h14">Discussion</option><option value="#h15">Conclusions</option><option value="#h16">Acknowledgements</option><option value="">References <<</option></select></form></td><td class="sectionHeading" align="right" valign="middle" width="10" height="16" nowrap="nowrap"><img src="Computer-basedLearning_files/10x10_spacer.gif" alt="" width="10" height="10"></td><td bgcolor="#ffffff" width="16" height="16" nowrap="nowrap"><a href="#h16"><img src="Computer-basedLearning_files/arrow_up.gif" alt="Previous section" border="0" width="11" height="9" hspace="5"></a></td></tr></tbody></table><ol class="references"><li id="b1"><a class="entryAuthor" href="http://informahealthcare.com/action/doSearch?action=runSearch&type=advanced&result=true&prevSearch=%2Bauthorsfield%3A%28Braeckman%252C%2BLA%29">Braeckman LA</a>, <a class="entryAuthor" href="http://informahealthcare.com/action/doSearch?action=runSearch&type=advanced&result=true&prevSearch=%2Bauthorsfield%3A%28Fieuw%252C%2BA%29">Fieuw A</a>, <a class="entryAuthor" href="http://informahealthcare.com/action/doSearch?action=runSearch&type=advanced&result=true&prevSearch=%2Bauthorsfield%3A%28van%2BBogaert%252C%2BHJ%29">van Bogaert HJ</a>. <span class="NLM_article-title">A web- and case-based learning program for postgraduate students in occupational medicine</span>. <span class="citation_source-journal">Int J Occup Env Health</span> <span class="NLM_year">2008</span>; 14: <span class="NLM_fpage">51</span>–<span class="NLM_lpage">56</span><div class="citationLinks"></div></li><li id="b2"><a class="entryAuthor" href="http://informahealthcare.com/action/doSearch?action=runSearch&type=advanced&result=true&prevSearch=%2Bauthorsfield%3A%28Colsman%252C%2BA%29">Colsman A</a>, <a class="entryAuthor" href="http://informahealthcare.com/action/doSearch?action=runSearch&type=advanced&result=true&prevSearch=%2Bauthorsfield%3A%28Sticherling%252C%2BM%29">Sticherling M</a>, <a class="entryAuthor" href="http://informahealthcare.com/action/doSearch?action=runSearch&type=advanced&result=true&prevSearch=%2Bauthorsfield%3A%28Stopel%252C%2BC%29">Stopel C</a>, <a class="entryAuthor" href="http://informahealthcare.com/action/doSearch?action=runSearch&type=advanced&result=true&prevSearch=%2Bauthorsfield%3A%28Emmrich%252C%2BF%29">Emmrich F</a>. <span class="NLM_article-title">Computer-assisted learning in medicine. 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