Computer-aided instruction (CAI), particularly online instruction afforded by the advent of the Internet, is ready to grow from infancy to adolescence. The infancy of CAI has been characterized by studies demonstrating that teaching medical students, residents, and practicing physicians can be done online, and that learning occurs.1–3 This is not particularly surprising. Why should reading information on a computer screen or hearing a lecture online not be associated with learning?
It is time to demand more from online learning. If online learning is going to gain widespread acceptance, it has to offer advantages over other, generally accepted measures of learning. In this issue of JGIM, a study of online learning demonstrates that learners want more from their online instruction. Spickard et al. compare the knowledge retention and learner satisfaction (2 standard methods of curricular evaluation) of a live lecture with that of an online slide presentation with or without audio.4 Despite the interactive potential offered by online instruction, in this study the online slide presentation without audio was in fact no different from reading a syllabus, and the minority of students who took the time to download the audio lead experienced the equivalent of a videotape slide presentation with voiceover. The students in the study wanted more from the online instruction. Not only did the students who used the online slide presentation without audio rate their satisfaction with the learning method significantly lower than that with the standard lecture (3.8 vs 4.4), but also the level of computer sophistication negatively influenced satisfaction. The students in this study are perhaps telling us they want more from online learning, especially if it is used to replace an existing method of learning, such as an interactive lecture.
Advantages of online learning can be divided into those that are learner centered and those that are teacher centered. For the learner, a principal advantage of online instruction is the asynchronous time frame in which learning can occur. As opposed to a lecture, online learning can occur at a time convenient to the learner. However, that is no different from the advantage offered by reading a book chapter or syllabus, so more is needed to justify online instruction. Fortunately, online instruction can be designed to be interactive, something that a book doesn't offer. Online quizzes with immediate feedback, score tracking, and real-time comparison with how other students are faring allows learners to learn from their mistakes and get a sense of where they stand. Students need not fear appearing unknowledgeable in front of their peers when answering questions. More sophisticated online programs could direct learners to special remedial sections to review topics on which they fared poorly when quizzed. Chat rooms or message boards could allow students to interact with course instructors and other students, perhaps allowing online instruction to truly compete with the advantages of an interactive lecture, and definitely offering more than a book or syllabus. Efficiency of learning, often promoted as an advantage of CAI, may be less important than thought; learning efficiency in the Spickard study was not associated with increased learner satisfaction.4
For the teacher, there are advantages as well. Besides obviating the need for remedial lectures, the interactive features can be used to improve the instructive content of a teaching module. Online instruction can be designed to track group scores of learners. Pretest quiz results can be reviewed to determine learners' preconceptions on a particular topic. Posttest quiz results can be reviewed to assess not only learning but also teaching. Learning objectives met with poor posttest scores can be reviewed, and modules can be enhanced to improve instructive content. Teachers from different institutions can share and compare content, representing a significant time and cost savings.
There are also disadvantages to online instruction, and it is best to acknowledge these so that they can be minimized. Design and maintenance of online instruction takes time and money. Spickard et al. comment that converting their lecture into an online presentation and downloading it took only three hours, yet their online course offered no interactive capability. Maximizing interactive components of online instruction takes time. Online instruction also presents new barriers, the most obvious being no access to those without computers. Online instruction lacks the portability of a syllabus or book. Download time, a significant barrier to students in the study by Spickard et al., must be minimized. Computer-aided instruction is likely to lack the social acceptance of a required lecture series. Unless satisfied with an online instruction module, learners will not be motivated to come back for more.
The end of online instruction's infancy has arrived. Let's see if its adolescence begins to demonstrate the potential that we all know is there.
REFERENCES
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