Doctors' Experience in Learning from Web-Based Compared with Print-Based Materials

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The summary below is from the full report titled "Self-Study from Web-Based and Printed Guideline Materials. A Randomized, Controlled Trial among Resident Physicians." It is in the 20 June 2000 issue of Annals of Internal Medicine (volume 132, pages 938-946). The authors are D.S. Bell, G.C. Fonarow, R.D. Hays, and C.M. Mangione.

What is the problem and what is known about it so far?

Doctors need to keep their medical knowledge up-to-date. Recently, the number of Internet or Web-based teaching materials available to doctors has grown tremendously. Web-based materials may offer certain advantages over print materials (books, journals, guidelines), including the ability to tailor presentations to meet individual learning needs and to provide interactive teaching. It is not known, however, whether doctors actually learn better when they study Web-based rather than printed materials.

Why did the researchers do this particular study?

To compare how much and how quickly doctors learn using Web-based compared with print-based materials.

Who was studied?

The researchers studied 162 resident physicians in internal medicine and family medicine at four universities. Residents are doctors who have completed medical school and are completing "hands on" training in their chosen specialty.

How was the study done?

The researchers assigned each doctor to receive either printed or Web-based guideline materials on caring for patients who have had a heart attack. The two sets of study materials contained identical information, and both included questions that doctors could use to assess their knowledge. However, the Web-based system also featured links from self-assessment questions to specific guideline passages and from guideline recommendations to the specific evidence that supports them. The doctors studied during a single session. They were instructed to study until they met a specified set of learning objectives. All of the doctors completed a 20-question test before and immediately after studying, and they also reported how satisfied they were with the learning materials. After 4 to 6 months, 114 of the doctors took the test again.

What did the researchers find?

Of the 162 doctors, 158 completed the study. After studying, doctors who used the Web-based system answered an average of 15 out of 20 questions correctly compared with 14.5 out of 20 for those who used the printed materials. However, the doctors using the Web-based system studied for less time (27 minutes) than the doctors who used the printed materials (38.5 minutes). The doctors were more satisfied with the Web-based materials. After 4 to 6 months, the Web-based group answered only 11 and the print-based group answered only 12 of the 20 questions correctly.

What were the limitations of the study?

The study does not tell us whether the results would be similar for doctors who had completed training or for study materials that addressed other topics. The results might also have been different if the doctors had the opportunity to use the materials repeatedly over time.

What are the implications of the study?

On-line study materials may reduce the amount of time doctors need to study to learn a specified amount. Doctors may also be more satisfied with Web-based than with printed learning materials. Further work is needed, however, to develop methods of self-study that result in lasting improvements in knowledge.