Adapting web-based instruction to residents' knowledge improves learning efficiency: A randomized controlled trial

David A. Cook, Thomas J. Beckman, Kris G. Thomas, Warren G. Thompson

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


BACKGROUND: Increased clinical demands and decreased available time accentuate the need for efficient learning in postgraduate medical training. Adapting Web-based learning (WBL) to learners' prior knowledge may improve efficiency. OBJECTIVE: We hypothesized that time spent learning would be shorter and test scores not adversely affected for residents who used a WBL intervention that adapted to prior knowledge. DESIGN: Randomized, crossover trial. SETTING: Academic internal medicine residency program continuity clinic. PARTICIPANTS: 122 internal medicine residents. INTERVENTIONS: Four WBL modules on ambulatory medicine were developed in standard and adaptive formats. The adaptive format allowed learners who correctly answered case-based questions to skip the corresponding content. MEASUREMENTS AND MAIN RESULTS: The measurements were knowledge posttest, time spent on modules, and format preference. One hundred twenty-two residents completed at least 1 module, and 111 completed all 4. Knowledge scores were similar between the adaptive format (mean±standard error of the mean, 76.2±0.9) and standard (77.2±0.9, 95% confidence interval [CI] for difference -3.0 to 1.0, P=.34). However, time spent was lower for the adaptive format (29.3 minutes [CI 26.0 to 33.0] per module) than for the standard (35.6 [31.6 to 40.3]), an 18% decrease in time (CI 9 to 26%, P=.0003). Seventy-two of 96 respondents (75%) preferred the adaptive format. CONCLUSIONS: Adapting WBL to learners' prior knowledge can reduce learning time without adversely affecting knowledge scores, suggesting greater learning efficiency. In an era where reduced duty hours and growing clinical demands on trainees and faculty limit the time available for learning, such efficiencies will be increasingly important. For clinical trial registration, see NCT00466453 ( ).

Original languageEnglish (US)
Pages (from-to)985-990
Number of pages6
JournalJournal of general internal medicine
Issue number7
StatePublished - Jul 2008


  • Adaptation
  • Clinical medicine
  • Computer-assisted instruction
  • Medical education
  • Problem solving
  • Web-based learning

ASJC Scopus subject areas

  • Internal Medicine


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