Time pressures negatively impact teaching and learning in ambulatory settings. Web-based (online) learning may help in meeting this challenge. Although online teaching is increasingly used in medical education, few reports have evaluated online learning in postgraduate training. A pre-test/post-test cohort study was undertaken in an academic medical center acute care clinic to determine whether internal medicine residents accept, learn with and continue to use a 'stand-alone' online curriculum. The participants were 56 first-year internal medicine residents. Eight evidence-based, symptom-oriented online modules in acute ambulatory medicine were completed by residents during a one-month rotation. Fifty residents completed all modules. Pre- and post-tests were administered and scored automatically by computer. Average test score improved from 70% to 95% (p < 0.001). Feedback was very positive, with 96% of residents recommending the curriculum continue and 88% listing the modules as one of the most helpful learning resources for the rotation. Some 74% of residents referred back to the curriculum while caring for patients. This 'stand-alone' online curriculum, with automated instruction and assessment, facilitated effective and satisfying learning without requiring faculty involvement. This method could easily be reproduced in other settings.
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