Purpose: To determine whether internal medicine residents prefer learning from Web-based (WB) modules or printed material, and to compare the effect of these teaching formats on knowledge. Method: The authors conducted a randomized, controlled, crossover study in the internal medicine resident continuity clinics of the Mayo School of Graduate Medical Education during the 2002-03 academic year. Participants studied two topics of ambulatory medicine using WB modules and two topics using paper practice guidelines in randomly assigned sequences. Primary outcomes were format preference (assessed by an end-of-course questionnaire) and score changes from pre- to postintervention tests of knowledge. Results: A total of 109 consented and 75 (69%) completed the postintervention test. Fifty-seven of 73 (78% [95% CI, 67-86%]) preferred the WB format (p < .001). Test scores improved for both formats (67.7% to 75.0% for WB, 66.0% to 73.3% for paper), but score change was not different between formats both before (p = .718) and after (p = .080) adjusting for topic, clinic site, study group, postgraduate year, and gender. Residents spent less time on WB modules (mean = 47 ± 26 minutes) than paper (mean = 59 ± 35, p = .024). Difficulties with passwords limited their use of WB modules for 71 % (59-80%) of residents. Conclusion: No difference was found between WB and paper-based formats in knowledgetest score change, but residents preferred learning with WB modules and spent less time doing so. Passwords appeared to impede use of WB modules. WB learning is effective, well accepted, and efficient. Research should focus on aspects of WB instruction that will enhance its power as a learning tool and better define its role in specific settings.
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