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Internet-based medical education: a realist review of what works, for whom and in what circumstances

机译：基于Internet的医学教育：对什么有效，适用于谁以及在什么情况下的真实评估

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Background Educational courses for doctors and medical students are increasingly offered via the Internet. Despite much research, course developers remain unsure about what (if anything) to offer online and how. Prospective learners lack evidence-based guidance on how to choose between the options on offer. We aimed to produce theory driven criteria to guide the development and evaluation of Internet-based medical courses. Methods Realist review - a qualitative systematic review method whose goal is to identify and explain the interaction between context, mechanism and outcome. We searched 15 electronic databases and references of included articles, seeking to identify theoretical models of how the Internet might support learning from empirical studies which (a) used the Internet to support learning, (b) involved doctors or medical students; and (c) reported a formal evaluation. All study designs and outcomes were considered. Using immersion and interpretation, we tested theories by considering how well they explained the different outcomes achieved in different educational contexts. Results 249 papers met our inclusion criteria. We identified two main theories of the course-in-context that explained variation in learners' satisfaction and outcomes: Davis's Technology Acceptance Model and Laurillard's model of interactive dialogue. Learners were more likely to accept a course if it offered a perceived advantage over available non-Internet alternatives, was easy to use technically, and compatible with their values and norms. 'Interactivity' led to effective learning only if learners were able to enter into a dialogue - with a tutor, fellow students or virtual tutorials - and gain formative feedback. Conclusions Different modes of course delivery suit different learners in different contexts. When designing or choosing an Internet-based course, attention must be given to the fit between its technical attributes and learners' needs and priorities; and to ways of providing meaningful interaction. We offer a preliminary set of questions to aid course developers and learners consider these issues.
机译：背景技术通过互联网越来越多地为医生和医学生提供教育课程。尽管进行了大量研究，课程开发人员仍不确定在线提供什么（如果有）以及如何提供。准学习者缺乏有关如何在所提供选项之间进行选择的循证指导。我们旨在产生理论驱动的标准，以指导基于Internet的医学课程的开发和评估。方法现实主义评论-一种定性的系统评论方法，其目的是识别和解释背景，机制和结果之间的相互作用。我们搜索了15个电子数据库和包括在内的文章的参考文献，以寻求从实证研究中确定互联网如何支持学习的理论模型，该实证研究（a）使用互联网支持学习，（b）涉及医生或医学生; （c）报告了正式评估。考虑了所有研究设计和结果。通过沉浸式和诠释，我们考虑了理论对讲解在不同教育背景下取得的不同成果的理解程度，从而对理论进行了测试。结果249篇论文符合我们的纳入标准。我们确定了课程中的两种主要理论，这些理论可以解释学习者的满意度和学习结果的差异：戴维斯的技术接受模型和劳里拉德的互动对话模型。如果与非互联网替代品相比，它提供了明显的优势，技术上易于使用并且与他们的价值观和规范相兼容，则学习者更倾向于接受一门课程。 “互动性”只有在学习者能够与教师，同学或虚拟教程进行对话并获得形成性反馈的情况下，才能进行有效的学习。结论不同的授课方式适合于不同背景下的不同学习者。在设计或选择基于Internet的课程时，必须注意其技术属性与学习者的需求和优先级之间的匹配;以及提供有意义的互动的方式。我们提供了一系列初步问题，以帮助课程开发者和学习者考虑这些问题。

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