, Volume 23, Issue 7, pp 985-990
Date: 10 Jul 2008

Adapting Web-based Instruction to Residents’ Knowledge Improves Learning Efficiency

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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.


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.


Randomized, crossover trial.


Academic internal medicine residency program continuity clinic.


122 internal medicine residents.


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.


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 http://www.clinicaltrials.gov NCT00466453 (http://www.clinicaltrials.gov/ct/show/NCT00466453?order=1).