The very idea that a computer presentation could substitute for his lecture gives Dr. Wolf pause. The lecture is a well-developed methodology, and he has spent years refining his presentation. He wonders what will be his role if lectures are replaced with computers. Earlier technologies for capturing lecture content such as videotape or audiotape certainly did not supplant the lecture in medical education. Are computer-based tools more effective and efficient than these earlier technologies? Can the computer help discern the level of understanding of his students and residents in order to provide them more targeted information?
In an effort to answer these questions, Dr. Wolf performs a search of the medical literature. Searching for randomized, controlled trials with the lecture format as the comparison group seems a reasonable strategy for comparing the standard “live” lecture with technology-based lectures. (Details of the search strategy are included in the Appendix
.) Even though his search strategy failed to identify any studies that specifically compared the computer-based lecture to the standard lecture, the search provided information on how a technology-based substitution compared with the “live” lecture16–24
Randomized Controlled Trials of “Live” Lectures with Technology-based Substitutions
One study compared the effectiveness of the lecture to that of an audiotape-pamphlet package, two to that of a video reproduction (tutored videotape, closed circuit television), and the other five studies to that of a variety of computer-based strategies (). All studies used a pretest-post-test methodology to measure effectiveness (knowledge gained). Six of the eight studies showed no difference in effectiveness, while two studies favored a computer-based strategy. Of the only two studies that examined efficiency (knowledge gained per amount of time expended by the student), one showed the lecture to be more efficient than a computer-based strategy while one showed no difference in efficiency between lecture and computer.
Based on the results of his search, Dr. Wolf infers that the computer-based lecture should be no less effective than a traditional lecture, an opinion that is reflected in other (nonmedical) educational fields.25,26
However, the limitations of such a search comparing computer-based teaching with traditional teaching are also apparent. For one, publication bias would likely favor the more novel technologies. Second, the randomized controlled trial methodology that we have come to expect in evidence-based medicine decision-making about interventions is not commonly used in education. Third, it is difficult to guarantee in reports of media comparisons that the content and quality of the standard “live” lecture and the computer-based intervention are exactly the same, despite the best efforts of the researchers.27,28
As is now commonly stated in analytic studies of computer-assisted instruction, taking full advantage of the novel features of a computing platform (video, audio, hyperlinks, and other interactive features) that cannot be replicated by other methods confounds any comparison with more traditional media and makes it logically impossible to have a true comparison group.29
Dr. Wolf surmises that lecturers should not give up their lectures just because there is a computer module covering the same content. There should be a role for the best of both methods. Just as lecture quality will vary among faculty, so will there be unevenness in the quality of computer-based presentations. Updating the content of the lecture is, of course, easier with a standard lecture, particularly with a field where information is rapidly changing. On the other hand, well-seasoned topics may be suited to capturing and preserving a lecture for a computer-based learning module.
The degree and types of interactivity in the traditional lecture depend on the style of the lecturer as well. Likewise, the computer offers a variety of potential interactive strategies. Interactive cases and brief quizzes as part of the lecture could reveal student's understanding of the subject. Quiz score and explanations of the answers can provide students immediate feedback and resources to improve gaps in knowledge on the topic. Online discussion could further delineate the student's progress in mastering the objectives for the lecture. Thus, the computer can serve as a diagnostic aide for Dr. Wolf to discern the impact of his lecture and to augment accountability in the learning process. Conversely, direct and formal feedback to Dr. Wolf through online evaluation forms provides him important information to improve his teaching efforts. Rather than a threat, Dr. Wolf realizes that the computer may actually assist him to perform his duties more effectively. Furthermore, a computer-based approach would free up time for him to spend time with students in more interactive activities (small group sessions or providing feedback), and a larger number of students (even students at other institutions) would be able to benefit from well-done modules on the computer.