Of the 23 students in the Study group, 21 (91.3
%) completed all components of the trial, i.e., pre-test, post-test and questionnaire, while 21 of the 22 students in the Control group completed all components (95.5
%). There was no significant difference in the mean documented previous academic performance (WAM) for participants in the Study and Control groups, which were essentially identical (Study: 71
1; Control: 71
1) (t (43)
There was no significant difference in mean percentage scores between groups for the pre-test on leukaemia (Study: 51
3; Control: 54
2) (t (43)
0.297). However, the Study group achieved significantly higher mean percentage scores in the post-test on leukaemia (Study: 80
3; Control: 66
3) (t (42)
0.001). Importantly, this striking difference was noted even though the Control group’s performance also improved significantly compared with the pre-test (Figure
Figure 4 Comparison of pre-test and post-test scores (mean and SEM) for participants in the Control and Study groups. *Mean post-test scores greater than mean pre-test scores for each group (p<0.05, t-test). #Study group mean post-test (more ...)
The Study group reported spending more time on average studying the topic of leukaemia than the Control group during the 2-week trial period, but this difference (equating to three minutes per day) was not statistically significant (Study: 2.3
0.4 hours; Control: 1.6
0.4 hours) (t (39)
In a stepwise multiple regression analysis, group allocation was the only significant predictor of performance in the post-test (R
0.516, R 2
0.001), i.e. 26.6
% of the variance in post-test scores was accounted for by group membership. In this model, neither known academic ability nor time spent studying was predictive, although the latter parameter in isolation correlated significantly with post-test scores (R
0.02). The correlation between WAM and post-test scores was not statistically significant (R
Via the online evaluation questionnaire, participants in both the Study and Control groups rated the perceived difficulty of the topic of leukaemia before and after the trial period on a 10-point Likert scale (1
least difficult, 10
most difficult). Pre-trial, there was no significant difference between groups in ratings of the perceived difficulty of leukaemia (Study median rating: 9; Control median rating: 8). Post-trial, there was a significant decrease in the median perceived difficulty of leukaemia in the Study group (median rating pre-trial 9; post-trial 6, P
0.001, Dunn’s multiple comparisons test), but not in the Control group (median rating pre-trial 8; post-trial 7) (Figure
The Study group’s online evaluations of the e-learning module were overwhelmingly positive, and their rating of each aspect (including enjoyment, guide to study and overall value for learning) was significantly higher compared with evaluations of the alternative e-learning resources by the Control group (all P
0.001, Mann-Whitney U tests) (Figure
). Of particular note, the Study group found the module to be the most useful resource for learning about leukaemia, compared with lectures, tutorials, private study and clinical experience, whereas the median ranking of the e-learning resources available to the Control group was third out of five.
Figure 6 Comparisons of Likert scale questionnaire responses from Control and Study groups, relating to their perceptions of existing e-learning resources and the e-learning module on leukaemia respectively. Data are represented by median±interquartile (more ...)
Students in the Study group found the following features of the module most helpful: interactivity; feedback; case studies; multimedia (videos, animations, audio); and histopathological images. In addition, participants in the Study group commented that revision of basic science concepts in the concepts and causes section of the module was extremely useful.
Below is a selection of representative comments from the participants in the Study group:
"“Accessible, easy to follow, provided key information.”"
"“Information was presented succinctly and was available for use in my own time, and as many times as required. It's good to have a guide on what we're expected to know, rather than being told to 'go learn leukaemia'.”"
"“The very nature of an e-learning module is much easier than having to sift through books. It is easy for me to get to, and I can do it whenever I feel like. Testing and feedback are crucial.”"
"“Best features: well structured, clear, easy to follow, teaching concepts and causes ,reinforced with cases where we were encouraged to think, recall and answer questions.”"
"“Interactivity helped maintain interest; the case studies were of a good digestible length. Overall, an enjoyable module that complemented my learning (and inspired me to do more reading)!”"
"“Interactive information and questions with immediate feedback so can correct misunderstanding straight away; simple navigation; ability to replay audio; multimedia (diagrams, videos, audio… particularly liked the diagram of haematological "family tree" with the interactive feature of fading out cells not involved in each condition).”"
"“Particularly liked the splenomegaly video and how the commentary linked back to the patient's presentation. The other linked videos were also very good (bone marrow biopsy video fantastic idea for those who haven't had the chance to see one in a clinical situation). Matching the interactive elements to the nature of the content (e.g. labels on pictures, matching lists of symptoms and pathophysiology etc) made it easy and fun to self-test and discover new info.”"
Study group participants also provided feedback to improve the module. Several suggested that a transcript of the audio should be available on each screen. This feature has subsequently been implemented. Participants generally preferred more text on each screen, rather than audio. Some participants, who had limited internet speeds due to their rural location, found that the module took a long time to download.
In contrast, online evaluation data provided by the Control group was less positive. The participants in the Control group indicated that the content of the e-learning resources they accessed was not sufficiently tailored to their context. Participants frequently commented that the information was too theory-based, yet they perceived that the pathophysiology underlying the results of diagnostic procedures was not well explained.
Control group participants suggested that the online learning resources needed to be more interactive, and more specific to their syllabus. Students commented that while there were “a lot of resources out there” many students have issues deciding “what level of knowledge is expected”.
Below is a selection of representative comments from the Control group:
"“Boring, not interactive, excessive detail.”"
"“The ASH resource was user friendly. However the case studies were not always labelled and the information related to an American context. I accessed the Robbins resource, however I did not use this as I find reading large segments of text online very difficult to concentrate on and remember.”"
"“I didn't like how it amalgamated leukaemia and lymphoma - although they are similar it only further added to my confusion between the two.”"
"“I found them hard to engage with (didn't really capture my attention).”"
"“Robbins text contained too much detail, teaching cases left out detail. Both approaches are off-putting.”"