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J Med Libr Assoc. Oct 2002; 90(4): 455–457.
PMCID: PMC128962

Distance education or classroom instruction for continuing education: who retains more knowledge?*

Connie M. Schardt, M.L.S., AHIP, Education Coordinator,1 Julie Garrison, M.I.L.S., AHIP, Assistant Director, Education Services,1 and Julia K. Kochi, M.I.L.S., Manager, Digital Library Operations2

Distance education has emerged as a viable alternative for providing educational opportunities to working health professionals [1]. Flexibility in scheduling, elimination of travel expenses, and improved access to the Internet are attracting students who might not otherwise be engaged in lifelong learning activities. Distance education presents new challenges in continuing education for both instructors and students. Instructors must develop innovative teaching strategies for learners who are not physically present, and students must modify their learning behaviors to engage in and absorb the course material. Studies have shown that the teaching environment, be it classroom or distance education, does not influence learning outcomes and knowledge retention as evidenced by examination and course grades [2–4]. Most of the research in this area has focused on comparing distance education with traditional classroom courses in an academic setting. This study will present data comparing distance education and classroom presentation in the context of professional continuing education (CE). Specifically, the authors will examine issues pertaining to knowledge retention as tested through a post-course questionnaire.

The Medical Library Association (MLA) defines CE as educational opportunities that “are planned, organized learning experiences designed to augment the knowledge, skills and attitudes of those who work in health sciences libraries” [5]. Two additional characteristics of CE are that it usually does not lead to an advanced degree and that it is presented at times and locations convenient to the individuals or groups being served.

The CE course used for this study, ” Evidence-based Medicine (EBM) and the Medical Librarian,” was first presented as a six-week distance-education program in the fall of 1999 for MLA. During the same time period, Schardt and Garrison also presented the same content as a traditional eight-hour classroom course. The content covered the practice of EBM in four modules: (1) introduction and question building, (2) selection of resources and completion of the search, (3) evaluation of the quality of the study methodology, and (4) roles for the librarian. Each module included information on the topic, required and recommended reading lists, and assignments to practice skills.

Eleven health sciences librarians registered for the distance-education course, eight from the United States and one each from India, the United Kingdom, and Guam. They had six weeks to read the material, to contribute to the class electronic mailing list and online chat, to submit the assignments, and to complete an evaluation. Six students completed the course, three never started, and two students failed to complete the required assignments. Reported reasons for not completing the course included discomfort with the logistics of distance education and lack of available time.

Sixteen health sciences librarians took the course in a classroom setting. All content and exercises were presented within eight hours, and all sixteen students completed the class. At the end of each session, all students filled out an MLA evaluation form.

The MLA evaluations showed that overall the distance-education students rated their course higher than the classroom students. The greatest difference was for gaining knowledge and meeting course objectives. The distance-education students averaged scores of 5.0 and 4.9, respectively, while the classroom group averaged only 4.4 for both categories. (Scores were based on a Likert scale of 1 to 5, with 5 being the highest score.)

The difference in scores for knowledge gained prompted the authors to send out a post-course questionnaire to all students who completed either session. The questionnaire asked for information covered in the course content:

  • What are the basic steps in practicing EBM?
  • What are the parts of the well-built clinical question?
  • What are two issues that determine the validity of a therapy study?
  • How would you limit MEDLINE search results to clinical trials?
  • What Medical Subject Headings (MeSH) would you use to get at the reliability of diagnostic tests?

Students were asked to answer the questions from memory and not to refer to class material. They were also asked if they had implemented any of the ideas presented in the course. Responses were received from six (100%) distance-education students and from six of the sixteen (38%) classroom students (Figure 1).

Figure 1
Responses from post-course questionnaire

Of the thirty total possible answers, the classroom group responded with twelve (40%) correct answers, two (6%) partially correct answers, and sixteen (54%) wrong or missing answers. The distance-education students responded with twenty-four (80%) correct answers, three (10%) partially correct answers, and three (10%) wrong or missing answers. All six (100%) of the distance-education students indicated that they had implemented some of the suggestions and information from the course, compared to only four of the six (67%) classroom students.

The authors believe that the differences in knowledge retention can be credited to three important attributes of distance education: more time for learning and reflection is available, individual attention stimulates learning, and motivation enhances the learning process.

The distance-education students had ample time to read the course material and practice their skills, module by module. Because they were also working while engaged in the course, they had time to assimilate the information into their library services and validate its usefulness before tackling the next step. These students reported that the course took on average about thirty hours to complete. In contrast, the classroom students were given only eight hours to understand all the concepts, and practice was limited to working within small groups.

The distance-education students received as much individual attention as they needed. Personalized feedback was provided for each learner for every assignment. All questions were addressed through the chats, electronic mailing list, personal email, and telephone conversations. There was never “not enough time” to respond to an individual's question or problem. Each instructor had to spend on average about four hours a week working with the students. In contrast, in the classroom, students were treated as a group, and, while individuals asked questions, responses and feedback to the exercises were directed toward the entire class.

The students taking the distance-education course had to be highly self-motivated and well organized [6]. They were responsible for taking active roles in reading the material and completing all of the assignments. To receive MLA CE credits for the course, students were required to complete all of the assignments. In the classroom, the individual's role could easily be more passive. The instructors presented the material to them, mainly through lecture, and the students worked in groups to complete the assignments. If students did not feel like actively participating, they were not penalized and could still receive credit for the course.

Based on our post-course questionnaire, the distance-education learners appear to have retained twice as much knowledge as the classroom students. Limitations of this study include the small sample size, which could not show statistical significance, and the possible bias in self-selection by students of the distance-education course, which may have attracted more motivated students. Future research on this topic will need to consider randomizing the student selection process, measuring baseline subject knowledge, accounting for time spent on the course, and examining the characteristics and learning needs of the students. The implication for future study is that distance education for CE, at least for some topics, may be a more effective teaching strategy than traditional classroom-based instruction.


* Based on a presentation at MLA/CHLA/ABSC 2000, the 100th Annual Meeting of the Medical Library Association; Vancouver, British Columbia, Canada; May 10, 2000.


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