Web-Based Learning Versus Standardized Patients For Teaching Clinical Diagnosis: A Randomized, Controlled, Crossover Trial

Background: Little evidence exists to guide the selection of methods for teaching clinical diagnosis. Purpose: To compare the efficacy, student preference, and cost of a Web-based (WB) program versus a standardized patient (SP) encounter for teaching clinical diagnosis skills to 2nd-year medical students. Methods: Randomized, controlled, crossover study comparing WB versus SP-based teaching for the clinical diagnosis of abdominal pain and headache. Outcome measures were performance on a 2-case SP examination (scored on the basis of a checklist completed by a faculty observer and an objective score on a postencounter subjective-objective assessment plan [SOAP] note), format preferences as assessed by end-of-course evaluations, and cost. Results: Thirty students consented to participate. WB and SP training produced similar scores on both the Abdominal Pain checklist (66% vs. 62%; p =. 17) and Headache checklist (56% vs. 63%; p =. 07). WB training produced a higher score on the Abdominal Pain SOAP note (69% vs. 47%; p =. 006), but not the Headache SOAP note (69% vs. 67%; p =. 85). Students rated the SP format higher than the WB format on all 7 preference measures. Start-up costs were estimated at $2,190 for the SP format and $2,250 for the WB format. Ongoing costs per case per student were estimated to be $45 for the SP format and $30 for the WB format. Conclusions: WB and SP learning outcomes were comparable, but students preferred the SP format. Start-up costs were comparable, but the ongoing costs of the WB format were less expensive, suggesting that WB teaching may be a viable strategy.