Linear versus web-style layout of computer tutorials for medical student learning of radiograph interpretation

We sought to determine which is more effective in increasing skill in radiograph interpretation: a linear (PowerPoint-style) computer tutorial that locks the student into a fixed path through the material or a branched (Web-style) version that allows random access.

We prepared a computer tutorial for learning how to interpret cervical spine radiographs. The tutorial has 66 screens including radiographs or graphics on almost every page and five unknown radiographs for the student to interpret. One version (linear) presents the material in a linear sequence with the unknown radiographs heading up "chapters" detailing an important aspect of the task. In the second (branched) version, the same 66 screens were accessed through hyperlinks in a frame beside the unknown radiographs. One hundred thirty-nine medical students at two sites participated in a randomized single-blinded controlled experiment. They interpreted cervical spine images as a pretest and then completed one of the two tutorial versions. Afterward, they did the same examination as a post-test.

The tutorial was successful, in both layouts, in improving the subjects' ability to interpret cervical spine radiograph images (effect size 2.1; 95% confidence interval 1.7-2.5). However, the layout did not make a difference to their gain in ability. Students in the linear group completed the tutorial in 17% less time (P < .001) but were slightly less likely to rate the tutorial as "valuable."

For these novice learners, computer tutorial layout does not affect knowledge gain. Students may be more satisfied with the linear layout, but in time-pressured situations, the Web-style layout may be preferable because it is more efficient.