Where are we with Web-based learning in medical education?

This article summarizes several years of research in Web-based learning (WBL) to illustrate that, in general, research fails to address the questions that will inform our use of this powerful tool. In particular, media-comparative research--the comparison of WBL to another medium (e.g. lecture)--is hopelessly confounded and does little to inform practice. Rather than asking 'If' we should use WBL (we should!), researchers should ask 'How' and 'When' to use WBL. 'How' will be answered by evaluating specific elements of instructional design including theory-based instructional methods, adaptations to individual characteristics and details of presentation enhancements. 'When' will require study of issues such as just-in-time learning, effective use of simulation, and integration of WBL within and between institutions. Both quantitative and qualitative research methods will be useful. Educators should also look outside medical education for evidence and theories to guide their practice. Finally, while WBL has many advantages it is not inherently better than other media. The author suggests that learning outcomes be defined first and WBL be used only when it appears to be the most effective means of achieving these outcomes.