discosion

The current study demonstrated that learners’ readiness is more than important in case of new modalities of education. In this study knowledge improved significantly for some participants that remained until the end but that it was not possible to measured for others; generally speaking, however, both trainees who completed the course and the tutor(s) who taught the course found the e-learning course to be acceptable if initially had been agreed or ready for it. Otherwise, those who claimed it is not suitable failed to continue the learning process and lead to high rate of drop-out.

The baseline and post-course scores were generally the same for both groups, and both methods of teaching have been to some extent effective in increasing conceptual knowledge; this finding is parallel to other studies (3). Students, who finished the course, achieved similar scores for overall knowledge gain after both the e-learning and lecture phases. This raises the opportunity of delivering some elements of curriculum through e-learning to some major disciplines, replacing the traditional lecture-based 

method without legitimate concern of knowledge loss, when the initial evaluation showed learners’ readiness for this new modality of learning. This approach will decrease education expenses and increase the feasibility and flexibility of learners in clinical settings and increases the collaboration rate of appropriately selected learners. So any concerns in learners should be understood and controlled before commencing new method of education (1).

Few studies have examined the effectiveness of computer-based teaching of medical content compared to standard lecture-based approaches in developing countries, and while our study is confirmed by findings from similar studies in developed countries, one major flag is raised. Our trial merits concern, as we implemented a modified design from previous studies and enrolled participants from different majors (4, 9-12). In Iran, according to national higher-education regulations, high school graduates are intended to participate in a nation-wide comprehensive exam and, according to overall rankings, can select majors from a large group of government-run, tuition-free universities. Additionally, regarding social interests and income, medicine is of the most requested and welcomed majors for natural science students. Due to the highly competitive nature of this exam, and considering the restricted positions in medicine, the most talented students are able to achieve acceptable ranks in the discipline: students accepted into medical schools will be, after seven continuous years of study, granted an MD degree. Accordingly, many of these students are selected from families higher up the socioeconomic ladder that have better access to computers and internet and, more so than students from other majors in the study, were familiar with information technology and the internet.

As mentioned above, one of the strategies of the study was to enrol the same number of participants from different majors; unfortunately, students from majors other than medicine were uncooperative and were excluded from the trial. However, this notion is parallel to their attitudes about e-learning, and there were a significant relationship between majors and overall intentions to pursue e-learning (P<0.001, x²=26.4, see Table 2). This notion was reinforced by low or decreased commitments to attend pre-

and post-course quizzes, confirming the necessity of readiness for students using novel learning methods, prior to installation and implementation (13). The data presented in Table 1 reveal the degree of disagreement expressed by students from excluded majors, in clear accordance with their attendance for pre- and post-course quizzes.

This is a particular concern with current educational research. Additionally, the enrolment of the same participants in both phases and inability to blind selection of participants and the teacher can cause concern in educational research expressed by other studies (3). To cover this limitation, another researcher not aware of which sub-syllabi have been enrolled online or lecture-based was responsible to analyze and interprets recorded data. To cover the difference returned by variations in baseline knowledge and learning abilities, the same groups of learners enrolled in the study but, in order to overcome variations of content in different phases, first attempted topics selected from a single course (malignancies and neoplasm of gynaecology), and, second, internally compared scores for pre- and post-course quizzes for each sub-syllabus.

It seems that just well-structured and managed e-learning classrooms are at least as effective as traditional lectures in developing and developed countries, particularly when used in blended mode (14). Although conceptual knowledge gained via online sessions will be practiced in clinical settings, this method does raise some concerns about the effectiveness of the learning, it seems that its flexibility and feasibility will cover this limitation (1). E-learning resources enable users to learn when and where they want, and for medical professionals working many different shifts, this approach is likely to provide them with better opportunities to learn whenever they are able (1,3).

E-learning can play various roles in medical education, including virtual environments or patients, medical simulations, and hospital information systems with integrated learning materials and tele-consultation (15-19).

Basic, simple electronic training programs are already 

effective when designed appropriately and offered to users ready for this modality of learning. The current study clearly reveals that, when two groups of students present varied interests in electronic learning, this belief clearly has an effect on their further participation in the learning process, and may even completely interrupt it. In conclusion, there was a significant difference in replies to the quizzes between the two groups in the study.

Subsequently, it seems that before instalment of any e-learning course, attention to some issues is important:

1.Learners’ skills: The learners’ ability to work with computer and internet and/or any other skills necessary for them to participate in the course. For example providing a course in non-native language to students’ weak in it. Will decrease learning despite provision of a high quality learning content.

2.Technological aspects: the used technology is very important, when this technology can not be supported or provided suitably, the effectiveness decrease, for example when the online large-size multimedia content is provided to students who don’t have access to broadband internet, should not expect high collaboration rate.

3.Learners learning styles: various kinds of interactions and instructional designs, and the context of the learning environments is available now, but it is important to know learners preferences and styles for learning and adopt the modalities of education based on this information (20).

Besides, medical training in Iran is currently encountering great challenges of employment, as well as an excess presence of professionals in large cities; in restricted rural and smaller cities or deprived areas, it is imperative that the challenges of providing high-quality teaching syllabi for future health professionals in changing environments be met. The benefits of an e-learning approach to teaching should be considered as a viable way to overcome these challenges, as it can support a wide range of learning activities, which are readily accessible and can be tailor-made to meet specific learning objectives.