In the present study, 175 (72%) students reported having intermediate to advanced computer skills, which included basic word processing, use of the Internet, the ability to use different software programs, knowledge of software and hardware, and the ability to troubleshoot and to advise and teach others. The remaining students were still capable of using word-processing software and the Internet. These findings are consistent with those of other studies reporting that increasing numbers of students are entering medical school with greater computer-related knowledge and experience than in past years.
2,14,21 This increase most likely reflects a greater emphasis at the undergraduate level on acquiring the necessary knowledge and skills to make technology an important tool for the rapid and convenient acquisition of information. In addition, a study of second-year medical students indicated a rapid ability to adapt to new computer-based resources.
24 The importance of these findings is underscored by a report on a sample of medical residents who were found to have inadequate computer literacy, largely resulting from a lack of computer training and experience in medical school or prior to their medical training.
25
In a review of the literature, Greenhalgh
17 reports that the advantages of CAI have not been shown consistently. It is suggested that a successful medical school curriculum will better accommodate different learning styles by allowing students to select from self-study modules and modules requiring personal interaction.
17,26 Furthermore, the literature neither indicates that Web-based learning is superior to text-based methods, nor that it promotes greater self-reported student confidence or competency. It has been asserted that CAI should not replace, but rather should serve as a valuable addition to learning techniques such as textbooks, lectures, small group discussion, and problem-based learning.
12,16,17,26,27 The survey-based data obtained in the current study are consistent with that assertion. Most respondents indicated that in their opinion, they learn new material best by both hearing and seeing or reading, and they believe that it was easiest for them to learn from a printed page. More importantly, students prefer live lectures where they can ask questions and access a Web site containing the lecture handout material. In addition, a majority of students indicate that they would buy a textbook rather than a CD-ROM of the same material, a finding similar to that reported by Steele et al.
26 The responses of the students in the current study demonstrate a view of CAI as being an important adjunct to traditional educational tools.
Most students were not in favor of a requirement by the school to own a computer or use a laptop computer in class. It should be noted, however, that a statistically significant difference in this preference was determined between students with advanced computer skills and those with basic and intermediate computer skills. Regarding a requirement that medical students own a computer, McAuley
18 highlighted issues such as whether an adequate amount of curricular material could be made available online to justify the expense to students and whether sufficient staff would be available to provide support. It is not clear from the results obtained in the present study whether the lack of support for such a requirement is based solely on the financial cost or whether there are other issues that were not assessed that would influence this preference. The majority of students were in favor of a personal digital assistants as tools in their medical education, however. Personal digital assistants, which have extensive capabilities yet are affordable, are widely used in clinical practice and by medical educators.
28,29
Within each skill group, most students indicated that they would use a Web site to supplement their learning, especially if it were free or paid for by the school. This finding seems to support the suggestion that a successful medical school curriculum should provide students with an opportunity to use a Web-based educational approach.
17,21 In contrast, only those students with advanced computer skills expressed a willingness to take a Web-based course, and few students endorsed taking examinations on a Web site. This reluctance to take computerized examinations may reflect a concern that this method of testing will not allow them to apply test-taking behaviors to which they have become accustomed. Furthermore, students may have reservations that their performance on these examinations may be adversely affected by their relative level of comfort with the technology, and thus, may not be an accurate reflection of their knowledge of the subject matter.
30 Such a reservation is supported by reports indicating that students may not perform as well on computerized examinations compared with hard copy examinations.
31,32
There were several limitations of the current study. The data for this study were collected from students at only one school. However, the findings are consistent with those of other studies, suggesting that this sample is not extremely different from other medical school student bodies. In addition, students' opinions may vary according to geographic location. Finally, it must be noted that these data were collected in late 2001 and may differ from current student views.