An Analysis of Web-Based Instruction in a Neurosciences
Chris Candler, MD and Robert Blair, PhD
University of Oklahoma College of Medicine.
Abstract - Among the recent trends in medical
education is the increased use of computer-aided
instruction (CAI), particularly via the World Wide
Web. While there have been many studies comparing
CAI to traditional instruction, there are relatively few
studies that analyze the benefits of web-assisted
instruction. Presently, many medical schools have
initiatives to web-enable significant portions of their
curriculum. To maximize the potential of the
medium, educators must carefully plan and design
their educational materials and do more than put
their syllabus online. Technical issues such as user
interface design, access and availability play an
important role in determining how students will
receive such materials. Furthermore, the web-based
portion of a course must be properly integrated with
more traditional educational modalities such as
lectures and labs. The following paper describes the
planning and implementation of web-based materials
in a pilot project involving a medical neurosciences
During the spring semester of 1997, 150 first-year medical students at
The University of Oklahoma College of Medicine were introduced to web-
based instruction in a newly offered neurosciences course. This course was
selected as a pilot project for the medical school's new computer-aided
instruction initiative. This initiative, which grew out of a student-lead
computer interest group, sought to enhance the educational process while
developing student's basic computer and information retrieval skills. The
project began with several planning sessions, which led to a massive
computer and network installation in the medical school education building.
Concurrently, students and software developers began construction of a
web-based syllabi, atlas, and lab manual for the Neurosciences course.
The new course consisted of approximately eight hours of traditional
neurosciences lectures per week supplemented with 10 laboratory sessions
throughout the semester. During their laboratory sessions, students were
responsible for identifying traditional gross brain structures in addition to
614 structures on digital cross-sectional images. Each image highlighted one
structure at a particular section level of the CNS. The image bank and other
ancillary course material were accessible via the college's curriculum web
site. Students could access the Neurosciences Web Site via the school's
computer labs or from workstations at home. Although mandatory computer
ownership was not in place at that time, it was strongly encouraged by the
Proper interface design was an important consideration in the
development of this online course. The quantity and complexity of the
material necessitated a logical interface and intuitive site navigation to
create a successful learning environment. In the previous neuroanatomy
course, students memorized structures using an atlas of neuroanatomy and
monochrome 2x2 slides. The black and white atlas sections contained many
numerically labeled structures that crowded the image, obscuring many
features. Conversely, the online course covered 40 CNS cross-sections,
which outlined each structure on a separate image. Thus, when presented
with an unlabeled image of a particular CNS section, the students could click
through a list of 15 or so structures which, when selected, loaded that same
image section with the structure clearly outlined. The entire web site
included over 600 images, each highlighting a separate structure.
The web user interface was designed to clearly display images and the list
of relevant structures. HTML frames were used to simultaneously present the
list of structures and the CNS cross-section image on the same screen.
Through the use of frames, students could select a structure from the text
frame which loaded the new image into the image frame. A third navigation
frame was added so students could quickly jump to various parts of the
In addition to the atlas of CNS structures, the Neurosciences Web Site
contained specific information on various tracts, a detailed tutorial on basal
ganglia disorders, and several lesion localization problems. The localization
problems were popular with students, as they required students to integrate
their knowledge of neuroanatomy with the appropriate clinical manifestation.
Using the aforementioned frameset, students were presented with a clinical
case, which required them to select from one of six images of CNS lesions. If
they choose the incorrect lesion image then the text frame displayed the
neuroanatomical manifestations of the image they selected.
A faculty member provided the CNS section images in kodachrome slide
format. After all the images were acquired, medical students digitized them
with a slide scanner, which was capable of digitizing slides in high resolution.
These images were then carefully labeled with the popular graphic-editing
application Adobe Photoshop where they were subsequently saved in a
compressed JPEG format. This widely used format allowed high quality
images to be reduced to 50-150 Kilobytes in size. Although many image
formats are available to instructors, the JPEG format is presently the de
facto standard for displaying full color images on the web.
To provide medical students with the highest degree of availability, the
web site was designed to work in either of the two common web browsers
(Microsoft's Internet Explorer and Netscape's Navigator) and on either a Mac
or a PC computer. Such flexibility allowed students to view the online course
from a variety of hardware and software configurations. The only technical
requirement involved was that the machine had to be capable of displaying
graphics in at least 16-bit color (thousands of colors).
Students could access the online course through a variety of means. They
could use the standard computer labs on campus or use their home
machines by dialing into the campus modem pool. At that time, the campus
modem pool consisted of 20 36.6K modems connected to the campus
network through which the students could then access the web server.
Several months after the course the modem bank was expanded to roughly
Examination and Feedback
Web-based resources that are merely accessory to existing coursework
are used little by students.8 To maximize the educational value and student
use of these web resources, practical examinations were partially comprised
of the online material.9 Although students used pen and paper to record their
answers, they had to identify structures from computer sections and gross
brain sections. During this practical exam the class scored an average of
96% in identifying structures from digital computer images and 88% in
identifying the traditional gross brain structures. Predictably, during the
three days preceding the exam, the web server registered over 200,000
"hits" from the entire class (approximately 1300 per student). Simply
defined, a "hit" is recorded any time a student requests a web page or a new
image from the web server.
Although true comparative studies are needed, the above finding suggests
that online web-aided instruction is a valid learning and testing modality.
Informal evaluations from both students and faculty were favorable. It was
clear that students wanted more of their curriculum online. Students also
requested more of the lesion localization problems and other problem-based
learning exercises to increase their exposure to the clinical sciences.
While the computer lab machines downloaded the images almost instantly
due to the speed of the campus network, students at home often complained
that their modem connection was prohibitively slow for the larger images. In
subsequent courses, CD-ROM's were created that contained all the images
from the online course site. Students are allowed to check out a CD-ROM
overnight and transfer the images to their home computer's hard drive. After
this, students may speedily review the images from their hard drive without
the bandwidth constraints of a modem. Schools looking to implement web-
assisted instruction to existing coursework should consider this CD-ROM
solution and construct their web site in such a way that it may easily be
transferred to a CD-ROM.
Despite careful design and development of the online course interface,
students said it felt backwards to them. Instead of selecting the name of the
structure, which brought up a labeled image, students have asked that the
interface be revised so that it would present them with an image outlining a
structure that they must identify. Witnessing how pairs of students used the
material reinforced the need for this change. One student would be the
examiner and cover up the structure he was selecting while the examinee,
after reviewing the labeled image would have to identify the structure.
Students felt this was a more natural way to study for the exam.
Student and faculty feedback will guide future improvements in this and
other online courses. Presently, the online component of the Neurosciences
course is under revision for the upcoming spring semester. Many of the lab
sessions have been reorganized, requiring changes in the online format.
Gross brain images and radiographs have been added to the cross-section
images, which should present students with a more holistic sense of
The portable and accessible nature of web-based materials may eliminate
the problems often seen in traditional computer-aided instruction.
Advantages to web-assisted instruction include increased availability of
materials, ease of web course construction, and the potential for a more
interactive learning environment. Disadvantages include hardware and
software costs of web servers and development equipment, instructor's time,
and the pressure for students to own computers. It is difficult to quantify the
exact costs required for this project since it necessitated the installation of a
massive computer and networking infrastructure, which was needed for
Clearly, the experience with the online Neurosciences course was
successful, both in terms of objective outcomes and subjective feedback.
More comparative studies are needed to evaluate the efficacy and cost-
effectiveness of this exciting new medium. It should not concluded that web-
assisted instruction is a replacement for instructors or lectures. However,
careful design and planning can make such materials an excellent
complement to existing courses.
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Correspondence should be addressed to Dr. Candler, Information Design
Group, 1000 Stanton L Young, Lib-418, Oklahoma City, OK 73104. Special
thanks to Dr. Ray Papka, Malcolm Buford, Susannah Collier, and Jack Collier
who were instrumental in acquiring, digitizing, and organizing the original
content for the course.
Candler, C, Blair R. An analysis of web-based instruction in a neuroscience
course. Med Educ Online [serial online] 1998;3:3. Available from URL