Evaluation of NILMOs: Neurology Independent Learning Modules Online

The goal of the NILMO project was to help medical students develop life long learning skills using elearning. The desired skills include researching and communicating information and are critical for medical students since medicine is an ever-shifting landscape. Currently, much of the content in the first two years of medical school is delivered in a lecture format and tested with multiple-choice assessments. In contrast, the NILMOs required students to answer four questions using a list of recommended resources. The students could draw or type their answers to the questions, which were then posted to a discussion board. After submitting their answers, the students could review other students’ answers as well as an expert answer. Student learning gains were determined using a pre-test post-test format and by looking at performance on the course examinations. The discussion board format was compared to an online lecture format, using a crossover design: each student watched 2 lectures and completed 2 discussion board activities. For the last NILMO the students could choose between the two formats.

We found that students strongly preferred the online lecture format with all of the students choosing this option for the last NILMO. One student stated that they “wanted to be told the important information”. We found that the preference was partly related to the fact that the discussion board format took significantly more time than the lecture format and that students felt more comfortable with the lecture since it was more familiar. The learning gains and performance on the course assessments were not significantly different for the two formats. It is challenging to measure acquisition of communication and research skills, but we would like to look at if the discussion board format led to improved retention of the material by testing the students 2 years later when they begin their neurology clerkships. There is a lot of interest in elearning and our results suggest that students can be resistant to unfamiliar, online environments requiring critical thinking skills. We are moving back to a flipped classroom approach in the future.