Abstract
Several usability issues were encountered during the design of a blended e-learning program for a course in evidence-based medicine for general practice trainers. The program was developed in four steps. We focused in this article on step 2 and 3. Step 2 focused on which educational principles to apply, that is, which learning theories, instructional designs and other theories should influence the program. Step 3 focused on the design elements, namely whether to use hypermedia and/or multimedia, and what screen design and which font to use. This article presents the important issues in designing an e-course and provides an impression of the complexity of designing high quality e-learning in particular for continuing medical education (CME).


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Bliuc, A. M., Goodyear, P., & Ellis, R. A. (2007). Research focus and methodological choices in studies into students’ experiences of blended learning in higher education. The Internet and Higher Education, 10(4), 231–244.
Brandsford, J. D., Brown, A. L., & Cocking, R. R. (2000). How people learn: brain, mind, experience, and school. Washington: National Academy Press.
Calcaterra, A., Antonietti, A., & Underwood, J. (2005). Cognitive style, hypermedia navigation and learning. Computers & Education, 44(4), 441–457.
Case, R., & Bereiter, C. (1984). From behaviourism to cognitive behaviourism to cognitive-development - Steps in the evolution of instructional-design. Instructional Science, 13(2), 141–158.
Chandler, P., & Sweller, J. (1991). Cognitive load theory and the format of instruction. Cognition and Instruction, 8(4), 293–332.
Clark, R. C., & Mayer, M. E. (2008). E-learning and the science of instruction. San Francisco: Jossey-Bass.
Cook, D. A. (2007). Web-based learning: pros, cons and controversies. Clinical Medicine, 7(1), 37–42.
Czabanowska, K., Klemenc-Ketis, Z., Potter, A., Rochfort, A., Tomasik, T., Csiszar, J., & Van den Bussche, P. (2012). Development of a competency framework for quality improvement in family medicine: A qualitative study. Journal of Continuing Education in the Health Professions, 32(3), 174–180.
Ellaway, R., & Masters, K. (2008). AMEE Guide 32: e-Learning in medical education Part 1: Learning, teaching and assessment. Medical Teacher, 30(5), 455–473.
European Health Forum Gastein. Possible shortage of up two million health care workers by 2020 - EU taking action to prevent impending crisis in providing health care. Website http://pr.euractiv.com/pr/possible-shortage-two-million-health-care-workers-2020-eu-taking-action-prevent-impending-crisis.
Fisser, P. (2001) Using Information and Communication Technology. Universiteit Twente. PhD Thesis, available: http://doc.utwente.nl/36152/1/t0000015.pdf
Furmedge, D. S., Iwata, K., & Gill, D. (2014). Peer-assisted learning - Beyond teaching: How can medical students contribute to the undergraduate curriculum? Medical Teacher, 1–6
Gagne, R. M., Briggs, L. J., & Wager, W. W. (1992). Principles of instructional design (4th ed.). Fort Worth: Harcourt Brace Jovanovich College Publishers. Available: http://www.facdev.niu.edu/facdev/resources/guide/learning/gagnes_nine_events_instruction.pdf. Accessed 29 September 2014.
Garrison, D. R., & Kanuka, H. (2004). Blended learning: Uncovering its transformative potential in higher education. The Internet and Higher Education, 7, 95–105.
Hannafin, M. J., & Hooper, S. (1989). An integrated framework for CBI screen design and layout. Computers in Human Behavior, 5, 155–165.
Illeris, K. (2003a). Towards a contemporary and comprehensive theory of learning. International Journal of Lifelong Education, 22, 396–406.
Illeris, K. (2003b). Adult education as experienced by the learners. International Journal of Lifelong Education, 22, 13–23.
Jarvis, P. (2006). The theory and practice of teaching (2nd ed.). London: Routledge.
Jochemsen-van der Leeuw, H. G. A. R., van Dijk, N., Etten van-Jamaludin, F. S., & Wieringa-de Waard, M. (2013). The attributes of the clinical trainer as a role model: A systematic review. Academic Medicine, 88(1), 26–34.
Keller, J. M. (1987). Development and use of the ARCS model of motivational design. Journal of Instructional Development, 10(3), 2–10.
Knowles, M. S., et al. (1984). Andragogy in action: Applying modern principles of adult education. San Fransisco: Jossey Bass.
Koroghlanian, C. M., & Sullivan, H. J. (2000). Audio and text density in computer-based instruction. Journal of Educational Computing Research, 22(2), 217–230.
Mayer, R. E. (Ed.). (2005). The Cambridge handbook of multimedia learning. New York: Cambridge University Press.
Mayer, R. E., Heiser, J., & Lonn, S. (2001). Cognitive constraints on multimedia learning: When presenting more material results in less understanding. Journal of Educational Psychology, 93(1), 187–198.
Melis, E., Weber, M., & Andrès, E. (2003). Lessons for (pedagogic) usability of eLearning systems. In A. Rossett (Ed.), Proceedings of World Conference on E-Learning in Corporate, Government, Healthcare, and Higher Education 2003 (pp. 281–284). Chesapeake: AACE.
Merriam, S. B., Caffarella, R. S., & Baumgartner, L. M. (2006). Knowles’s andragogy, and models of adult learning by McClusky, Illeris, and Jarvis. In Learning in adulthood: A comprehensive guide (pp. 83–104). 3th ed. San Francisco: Jossey-Bass
Merrill, M. D. (1983). Component display theory. In C. M. Reigeluth (Ed.), Instructional design theories and models: An overview of their current status (pp. 279–334). Hillsdale: Lawrence Erlbaum Associates.
Merrill, M. D. (2002). First principles of instruction. ETR&D, 50(3), 43–59.
Merrill, M. D., Drake, L., Lacy, M. J., & Pratt, J. (1966). Reclaiming instructional design. Educational Technology, 36(5), 5–7.
Mishra, P., & Koehler, M. J. (2006). Technological pedagogical content knowledge: A framework for teacher knowledge. Teachers College Record, 108(6), 1017–1054.
Moreno, R., & Mayer, R. E. (2002). Verbal redundancy in multimedia learning: When reading helps listening. Journal of Educational Psychology, 94(1), 156–163.
Mousavi, S. Y., Low, R., & Sweller, J. (1995). Reducing cognitive load by mixing auditory and visual presentation modes. Journal of Educational Psychology, 87(2), 319–334.
Nadolski, R. J., Kirschner, P. A., & van Merrienboer, J. J. G. (2005). Optimizing the number of steps in learning tasks for complex skills. British Journal of Educational Psychology, 75, 223–237.
Nilsson, M., Ostergren, J., Fors, U., Rickenlund, A., Jorfeldt, L., Caidahl, K., & Bolinder, G. (2012). Does individual learning styles influence the choice to use a web-based ECG learning programme in a blended learning setting? BMC Medical Education, 12, 5.
Ormrod, J. E. (2009). Human learning (5th ed.). Upper Saddle River: Pearson Education, Inc.
Ruiz, J. G., Mintzer, M. J., & Leipzig, R. M. (2006). The impact of E-learning in medical education. Academic Medicine, 81(3), 207–212.
Scheiter, K., & Gerjets, P. (2007). Learner control in hypermedia environments. Educational Psychology Review, 19(3), 285–307.
Siemens, G. (2005). Connectivism: A Learning Theory for the Digital Age. International Journal of Instructional Technology and Distance Learning, 2.
Squires, D., & Preece, J. (1996). Usability and learning: evaluating the potential of educational software. Computers Education, 27(1), 15–22.
Steinberg, E. R. (1989). Cognition and learner control: A literature review, 1977–1988. Journal of Computer-Based Instruction, 16(4), 117–121. Validated: ACM Digital Library, http://dl.acm.org/citation.cfm?id=70832.
Strickland A.W. (2006) ADDIE, Idaho State University College of Education Science, Math & Technology Education. Website http://web.archive.org/web/20060709154016/http://ed.isu.edu/addie/index.html. Accessed 29 September 2014.
Sun, P., Tsai, R. J., Finger, G., Chen, Y., & Yeh, D. (2008). What drives a successful e-Learning? An emperical investigation of the critical factors influencing learner satisfaction. Computers & Education, 50, 1183–1202.
Sweller, J. (1988). Cognitive load during problem solving: Effects on learning. Cognitive Science, 12, 257–285.
Sweller, J. (2005). The redundancy principle in multimedia learning. In R. E. Mayer (Ed.), The Cambridge handbook of multimedia learning (pp. 159–167). New York: Cambridge University Press.
Sweller, J., van Merrienboer, J. J. G., & Paas, F. G. W. C. (1998). Cognitive architecture and instructional design. Educational Psychology Review, 10(3), 251–296.
te Pas, E., van Dijk, N., Bartelink, M. E. L., & Wieringa-de Waard, M. (2013). Factors influencing the EBM behaviour of GP trainers; a mixed method study. Medical Teacher, 35(3), e990–e997.
Tindall-Ford, S., Chandler, P., & Sweller, J. (1997). When two sensory modes are better than one. Journal of Experimental Psychology: Applied, 3(4), 257–287.
Trivette, C.M., Dunst, C.J., Hamby, D.W., O'Herin, C.E. (2009) Characteristics and consequences of adult learning methods and strategies. Research Brief, 3(1)
University World News. Call for universities to respond to shortages of health professionals. Website http://www.universityworldnews.com/article.php?story=20121206111338460. 9 December 2012. Accessed 29 September 2014.
van Merrienboer, J. J. G., & Kirschner, P. A. (2007). Ten steps to complex learning: a systematic approach to four-component instructional design (1st ed.). Oxford: Routledge.
van Merrienboer, J. J. G., & Sweller, J. (2005). Cognitive load theory and complex learning: Recent developments and future directions. Educational Psychology Review, 17(2), 147–177.
van Merrienboer, J. J. G., Jelsma, J. J. G., & Paas, F. G. W. C. (1992). Training for reflective expertise: A four-component instructional design model for training complex skills. Educational Technology Research and Development, 40(2), 23–43.
Wikipedia Learning theory (education). Website http://en.wikipedia.org/wiki/Learning_theory_(education). Accessed August 8, 2013.
Wood, D., Bruner, J. S., & Ross, G. (1976). The role of tutoring in problem solving. Journal of Child Psychology and Psychiatry, 17, 89–100.
Zufic, J., Kalpic, D. (2009) More efficient e-learning through design: color of text and background. World Conference on E-Learning in Corporate, Government, Healthcare, and Higher Education (ELEARN). Vancouver, Canada, Oct 26–30, 2009
Notes on contributors
Ellen te Pas is a registered nurse, educationalist and PhD student in the Department of General Practice/Family Medicine, Academic Medical Center, University of Amsterdam, the Netherlands.
Margreet Wieringa–de Waard is a GP and a professor of General Practice in the Department of General Practice/Family Medicine, Academic Medical Center, University of Amsterdam, the Netherlands.
Bernadette Snijders Blok is an educationalist in the Department of General Practice/Family Medicine, Academic Medical Center, University of Amsterdam, the Netherlands.
Hendricus Theodorus Pouw is a GP and a GP trainer in Health Center “Op maat”, Almere, the Netherlands and a former lecturer in General Practice in the Department of General Practice/Family Medicine, Academic Medical Center, University of Amsterdam, the Netherlands.
Nynke van Dijk is a clinical epidemiologist. She holds a Master’s in Health Profession Education, and works as an assistant professor in General Practice in the Department of General Practice/Family Medicine, Academic Medical Center, University of Amsterdam, the Netherlands.
Conflicts of Interest
This study was financed by CASH (commission to stimulate activities regarding GP training) of the SBOH. The SBOH is the employer of GPs in training, and finances all Dutch GP training programs.
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te Pas, E., Waard, M.Wd., Blok, B.S. et al. Didactic and technical considerations when developing e-learning and CME. Educ Inf Technol 21, 991–1005 (2016). https://doi.org/10.1007/s10639-014-9364-2
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DOI: https://doi.org/10.1007/s10639-014-9364-2