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Open Access Open Badges Research article

Comfort and experience with online learning: trends over nine years and associations with knowledge

David A Cook12* and Warren G Thompson3

Author Affiliations

1 Mayo Clinic Online Learning, Mayo Clinic College of Medicine, Rochester, MN, USA

2 Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

3 Division of Preventive Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

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BMC Medical Education 2014, 14:128  doi:10.1186/1472-6920-14-128

Published: 1 July 2014



Some evidence suggests that attitude toward computer-based instruction is an important determinant of success in online learning. We sought to determine how comfort using computers and perceptions of prior online learning experiences have changed over the past decade, and how these associate with learning outcomes.


Each year from 2003–2011 we conducted a prospective trial of online learning. As part of each year’s study, we asked medicine residents about their comfort using computers and if their previous experiences with online learning were favorable. We assessed knowledge using a multiple-choice test. We used regression to analyze associations and changes over time.


371 internal medicine and family medicine residents participated. Neither comfort with computers nor perceptions of prior online learning experiences showed a significant change across years (p > 0.61), with mean comfort rating 3.96 (maximum 5 = very comfortable) and mean experience rating 4.42 (maximum 6 = strongly agree [favorable]). Comfort showed no significant association with knowledge scores (p = 0.39) but perceptions of prior experiences did, with a 1.56% rise in knowledge score for a 1-point rise in experience score (p = 0.02). Correlations among comfort, perceptions of prior experiences, and number of prior experiences were all small and not statistically significant.


Comfort with computers and perceptions of prior experience with online learning remained stable over nine years. Prior good experiences (but not comfort with computers) demonstrated a modest association with knowledge outcomes, suggesting that prior course satisfaction may influence subsequent learning.