Lora - I agree with many of your comments regarding the discussion of online versus traditional instruction for health care providers, especially regarding practical application and hands-on instruction. While there may be great ways to encourage reflection-on-action and reflection-for-action, for future encounters in an online platform, it fails to provide authentic experiential learning that is key for the learning process. Additionally, considering that failure is such an important aspect of learning, a traditional classroom environment with live patients, for example, provide a more representative context to fail, reflect, and improve.

Myra - You make some interesting points and arguments in favor of online education. Additionally, I agree that technological advancements have certainly influenced access and availability to online education. Like you, I found many articles with supportive results for some measured aspects of online instruction and several papers of high level evidence (meta-analysis or systematic review) suggesting the use of blended learning and instructional methods. The more I review the evidence, however, the more contextually dependent and student dependent I think the success of these programs may be. Considering models of development, such as Dreyfus and Dreyfus, online instruction may be very effective for the novice or advanced beginner who needs rules, structure, and boundaries for their learning. More advanced levels of development (proficient, or expert, for example), may require more real-world, experiential or contextual application of concepts to facilitate situations with more ambiguity and uncertainty. Much like our treatment plans, we luckily have many options available, and finding the right mix or dosage is key to clinical success. I think blending these constructs of traditional and online instruction with opportunities for asynchronous reflection and peer interaction gives students the "best of both worlds" and may speak to larger sample of learning styles.

The numerous intrinsic and extrinsic factors that influence the learning process are certainly relevant to a discussion of online versus traditional face-to-face instruction efficacy. With this is mind, it seems difficult to dichotomize this question into an argument where one method is seen as more effective than the other. However, considering the current academic lens through which I look on a daily basis, I do not feel that online education is as effective as traditional classroom education. While plenty of authors advocate for the efficacy of online instruction, I believe that success of instruction is dependent on, to some extent (among other things), the content at hand. Considering allied health education and our professions where content mastery is not equivalent to clinical effectiveness, online instruction in isolation may not necessarily benefit all domains of learning. As high levels of affective and psychomotor abilities are associated with expert clinicians, instruction must seek to develop these characteristics. Hale et al (2009), describe similar themes concerning the efficacy of an undergraduate allied health pharmacology course. In this study, while learning scores and withdrawal rates were comparable between both online and classroom groups, students in the online group were less satisfied with instructor rapport, peer interaction, and self-perceived knowledge gains. While it does not appear realistic to instruct psychomotor skills or techniques through an online platform, virtual patient training (Al-Dahir et al., 2014) and surgical simulations (Antonoff et al., 2014) have been utilized to supplement traditional instructional methods. In addition to the type of content being delivered, intrinsic factors such as motivation and inherent academic ability influence efficacy of health science online instruction. Lu and Lemonde (2013) reported comparable results of online versus face-to-face instruction for a statistics course to undergraduate health science students, only if the students were high achieving academically. Students who were considered lower performing students performed significantly worse in an online environment, as compared to a face-to-face environment. When considering content that requires additional methods to encourage affective and psychomotor domain development, and possibly benefits lower achieving students, face-to-face traditional instruction appears to be more effective.

Al-Dahir, S., Bryant, K., Kennedy, K.B., & Robinson, D.S. (2014). Online virtual-patient cases versus traditional problem-based learning in advanced pharmacy practice experiences. American Journal of Pharmacy Education, 78(4), 1-8.

Antonoff, M.B., Verrier, E.D., Yang, S.C., Lin, J., DeArmond, D.T., Allen, M.S., Varghese, T.K., Sengewald, D., Vaprorciyan, A.A. (2014). Online learning in thoracic surgical training: promising results of multi-institutional pilot study. Annals of Thoracic Surgery, 98(3), 1057-1063.

Hale, L.S., Mirakian, E.A., Day, D.B. (2009). Online vs classroom instruction: student satisfaction ad learning outcomes in an undergraduate allied health pharmacology course. Journal of Allied Health, 38(2), 36-42.

Lu, F., Lemonde, M. (2013). A comparison of online versus face-to-face teaching delivery in statistics instruction for undergraduate health science students. Advanced Health Science Education Theory and Practice, 18(5), 963-973.