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To the Editor: The meta-analysis by Dr Cook and colleagues¹ deals with the very current topic of Internet-based education for health professionals. The authors conducted a comprehensive and rigorous approach: multiple dimensions (satisfaction, knowledge, and behaviors) were considered both for experimental and quasi-experimental studies. Unfortunately, neither methodological accuracy nor the broad inclusion criteria can overcome the weakness of the primary research included in the analysis. The consistency of the results demonstrated by the sensitivity analysis may be reassuring regarding the inclusion of many uncontrolled before-and-after designs (more than half in the Internet-based learning vs no intervention comparison), but more concerns arise from the novelty effect sometimes referred to as the Hawthorne effect.²

Because double-blinding is usually impracticable in human behavior research, the review process of interventions designed to improve professional practice, including educational systems, presents additional pitfalls in how best to interpret trial results.³ Positive excitement and attention effects caused . . . [Full Text of this Article]

Rita Banzi, PhD
banzi@marionegri.it

Ivan Moschetti, MD; Lorenzo Moja, MD, MSc, DrPH
Italian Cochrane Centre
Mario Negri Institute for Pharmacological Research
Milan, Italy

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