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In Reply: Dr Wong notes the limitations of quantitative syntheses in education, inasmuch as the study designs, interventions, participants, institutional contexts, and outcomes all represent sources of heterogeneity. These reviews, therefore, often fail to permit strong causal inferences. Realist reviews¹ and other systematic efforts to summarize disparate sources of evidence will provide important insights beyond a pooled estimate. We think, however, that such heterogeneity need not remain the norm in the future. On the contrary, as researchers work collaboratively using common theoretical frameworks, intervention definitions, and outcomes, we expect evidence will accrue that can be systematically synthesized to illuminate practice and advance theory.

Dr Banzi and colleagues suggest the influence of novelty as a confounder in the results of our meta-analysis. Such effects have long been acknowledged in computer-assisted instruction.² Although this confounding limits our ability to make causal claims, we doubt that novelty alone would account for the large . . . [Full Text of this Article]

David A. Cook, MD, MHPE
cook.david33@mayo.edu

Victor M. Montori, MD, MSc
Mayo Clinic College of Medicine
Rochester, Minnesota

Anthony J. Levinson, MD, MSc
McMaster University
Hamilton, Ontario, Canada

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Internet-Based Education for Health Professionals
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