Background: E-learning is a tool for enhancing knowledge which can potentially increase medical students' ability to learn and understand complex subjects.

Objective: To assess the effectiveness of e-learning in increasing understanding of metabolic bone diseases by medical students during their orthopaedic rotation.

Materials and Methods: A retrospective cohort study was conducted at the Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital. Fifth-year medical students doing their rotation in the Orthopedics Department between August 2012 and July 2013 were enrolled in the study. All participants were instructed to study metabolic bone diseases using a lesson plan, handouts, and a textbook. They were also given the opportunity to volunteer to participate in an e-learning class prior to attending a one-hour case-based lecture. Students who missed the class were excluded from the present study. Baseline characteristics, in-class scores, multiple choice question [MCQ] grades, and orthopaedic grades of the participants were collected. Associations
between study factors and outcomes were analyzed using multiple regression analysis.

Results: A total of 154 medical students were included in the study. Their average age was 23 years, and 57% were female. Only 12 (8%) participated in the voluntary e-learning class. The e-learning group had higher in-class scores (9.00+0.95) compared to the non e-learning group (7.70+1.30) with p-value = 0.001. Cumulative GPA and participation in the voluntary e-learning class were factors included in the multiple regression analysis. After adjusting for cumulative GPA, attendance at the e-learning class was significantly associated with in-class scores (coefficient 1.20, 95% confidence interval 0.43, 1.96, p-value = 0.002). Participation in the e-learning class was not significantly correlated with either MCQ grades or orthopaedic grades.

Conclusion: E-learning as an adjunct to traditional teaching methods can increase knowledge about metabolic bone disorders among medical students, but it does not affect either MCQ grades or orthopaedic grades.

Keywords: Metabolic bone, Diseases, E-learning, Medical students, Effectiveness