The senior-level course "Differential Diagnosis of Soft Tissue Lesions" (Oral Path) is challenging because it requires students to learn both new concepts and decision-making skills. We developed a web-based, interactive multimedia program as supplemental material for the course. Interactive multimedia programs, controlled by the learner, can have a positive effect on the development of higher cognitive skills in science learning, but most evaluative studies are based on users' satisfaction or test grades, which do not adequately describe an interactive program's specific effects. Objectives: Evaluate the effect of our web-based program material on cognitive learning and user satisfaction. Methods: In fall 2003, sixty 4th year dental students in Oral Path were given access to the web-based support material; at end of semester they completed a survey on the usefulness of the material. Server records of students' actual usage were obtained. Students, from year 2000, who did not have the web-based program, served as the control group. The cognitive level of each question in all exams (2000 & 2003 mid-term exams, 2000 & 2003 final exams) was categorized according to Bloom's taxonomy as either a high or low cognitive level question. Results: The web-using class had a significantly higher score on the mid-term exam (93.5:85.6, t-test p=0.001) for both higher and lower cognitive questions (p=0.035; 0.001). The final exam showed no significant difference. When frequency of actual web use was correlated with students' grades, results showed no significant effect for either midterm (r= 0.257) or final exam (r=0.077). There was a positive trend in frequency of web use with correctly answered low cognitive level questions. Survey results: Most students were highly satisfied; students who used the web material more found it easier to navigate. Conclusion: An interactive program can differentially affect students' acquisition of higher/lower levels of cognitive knowledge.

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