Adv Physiol Educ 34: 70–74, 2010;
How We Teach
Development, implementation, and assessment of a distance module
in endocrine physiology
Elaine Maria Leite Rangel, Isabel Amélia Costa Mendes, Evelin Capellari Cárnio,
Leila Maria Marchi Alves, Simone de Godoy, and Juliane de Almeida Crispim
University of Sao Paulo at Ribeirao Preto College of Nursing, World Health Organization Collaborating Centre for Nursing
Research Development, Sao Paulo Brazil
Submitted 6 August 2009; accepted in final form 4 February 2010
Rangel EM, Mendes IA, Cárnio EC, Marchi Alves LM, Godoy
S, Crispim JA. Development, implementation, and assessment of a
distance module in endocrine physiology. Adv Physiol Educ 34: 70–74,
2010; doi:10.1152/advan.00070.2009.—This study aimed to develop,
implement, and assess a distance module in endocrine physiology in
TelEduc for undergraduate nursing students from a public university
in Brazil, with a sample size of 44 students. Stage 1 consisted of the
development of the module, through the process of creating a distance
course by means of the Web. Stage 2 was the planning of the module’s
practical functioning, and stage 3 was the planning of student evaluations.
In the experts’ assessment, the module complied with pedagogical and
technical requirements most of the time. In the practical functioning
stage, 10 h were dedicated for on-site activities and 10 h for distance
activities. Most students (93.2%) were women between 19 and 23 yr
of age (75%). The internet was the most used means to remain
updated for 23 students (59.0%), and 30 students (68.2%) accessed it
from the teaching institution. A personal computer was used by 23
students (56.1%), and most of them (58.1%) learned to use it alone.
Access to a forum was more dispersed (variation coefficient: 86.80%)
than access to chat (variation coefficient: 65.14%). Average partici-
pation was 30 students in forums and 22 students in the chat. Students’
final grades in the module averaged 8.5 (SD: 1.2). TelEduc was shown
to be efficient in supporting the teaching-learning process of endo-
crine physiology.
distance education; nursing
DISTANCE EDUCATION (DE) is a teaching model that uses pro-
cesses to go beyond physical distance (10).
Teaching institutions around the globe are trying to follow
ongoing changes, including traditional DE institutions. Online
education is changing educational paradigms. It implies
changes in on-site and distance teaching methods as well as
pedagogical models to adapt to new technologies and to a
society always searching for information and attempting to
overcome limits to achieve education (13).
DE has a characteristic that presupposes a great emphasis on
self-teaching. Students should be encouraged to study and
research independently. Collaborative learning and informa-
tion exchange among students should be intensified so as to
consolidate learning through group activities. These virtual
group activities can be performed in synchronous (e-mail and
chat) or asynchronous (discussion forums) meeting spaces that
permit this interaction, which are conditions available in the
Virtual Learning Environment (VLE) (15).
Address for reprint requests and other correspondence: E. M. L. Rangel,
Avenida Bandeirantes, 3900, Campus Universitário, Ribeirão Preto, Sao Paulo
SP 14040-902, Brazil (e-mail: elrangel@eerp.usp.br).
70 1043-4046/10 Copyright © 2010 The American Physiological Society
Downloaded from journals.physiology.org/journal/advances (168.227.017.186) on October 23, 2023.
doi:10.1152/advan.00070.2009.
In Brazil, nursing already benefits from VLE and its re-
sources for teaching themes related to medication administra-
tion and mood disorders, among others (17, 19).
Physiology is a basic science important for nurses. When it
is applied in clinical practice, nursing care to clients is better
and nurses’ participation in clinical decision making in multi-
disciplinary teams becomes more frequent. This occurs be-
cause nurses are more capable of asking pertinent questions,
doing an efficient research on patients’ history, reading results
of examinations, and performing appropriate nursing interven-
tions (4).
Thus, professors should use teaching strategies that promote
learning, retention, and motivation of students regarding phys-
iology, creating an environment that provides opportunities to
learn in different ways (21). VLE and its resources are an
internationally used strategy to support physiology teaching in
nursing programs (7). However, there are no studies in litera-
ture on the use of DE and its resources for teaching endocrine
physiology.
Hence, this study aimed to develop, implement, and assess a
distance module in endocrine physiology in VLE TelEduc with
students from an undergraduate nursing diploma program of a
public university in Brazil.
METHODS
This study is descriptive applied research, with quantitative data
analysis, carried out in the second semester of 2007 at a College of
Nursing of a public university in Brazil.
The study population consisted of 53 regularly enrolled first-year
students of the undergraduate nursing diploma program taking phys-
iology coursework. The sample size was 44 students who met the
following inclusion criteria: being a student of the undergraduate
nursing diploma program, agreeing to participate in the distance
module in endocrine physiology by signing a free and informed
consent form, and being registered in the physiology course for the
first time.
The research project was analyzed and approved by the Research
Ethics Committee of the University of São Paulo at Ribeirão Preto
College of Nursing (protocol no. 0819/2007).
This study was developed in three stages.
Stage 1: development of the distance module in endocrine physi-
ology. The method adopted to develop the module was an adaptation
of the process for creating a distance course through the Web (22).
The process consisted of the survey of objectives, organization of the
content, selection of the most appropriate VLE, development of the
lessons, and evaluation of the module and students.
The survey of the objectives of the distance module in endocrine
physiology was based on the syllabus of the physiology course offered
in the undergraduate nursing diploma program. The organization of
the content was done based on classical references in physiology (1,
8). At the end of each lesson, content retention exercises with

DISTANCE MODULE IN ENDOCRINE PHYSIOLOGY
multiple-choice and true/false questions and interactive JCROSS
crossword exercises were applied. TelEduc was the VLE used.
Different digital media elements were used for the development of
the lessons, such as the following: text, statistical graphs, animations,
and interactive exercises. The development of the animations required
the participation of computer science professionals and the use of two
animation software packages, Macromedia Flash and Blender. Inter-
active JCROSS crossword exercises were developed by the researcher,
using the free software Hot Potatoes, for nonprofit institutions.
Four informatics experts and four physiology experts assessed the
module using an instrument available in the literature (3). It comprised
pedagogical aspects with items related to content, interaction, and
activities and technical aspects with items related to the response time
and quality of the interface. Assessed categories in each of these items
were as follows: 1) content (pertinence, intelligibility, applicability,
quantity, and consistency); 2) interaction (student-student, student-
machine, student-group, student-professor, and group-professor);
3) activities (pertinence, intelligibility, applicability, quantity, consis-
tency, and educational assessment); 4) response time (accessibility
regarding the ease of access to pages in the environment and naviga-
tion concerning the functioning of buttons, links, and students’ ori-
entation in the environment); and 5) quality of the interface (colors,
space on the screen, and letters, figures, and animations).
For each of these items, each reviewer attributed a value: ⫹1 if the
characteristic was completely fulfilled, 0 if the characteristic was
partially fulfilled, and ⫺1 if the characteristic was not fulfilled. If
reviewers chose 0 or ⫺1, they included a comment and justification.
Stage 2: planning of the module’s practical functioning. Before the
module was put to work, a meeting was held with students to
1) provide guidance about the objectives to be achieved with the
module by VLE TelEduc; 2) invite participation; and 3) clarify that,
in the case of a disagreement, the traditional teaching mode would be
offered. At the end of the meeting, all 53 students registered in the
physiology course, according to a list provided by the undergraduate
office, were asked for their e-mail contact information to register in
the module, and received a login and password to access the module.
Although 44 students were part of the study analysis, the module was
also applied to the 9 students who did not meet the inclusion criteria,
since none of the students refused to participate in the distance
module. In the same meeting, a questionnaire was administered to
obtain data related to sociodemographic, internet, and personal com-
puter use characteristics.
In total, 20 h were spent on the implementation of the module,
distributed among the following TelEduc tools: agenda, support ma-
terial, exercises, activities, compulsory stop (used to call students’
attention to an important item), and discussion forums, respectively.
This pertained to the following: 1) schedule of the on-site and distance
activities, 2) content of the lessons, 3) proposed exercises for content
retention, 4) interactive exercises, 5) the script for the chat on diabetes
mellitus used in the two sessions (sessions A and B) had the help of a
monitor in each, and 6) questions related to the theme of endocrine
physiology.
To perform the diabetes mellitus chat, students were divided into
two groups: groups A and B. Two chat sessions were held, one for
group A and one for group B, outside of class time. Both sessions
were carried out by the same instructor, who was assisted by a monitor
in each session.
Stage 3: planning of student evaluations. Formative and summative
evaluations were carried out with students. Formative evaluation was
based on interactions between the students and professor during the
module, as measured by the “access” tool, available in TelEduc,
which considered the following: access to support material, access and
solving of the content retention exercises, access and participation of
students in discussion forums, and access and participation of students
in chat. Participation in these activities was worth 2.0 points in the
final grade. Summative evaluation occurred during the last on-site
meeting of the module, through the application of an exam with
Advances in Physiology Education • VOL 34 • JUNE 2010
Downloaded from journals.physiology.org/journal/advances (168.227.017.186) on October 23, 2023.
How We Teach
71
multiple-choice and true/false questions, which was worth 8.0 points.
The student’s final average grade was obtained by adding up the exam
grade (8.0) and two points (2.0) for participation in the formative
evaluation activities, with a maximum final average of 10.0.
The obtained data were coded to develop a data dictionary. Later,
they were transcribed into Microsoft Excel worksheets using the
double-entry process. After errors had been corrected, data were
exported and analyzed with SPSS 16.0 (Statistical Package for Social
Science) to calculate absolute frequencies and percentages.
RESULTS
Distance module in endocrine physiology. The general ob-
jective of the module was to develop knowledge concerning
the physiology of the endocrine system. The specific objectives
are shown in Table 1.
Organization of the content of the distance module in endo-
crine physiology is shown in Table 2.
Module assessment. As to the module assessment, the four
physiology experts addressed the items’ content, interaction,
activities, response time, and quality of the interface. The four
informatics experts addressed only items concerning the re-
sponse time and quality of the interface.
Regarding content and interaction, all expert answers (100%)
indicated that the characteristics were fulfilled. For the activi-
ties item, one of the experts (25%) determined in the intelligi-
bility category that the characteristics were partially fulfilled,
due to the difficulty of understanding one statement in a
content retention exercise in lesson 7. The exercise was re-
viewed, and the modification that the expert suggested was
accepted.
For the response time, most experts [6 (75%)] considered
that the characteristics were fulfilled. However, two of the
expert answers (25%) indicated that the characteristics were
partially fulfilled in the navigation category, justified by the
fact that some pages of the material opened quickly, which, in
their view, could be a source of confusion for the student.
Regarding the quality of the interface, all expert answers [8
(100%)] showed that the characteristics were fulfilled.
Implementation of the distance module in endocrine physi-
ology. The implementation of the module occurred between
November 21, 2007 and December 10, 2007. Ten hours were
dedicated to the accomplishment of on-site meetings and 10 h
to carry out distance activities. During the on-site meetings,
the students became familiar with the VLE of TelEduc and
discussed doubts regarding the introductory lesson and les-
sons 1–7.
To carry out distance activities, students studied the content
of the lessons, did content retention exercises, and participated
in discussion forums and in the chat about diabetes mellitus.
Characterization of students participating in the distance
module in endocrine physiology. Of the 44 students (100%)
who participated in the implementation of the module, most of
the students were women (93.2%) and between 19 and 23 yr
old (75%).
Data related to the students’ use of the internet and personal
computers are shown in Table 3.
Twenty-three of the students (59.0%) indicated that the
internet was the most used means to obtain updated knowl-
edge, and 30 students (68.2%) accessed it predominantly from
the teaching institution. Twenty-five students (56.8%) used a
personal computer every day, 23 students (56.1%) used it from
How We Teach
72 DISTANCE MODULE IN ENDOCRINE PHYSIOLOGY

Table 1. Distribution of the specific objectives of the lessons 86.80%), followed by chat (VC: 65.14%), exercises (VC:
of the distance module in endocrine physiology 50.16%), and support material (VC: 44%).
Student average scores on content retention exercises
Lessons and Specific Objectives (lessons 1–7) are shown in Fig. 1. Figure 1 also shows the
variation in average scores on the content retention exer-
Introductory lesson: the endocrine system
cises (lessons 1–7).
1. To define hormones The average participation in the discussion forums was 30
2. To identify the endocrine glands
3. To describe the hormonal regulation mechanisms students.
The average participation in chat sessions A and B was 22
Lesson 1: physiological aspects of the hypothalamus-hypophyseal axis
students.
1. To identify the hormones synthesized by the hypothalamus and With regard to the summative evaluation, the students’
hypophysis
2. To describe the role of the hypothalamus in the control of hypophyseal average exam score was 6.5 (SD: 1.1).
secretion Students’ final grades in the module averaged 8.5 and the
Lesson 2: physiology aspects of the thyroid gland standard deviation 1.2.
1. To identify the hormones released by the thyroid gland
2. To describe the action of the thyroidal hormones
3. To explain the regulation mechanism of thyroidal hormone secretion
4. To describe the clinical manifestations of hyperthyroidism and Table 2. Distribution of the organization of the contents of
hypothyroidism the lessons of the distance module in endrocrine physiology
Lesson 3: physiological aspects of the adrenal gland
Lessons and Contents
1. To identify the hormones secreted by the adrenal gland
2. To describe the actions of hormones secreted by the adrenal gland
3. To describe the clinical manifestations of Addison’s and Cushing’s Introductory lesson
disease ● Hormones and glands
Lesson 4: physiological aspects of the parathyroid gland ● Hormonal regulation
● Positive feedback
1. To identify the hormone secreted by the parathyroid gland ● Negative feedback
2. To describe the actions of the hormone secreted by the parathyroid gland
3. To explain the regulation mechanism of the hormone secreted by the Lesson 1
parathyroid gland ● Hypothalamus-hypophyseal control
4. To describe the clinical manifestations of hypoparathyroidism and ● Anterior and posterior hypophysis
hyperparathyroidism ● Hormones of anterior hypophysis
Lesson 5: physiological aspects of the pancreas ● Hormones of posterior hypophysis

1. To identify the hormones secreted by the pancreas Lesson 2

2. To describe the actions of the hormones secreted by the pancreas ● Hormones of the thyroid gland
3. To explain the regulation mechanism of the secretion of hormones ● Actions of thyroidal hormones
secreted by the pancreas ● Regulation of thyroidal hormones
4. To describe the clinical manifestations of type 1 and type 2 diabetes ● Thyroid diseases
mellitus
Lesson 3
Lesson 6: physiological aspects of the male reproductive system
● Hormones of the adrenal gland
1. To identify the functions of the testes ● Actions of adrenal hormones
2. To describe spermatogenesis ● Regulation of adrenal hormones
3. To explain the hormonal control mechanism of spermatogenesis ● Adrenal diseases
4. To describe the actions of testosterone
Lesson 4
Lesson 7: physiological aspects of the female reproductive system
● Hormones of the parathyroid gland
1. To identify the functions of the ovary ● Action of parathyroid hormone
2. To explain the hormonal control mechanism of the menstrual cycle ● Regulation of parathyroid hormone
3. To describe the actions of estrogen and progesterone ● Parathyroid diseases
Lesson 5
● Function of the pancreas
the teaching institution, and most students (58.1%) learned to ● Action of pancreatic hormones
● Diseases of the pancreas
use it alone or by trying.
Student evaluations. Concerning the student formative eval- Lesson 6
uations, the number of subjects, minimum and maximum ● Function of the testes
accesses, average, SD, and variation coefficient (VC) for the ● Hormonal regulation
● Actions of testosterone
access variables of support material, exercises, discussion fo-
rums, and chat are shown in Table 4. Lesson 7
The data shown in Table 4 revealed great variation in access ● Function of the ovary
to support material, exercises, discussion forums, and chat, ● Regulation of the menstrual cycle
demonstrating a lack of homogeneity in distributions. Compar- ● Actions of estrogen
● Actions of progesterone
atively, access to discussion forums was more dispersed (VC:

Advances in Physiology Education • VOL 34 • JUNE 2010

Downloaded from journals.physiology.org/journal/advances (168.227.017.186) on October 23, 2023.
 How We Teach
DISTANCE MODULE IN ENDOCRINE PHYSIOLOGY 73

Table 3. Distribution of students participating in the

distance module in endocrine physiology according to the
use of the internet and personal computer

Students

Use of the Internet and Personal Computer Number %

Means used to obtain updated knowledge:

Internet 23 59.0
Television 11 28.2
Newspapers 3 7.7
Magazines 2 5.1 Fig. 1. Distribution of the average scores of content retention exercises
Total* 39 100.0 (lessons 1–7).
Place from where you predominantly access the internet:
From the institution where I study 30 68.2
From home 13 29.5 fill the physical and geographic distance between the student
Frow work 1 2.3 and professor (10). However, it is an aim for students to
Total* 44 100.0 develop self-management abilities in the construction of their
Frequency of personal computer use:
Daily 25 56.8 knowledge, and professors mediate and facilitate this process.
Between 3 and 6 times/wk 17 38.6 The following activities can be developed in digital environ-
1 or 2 times/wk 1 2.3 ments: multiple-choice and true/false reinforcement exercises
Sporadically 1 2.3 as well as leisure activities, such as games, in which the
Total 44 100.0
Place where I most frequently use the computer:
feedback provided to students is immediate (5). Concerning
At the insitution where I study 23 56.1 accessibility, easy access to the Web from any computer
At home 17 41.5 connected to the internet should be guaranteed. The design of
At work 1 2.4 the interface should be consistent and aesthetically pleasing to
Total* 41 100.0 orient students and catch their attention (4a).
How did you learn to use the personal computer?
Alone, by trying 25 58.1 The use of computers in school to access the internet and
In specialized courses 17 39.5 self-taught learning to use them, as evidenced in this study, has
With orientation, at the institution where I study 1 2.3 also been shown in national and international research (6, 16).
Total 44 100.0 This intensifies the role of universities in training undergrad-
*Only participants who answered the question were considered. uate nursing students in the use of computer resources (2).
High dispersion in the access of discussion forums, chat,
exercises, and support material has also been verified in a
DISCUSSION distance module in medication administration (20).
In this module, after the exercises proposed for content
Digital technology resources permit the development of
retention and the interactive JCROSS crosswords exercises
educational resources, including several tools and random
were completed and sent in, feedback to students was imme-
browsing by students. These conditions can favor physiology
diate. Learning in physiology courses is more efficient if
learning, since students with different learning styles can be
students have instantaneous feedback on the activities carried
offered the same content in multiple formats and sequences,
out and if these replace the ones done outside the classroom (9,
allowing them to choose the best way for them.
12, 18).
The present study used VLE TelEduc to host the distance
On average, 30 students participated in the discussion fo-
module in endocrine physiology. The use of this environment
rums in this study. This result differs from the findings in an
is becoming more and more common in nursing (17, 19).
online course in mood disorders with nursing undergraduates,
According to the experts’ assessment, the distance module in
which found little participation in discussion forums, due to the
endocrine physiology totally fulfilled the pedagogical aspects
absence of a professor in the discussions (14, 17). In the same
(content, interaction, and activities) and technical aspects (re-
study, chat was shown to be a tool students frequently used for
sponse time and quality of the interface) most of the time. The
informal conversations and to work content related to the
content of a distance module should have small units and
proposed course. In the present study, the average participation
communicate what is necessary to achieve the proposed aims.
in the chat on diabetes mellitus was 22 students.
It is desirable for an online course to offer interaction so as to
Summative evaluation showed that, in general, student per-
formance was satisfactory. Although this kind of evaluation is
Table 4. Distribution of access to support material, a proposal originating in traditional teaching, which does not
exercises, discussion forums, and chat favor autonomous study, creative and significant learning is
expected from the students. In Brazil, this type of evaluation
Variation remains obligatory by law in distance courses.
Access Minimum Maximum Average SD Coefficient, %
Conclusions. The VLE of TelEduc was shown to be an
Support material 9 63 27.98 12.31 44.00 efficient tool to host a distance module to support the teaching-
Exercises 9 64 37.30 18.71 50.16 learning process of endocrine physiology. In addition, the
Discussion forums 1 116 25.32 21.98 86.80 simplicity in handling its synchronous and asynchronous com-
Chat 1 12 4.82 3.14 65.14
munication tools permitted interactions between the students
n ⫽ 44 students total. and professor.

Advances in Physiology Education • VOL 34 • JUNE 2010

Downloaded from journals.physiology.org/journal/advances (168.227.017.186) on October 23, 2023.
How We Teach
74 DISTANCE MODULE IN ENDOCRINE PHYSIOLOGY
In activities in which the professor was not present, not even
virtually, student participation was lower. This compares with
traditional education, in which students are learners and the
professor is the coordinator of the process.
The teaching strategies that students are routinely exposed to
need to be reviewed. Thus, this generation of students can be
supplied the competencies expected for their professional per-
formance. Since physiology is one of the basic sciences to
support nursing care, this course needs to be taught in an
innovative way, and further studies need to be developed that
test these strategies.
ACKNOWLEDGMENTS
Statistical analysis was performed by Jesusmar Ximenes Andrade (Depart-
ment of Accounting and Administration, Centro de Ciências Humanas e
Letras, Federal University of Piauı́ and PhD candidate in Controlling and
Accounting, Faculty of Economics, Administration and Accounting, Univer-
sity of Sao Paulo).
REFERENCES
1. Aires MM. Fisiologia (2nd ed.). Rio de Janeiro: Guanabara Koogan,
1999.
2. Alves RH, Cogo AL. Vivência de estudantes de licenciatura em enfer-
magem em disciplina na modalidade a distância. Rev Gaúcha Enferm
Porto 29: 626 – 632, 2008.
3. Caetano KC. Desenvolvimento e Avaliação de um Ambiente Virtual de
Aprendizagem em Administração em Enfermagem (Master’s Thesis). São
Paulo, Brazil: Escola de Enfermagem/USP, 2006.
4. Chummun H. Understanding changes in cardiovascular pathophysiology.
Br J Nurs 18: 359 –364, 2009.
4a.de Azevedo Nacimento AC. Princı́pios de Design na Elaboração de
Material Multimı́dia para Web (online). http://rived.mec.gov.br/artigos/
multimidia.pdf [17 February 2010].
5. Falkembach GA. Concepção e desenvolvimento de um material educa-
tivo digital. Novas Tecnologias Educação 3: 1–15, 2005.
6. Fetter MS. Graduating nurses’ self-evaluation of information technology
competencies. J Nurs Educ 48: 86 –90, 2009.
7. Green SM, Weaver M, Voegeli D, Fitzsimmons D, Knwles J, Harrison
M, Shephard K. The development and evolution of the use of a virtual
learning environment (Blackboard 5) to support the learning of pre-
Advances in Physiology Education • VOL 34 • JUNE 2010
Downloaded from journals.physiology.org/journal/advances (168.227.017.186) on October 23, 2023.
qualifying nursing students undertaking a human anatomy and physiology
module. Nurse Educ Today 26: 388 –395, 2006.
8. Guyton AC, Hall JE. Fisiologia Médica (10th ed.). Rio de Janeiro:
Guanabara Koogan, 2002.
9. Kibble J. Use of unsupervised online quizzes as formative assessment in
a medical physiology course: effects of incentives on student participation
and performance. Adv Physiol Educ 31: 253–260, 2007.
10. Moore M, Kearsley G; translated by Galman R. Educação a Distância:
uma Visão Integrada. São Paulo, Brazil: Thomson Laerning, 2007.
12. Paschal CB. Formative assessment in physiology teaching using a wire-
less classroom communication system. Adv Physiol Educ 26: 299 –308,
2002.
13. Rodrigues RC, Peres HH. Panorama brasileiro do ensino de enferma-
gem. Rev Esc Enferm USP 42: 298 –304, 2008.
14. Romanowski JP, Wachowicz LA. Avaliação formativa no ensino supe-
rior: que resistências manifestam os professores e os alunos? In: Processos
de Ensinagem na Universidade: Pressupostos para as Estratégias de
Trabalho em Aula, LG, Alves LP. Joinvile, SC: Univille, 2007, p.
130 –150.
15. Schlemmer E. Metodologias para educação a distância no contexto da
formação de comunidades virtuais de aprendizagem. In: Ambientes Vir-
tuais de Aprendizagem, edited by Barbosa RM. Porto Alegre: Artmed,
2005, p. 29 – 49.
16. Severo CL, Cogo AL. Acesso e conhecimento dos acadêmicos de enfer-
magem acerca de recursos computacionais. Rev Gaúcha Enferm 27:
516 –523, 2006.
17. Silva EC. Educação a Distância: Ambientes Digitais para o Processo
Ensino-Aprendizagem em Enfermagem Psiquiátrica (PhD Dissertation).
São Paulo, Brazil: Escola de Enfermagem de Ribeirão Preto/USP, 2007.
18. Taradi SK, Taradi M, Radic K, Pokrajac N. Blending problem-based
learning with Web technology positively impacts student learning out-
comes in acid-base physiology. Adv Physiol Educ 29: 35–39, 2005.
19. Telles Filho PC, Cassiani SH. Ciclo de criação e avaliação do módulo
administração de medicamentos para ensino a distância. Rev Latino-am
Enfermagem 16: 78 – 85, 2008.
20. Telles Filho PC, Cassiani SH. Implementação e avaliação do módulo a
distância. Cogitare Enfermagem 12: 222–235, 2007.
21. Weherwerein EA, Lujan HL, Dicarlo SE. Gender differences in learn-
ing style preferences among undergraduate. Adv Physiol Educ 31: 153–
157, 2007.
22. Zaı́na LA. Acompanhamento do Aprendizado do Aluno em Curso a
Distância Através da Web: Metodologias e Ferramentas [Master’s thesis].
São Paulo, Brazil: Escola Politécnica/USP, 2002.