he development of a CAI program can be viewed analogously to publication of a textbook, except that with CAI the role of the publisher has often
been removed. Although there are advantages to the ease of making teaching
materials available via the Internet, there may also be unintended consequences. CAI developers are uniformly motivated to create programs that
will be useful but, without the filter of a publisher, there may be a disconnect
between CAI developers and users. CAI developers may not recognize that
the person making most decisions about CAI use is not the learner, but the
educator or course director. It is unlikely that most students or residents will
take it upon themselves to find new and novel ways to learn that are not
assigned or sanctioned by the course director. For course directors to decide
to implement a CAI program in their curricula there must be a need to adopt
it, the program must comprehensively meet their educational needs, and the
program must be educationally sound and accepted by students (Cook &
Dupras, 2004; Fall et al., 2005). Given the low level of CAI implementation
one can assume that few programs have met these criteria