Kieran Walsh: Class war—e-learning

In the early days of e-learning there was great enthusiasm, but little evidence of effectiveness. The enthusiasts said that they couldn’t wait for evidence and so went ahead anyway. When evidence did start to emerge, it seemed to suggest that e-learning offered similar outcomes as traditional methods of medical education—which was a good and solid result. [1]

But the enthusiasts weren’t satisfied. They said that the evidence was based on early forms of e-learning and the technology had already moved on. E-learning was now about massive open online courses and flipped classrooms and all-singing all-dancing online resources. Advocates of evidence based education then split into those who wanted to evaluate these new forms of e-learning and those who said enough is enough—e-learning is like any other form of learning—except that it is online.

In the meantime, another group emerged that was interested in looking at e-learning from the point of view of convenience, choice, and cost effectiveness. At BMJ Learning we have always been most interested in these outcomes and also in how e-learning might be able to help medical learners, and in what subjects and contexts it might work best. We have also been interested in barriers to e-learning and how best to overcome these barriers.

Kohan et al have recently published a clever study on barriers to e-learning among medical learners. [2] They found a number of barriers. These included information overload—which is not surprising considering the amount of information that is now available over the internet. They found that some students were ambiguous about their role and were uncertain of exactly how to act in virtual learning environments. The learners had to communicate as part of their online learning course but often had inadequate writing skills and this prevented them from communicating as they wished to—with both their tutors and their peers. Some of the students found that the workload from their online learning was heavy and that they simply didn’t have enough time to complete their online coursework.  

But what interested me most was not the barriers that they found but rather the barriers that they didn’t find. Technological barriers were not a predominant theme. By contrast, nearly ten years ago we did a study of barriers to e-learning and found mainly technological barriers. [3]

So what has happened over the ten years? It is likely that e-learning has gone mainstream and is seen by learners as just like any other form of learning. So there must be a lesson for providers of e-learning in the 2017 paper—which is that e-learners are no different from other types of learners. And that they need short bite sized chunks of learning to help them overcome information overload. This fits with the feedback that we get at BMJ Learning and with the types of resources that we are trying to provide.  

There is also a lesson for employers—that healthcare professionals need protected time to do their e-learning just as they need protected time for their other learning activities. How long will it be until healthcare professionals will be able to claim study leave to do e-learning?

Kieran Walsh is clinical director of BMJ Learning and BMJ Best Practice. He is responsible for the editorial quality of both products. He has worked in the past as a hospital doctor—specialising in care of the elderly medicine and neurology.

Competing interests: Kieran Walsh works for BMJ, which produces the online clinical decision support tool BMJ Best Practice.


  1. Cook DA, Triola MM. What is the role of elearning? Looking past the hype. Medical education. 2014 Sep 1;48(9):930-7.
  2. Kohan NSoltani Arabshahi KMojtahedzadeh RAbbaszadeh ARakhshani TEmami A Self- directed learning barriers in a virtual environment: a qualitative study. J Adv Med Educ Prof. 2017 Jul;5(3):116-123.
  3. Walsh K. Barriers to online learning – the BMJ Learning experience. Focus on Health Profession education: a multidisciplinary journal, Vol. 10, No. 1, 2008, pp77-78.
  • Jean McK

    Very interesting essay, thank you, Kieran. About the point at the end – when I started designing computer-based training in industry back in the pre-Internet dark ages, the one thing we repeatedly said to senior management was that protected time was needed to utilise this training option and that it should not just be yet another thing added to people’s workload or to be done on their own time. It seems that, sadly, that lesson has still not been learned 30 years later.

    As for some medical students not being able to write adequately, I have certainly found that to be true and find it depressing and dangerous. These are highly intelligent students in a demanding university course.Their lack of experience in academic writing and inability to express themselves clearly should be a concern for all of us. I wonder how many have actually had to do any extended writing before university and, if they have not, why not??

  • Mohammed Al-Musawi

    Thanks Kieran…well said. Methods of learning should be viewed as complementary rather than competing rivals. There is no right and wrong in this, it is preference, which is complex issue. And what matters really is what works for you and the impact out of it, which is also a complex issue to. People can mix and match between the methods and they are still ok if this is what they prefer and works for them.