Kieran Walsh: E-learning—do directors of education need an upgrade?   

E-learning in medical education has been around for twenty years. Some studies have shown it to be as effective as traditional forms of education—at least for selected learning outcomes. [1]

It may also result in cost savings compared to more traditional forms of education. But any potential savings from e-learning depend upon the e-learning resources fitting in with the rest of a medical education programme and not just reproducing the programme online. For example, if junior doctors learn about how to diagnose asthma online and then learn the exact same information in a tutorial about asthma, there won’t be any savings from e-learning. If, however, the doctors use e-learning to learn knowledge on the diagnosis of asthma and afterwards attend a skills-based tutorial on performing spirometry, then there may be savings of time and resources. This is not new—it used to be called blended learning and is now increasingly called flipping the classroom.

But all of this depends upon tutors and programme directors knowing about e-learning resources, and feeling that they are worthwhile, and recommending them to their learners. So, do they do this?

Witch and colleagues have conducted a fascinating study to get an answer to this question. [2] They surveyed directors of residency programmes in the United States to find out how much e-learning is used within these programmes and to find out the perceptions of directors regarding e-learning. They found a great deal of variation. Some programmes used e-learning a great deal; some used it rarely; and some not at all. Delving deeper, there was higher use of asynchronous than synchronous learning. Some directors had positive perceptions of e-learning and some had negative perceptions. On balance, the directors were somewhere between lukewarm and positive about e-learning.

E-learning will only really be effective and efficient in postgraduate or residency based education when it fits in with the rest of the programme. But this will only happen with the active support of the programme directors. My experience of talking to programme directors is that they are usually busy trying to satisfy multiple internal and external demands. The internal demands come from residents, tutors, and colleagues in education. External demands come from funders, governments and evaluators. As a result, programme directors might simply not have time to think about e-learning. But without them, we will struggle to reap the real rewards of e-learning. Many of them will have trained when there was no e-learning or when e-learning was much more basic than it is now. Some will still be up to speed in their knowledge of e-learning, but others might need an upgrade.

Medical education has become much more learner centred in the past twenty years. This is good news for learners and the patients that they serve. But we must somehow ensure that tutors and directors receive support so that they can continue to facilitate new ways of teaching and 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 interestsKieran Walsh works for BMJ which produces the e-learning resource BMJ Learning.


  1. Sinclair PMKable ALevett-Jones TBooth D. The effectiveness of Internet-based e-learning on clinician behaviour and patient outcomes: A systematic review. Int J Nurs Stud.2016 May;57:70-81.  
  1. Wittich CM, Agrawal A, Cook DA, Halvorsen AJ, Mandrekar JN, Chaudhry S, Dupras DM, Oxentenko AS, Beckman TJ. E-learning in graduate medical education: survey of residency program directors. BMC Med Educ. 2017 Jul 11;17(1):114.