Learning Management Systems and Lecture Capture in the Medical

Learning Management Systems

and Lecture Capture in the

Medical Academic Environment

Larry F. Chu, MD, MS (BCHM), MS

(Epidemiology)

Chelsea A. Young, BS

Lynn K. Ngai, BS

Tony Cun, BS

Ronald G. Pearl, MD, PhD

Alex Macario, MD, MBAStanford University School of MedicinePalo Alto, California

Historically, the use of computers in medical education has beenlimited to supporting the work of traditional classroom learningthrough tasks such as word processing, displaying slides, and recordinggrades. With the advent of worldwide networks of computers (TheWorld Wide Web) and the more recent emergence of web 2.0 andstreaming media technology, medical educators today have importantnew tools that could transform modes of traditional medical education.

This review will discuss two of these technologies: learningmanagement system (LMS) and lecture capture (LC), explaining theadvantages and disadvantages associated with each in the context ofmedical resident education. Commercial products that enable LMS andLC available today will be discussed. We will subsequently present anactual application of LMS/LC for an online, blended-learning coursedesigned to enhance preparedness of interns to begin anesthesiaresidency. This case study of the Successful Transition to Anesthesia

INTERNATIONAL ANESTHESIOLOGY CLINICSVolume 48, Number 3, 27–51r 2010, Lippincott Williams & Wilkins

www.anesthesiaclinics.com | 27

REPRINTS: LARRY F. CHU, MD, MS (BCHM), MS (EPIDEMIOLOGY), ANESTHESIA INFORMATICS AND MEDIA LAB,DEPARTMENT OF ANESTHESIA, (HTTP://WWW.AIM.STANFORD.EDU), STANFORD UNIVERSITY SCHOOL OF MEDICINE, 300PASTEUR DRIVE, ROOM H3580, MC5640, STANFORD, CA, E-MAIL: [email protected]

Residency Training (START) program implemented at Stanford willillustrate the potential of Web 2.0 technology to advance graduatemedical education.

’ LMS

What is an LMS?

An LMS can be thought of as a four classroom that stays open 24hours a day and seven days a week (Fig. 1; Panel A). An LMS may bebroadly defined as a software application that automates the adminis-tration, tracking, and reporting of training events.1 The most basic formof LMS simply serves as a storage space for course materials into whichstudents must log in to obtain access. More advanced LMS productsoffer additional features, including test and quiz options, audio or video

Figure 1. Panel A, Diagram of learning management system (LMS). The learning managementsystem functions as a virtual classroom enabling interactions between students and the classroom (1),student-student peer interactions (2), student-teacher interactions (3) and teacher-teacherinteractions (4). The LMS provides core services that support the four key principles of online-learning best practices: presentation of learning objects, facilitating interactions, collaborativelearning, and providing prompt feedback. Panel B, Schematic of lecture capture (LC) system.A typical lecture capture system utilizes a personal computer with audio (and/or video) recordingcapabilities and special software to record a lecture presentation to a hard drive. The data isthen transmitted via the internet to a cloud computing application (e.g. Panopto CourseCast)where the data is transcoded to various proprietary and open platform media formats and providedto students as Podcasts, video files, audio files, and/or integrated as a learning object intoan LMS.

28 ’ Chu et al

www.anesthesiaclinics.com

materials, interactive forums, advanced search capabilities, and gradebooks. The instructor may grant access to specific aspects of the courseto students or to other instructors. Students may be divided into groups towork competitively or collaboratively. Materials or activities may bepreprogrammed and hidden until they are ready to be used. To reachits full potential, an LMS should facilitate more effective and efficientdissemination of material and receipt of feedback, thereby optimizing thelearning process.2–4 In graduate medical education specifically, LMS’s canhelp the program director to achieve the Accreditation Council forGraduate Medical Education (ACGME)’s goal of providing documenta-tion for students’ learning progress in various stated objectives.5

Advantages of LMS

Allows Students to Time Shift and Place Shift While traditionalclassroom styles of learning require students to meet in the samegeographic location at the same time of day for a specified period oftime, an LMS is a virtual classroom allowing students to access informationand participate in a structured, comprehensive curriculum while timeshifting or place shifting. Time shifting is the recording of programmingto a storage medium so that it can be viewed or listened to at a time moreconvenient to the consumer. The phrase time shifting was originallycoined in the context of television programming.6 Place shifting iswatching or listening to live, recorded, or stored media on a remote devicethrough the internet or over a data network.7 Curricula implementedthrough an LMS can use one or both of these concepts.

Thus, LMS’s have created a more convenient way of learning,overcoming the physical and temporal barriers associated with tradi-tional classroom learning. While maintaining the ability to trackstudents’ progress and facilitate interaction among faculty and residents,LMS’s grant students independence and flexibility. These characteristicsare particularly advantageous in medical residency programs becauseresidents often work odd and long hours while needing to adhere to theACGME’s 80-hour workweek cap, as well as being scattered acrossmultiple hospital environments and facilities.8 For instance, a residentwho misses a meeting of journal club could still locate the relevantjournal article online, participate in virtual discussion with his peersthrough forums and chat rooms, and receive instantaneous feedbackfrom instructors.

Logically Organizes Material for Spiral Learning An LMSprovides a virtual structure for the storage of information, such aspresentation slides, lectures, and quizzes. Depending on the nature of the

LMS and LC in Medical Academic Environment ’ 29


course, information may be categorized by module or topic. Thisorganization allows students to quickly and easily locate and reviewmaterial from previous modules to create a strong foundation on which tobuild new knowledge. For example, before beginning the second modulein a lesson about induction agents, students could review previous lessonsabout induction agents, re-watch previous lectures, and retake previousquizzes to test their retention of knowledge. Thus, an LMS naturally lendsitself to the development of a ‘‘spiral curriculum,’’ in which topics arerevisited in greater depth and complexity over time. ‘‘Spiral curriculums’’have been shown to be effective in medical education.9

Allows Material to be Easily Archived and Searched LMS’s allowmaterial to be easily archived for later usage. Search functions allowstudents to sort materials by date or relevance. A well-implementedLMS, like a teaching assistant who has been teaching a course for manyyears and has a flawless understanding of the subject, helps students tolocate the requested material at a moment’s notice. Again, reviewingprevious materials as needed will help the student to develop a betterunderstanding of the topics at hand.

Allows Educators to Maximize Their Efforts (Scalability) Thetraditional style of teaching, which require one to manually designcurricula, collect course materials, prepare and present lectures, andprepare and grade tests and quizzes, is very time and resource-intensiveprocess. An LMS can enhance efficiency by allowing instructors to reusecourse materials, reassign quiz questions to different tests, and easilyshare course content with colleagues.

Long-term Investment may have Significant Returns Even thoughLMS’s require initial outlay, the long-term efficacy returns from such aninvestment can be significant. LMS can avoid expenses arising fromprinting materials, reserving classrooms, or paying instructors to givelectures and hold office hours. In addition, lunchtime lectures can bereplaced with a supplementary online curriculum.10

Allows for Monitoring of Student Effort and Progress An LMSmay be used to measure the efficacy of an institution’s instruction as wellas overall student performance and satisfaction. As grading quizzes andtracking student progress is instantaneous, administrators may revisethe curriculum at any time as needed to enhance learning. Feedbackfrom the students takes on new importance. Finally, LMS’s mayprovide a viable solution to the ACGME’s requirement that residencyprograms be able to quantitatively assess and demonstrate student

30 ’ Chu et al


learning in each of its stated six core competencies and to documentresidents’ participation in annual required substance abuse and fatiguetutorials.5

Disadvantages of LMS

Installation may Require Technical Expertise and AdditionalExpense Although vendors market LMS’s as user-friendly, LMS techno-logy may in fact be challenging for a layperson to implement and maintain.Depending on the size and nature of the course, implementation andmaintenance of an LMS may prove expensive. Institutions seekingto implement an LMS must have access to a technology departmentwith LMS experience or a person with time to dedicate to setting up thesystem, creating usernames and passwords for students, and importingmaterial. Of course, one can transfer the burden of installation andmaintenance to an outside party for a fee. Some LMS products aresimple to use and require minimal or no outside support (Table 1). Forexample, over 200 universities currently use Sakai, which has manydifferent options for support. Some choose to garner support from thecommunity through shared forums, whereas others choose to work withcommercial enterprises that provide Sakai services (http://sakaiproject.org).Longsight’s Sakai as a Service provides a fully hosted solution for Sakaiusers for a baseline cost of $12,500 per year for installation, branding,hosting, and comprehensive support. Additional costs depend on the scaleof use (www.longsight.com).

Students may Initially Require Assistance Although LMS pro-ducts aspire to simplicity, students sometimes encounter problemswhen using the technology. For example, students may experiencedifficulty locating course activities or materials, may be confused by theconcept of online forums, or may require support from administratorsto understand how to appropriately use the LMS to suit theireducational needs.11 An initial tutorial may prove effective to addressthis obstacle.

Students and Staff may Resist Implementation LMS implementa-tion is sometimes met with resistance from students and staff.Students may feel that an LMS is too cumbersome and wastes theirtime.12 Students may also be unenthusiastic about interacting withtheir peers and instructors in an online environment. Instructors mayfeel that an LMS increases their workload, at least initially. Bothstudents and instructors may be attached to traditional styles of learningand teaching and feel that an LMS depersonalizes the learningprocess.13



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32 ’ Chu et al


LMS Products

Commercially available LMS’s can be divided into three categories:commercial enterprise-wide LMS, open source enterprise-wide LMS,and educator-centric LMS (Table 1).12

Commercial Enterprise-wide LMS A commercial enterprise-wideLMS is one solution for an entire university, corporation, or otherinstitution. This usually means that the system encompasses featuresthat will accommodate the needs of all and different types of users in alarge organization (Table 2). In 1995, WebCT pioneered the start ofcommercial enterprise-wide LMS software development and becameone of the dominant LMS solutions. The ability to track and facilitate thedelivery of course content was revolutionary. Since then, numerousother companies have developed competing products. However, thecomplexity of the software and the costs of maintaining such anenterprise-wide system, because of the requisite high-end nature of thecomputer servers, may not correctly meet the needs of educationproviders, who may prefer less expensive, more customized LMSalternatives (Table 2).

Open Source Enterprise-wide LMS Open source is a developmentpractice that allows open access to a product’s source materials or code.It promotes collaboration among various companies during develop-ment of a software product, which is ultimately free to the public.14 Anopen source enterprise-wide LMS is a customizable enterprise-widesolution to online learning, released under open source licenses. TheLMS can be tailored to the needs of the specific sector in which it is used,so that the entire LMS does not need to be used by all users at all times.Sakai is probably the most familiar example of an open-sourceenterprise-wide LMS. Created through collaboration between theUniversity of Michigan, Stanford, Indiana University and the Massa-chusetts Institute of Technology, the Sakai Project refers to its product as‘‘community source’’ because many of its developers are from institu-tions that actually use Sakai.15 Sakai is referred to as Coursework atStanford University. dotLRN is a similar service that was developed atMIT (dotlrn.org). These LMS’s usually cost nothing for the departmentto license, although they may require the institution to pay a yearlysubscription fee (sakaiproject.org). Although they are usually moremodifiable than commercial enterprise-wide options, these systems stillrequire sophisticated computer servers and specialist technicians.

Educator-centric LMS’s An educator-centric LMS is either acommercial or open source system that is customized by educators to



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34 ’ Chu et al


fit the needs of their own courses. These systems are not only used forclassrooms, but also for continued online education, with the intent thatinstructors can amass content and create one great source of informa-tion stored on an LMS. Educator-centric LMS solutions combinemultiple online software technologies—they offer integration of aca-demic content, testing, and collaborative software like blogs anddiscussion forums. One of the primary benefits of educator-centricLMS solutions is that they do not need complex computer servers ortechnical personnel; a computer-educated person with a standardcomputer can single-handedly manage the educator-centric LMS. AnIT department will still be necessary to initially install and maintain thesoftware, although ongoing maintenance is minimal for these types ofapplications. In addition, members of ‘‘learning communities,’’ groupsof people with shared educational interests, are able to interact easily byimplementation into educator-centric LMS solutions.

’ LC Review

What is LC?

LC is a tool by which lectures can be recorded and archived for lateror real-time viewing through a variety of media players while stillpreserving the visual and auditory aspects of the original didacticpresentation (Fig. 1; Panel B).16 Traditionally, medical education hasused the didactic lecture as a means of disseminating large amounts ofaccumulated information to students.17 Ideally, LC technology allowseducators to communicate the exact same quantity and quality ofinformation in a digitized form. Studies are needed to determinewhether LC results in better retention or higher student satisfactionthan traditional classroom talks by the teacher.

The most basic form of LC technology records solely audioinformation. Other more advanced products capture video, and evenmore advanced LC technologies capture three-dimensional informa-tion.18–20 Instructors can create supplementary slides to be shown duringthe lecture and students can write and share notes on the lecture itself. Forexample, students could make notes at places in the lecture where theyhave questions. A peer or administrator could then respond, at the sametime point in the lecture, to the question. Finally, LC systems can eitherfocus on recording only the lecturer or they can incorporate and captureactivity of the entire class, based on the setup of the audio and/or videosystems, depending on what the students and instructors prefer.

If used properly, such technology should minimize confusion andmaximize efficiency. Further, LC expands the potential audience. Forexample, a student in China could watch in real-time a lecture beinggiven in Palo Alto and could even hear the questions and comments



from the audience and pose his own questions for the class andinstructors to respond to. Similarly, a resident may be unable to attendGrand Rounds while on an ‘‘away rotation’’ at an affiliated off-sitehospital. LC would allow this resident to watch missed lectures andparticipate in other educational activities once his schedule permits himto do so. Furthermore, the resident could do this from the comfort of hisown home, which by current rules does not count toward theACGME duty hour restrictions, and would also avoid commutingtime. LC breaks down physical and temporal barriers, encourages globalcommunication and cooperation, and maximizes students’ learningexperience.

Advantages of LC

Allows for Geographical and Temporal Flexibility As with LMS’s,one of the primary benefits of LC is its ability to provide a geographicaland temporal flexibility that is not possible with traditional classroom-based learning. If students miss a lecture, LC allows them to watch it at aconvenient time and when they feel they will learn the most.21 Studentscan re-watch lectures to clarify or reinforce important information.21

When watching pre-recorded lectures, students can speed up or slowdown the lecture in a way that best suits their learning style. Studentscan pause lectures to take notes or search the web for additionalinformation. Students can watch the lecture in multiple sittings if they sodesire. Students can take breaks. Indeed, the flexibility that LC providestheoretically should improve students’ ability to absorb and retaininformation.22 Further, as mobile computing technology can nowsupport LC systems, students can now view lectures at any time of dayfrom any location. For example, students can listen to or view lectureson their iPod or iPhone while working out at the gym or whilecommuting. Access to lectures becomes unlimited with respect to placeor time.21

Allows Lectures to be Archived and Searched Lectures can beeasily archived and searched by topic or date. Students have thecapability to search for specific slides or annotations within the lecture.The LC technology will enhance residents’ ability to act independentlyto resolve their questions, a key component of adult learning.23

Archived lectures and the ability to search within lectures can help thestudents to prepare for an examination, and seem to improve thestudent’s learning and experience.24 The easy availability of lecturesonline is intended to improve the student’s educational experience byproviding flexibility in the way the student learns, allowing specificquerying while studying, and reducing stress and anxiety.25,26 Onesurvey of 7000 undergraduates showed that students use LC technology

36 ’ Chu et al


primarily to reinforce material, not as a replacement for attendingtraditional lecture.27 Therefore, if a student were confused about aparticular topic, he could easily search the lecture database for lectureshaving to do with that topic and re-watch every relevant lecture in anattempt to improve his understanding. The student may replay a singlelecture as many times and at whatever speed he desires.

LC Technology can be Easily Implemented and Used Hosted LCtechnologies, which are fairly easy to install and maintain, do not requiretechnical expertise on the part of the instructor. LC is also easy for thestudent to use, requiring little or no explanation beforehand.

Meets Students’ Desires and Expectations Multiple studies havedemonstrated that medical students and residents appreciate, use, andexpect LC in support of their academic curriculum. One survey of 7000undergraduates found that students prefer courses that offer recordedlectures over those that do not, citing convenience, flexibility, andenhanced learning ability as the primary advantages.21,27 Radiologyresidents in one academic radiology program using LC ranked recordedlectures as ‘‘extremely useful,’’ on average, and reported most oftenviewing lectures to reinforce material.16 Interestingly, the same studyshowed that two-thirds of students noted an improvement in lecturequality as a result of the LC program. The exact reason for thisperceived improvement merits further investigation.

Disadvantages of LC

Failure of Students to Watch Lectures The primary concern withthe LC paradigm is the risk that students will skip lectures. Lack ofattendance at lectures is worrisome to the educational community forseveral reasons:

� It may discourage the formation of a sense of community orcohesiveness within the educational institution.� As students cannot ask for and receive instantaneous feedback or

engage in a discussion (unless watching in real-time with theappropriate technology), the educational value of the lectureexperience may decrease.26

� Administrators worry that students who skip lecture may lack themotivation to watch lectures on their own.� Instructors may be concerned that students do not devote their

full attention to the lecture while watching it at home, but instead



do other activities simultaneously, which could limit the benefitthey would receive.

However, in one study of LC in a large academic radiology program,93% of residents reported that having lectures recorded had noeffect on their lecture attendance.16 Therefore, it seems that theavailability of online lectures does not change the lecture-watchingbehavior of adult learners such as residents, but instead supplementstraditional sources of learning.

Resistance from Students and Staff As with an LMS, theimplementation of LC may be met with resistance from students andstaff.16 The traditional lecture allows for face-to-face interaction betweenthe student and lecturer and helps to establish the teaching philosophyand the organizational structure.26,28 Instructors may worry that thisbenefit is lost with online lectures. Moreover, LC may disrupt thetraditional culture of live lectures, and the development of relationshipsbetween students and faculty may be hindered.29 Other disadvantagesnoted by faculty members include concerns about proprietary rights torecorded lectures, that preparation time may increase, and that thelecturers’ presentation style may be constrained because of physicalimitations with recording voice and image.16 For these reasons andothers, it may become more difficult to recruit guest lecturers for filmedlectures. However, in a study in which LC was implemented in anacademic radiology program, 88% of faculty reported no increase intime required to prepare for lecture.16

A subject requiring more research is whether LC systems actuallyenhance student learning. Students have noted the perceived usefulnessof LC, but there have been no studies to show under what conditions anLC program actually enhances learning.26,29 The utility of LC withinmedical resident education may be the easiest to imagine because of thehouse staff ’s disparate schedules and work locations. For example,residents are often forced to miss lectures because of patient-care duties;thus, watching them on their computers at home at a later time seemsquite useful.16,30

LC Products

There are a variety of LC systems available on the market; some arefree whereas others vary in price (Table 3). Different LC systems offerdifferent applications (Table 4).

Free LC Systems The two most common free LC systems arePanopto CourseCast Core and openEyA. Mainly used for educational

38 ’ Chu et al


lectures, CourseCast Core allows users to see the lecturer andpresentation slides simultaneously and to type notes directly onto therecorded lecture.31 The latter feature could be of use to residentsbecause they could add their own notes to those of the lecturer toserve as reminders to ask questions at specific points during thepresentation. As CourseCast Core automatically transcodes to multipleviewing formats (eg, iTunes, personal computer, and iPod), notechnical knowledge is required to make lectures readily available inmultiple convenient formats. CourseCast Core is free for educa-tional institutions that qualify for Panopto’s Socrates Program. Panoptoalso offers CourseCast Premium, which provides additional featuresfor a fee (Table 4). Another free system, OpenEyA, can be used tocapture any lecture regardless of the type of visual aids used.32

Although it is simple to use, openEya requires a Ubuntu Linuxoperating system. Although openEyA may be useful on a small scale, itmay not be feasible to implement throughout an entire university ormedical center.

Non-free LC Systems Many commercial products available repli-cate features and functions of free systems, but may offer the advantageof improved technical support. Although free LC systems can meet theneeds of a variety of programs, in some cases it makes sense for aprogram to pay for an LC system to obtain specific features or services.Camtasia Relay allows for lectures to be posted on the web, or in formatscompatible for an iPod or Windows Media Video.33 This allows forportability, which is highly beneficial for medical residents as they canwatch and listen wherever they are and however they want. TechSmith’sCamtasia Relay provides a comprehensive software that only requires aserver.33 Tegrity Campus, which primarily serves academic institutions,allows students to view lectures at adjustable speeds and allows lecturersto record lectures from any location.34 Lectures are sorted into adatabase by the course to allow for easy searching. In general, theLMS’s cost will depend on the number of classrooms and studentsthat use it.34

’ A Case Study: Stanford START

To illustrate how LMS/LC technology may be realistically used in amedical education environment, we present a case study of the STARTprogram at Stanford University School of Medicine. This 10-monthonline blended-learning educational and virtual mentorship programwas designed by the Anesthesia Informatics and Media Laboratorywithin the Department of Anesthesia to enhance the preparedness ofinterns to begin anesthesia residency. Blended learning has been



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defined as ‘‘learning that is facilitated by the effective combination ofdifferent modes of delivery, models of teaching, and styles of learning,and is based on transparent communication amongst all parties involvedwith a course.’’35

The START program blends e-learning with virtual mentorship andcombines different teaching styles (lecture and video-based) and modesof delivery (text, video, and group interaction). To our knowledge, theSTART program represents the first blended-learning and virtualmentorship program using integrated LMS/LC technology designed forinterns in any medical specialty. STARTruns from September 1 to July 1of the intern or first postgraduate year after graduation from medicalschool and is divided into monthly modules, each launched on the firstday of each month (Table 5). Each module contains three com-ponents:

1. A 30-minute video podcast featuring clinical vignettes and mini-lectures using a Moodle LMS

2. In-depth lectures accompanied by pre-quizzes and post-quizzes usingthe Panopto LC system

3. An interactive/collaborative assignment, often involving mentorship.

The curriculum was designed based on need assessments conduc-ted through focus groups and surveys of incoming or current residents,in which respondents reported that an online course designed toprepare them for residency would have been beneficial. Therefore,the START curriculum was designed to encourage the acquisitionof basic knowledge and skills related to anesthesia. Additional goalswere to allow for bonding with classmates and mentors, and toincrease confidence and preparedness to begin residency training,while at the same time incorporating each of the six ACGME corecompetencies.

Implementation of START Website

Two co-directors and one course teaching assistant (TA) run theSTART program, with administrative support from various facultyand staff members within the department. The program has its ownwebsite (start.stanford.edu), which links to an educator-centric LMS,a Moodle website that serves as a centralized location housing linksto all of the past and current course resources, quizzes, and surveys(Fig. 2).

Students have their own login names and passwords. Students canaccess all course materials, post messages in forums, or view their gradesonce logged in to the START website. Moodle was selected based on itsease of use and affordability. Although a programmer was not hired to

42 ’ Chu et al


develop the START website, one of the program’s co-directors (L.F.C.)has technical expertise and dedicated a significant amount of time toset up the website. The course TA, who had little to no technicalskills before her experience with the START program, is responsiblefor updating the course website with monthly activities. Programmingthe website with a new monthly module requires about one and onehalf hours, with developing the quizzes being the most time-intensiveaspect. Moodle was introduced during the first video podcast andstudents were shown a screenshot of how to use their log in names toaccess the START website. A few of the interns needed to be remindedto log in to the Moodle website and many of them forgot theirpasswords and needed to have them reset. However, by the second orthird module, the interns seemed to be using Moodle with little to nodifficulty.

Video Podcasts

A podcast is a series of digital media files (either audio or video) thatare released episodically and often downloaded through web syndica-tion. START podcasts are typically half an hour in duration (Fig. 3).Cyberlink PowerDirector Pro was the video editing software used.Initially, podcasts were filmed informally with a handheld Flip Camera.However, because the sound quality was poor, the camera was upgradedwith a wireless microphone system. The interns in START wereextremely appreciative of this improvement. One intern noted, ‘‘Greatvideo. I wish I could show that clip to my friends and family. The day inthe life video’s production value was amazing!’’ Feedback from theinterns was considered and implemented before the next month’smodule. START used an online media service to distribute the

Table 5. Monthly Topics Presented in the START Program’s Curriculum

Month Curriculum Content

September Introduction to the START program

October Induction of General Anesthesia

November Intraoperative Patient Management

December Airway Management

January Postoperative Patient Management

February Crisis Resource Management

March Practicum I

April Practicum II

May Practicum III

June Final Video



podcast videos (vimeo.com), which allows users to provide links from thatwebsite to other websites. All video podcasts were available inhigh-definition.

Lectures

LC was integrated into the Moodle LMS using Panopto CourseCast(Fig. 4). Even faculty with relatively limited technical experience in usingLC found it easy to create lectures using CourseCast software. Theprogram automatically uploads the completed lectures to panopto.com.The course TA subsequently inserts a link to the lecture onto the STARTwebsite. The slides are synchronized with the lecture so that studentsmay process information through both auditory and visual learning.After the first lecture, on the basis of student feedback, PDF files withcontent from the lecture were included. CourseCast allows courseinstructors to audit and confirm that the interns are viewing the lectures(Fig. 5). This information shows how long the interns watch, and/orwhen they lose interest, allowing lecturers to potentially tailor theirlectures specifically to suit students’ preferences. Although the podcastsgenerally contained summaries of important information, the lecturesprovided interns with more detailed information about one or twospecific topics mentioned in the podcasts.

Figure 2. The Successful Transition to Anesthesia Residency Training (START) homepage, hostedthrough Moodle.

44 ’ Chu et al


Quizzes, Activities, and Grade Book

Moodle LMS technology simplifies the process of assessingand documenting learning in the ACGME’s six stated core competen-cies.

In the START program, students take monthly pre-lecture and post-lecture quizzes based on content in the lecture to measure gains inanesthesia-related knowledge and understanding of the six corecompetencies (Fig. 6).

Moodle offers:� Different types of quizzes and questions (eg, multiple choice and

essay).

Figure 3. A Successful Transition to Anesthesia Residency Training (START) program podcastabout crisis resource management.



� The ability to shuffle the order of questions and answers.� Option for students to make single or multiple attempts at the

same quiz.� Different options for grading (eg, partial credit for specific answer

choices).

Figure 4. The lecture is accompanied by slides and links to PDF files.

Figure 5. CourseCast allows viewing of students’ lecture-watching habits.

46 ’ Chu et al


� Option for students to view their grades and receive feedbackinstantaneously.� Feedback for specific answer choices or specific grade ranges can

be preprogrammed.

Quiz questions are entered into a question bank and then assignedto specific categories and quizzes (Fig. 6). Entire quizzes or singlequestions can be reused in multiple courses. Quizzes can be output asSharable Content Object Reference Model (SCORM) compliant files,which allow quizzes and lessons to be shared with colleagues.

Other types of activities are available:

� Students can chat in forums, upload media files, view text or webpages, take surveys, or contribute to wikis.� Scores for completed quizzes and activities are automatically

entered into a grade book.

Grades for external activities are entered manually by a TA.Instructors can leave comments for the students about each gradereceived. The grade book allows for easy documentation of students’learning progress (Fig. 7).

Preliminary Results

Although the START program is currently finishing up its first year,student and faculty responses have been encouraging. The START

Figure 6. An example of a quiz from the Successful Transition to Anesthesia Residency Training(START) program.



program has achieved 100% participation every month and residentsconsistently rank the program’s podcasts and activities as extremelyuseful. Our preliminary results suggest that an online educationalprogram using LMS/LC technology is both enjoyable and useful forincoming anesthesia residents. The START program’s success suggeststhat an integrated LMS/LC system may be implemented by medicaleducators, but does require a significant degree of technical expertise ininitial setup. However, less technically knowledgeable educators mayinteract with the system as content experts without difficulty once thesystem has already been established. On account of its flexibility,accessibility, and ease of use, LMS/LC technology provides an ideallearning environment for medical residents who are motivated tosupplement their clinical experiences with a comprehensive, structuredcourse designed to enhance their proficiency. In the future, thetraditional classroom setting will be augmented, if not replaced, byLMS and LC.

’ Summary

As residents work disparate schedules at multiple locations andbecause of workweek hour limits mandated by the ACGME, residentsmay be unable to attend lectures, seminars, or other activities that wouldenhance their skills. Further, the ACGME requires that residencyprograms document resident learning in six stated core competenciesand provide proof of completion for various other requirements.

Figure 7. The grade book is viewable by the instructors and the course TA (student names areblocked out to maintain privacy). START indicates Successful Transition to Anesthesia ResidencyTraining.

48 ’ Chu et al


LMS/LC is a promising technology to provide a means by whichresidency programs may overcome these obstacles. More studies areneeded to show under what conditions an LMS/LC program actuallyenhances learning, and which elements are most useful to the newgeneration of learners comfortable with Web 2.0 technologies.

’ Acknowledgment

The authors would like to thank Scott Seki for his contributions tothe development of this article.

This article is intended as a review of commercial LMS and LC products that arecurrently available. None of the authors of this article are employed by, have financial tiesto, or are receiving incentives from the companies mentioned in this article.

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Documents

Learning Management Systems and Lecture Capture in the Medical