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Understanding the Pros and Cons of Learning Management Systems in Surgical Education

Shaghayegh Sabbaghan, MD; Roy Phitayakorn, MD, MHPE, MAMSE, FACS; Emil Petrusa, PhD

September 24, 2024

Key Learning Objectives

  • Explain what a learning management system (LMS) is and how it can be used in the context of surgical education.
  • Provide an overview of major LMS platforms used in medical education, highlighting their pros, cons, and pricing.
  • Identify strengths and limitations of major LMS for surgical education and suggest implementation strategies.
  • Offer practical recommendations for effectively implementing LMS in surgical education to maximize benefits and mitigate challenges.

Intended Audience

This article is intended for surgical educators, residency program directors, instructional designers, and IT support staff involved in the design, implementation, and administration of educational programs in surgical residency training. It is also useful for medical education researchers and healthcare administrators interested in enhancing educational outcomes through technology.

Introduction

A learning management system (LMS) is a software application for the administration, documentation, tracking, reporting, and delivery of educational courses for training programs.1 They provide interactive course materials and facilitate blended learning approaches to enhance the learners’ educational experiences.2 The LMS structure can help align course objectives with learning activities and better prepare undergraduate and postgraduate students for in-person sessions.3 However, it is unclear how an LMS should be utilized in surgical residency programs and there are no published articles on this topic to date. This article will provide the surgical education community with an overview of the major LMS platforms and how they might enhance learning for surgeons.

Table 1: LMS Platform Comparison
Table 1 lists LMS commonly used in medical education, with pricing and and an overview of pros and cons. “Per user” pricing assumes 50 residents. (Pricing is as of 9/23/2024).

LMS Platform

Pricing

Pros

Cons

Absorb LMS

Starts at $800 per month ($9,600 annually) plus $16 per active user, per year

  • Customizable and scalable
  • Strong reporting and analytics
  • May be complex for small organizations
  • Cost can scale with features and users

Auzmor Learn

TBD

  • Intuitive user interface
  • Comprehensive training and development features
  • Good integration and capabilities
  • Mobile-friendly design
  • Complex earning curve for new users
  • Limited customization for complex requirements

Blackboard Learn

$9,500 per year

  • Comprehensive features
  • Strong assessment tools
  • Widely used in higher education
  • Strong security
  • Expensive
  • Less intuitive
  • Outdated interface

Brightspace by D2L

$30,000 for 500 users for 12 months

  • Modern user interface
  • Strong analytics and personalization
  • Good educator and learner support
  • Highly customizable
  • Feature rich
  • Potentially overwhelming
  • Pricing may be a barrier for smaller institutions

Canvas by Instructure

Free for some plans and average $27 per month

  • User-friendly interface
  • Extensive integration capabilities
  • Robust features for course creation and management
  • Customization can be limited and requires resources
  • Can be costly for smaller organizations
  • Expensive for large setups

Cornerstone Learning

Starts at $6 per user per month

  • Extensive customization options
  • Robust analytics and reporting
  • Can be complex to navigate
  • Setup and maintenance may require resources

Docebo

Starts at $1,600 per month ($19,200 annually)

  • Modern UI
  • Strong in analytics and reporting
  • Scalable
  • Flexible
  • AI-driven personalization
  • Pricing can be higher for many users
  • Some features may be excessive
  • Can be overwhelming for new users

eFront

Starts at $1,200 per month

  • Highly customizable and scalable
  • Blend of traditional and modern features
  • Strong security
  • Complex setup
  • Can be expensive for larger institutions

EthosCE

Starts at $1,750

  • Designed for continuing medical education
  • Comprehensive tracking and reporting
  • Robust features for compliance
  • Custom pricing can be high
  • Focus is more on CME

GIBLIB

$83 per month per user

$990 annually per user

  • Surgical videos and lectures
  • Content from renowned professionals
  • Supplementary resource, not a full LMS
  • Limited interactive learning

HealthStream Learning

$21 per month per user

  • Specialized in healthcare compliance and training
  • Extensive library of medical content
  • May focus more on compliance than broad learning needs
  • Interface and usability vary

iSpring Learn

Starts at $2.29 per user per month

  • User friendly
  • Supports detailed reporting
  • Offers course authoring tools
  • Limited customization
  • Pricing may be high for small organizations

LearnUpon

From $15,000 per year

  • Easy to use
  • Scalable
  • Good customer support
  • Integrates with webinars
  • Customizable learning paths
  • Limitations in customization
  • Corporate oriented
  • Basic plan may lack advanced or academic features

Litmos

Starts at $3 per user per month

  • User-friendly interface
  • Extensive course library
  • Mobile compatibility
  • Robust reporting and tracking
  • Limited customization for specific needs
  • Advanced features may require higher-tier plans

MedHub

TBD

  • Designed for medical education and training
  • Comprehensive features
  • Integrates with clinical systems
  • More expensive than general platforms
  • Steeper learning curve

Moodle

$120 per year

  • Highly customizable
  • Large community
  • Extensive range of plugins
  • Requires technical expertise
  • Less modern UI
  • Resource intensive

Relias Healthcare

Starts at $25 per license

  • Specialized in healthcare learning
  • Adaptive learning technology
  • Compliance tracking
  • Primarily healthcare-focused
  • May not be as flexible for non-healthcare contexts
  • Cost transparency

SkyPrep

Starts at $199 per month

  • Intuitive platform
  • Strong tracking and reporting
  • Good customer service
  • Limited social learning features
  • Customization options might be restricted

Talent

Starts at $828 per year for 6–40 users; free for up to 5 users and 10 courses; paid plans from $59 per month

  • Intuitive
  • Easy to use
  • Scalable
  • Good for small to medium programs
  • Supports blended learning
  • More generic
  • May lack some advanced customization options
  • Features may be basic for complex needs

Tovuti

Starts at $11,160 annually with a $3,000 setup fee

  • Interactive
  • Engaging learning experiences
  • Comprehensive feature set
  • Customizable
  • Pricing can be high for full feature set
  • May require time to learn all features

Totara Healthcare

$28,375 for up to 500 uses

  • Highly flexible
  • Customizable
  • Strong reporting and compliance features
  • Requires investment in hosting and development
  • Might be complex for smaller programs

The advantages of using an LMS for a surgical residency program are multifaceted. First, an LMS can provide surgery residents with unparalleled flexibility, allowing them to access educational content and training modules at any time and from any location. This accessibility is especially beneficial given the busy schedules of surgical residents. Furthermore, an LMS enables the standardization of educational content throughout the training program, ensuring that all residents gain the same high-quality training. Similarly, most LMS platforms come equipped with tools designed for tracking progress and assessing performance. These features are important to allow both resident physicians and education leadership to monitor areas that require further improvement, thereby enhancing the overall learning experience.4,5

On the other hand, the implementation of an LMS in a surgical residency program is not without its challenges. Technical issues are not uncommon, and both residents and faculty might find themselves needing to navigate these challenges or undergo training to use the LMS effectively, which can be a time-consuming endeavor. Moreover, while an LMS can significantly bolster theoretical knowledge, it falls short of providing the hands-on surgical experience that is critical for comprehensive surgical training. Another significant concern is the difficulty in maintaining engagement within a virtual learning environment. The absence of face-to-face interactions can detract from the interpersonal aspects of learning, potentially leading to a lack of engagement among residents. These disadvantages highlight the need for support and underscore the importance of measuring learner engagement along with learning outcomes in an LMS framework.

The support needed for implementing LMS in surgical education includes:

  • A department server and IT support
  • An instructional designer to assist with building modules
  • Division content champions to work with the instructional designer to build, monitor, and update information
  • Instructors and equipment, if part of the modules are "hands-on" and require follow-up simulation training

To address the challenges of using LMS in surgical residency programs effectively, here are some potentially useful suggestions:

  • Strengthen IT and departmental support to streamline LMS integration. Develop a comprehensive training program for residents and faculty to minimize technical issues and maximize the LMS's utility, ensuring everyone can navigate and use the system efficiently.
  • Encourage collaboration between instructional designers and department specialists to create dynamic, engaging modules. This partnership should focus on developing hands-on simulation components where feasible, blending digital learning with practical experience.  These instructional designers may be present in the larger university or medical school and do not have to be supported by the individual departments. 
  • Implement interactive elements such as quizzes, discussion forums, and live Q&A sessions to increase engagement. Regular feedback mechanisms can also help in adjusting the content and format based on resident input, ensuring the LMS content remains relevant and engaging.
  • While acknowledging LMS limitations in providing hands-on experience, integrate video demonstrations, virtual reality simulations, and other interactive tools to complement theoretical knowledge with visual and practical learning experiences.
  • Establish clear parameters for tracking engagement, updating content, and learning outcomes. Use these insights to continuously refine and adapt the LMS content, ensuring it meets the evolving needs of the residency program and its participants.

Summary

Although an LMS will not solve all of the issues we currently face in surgical education, it is an excellent first step to improving the resident physician education experience and future work should look at their use for faculty development as well.

The thoughts and opinions expressed in this article are solely those of the authors and do not necessarily reflect those of the ACS.

References

  1. Rimsha S, Moosa FA, Zaheer F, Kamal MT, Majid A. What Does the Future Hold for a Surgical Trainee? This Lockdown Is Not a Letdown Yet: A Survey on Moodle Learning Management System as a Part of Blended Learning During COVID-19 Pandemic. Cureus. 2021;13(7):e16690. Published 2021 Jul 28. doi:10.7759/cureus.16690
  2. Zakaria N, Jamal A, Bisht S, Koppel C. Embedding a learning management system into an undergraduate medical informatics course in Saudi Arabia: lessons learned. Med 2 0. 2013;2(2):e13. Published 2013 Nov 27. doi:10.2196/med20.2735
  3. Steindal SA, Ohnstad MO, Landfald ØF, et al. Postgraduate Students' Experience of Using a Learning Management System to Support Their Learning: A Qualitative Descriptive Study. SAGE Open Nurs. 2021;7:23779608211054817. Published 2021 Nov 4. doi:10.1177/23779608211054817
  4. Back DA, Behringer F, Haberstroh N, Ehlers JP, Sostmann K, Peters H. Learning management system and e-learning tools: an experience of medical students' usage and expectations. Int J Med Educ. 2016;7:267-273. Published 2016 Aug 20. doi:10.5116/ijme.57a5.f0f5
  5. Dua A, Sudan R, Desai SS. Improvement in American Board of Surgery in-training examination performance with a multidisciplinary surgeon-directed integrated learning platform. J Surg Educ. 2014;71(5):689-693. doi:10.1016/j.jsurg.2014.02.007

Authors

Shaghayegh Sabbaghan, MD
Research fellow at surgical education and simulation fellowship
Massachusetts General Hospital, Harvard Medical School
Roy Phitayakorn, MD, MHPE, MAMSE, FACS
Vice chair of education, department of surgery, Massachusetts General Hospital General
Endocrine surgery associate professor of surgery, Harvard Medical School
Emil Petrusa, PhD
Senior education researcher, department of surgery and learning laboratory
Professor, Massachusetts General Hospital, Harvard Medical School