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

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.

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