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Column Editor: Vjeko Hlede, PhD, DVM, CHCP

This column aims to provide insight and practical information on the impact of e-learning on CME/CPD and the latest trends in technology available to enhance the online learning experience.

Learning Management System, Learning Experience Platform, or Something New: What is the Fuss About?

Column Editor: Vijekoslav Hlede, PhD

Technology helps us improve our lives. It allows us to do things we have already been doing – but better, faster, and differently. The number of tools we can use to enhance CME/CPD activities is growing. They come in various shapes and formats. They are usually grouped in packages that allow comprehensive learning delivery. A Learning Management System (LMS) is an example of such a package. In this article, I’ll reflect on what an LMS is, how we got here, and what the future may bring. The Learning Experience Platform (LXP) and Performance Management System (PMS) are two new(er) LMS-related solutions.

Learning Management Systems. LMS have become a standard part of the CME/CPD mosaic and broader educational community. As a practical educational tool, LMS were introduced in the late 1990s (Davis, Carmean, & Wagner, 2009). Leaders in medical education recognized its potential early. Therefore, at the beginning of the century, medical schools were often on the frontline of technology adoption (Broudo & Walsh, 2002; Kukolja Taradi, 2002).

During the second decade of this century, LMS have become an established tool in the CME/CPD area. For many CME/CPD providers (including professional associations), LMS has become the primary mechanism of learning and CME credits delivery. The COVID pandemic solidified that trend, and we are continuing in this change process.

History of LMS

What is an LMS? As the name indicates, it is software that enables us to manage learning activities. In LMS software, learning is packed into online courses. The core management elements of an LMS are course creation, administration, delivery, reporting, and awarding credits.

LMS puts dominant powers in the hands of administrators, content experts, instructional designers, and faculty. That team can use LMS to address the ACCME requirements and use predefined learning objectives to create learning activities. LMS empowers learners to learn anytime from anywhere and browse through a catalog of courses to find solutions for their unique learning needs. LMS supports a variety of learning formats: from self-guided, click-through courses and quizzes to project-based learning, simulations, and synchronous and asynchronous social learning modalities. However, the catch is that all those activities have to be created by CME/CPD providers. In an LMS, the learner usually has the role of a user, not a designer.

Criticism and the need for additional development. As interactive Web 2.0 and new online learning tools have gained prominence, questions have been raised about the value and future of the LMS. LMS has become a learning infrastructure that is needed for our learning operations, and we need to ensure that it has connectivity with other applications in the dynamic Web 2.0 environment. While it is certain that LMS’s are here to stay, we can think about how to improve them. For some time, better support for informal learning and performance management has been noted as an improvement opportunity (Cohen, 2010). This is where the experience of using a learning platform (LXP) comes in.

What is an LXP? An LXP personalizes the learning experience to the needs of each learner by combining formal and informal learning activities. It is an open system that connects the learner with learning solutions from a variety of sources. An LXP serves as a single point of entry for expert content, internal department or resident program content, premium content (a library, for example), free and open-source content, and formal learning content (courses). It enables learners to create, share and recommend relevant content to peers.

LXP functionality is significantly different than LMS functionality; yet it is very needed. As Leong, Lam, Tan, and Ng (2022) convincingly explain, instead of a predefined, lecture-based curriculum, our focus should be on the development and support of learning communities. Such refocusing can help us better utilize our social and technological powers and improve our capacity to address the needs of adult learners.

Adult learners are self-directed, goal-focused, experienced learners. They need to know how a new skill will help them in their professional practice. They prefer to take ownership of their learning (how and what to learn) and value the help of peers and mentors. Furthermore, adult learners want to implement new skills in their daily practice.

For adult learners, learning is not something that happens “out there in an LMS,” detached from daily practice; it is not something you have to do just to get a passing grade or a minimal number of CME credits. For healthcare professionals, learning is an integral part of daily practice.

Yet, as Bucklin, Asdigian, Hawkins, and Klein (2021) argue, we need to better implement active learning strategies in the professional development of the healthcare workforce. Strategies that engage learners, foster their critical thinking skills, and support their problem-solving practices are especially needed.

LXP is an important step in that direction. As learners use an LXP system, they are empowered by 4 types of inputs:

Each learner can contribute to the system by providing ratings or comments, sharing/recommending the existing content, and uploading new content.

Two challenges with this model are that only some activities can be ACCME accredited, and since anyone can upload content, quality control mechanisms should be implemented. For example, an editorial board or broader community of authors and editors may monitor the quality of all newly added content and flag content of low quality.

The table below compares LMS and LXP functionality.

	LMS	LXP
Focus on	Administration of learning	Personalized learning
Empowers primarily	Administrators and course creators è Administrator-driven	Learners è Self/learner-driven
Open/closed system	Closed system. Only admins can add content	Open system. Anyone can add new content or share a link to an external learning opportunity
Self-directed	Partially. A considerable amount of direction is mandated by the administrators	Dominantly self-directed. LXP creates a context for open-ended discovery and continuous professional development
Key features	Course administration, assessment compliance rules, business rules, assessment,	Content discovery, content recommendations, self-publishing, collaboration, social learning
Content consumption	Admin-centered push model where learning paths are pre-set	Learner-powered pull model where content is often found and consumed in a micro-learning manner
Track completion	Goal-based learning. Courses usually have a considerable level of detail and scope, and a learner has to address specific learning metrics on time	Continuous, open-ended learning where users follow flexible, performance-related objectives
ACCME compliant	Yes	Partially/maybe. Part of the content may have CME credits attached. However, a considerable amount of content will not have CME credits attached The use of an LXP can be categorized as an internet searching and learning activity

Performance management is the last part of this mosaic. A performance management system (PMS) tracks the performance of individuals and teams in a reliable and quantifiable manner. It provides insight into how coworkers perceive performance, how performance maps to broader strategic objectives of the department/organization, and how performance can be improved.

Due to the sensitive nature of data used by performance management systems, full-featured performance management systems are rarely used by CME/CPD providers. Performance management systems are more commonly used by healthcare organizations and their human resources departments. However, national programs such as the American Board of Medical Specialties Maintenance of Certification Program, the Federation of State Medical Boards Maintenance of Licensure, and revalidation programs in Canada and the United Kingdom (Horsley et al., 2016) are designed as high-level/national performance management systems.

What will the future bring us? Whether we are talking about an LMS that covers LXP and performance management functionality, or separate subsystems, these concepts are here to stay. The question is not whether we should use one or the other. Rather, the question is: How can we maximize the benefits by combining these systems and use them more effectively?

I use the word “continue” deliberately because we have been using those systems for some time. For example, all physicians are familiar with a performance system called maintenance of certification. In the same manner, we have all experienced the use of Wikipedia and Google search to learn about a job-related task. This is very similar to how an LXP works; that is, an enhanced LXP experience. Thus, we all have experienced the rudimentary functionality of an LXP.

This learning format is so common that ACCME already has defined it. An internet searching and learning activity is one where learners participate in self-directed online learning that is focused on an area important for their clinical practice while using a database vetted by an accredited CME provider. An LXP can support all 3 critical parts of that learning format: developing the database, vetting the database, and empowering learners with additional tools for self-directed learning. In short, an LXP may significantly enhance Internet searching and learning activity.

In the future, we will not be doing different things, but we will do the same things better, faster, and while being more connected.

LXP Example – Anesthesia Toolbox

Anesthesia Toolbox is a learning platform and community built to help anesthesiology departments and residency programs to develop, peer review, and share learning resources. Collaborative development and resource sharing are common between residency programs because programs have limited resources to create new learning materials. Collaboration and sharing help improve the quality of learning resources while reducing cost.

In its essence, the Anesthesia Toolbox is an LXP enhanced by a big quiz bank and an adaptive, artificial intelligence-enabled quiz engine. Each resident program is located in their own dedicated LXP workspace.

Anesthesia Toolbox was initiated in 2014 by Oregon Health & Science University, and since early 2022 is acquired and managed by the American Society of Anesthesiologists. Currently, 102 out of 157 residency programs in the USA (65%) use Anesthesia Toolbox.

Learn more: https://www.asahq.org/education-and-career/asa-resident-component/anesthesia-toolbox.

References

Anthony-pillai, C. (2018, July 5, 2018). Why You Need To Move Away From The LMS And Look For New Software For Corporate Learning. LEARNING MANAGEMENT SYSTEMS. Retrieved from https://elearningindustry.com/new-software-for-corporate-learning-need-move-lms-look

Broudo, M., & Walsh, C. (2002). MEDICOL: online learning in medicine and dentistry. Academic Medicine: Journal of the Association of American Medical Colleges, 77(9), 926-927.

Bucklin, B. A., Asdigian, N. L., Hawkins, J. L., & Klein, U. (2021). Making it stick: use of active learning strategies in continuing medical education. BMC Medical Education, 21(1), 44. doi:10.1186/s12909-020-02447-0

Cohen, E. (2010). Is the LMS Dead? Chief Learning Officer Magazine.

Davis, B., Carmean, C., & Wagner, E. D. (2009). The evolution of the LMS: From management to learning. Santa Rosa, CA: e-Learning Guild.

Horsley, T., Lockyer, J., Cogo, E., Zeiter, J., Bursey, F., & Campbell, C. (2016). National programmes for validating physician competence and fitness for practice: a scoping review. BMJ Open, 6(4), e010368. doi:10.1136/bmjopen-2015-010368

Kukolja Taradi, S. (2002). Integration of Internet into medical education. Lijec̆nic̆ki vjesnik, 124, 36-41.

Leong, J. M. C., Lam, W. L., Tan, S. Z., & Ng, C. Y. (2022). Changing face of medical education during a pandemic: tragedy or opportunity? Postgraduate Medical Journal, 98(1161), 492. doi:10.1136/postgradmedj-2021-140330

Stern, D. M., & Willits, M. D. (2011). Social media killed the LMS: Re-imagining the traditional learning management system in the age of blogs and online social networks. In Educating educators with social media (Vol. 1, pp. 347-373): Emerald Group Publishing Limited.

Vjekoslav Hlede, Ph.D., is an LMS Manager with the American Society of Anesthesiologists, Chicago.

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