Article Text

Download PDFPDF

Cost and value in e-learning: the perspective of the learner
  1. Kieran Walsh
  1. BMJ Publishing Group, London, UK
  1. Correspondence to Dr Kieran Walsh, BMA House, Tavistock Square, London WC1H 9JR, UK; kmwalsh{at}

Statistics from


Medical education is expensive. Its expense has led to growing interest in methods to deliver medical education that will maximise outcomes for a given spend.1 There has long been enthusiasm for the use of e-learning as a method that can be low cost and that can deliver worthwhile outcomes. However, this enthusiasm has not been built on strong evidence. There is evidence that e-learning produces broadly similar outcomes as face-to-face education.2 However, there is little evidence as to the cost utility of e-learning in medical education. There is also little evidence as to how learners perceive the utility of e-learning in light of its cost. This paper reports an evaluation of the perceptions and views of general practitioners (GPs) with regard to the cost and utility of an e-learning resource—BMJ Learning.


BMJ Learning is the e-learning service of the BMJ. UK GPs who are users of BMJ Learning were asked by email to take part in an evaluation as to the cost and utility of the e-learning. Semistructured interviews were conducted by telephone with those who responded to the email. The interviews were conducted according to a schedule which was founded on existing literature in this field.3 4 Interviews lasted approximately 20 min. Detailed field notes were taken during the interviews. Notes were analysed using thematic analysis.5 This was used to allow new concepts and themes to emerge from the data. Interviews were continued until data saturation was achieved; this was defined as two successive interviews in which no new themes emerged.6


Eighteen learners took part in the semistructured interviews. Five key themes emerged from the interviews.

Theme one: linking e-learning to clinical practice

The learners saw the value in the BMJ Learning resources as a means of helping them put their learning into practice. They saw the benefits of e-learning in improving their practice, in confirming that their practice was correct and in updating their practice so that it is compatible with current guidelines. One learner commented: ‘Recently I did one of the allergy modules. A patient wanted a steroid injection and I wasn’t sure so I did the online module—my practice changed as a consequence—I now alter the order in which I use the drugs—that is, what drug to use first for allergic rhinitis’.

Theme two: the convenience of e-learning

The learners valued the convenience of e-learning and thought about the cost of e-learning in comparison with the cost of attending face-to-face events. They thought that e-learning was likely to be lower cost, but they also greatly valued the fact that they did not have to worry about ancillary costs associated with face-to-face events such as travel and accommodation. One learner commented: ‘E-learning is far more convenient than going to meetings. It doesn’t involve travel and time off work and lots of different things. Meetings are expensive also—there is usually a fee’.

Theme three: e-learning is associated with its own unique costs, but these costs are largely accepted as being inevitable and part of a doctor’s personal and professional life

e-Learning is associated with its own unique costs; for example, the costs of hardware, software and internet connection. These still exist even if the resource is free. Most of the learners did the e-learning at home and used their own equipment; however, they saw this as inevitable and an inseparable part of their personal and professional life. Most did not expect protected time for learning; they saw using e-learning to keep themselves updated as part of their duties as a professional. One learner commented: ‘I do it in my own time. But this is ok. It is part of being a doctor—I expect it—it is something that I have done all my life’. Another said: ‘I use my own computer and internet but I have these things anyways—so it is no extra hassle for me and no extra expense. There is no time to do it at work anyways’.

Theme four: the cost utility of e-leaning is weighted heavily towards knowledge

Learners saw their investment of resources and time in e-learning as worthwhile largely because they gained new knowledge. Some learners valued learning skills and behaviours but most felt that they learnt new knowledge and, in particular, knowledge of recently updated guidelines. One learner commented: ‘Knowledge is the core benefit that I am trying to gain. Skills are difficult to learn online. Keeping up-to-date with clinical policies and guidelines are most important’.

Theme five: appraisal as a motivator

Many learners see a strong performance at their appraisal as a key return from their investment in e-learning. However, it is not the only motivator. Many learners also saw being able to improve their practice as an equally important outcome. One learner commented: ‘Appraisal and continuing professional development (CPD) are motivators but I would be doing it anyways. I have to do an appraisal—this is a must. But learning is something that I would be doing anyways. I guess that it is all about doing learning that ticks the most boxes—this might be getting CPD, getting a good appraisal and learning important things—that is a good outcome’.


Learners view the cost and utility of e-learning from a number of perspectives. They see value for their investment in being able to link their e-learning to their clinical practice, in being able to update their knowledge in a convenient and low-cost way and in being able to demonstrate their compliance with appraisal requirements.

There are limitations to this evaluation. All of the learners were users of e-learning; they may not represent the wider population who do not use e-learning. All were users of a single e-learning resource: once again they may not be representative of users of other e-learning resources. This was a relatively small evaluation; however, it used a standard protocol that allowed the operationalisation of data saturation to achieve an adequate sample size.

This paper evaluates this issue from the perspective of the learner. Until now much of the literature in this field has looked at the issue from the perspective of institutions, governments or funders. However, this paper should help to redress this shortcoming by sharing the perspective of the most important stakeholder—that of the learner.



  • Provenance and peer review Not commissioned; internally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.