Why Online Courses Fail

David BeardGroup Education, Medical Schools, Nursing Programs, Residency Programs

Why Online Courses Fail

From our Blog Series: Challenges of Online Medical Education

Online courses fail due to a number of factors.  Online medical education programs are growing rapidly and when online courses fail to produce successful outcomes, it can threaten a program's reputation and viability.  So why do online courses fail?  In this article, we'll look at why online courses fail, the factors in play, and insights into creating online courses that get their job done.

We should probably start with the good news.  Online courses in medical training have a significantly higher success rate than online courses in other professions. But, as you guessed, there’s some bad news too. The failure rate for online medical training courses is still very high. 

We’ve categorized failure types into two areas:

  • Matriculation Failure - students that drop an online course or opt out of a degree or certification program entirely.
  • Certification Failure - students pass a course, but with knowledge gaps that prevent them from passing a certification exam.

Online training courses themselves usually have one of three objectives, at least in medical training:

  • New learning: courses that attempt to teach and provide retention for materials that are new to the student.
  • Material review: preparing students for a major test or certification by means of reviewing essential material.
  • Skills updates: materials designed to help students fill knowledge gaps, or materials designed to change practice within a particular standard of care or guideline

In examining why online courses fail, we want to know the type of failure and the objective of the course.  That helps us determine where we ought to be looking first. Courses that fail to matriculate students or fail to prepare a student for a major examination are costly, and can be devastating in the medical field. 

So why do online courses fail?

One author answered by saying, “The only problems with online education are the students, faculty, and the content.”  He was engaging in a little comedy, but he made a good point.

Studies show that learners have a number of issues with online courses.  The student’s view of why they’re struggling, and the actual issues with the program, can sometimes take a bit of interpretation. This is true even in medical education, where the determination and stakes for the student are far higher than many e-learning environments.

why do online courses fail?


Students will complain that courses are repetitive, tedious, boring, too broad, not broad enough.  Their critique is usually with the process of working through a course. 

Sometimes they are correct, other times the implementation of the material is to blame:

  1. There’s insufficient feedback.  A course is not a live environment; there’s no sense of achievement unless you provide one.
  2. There’s no measure of progress.  The student isn’t sure if they are progressing, or doing poorly.
  3. Course implementation is too broad.  Giant question banks are good for providing material review, but not necessarily good in a new learning environment.
  4. Courses are too advanced.  Faculty assume skills or background knowledge that isn’t universal in the audience. 

Courses should be implemented with the objective in mind.  Skills updates or remediation should be short and to the point.  New learning courses should have extensive remediation and guidance.  Material review courses should be broad, but provide feedback by blueprint topics, and also include exam simulations.  


The biggest problem facing faculty at organizations that are implementing online courses, or blended learning, is that the online environment is not the same as a live environment.  Simply recording video of lectures, or transcribing lectures and adding some test questions, won’t cut it.  

In an online environment, there’s no ability to ask questions of peers or instructors.  The online course has to anticipate the types of questions, as well as provide review materials or links.  In a live environment, when one student asks a question of the instructor, all of the other students hear the ensuing discussion and responses.  This doesn’t happen in the online environment. In designing online courses, or supplemental asynchronous reinforcement courses, instructors struggle with this.

There can be assumptions about student levels as well by faculty or course designers.  The instructor may have an assumption about the student’s base knowledge in the subject being covered in the course - and they may be incorrect.  That leaves the student struggling with materials and questions and leads to matriculation failures. This is called the expertise gap.  These can be resolved by doing baseline tests at the start of the online course to ensure that you are beginning at the correct level.

Course Content

In medicine, we generally have highly motivated learners.  Whether it’s a review for a recertification, prep for an ITE, or new learning for an initial certification, students in medical fields are motivated and work hard.  There’s little we can do with this content that can make it fun to learn.  We can, however, make it more interesting.

‘Interesting’ usually is not in the interactivity.  A lot of course and programmatic design go into making courses interactive, trying to keep the student’s attention through gimmicks.  Said gimmicks, gamification, video and animations certainly do have a place in course content and presentation.  

"Studies show that learners have a number of issues with online courses. The student’s view of why they’re struggling, and the actual issues with the program, can sometimes take a bit of interpretation. This is true even in medical education, where the determination and stakes for the student are far higher than many e-learning environments."

The answers to student engagement include motivation, matching the course content to the course objective, the thoroughness of the course, and frequent feedback to the learner.  Our students are already motivated.

Material review courses should use assessment-style questions that are simple, case-based, as well as easy to read and respond to. New learning courses need complex teaching questions that force the comprehension, study, and retention of material. 

For remediation or skills updates, these questions will often be heavier on text and explanations than on question complexity.  

The area of online learning, or e-learning as it’s come to be called, is growing incredibly rapidly, and for good reason.  It is cheaper and faster than traditional learning, self-paced, asynchronous, and often has overall higher retention rates. 

In medicine, there are several areas of non-procedural training that can benefit tremendously from well-designed e-learning. And there have been some great successes in online medical courses.

And that will be our next topic!

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