Online Learning: In Another Vein

by Julie Cardoso, Ryan Crowder and Eduard Marmut

Man taking an online learning class

Online learning, also known as e-learning, is the application of the internet and connected electronic devices for the acquisition of knowledge and expertise. It is a process of education that runs contrary to traditional classroom learning and has gained a strong foothold in the educational landscape. Online learning comes in various formats, ranging from live video sessions to individual programs to entire academic curricula delivered through learning software.

Current research holds that the e-learning market will reach $275 billion in four-years’ time with at a compound annual growth rate (CAGR) of 7.5% during this same period.1

Growth is driven by the historically slow digitization of the world’s education infrastructure that less than a decade ago remained firmly grounded in brick and mortar institutions, and it is certain that e-learning and its chief proponents will remain a vital component to this expansion of education the world over.

Advantages of Online Learning

What’s most unique about online learning is its method of delivery. Imagine (or remember) a commute to an academic center--waiting for a lecture to begin, the typical shuffle between lectures. Over the course of an entire semester, or even an entire program, these delays add up to tarnish the academic experience. With online learning, there is no commute, no wait, no shuffle. A packet of information can be delivered as quickly as the internet signal can reach you.

The use of connected electronic devices enables another unique benefit: interactivity. E-learning programs are more nuanced than simply the remote viewing of didactic video materials; they employ a hybrid model of both didactic and interactive sessions.

During interactive sessions, learners use their computer to respond to benchmark testing then instantly receive pre-programmed feedback depending on their response. E-learning programs track course progress and testing results in order to provide the learner with a constantly updated analysis of areas that require focus or improvement.

Some programs take this a step further, using this analysis to customize the course content to the learner. As technology progresses, limited keyboard input will inevitably be superseded as the source of user interaction. In the vascular field, augmented reality via tools that simulate the ultrasound probe and even virtual reality training is the next step of optimizing the learning experience.2

Due to its unique method of delivery, online learning is also distinguished by its ubiquity. Out of all 195 countries, only 35 have populations with an internet access rate of under 20 percent, meaning that a majority of users around the globe are able to access e-learning programs where they currently reside.3

This is particularly helpful for learners in developing countries who aspire to foster careers in health care yet remain marginalized by the accessibility and expense of traditional education. To learners who lack the time or resources to attend long-term academic programs or fly internationally to attend symposia, online learning offers a critical alternative.

Promise of Uniformity in Education

The ubiquity of access online learning provides, yields another important benefit: uniformity of reach. Unlike the fragmented nature of traditional classrooms, in which every cluster of students absorbs vastly different information depending on the quality and preferences of their instructor, an e-learning program can reach its entire user base with identical content at equivalent quality.

This is especially vital in the vascular field. Societal standards of care have been set by a consensus of the world’s premier vascular experts. However, this crucial information is not conveyed to every learner equally due to the variance between individual institutions, instructors, and teaching methods. Consequently, a high degree of variance exists in the use of indications, technical protocols, and even diagnostic criteria.

Different vascular technologists may perform a venous insufficiency evaluation in different steps and acquire different findings. Even if provided with an identical set of vessel diameters and flow velocities, different physicians may offer different interpretations and prescribe entirely different treatment plans.

Conveying these standards via uniform content to a grander scale of physicians and allied health professionals would go a long way in decreasing the variance of their application, and ultimately increasing the quality of patient care. This positive effect has been demonstrated by the establishment of online accreditation in the United States, primarily with the Intersocietal Accreditation Commission.4

The reason for the high degree of variance in the vascular field stems from its constant renovation. Peripheral arterial research underwent a revolution in the 1980s and, between the discoveries regarding venous pathophysiology and advances in endovenous ablation, peripheral venous research is presently experiencing a similar revolution.

Thus, although it is beneficial to write these standards, we avoid writing them in stone. This is a notable area where online learning excels over every alternative. New and exciting information is being published on a weekly basis, and online learning is the only modality that can adapt in a timely manner. If the education platform and its developers remain diligent, information can potentially be updated on the exact date that it is published.

The eager learner would no longer have to research their textbook edition number to have confidence that they are reading the most recent data.

Challenges of Online Learning

As with its many opportunities, online learning presents unique challenges. Most notable is the oft-missing element of sociability. Consciously or subconsciously, students desire a personal connection with their instructors. A student tends to enter the zone of full immersion when they have a living authority to listen to, an inquisitor to raise their hand for. Positive student-instructor relationship has been shown to be a strong indicator of not only academic engagement, but also academic accomplishment.5

Where the instructor’s voice and body language (including eyesight and voice) seeks to displace a learners’ drifting attention, e-learning must rely on stronger methods of engagement—not only to teach, but also to inspire learners to become self-motivating in their search for new and relevant knowledge. It is this specific aim, through the medium of conversation, narrative, and emotion, that effective e-learning must develop.

For online learning to realize its full potential, program developers must make a genuine effort to overcome the challenge of sociability. Indeed, at least until the advent of artificial general intelligence, a laptop is not a conscious instructor.

But what if we displayed a conscious instructor who spoke directly to the viewer through its monitor? What if an entire program was filmed not in a stoic manner, but in one that evoked earnest emotion? Would this medium still lack sociability or would it perhaps offer even more than the average professor in a lecture hall, reading their presentation verbatim from its projection on the wall?

These are all questions that the founders of one education platform, 123sonography, asked themselves when they designed their first e-learning program nearly a decade ago.

123Sonography and Universal Ultrasound Management

In a 2011 article in the Wall Street Journal, a prominent venture capitalist, Marc Andreessen, remarked that software was “eating the world.”6 An effective analogy for the speed of consolidation taking place worldwide, where traditional industries historically requiring vast formations of human labor are increasingly undertaken by electronic components no larger than a first aid kit.

And yet while certain industries have experienced rapid uplift, much of the medicine and education sectors saw only marginal improvements, leaving the structure of traditional medical education, that critical sliver of Venn overlap between the two fields, wholly intact.

123sonography, an independent global e-learning platform for medical ultrasound and echocardiography, sought to surpass this rate of marginal improvement with its founding nearly a decade ago. For Dr. Thomas Binder, a cardiologist and current CMedO of 123sonography, video provided a means to humanize the traditionally isolating and impersonal experience which e-learning has been notorious for producing.

Eight years on, and with the addition of expertise from sectors as diverse as medicine, filmmaking, and programming, 123sonography evolved a formula for developing both engaging and effective e-learning courses through a unique blend of narrative, visualizations, casual discourse, and a general excitement towards learning sonography—a formula the company says is critical for growth into other medical fields.

Meet 123sonography


Operated by a team of nearly 30 staff from 12 nations, 123sonography currently offers eight film-quality ACCME-certified diploma courses across a range of ultrasound modalities with another three to be added shortly. These courses, along with a premium membership for echocardiography content, a digitized case-based interactive video suite known as the EchoSkill Lab, a digitized version of its popular Echo Facts Book, and it's soon-to-be-released Ace of Hearts cardiology quiz app, together comprise the company’s entire portfolio.

As a truly online education provider, 123sonography finds itself unbound by geography, with over 26,000 customers and a registered user base of over 260,000 from over 175 nations worldwide. Beyond its Vienna, Austria headquarters, the company recently established a second office in Cambridge, Massachusetts to strengthen its capabilities in the USA, which coupled with a profitable record over the preceding 4 years will be critical to its ambitious goal of transforming itself into the medical online university for the 21st century.”

Universal Ultrasound Management, a US-based team of expert instructors that specialize in live ultrasound training and imaging laboratory setup, is currently collaborating with 123sonography to create a multi-part vascular ultrasound course. For the team working on this project, the challenges of developing an engaging e-learning program were overcome by a necessity of purpose. The team had to always keep in mind that the camera lenses represent the eyes of thousands of users, colleagues, and friends ready to learn.

In post-production, editing and animations add dynamicism to the training; but the majority of emotional power is captured on the set, in the training itself, between the presenter and the cameras (operated by a talented crew), with everyone acting under the pressure of cost and time. From the first conceptual drafts to the final cut, every action had to adhere to principles of didactics and audience engagement. It is this accumulation of details across the value chain that is essential to 123Sonography’s business model.


Will online learning continue this upward trend? Considering the unique benefits offered to the learner via the internet and connected electronic devices, it is difficult to predict anything but continued growth. Although growth is driven by the historically slow digitization of the world’s education infrastructure that less than a decade ago remained firmly grounded in brick and mortar institutions, it is certain that e-learning and its chief proponents will remain a vital component to this expansion of education the world over.

Witnessing the way technology can be wielded in the clinic, it’s only logical that technology will be at least as effective in learning, becoming another extension of the medical professional in their work, yet in another vein.


  1. Stratistics MRC. (2017) E-Learning Global Market Outlook 2016-2022. Orbis Research,
  2. J. F. Kutarnia, P. C. Pedersen and C. Yuan. Virtual reality training system for diagnostic ultrasound. 2010 IEEE International Ultrasonics Symposium, San Diego, CA, 2010, pp. 1652-1656.
  3. Smith, Oliver. (2017) The Last Places on Earth with No Internet. The Telegraph, Telegraph Media Group,
  4. Bremer, M. L. (2016) Relationship of sonographer credentialing to IAC echocardiography case study image quality. Journal of the American Society of Echocardiography, 29: 43–48
  5. Sher, A. (2009). Assessing the relationship of student-instructor and student-student interaction to student learning and satisfaction in Web-based online learning environment. Journal of Interactive Online Learning, 8(2).
  6. Andreessen, M. (2011, August 20) Why Software Is Eating the World. The Wall Street Journal. Retrieved from: