With OutStart LCMS, Challenger builds world’s largest electronic library for clinical training.

Challenger Corporation runs the world’s largest electronic library for clinical training. Since 1991, more than 40,000 medical professionals have taken Challenger’s courses either via CDs or through an online learning portal. Memphis, Tenn.-based Challenger built its vast library, so physicians can prepare themselves to meet a slew of healthcare standards and certifications for practicing medicine. Challenger’s library holds thousands of hours of technical courses packed with statistics, tests and more than 18,000 graphics. Each year, an array of medical societies and prominent universities reviews and approves Challenger’s training, which is developed and peer-reviewed by teams of academic and practice experts in several specialties.

Challenge

“Today’s medical standards are constantly evolving,” said Bob Sweeney, CEO of Challenger. “In the old days, if a person had a medical license, he could keep current by taking some continuing medical education, or CME. But today, the standards are more complex. And the knowledge doctors need to meet today’s standards exists in a thousand places—journals, people’s heads, seminars, textbooks. Ultimately, doctors have to show the government and the public that their skills are up to par, or they will lose their right to practice medicine.”

So, more than 15 years ago, Challenger began building its electronic library for clinical training. But as that library grew, so did the complexity of keeping it current with evolving medical standards. In the early 2000s, things reached a critical point for Challenger. Namely, the size of the library was becoming unmanageable. And if Challenger failed to keep its library up to date, Challenger’s business would fail too.

For Challenger, this wasn’t a question of simply delivering and tracking training. Rather, the Tennessee-based company had to find a way to orchestrate complex changes to its library quickly and accurately. The company also needed a way to create new courses by leveraging all the knowledge it had already accumulated. By doing that, Challenger would be able to provide a better learning experience than anyone else offering clinical training.

“If we developed a course, say, five years ago, it had to be maintained as medical procedures changed,” said David Beard, Challenger’s CFO. “What we wanted was a software application that would treat training content like a database in which you don’t have to create a new course; instead you just change relevant bits and pieces of the course.”

Solution

“We have thousands of hours of courses and tests,” added Beard. “All these images, statistics, and Q&As are reviewed and approved for doctors to use to gain accreditation. The depth and breadth of what we have is really much, much larger and complicated than a text book of medicine. Plus, much of the material in the courses is interconnected.”

Sweeney and Beard examined options for technology. They quickly determined that a learning management system (LMS), which tracks training, wasn’t a fit. “An LMS cannot create and manipulate courses; it can’t reuse the content of one course when building another,” said Sweeney. “Instead, we picked a learning content management system (LCMS), which can create, manage and deliver not only training modules but also edit all the millions of bytes that make up a catalog of training.”

The acronyms LCMS and LMS are barely discernible, but the differences are tremendous according to Challenger CFO Beard. “Once we implemented our LCMS, we could add to, edit, and maintain our library like never before. And this meant our customers were assured of getting up-to-date, accurate medical training.

“For example, after Merck pulled VIOXX^® from the market, we had to look at our library to see where references to VIOXX showed up,” said Beard. “With the editing system in our LCMS, we could link to one piece of content in our library and change every reference to VIOXX in one day. If we didn’t have this system, we would have had to go through more than 3,000 hours of courses to find every instance of the word VIOXX. I’ve no idea how long that would’ve taken, or if we could’ve even done it.”

To put a finer point on editing content, Beard noted the difference between an LCMS that operates as a so-called “page-based system” versus “asset-based system.”

With a page-based LCMS, says Beard, you create one e-learning course at a time. These are good courses, he notes, but it’s a lot like building muskets—the parts aren’t interchangeable. And, he adds, you’re limited to creating e-learning courses alone, no other formats. On the other hand, with an asset-based LCMS, a company creates courses with chunks of content, or assets, such as graphs, images of procedures, assessments, Q&As, and so forth. These chunks can be used again and again in all sorts of ways and for all sorts of training, whether it’s e-learning, a CD, or even a text book.

“If you’re doing OSHA training that spells out how to lift a box, then how often does that procedure change? It’s not going to need editing, or reviewing, every year,” said Beard. “But in medicine, or any complex industry where techniques and procedures change rapidly, you need an asset-based LCMS to survive. Without one, it becomes nearly impossible to manipulate all the training you’ve created.”

And having the power to nimbly orchestrate the training content is something that produces better training in less time.

“With a library like ours, the ability to store, edit and reuse vast amounts of content lowers development and production costs,” said Sweeney. “Our LCMS also allows us to embed testing into our materials. Along with testing, the LCMS provides tools that measure how well someone understands a subject or ranks relative to his or her peer group.”

Results

By implementing Evolution LCMS, which is made by Boston-based OutStart, Challenger Corporation has been able to manage the growth and quality of its vast electronic library of medical courses. Because Challenger can react quickly to changes in medical technology, procedures and standards, the company can provide a superior training product that nets results.

In the individual physician practice environment, over 8,600 physicians have used the company’s Med-Challenger test preparation series to prepare for their initial certification or recertification exam. The pass rate is over 99 percent, which is simply unmatched in the training and testing world by any alternative medium or training regime.

The institutional training environment has benefited from the Challenger training and evaluation system as well. For one Tennessee-based college, which began using Challenger’s LCMS-fueled library, the pass rate on the initial Physician Assistant National Certifying Exam (PANCE) rose from 69 percent to 100 percent over three years.

“Before using Challenger, the college helped students prepare for PANCE by bringing in speakers, recommending books and highlighting anecdotes,” said Sweeney. “That approach is sometimes effective. But a far better way is to provide cutting-edge training with embedded tests that show students how they stack up against their peers. That’s what our LCMS does for our students.”

“With our LCMS, we can maintain the equivalent of a textbook on emergency medicine with 4,000 images and almost 5,000 Q&As for a fraction of what it would cost a publisher. In fact, because of how easy it is to reuse and maintain our content, we now spend about $4 per hour of continuing medical education to keep our library current,” said Sweeney. “What would it cost to put together a new textbook each year, review the product and incorporate any changes because of developments in medical science?”

According to Sweeney, with the LCMS, his team has been able to boost output of medical training by nearly 300 hours per year, or 10 percent on an ongoing basis. Today, there is roughly 3,800 hours of training content in the Challenger curriculum. By implementing an LCMS, Sweeney and his team are able to manage the contributions of more than 200 medical authors and, consequently, have increased the size of Challenger’s library tenfold.