Betsy Comstock, a usability engineer at PictureTel, commented that each use environment is different and therefore what is needed for success is different. She cited some successful uses of video conferencing for medical education at Boston's Deaconess Hospital. Jenny commented that the scale of distance learning classes was an important factor in determining which technologies to use, how these technologies are deployed and how learning is supported. She pointed out that developing courses for hundreds or thousands of students as happens at the British Open University, is quite different to classes of 10 or 20 students. In the former, technology and programs for its use must be robust.
Much more experimentation is possible with smaller groups.
Developing quality distance learning courses is not a cheap option. A participant from Michigan State Medical School explained how they had campuses in 6 cities and used desktop video conferencing to deliver classes and for faculty meetings. One reason for doing this is to provide guidelines for the instructors on how to teach with these technologies. She has found that the tools control and constrain how classes are taught. They have developed an electronic classroom using a blackboard metaphor.