Physiology teaching has a history of being at the forefront in the use of technology-enhanced learning methods. This presentation will cover the use of technology-enhanced learning in physiology from multimedia CALs in the 1980s and 1990s, virtual learning environments, open educational resource initiatives and learning object repositories in the early 2000s, and more recently web-based courses delivered entirely online and Massive Open Online Course (MOOCs) initiatives. Early use of technology in physiology teaching focused on learning materials such as multimedia resources, largely developed to support student-centred learning. Typically such resources made effective use of features such as high-quality graphics, animation, video and audio bringing a range of media together into a single package and delivering it on CDROM. Some were developed to support teaching of practical physiology providing students with activities and self-assessments built around data from laboratory experiments on either human or animal subjects. In a virtual laboratory students might sit at a computer and be required to ‘design’ experiments, collect data from the computer screen, analyse and report their results in much the same way as they would in the real laboratory. Built-in self-assessment questions would test accuracy of data collection, data interpretation skills and knowledge of underlying physiological principles. Students could use the virtual labs to better prepare themselves for a real laboratory teaching session or they might use them to collect additional data outside the laboratory session. In some instances the ‘simulations’ might replace a real laboratory session and this practice has become more common as the ‘cost’ of providing real laboratory experiences for students has increased. Other multimedia resources focused on supporting lectures, presenting factual information on specific topics and structuring this alongside student activities and self-assessments in an interactive format which went beyond the traditional textbook approach. Students would commonly have 24/7 access to such resources with tutors often embedding the resources into the curriculum. Numerous evaluations of the educational effectiveness of both virtual labs and interactive tutorials have been carried out, most suggesting that the computer-based learning materials can address many of the learning objectives very effectively, and data from some of these studies will be presented. The last ten years has seen the growth of Internet resources many of which are openly accessible, some provided by institutions as ‘open courseware’, others provided by individuals. It is now possible for students to access teaching materials, e.g. an online video lecture, from a world expert on a particular topic; they have access to online textbooks, online wikis, e-books and more and more universities are putting their course content online. Teachers can now provide their students with prior access to a wide range of high-quality factual information, generated by themselves and/or others and utilize face-to-face teaching sessions in a more interactive way to, for example, diagnose learning difficulties, better explain curriculum topics which students find difficult, or contextualise the factual information through problem-based or scenario-based learning approaches. Audio-responses systems are often cited as an effective way of making such sessions more engaging and promoting peer learning. This ‘flipped-classroom’ approach has been found to be effective in supporting student learning. While there may be some questions around the quality of open-access resources there is little doubt that students will continue to use the web as their first port of call for factual information and we need to ensure that students are provided with resource discovery skills and the ability to properly critique and quality-assure those resources. More recently some universities have started to offer online courses in which all student – tutor interactions take place online. These may be credit-bearing courses (e.g. University certificate, diploma or Masters degree), or they be short non-credit bearing courses, such as MOOCs, which typically offer certificates of completion rather than educational credits. There is no doubt that the flexibility such courses offer is highly beneficial to and highly valued by many learners particularly those in developing countries where access to high quality learning resources can be problematic for many. The presentation will look at some examples of online distance learning courses and MOOCs and give some institutional perspective of their development, sustainability and how they might be evaluated.