In an eLearning workshop, at the 2007 Canadian Conference on Medical Education, there was an informal survey of Canadian medical schools about their use of learning management systems (LMS). All schools had one but their use was very sparse. Despite much interest in eLearning developments, the LMS remains largely unused twelve years later. Group discussions have suggested a number of reasons: the course is the atomic unit on which the LMS architecture is based; med school curricula are rotation-based, not course-based; problem-based learning in small groups rather than large group lectures, with an emphasis on a heutagogical approach; the effects of community-based and distributed medical education; the strong influence of competency-based education; but surprisingly, a recent review showed that this whole area has been little studied. It also relates to some of the unusual assessment methods that are popular in medical education: script concordance testing, situational judgement testing; key feature questions, virtual patients, objective structured clinical exams (OSCEs), most of which are not well accommodated within the LMS structure or design. International collaborations in eLearning suggest that this situation is not unique to Canada but, as noted, there has been little work to assess this.