Idaho's TBI Virtual Grand Rounds: A Step-by-Step Approach to Delivering Highest Quality Web-based Training


Laura J. Tivis, PhD, Kirsti Beck, & Russell C. Spearman, MEd

The use of web-based training is well-documented, often in terms of its utility for rural learners with decreased access to services, providers, and resources (Amarsaikhan, Lkhagvasuren, Oyun and Batchuluun, 2007; Fertman, Dotson, Mazzocco, and Reitz, 2005).  Theme-based training programs, including focuses on mental illness issues, traumatic brain injury, and other sensitive topics (Reinke, Griffith, Wolpin, Donesky-Cuenco, Carrieri-Kohlman, and Nguyen, 2011; Reupert, Foster, Maybery, Eddy, and Fudge, 2011; Wade, Oberjohn, Conaway, Osinska and Bangert, 2011; Whitham, Eddy, Maybery, Reupert and Fudge, 2009), have been conducted using televideo technology to educate, network, and share resources. Despite reported success with web-based training (Guanci, 2010; Pletcher and Rodi, 2011) guided instruction for preparing a live webinar series is sparse.

In 2010, the authors’ home institution, the Institute of Rural Health (IRH) at Idaho State University, embraced webinar technology, adopting it as its primary method for TBI education delivery.  During a recent six-seminar series over 1200 registrations and 600 attendees across 46 states and Canada were recorded.  To participate, attendees were required only to have access to a computer (within a few generations of current typical consumer standards) and internet access.  Our goal here is to describe the process for delivering high quality, low-cost seminars that reach a diverse audience with minimal inconvenience and high likelihood for repeat participation.

Roles and Responsibilities

The decision to use GoToWebinar ( as the host was the result of extensive testing of various services. Most hosting groups will charge a monthly fee.  The number of “seats” is reflected in the price.  Generally, any webinar hosting group will charge a fee, likely paid on a monthly basis.  Often, a large number of people (e.g., 1000) can register and attend each session for a monthly fee.  The number of virtual seats is reflected in the price.  For example, 1000 seats is typically more expensive (e.g., $500/month) than 100 seats (e.g., $100/month). Terms and conditions should be carefully reviewed. Generally, hosting companies do not provide a technician or a moderator.  These are critical positions.

At the IRH, the director of the TBI program fulfills the moderator duties and a highly skilled individual from our team serves as our technician. Other costs to consider are salary for staff, as well as any investment toward dedicated equipment. For example, our technician (KB) works approximately 15 hours for each webinar, coordinating with the presenter, overseeing practice sessions, managing registration, and supporting the event itself.  Regarding equipment, beyond our own computers, we provide headsets for those presenters that do not own one. This requires having several on hand. A single minimal expense, postage for mailing headsets to out-of-state presenters can add up, particularly if they have to be replaced or if return postage is reimbursed. 

Presenters must be chosen well in advance.  It is important to determine if potential presenters have the computer capacity to present a webinar.  Specialized equipment beyond a computer with web browser software (both within a few generations of current computer standards) with speakers, and a headset/ microphone is not required. As indicated above, if an adequate headset/microphone is unavailable, the home institution can provide a loaner set by mailing a light-weight, inexpensive set will in advance. A systems check must occur between the technician and the presenter to test the connection and to troubleshoot problems prior to the session. It is critical to run this test prior to advertising in case the presenter finds his/her system will not accommodate the host system.

Depending on the goals of the organizing unit, it may be important to procure an electronic copy of the presenter’s materials (e.g., slide show presentations, written objectives, quizzes, or syllabi) and/or a recording of the presentation for later viewing.  Links for viewing the presentations and for downloading handout materials can be organized for easy access by viewers.  Most speakers are willing to provide a handout and give permission for recording.  However, some are not willing to share materials or be recorded.  It is essential to inform presenters of your intentions prior to their accepting the invitation to present.

Testing the Connection

Conducting a full system check with the presenter on the computer, equipment, and internet connection they will be using, and at the location from which they plan to present is key to avoiding critical errors that cause “live” problems for the presenter. 

If the presenter is to be viewed by attendees, the camera must also be tested.  IRH webinars do not involve a camera; attendees hear the presenter but see only the slideshow.  This reduces the risk for problems and demands less bandwidth. Always test the presenter’s microphone and speakers.  If a headset with microphone is unavailable, the organizing unit can mail a loaner set in advance. Its connection should also be tested.

With GoToWebinar, materials are shown via “screen-share,” where the desktop or a specific application on the presenter’s computer is visible. It is necessary to conduct a successful “screen-share” test to ensure the presenter is familiar with the process and that the technician is aware of all items and software that the presenter plans to use.  Video files are frequently not supported by webinar hosting systems.  If a video demonstration is essential, it may be uploaded to an online host ( and a link to it embedded in the presentation slides. Finally, the technician should review with the presenter the host’s dashboard controls. This functions as a good dress rehearsal and ensures basic familiarity of the available options.

Advertising and Pre-registration

Advertising can take many forms. For TBI webinars we construct a flier that can be posted and emailed to TBI providers, family members, advocates, educators, and other stakeholders. The IRH also provides it to the presenters for further distribution.  Regardless of the form or type of advertising, it is imperative that the information contain very clear instructions for pre-registration.  GoToWebinar has an online platform that allows pre-registration, up to the day each session is scheduled to occur.  Pre-registration is beneficial to the technician, the moderator, and the presenter in their preparation. Once pre-registered, users will receive confirmation and guidance through a set-up process.  The host will generally send an automatic reminder and link to each participant a few days or hours before each session.  

Presentation Time: Ready, Set, Action!

About 60 minutes prior to the start time the technician and moderator should log into the hosting group’s website, establishing their connection.  The technician is the “operator” and will need to give the moderator administrative permissions for access to “backstage” discussions and to the list of logged-in attendees.  The presenter should also be logged in and will have direct verbal communication with the technician and moderator via his/her headset.  Last minute concerns can be addressed, including screen sharing processes and other logistical issues.

At the appointed starting time, the technician, in full communication with moderator and presenter, makes the session live, muting his/her own microphone.  While only the moderator and presenter have live microphones the technician can still communicate via “backstage” chat mechanisms.  We advise that attendees are not verbal-input enabled; they can still ask written questions or provide commentary seen only by the technician and the moderator, and can use the ‘raise your hand’ feature common in webinar software. The negative aspects of managing many live audio inputs, even for short question/answer periods, outweigh any benefit.

The moderator opens the session by welcoming attendees and introducing the presenter.  We find it important to keep the introduction brief, as a detailed introduction becomes tedious and uninteresting giving the presenter a bad start to the session.

Attendees often begin to send questions a short way into the presentation.  Questions appear in a window that only the technician and moderator can see.  At the appropriate time, the moderator orally presents the question(s) and the presenter answers.  An alert moderator can run a nearly flawless Q&A dialogue despite poorly worded or confusing questions by reading ahead and rewording them if needed.

The IRH stays true to the advertised time and recommends scheduling each session for 30 minutes longerthan the anticipated time. This allows a cushion should there be a high volume of questions or if the presenter takes longer than anticipated.  Once all of the questions are answered, or the advertised window of time is up, the moderator should close the session by thanking the presenter and the audience, and providing a closing remark about how and when the online materials/recording can be accessed.

Technological Problems

During the session, the technician watches for troublesome issues but can only be of assistance if the problem relates to lack of user knowledge. Even with a successful system check, problems can still occur, but most are related to the presenter’s inexperience with the technology and if handled appropriately, result in minimal embarrassment for all parties.  For example, presenters may not remember how to forward slides, may have trouble positioning the microphone for best quality audio transmission, or may feel unsure about how to communicate with the moderator or technician.  These situations are best handled on a case by case basis.  Sometimes the technician must “unmute” his/her microphone and speak directly to the presenter.  This is not optimal since the entire audience will also hear the communication, but if handled professionally, little or no damage will arise.

If the hosting system suddenly “goes down,” little can be done.  The technician cannot bring the system back online and the host’s system is likely handling many clients simultaneously making their ability to respond immediately improbable.  If this happens, we encourage sending an email to all audience members, apologizing for the inconvenience with notification of your intent to reschedule. An immediate telephone call to the presenter is essential.

Some hosting providers allow the technician to designate additional participants as ‘organizers’, thus giving technician-level access and control to another person. This is a good practice as it allows the webinar to continue if the technician’s computer or internet connection fails.

Occasionally, attendees request technical support by way of the forum meant for questions about the presentation.  Usually, the technician can reply directly to the participant with a simple instruction. Sometimes attendees will have more time consuming requests related to the speed of their computer connection or IT security restrictions that prevent them from participating.  For these problems we simply remind the caller that the session is being recorded (if it is) and encourage its viewing or for future presentations, attending from an alternative location. 

Session Recording

Hosting sites typically provide a recording feature that is within the control of the technician to record each session.  The organizing unit may have the technology and support necessary to host recordings directly on its website. For those that do not, a video hosting site such as Vimeo ( is advantageous.  Such companies offer a free or low-cost account, allowing a finite upload (e.g., number of videos, MB per week). Once loaded into a video hosting site, the link to the presentation can then be placed on the organizing unit’s website.


Presenter honoraria are appreciated and may serve to maintain enthusiasm among busy colleagues for future webinars. Some potential presenters cannot accept honoraria for their work as per agreements with their institutions, but in our experience the majority of these is well aware of their individual institutional rules and has no qualms about presenting without incentive.

Attendee Data and Quality Control Information

Descriptive statistics can generally be obtained through the host system. Some statistics, such as average attentiveness rating and average interest rating (based on system readings of the computer activities during the session) are confounded because it is not possible to determine a participant’s true interest or attentiveness in an objective manner.  Even so, user statistics can be a general guide to inform coordinators as to the overall success of a given seminar. 

Importantly, webinar hosts frequently limit their history and it is essential to inspect downloaded user reports and to verify accuracy prior to the expiration.  To avoid finding a data error after the information has been purged from the host’s system, we recommend careful inspection of the reports as soon as they become available and, if errors are noted, consulting with the host as soon as possible.

In addition to user statistics provided by the webinar host, additional information can be extracted from some of the attendees who voluntarily answer survey questions, take quizzes, or who provide other types of feedback.  For example, for those requesting a certificate of attendance, we require attendees to answer online questions about the quality of the presentation, including their likelihood for using the information in their work. We recently conducted an informal survey of 2011 TBI webinar series. About one half responders indicated that attending the webinar(s) changed the scope of their practice.  Twenty percent of responders indicated that they were not involved in clinical practice and one-third reported that webinar attendance did not change their practice. We have found it helpful to ask attendees to suggest topics for future presentations.  In addition, staff can internally track the numbers and kinds of questions asked of presenters thereby determining possible future topics or adjusting the amount of time allocated to the question and answer session following each presentation.


Webinar technology is an effective and efficient mode for information dissemination across organizations, easily extending beyond state and national borders.  This article details one approach in providing webinar-based seminars to a mixed audience of TBI providers, family members, and survivors.  Steps include finding a webinar host, identifying potential speakers, and testing the connection.  Key points for a seamless presentation and collection of useful data are described.   


This work is funded by the Health Resources and Services Administration, Maternal and Children’s Health Bureau through a state planning grant and three implementation grants. Idaho State University is Idaho’s Lead State Agency for TBI. The authors wish to thank the presenters who gave of their time and talent to make these TBI webinars a success.  We also thank the many attendees who participated in the sessions and provided feedback.  Special thanks are extended to Beth Hudnall Stamm, Ph.D. for her vision and development of TBI work in Idaho, and to Mr. Graham Alderson and Mr. Kenneth Cutler for establishing the technical groundwork for the TBI webinar series.


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