This book documents the evolution of a course for Physician Assistant students as it evolves from a classroom based lecture format through an intermediate correspondence course modality to online asynchronous delivery. Methods to incorporate best practices in education into distance courses is explored. Academic achievement, student satisfaction, and cost effectiveness for each format is determined and compared. Achievement is considered in relation to demographic variables such as language, gender, and computer literacy. The relationships between satisfaction and academic outcome and distance from campus are explored. Marginal cost analysis is used to calculate a cost effectiveness ratio for each method.