Another major strength to our program was the interactive, repetitive, and case-based learning style that we incorporated into each educational session. Research has shown the importance of active-learning exercises, personal interactions and feedback, intensive practice and repetition, and peer discussion in improving learning outcomes (24–26). A major advantage to using telehealth technology over web-based e-learning is the ability to have real-time interaction and active participation that facilitates asking questions, receiving clarifications, and discussing case presentations. In a review of e-learning in LMICs (27), lack of face-to-face interaction is discussed as a challenge to educational effectiveness. Additionally, all members of our team have traveled to the site in Guatemala, met the CHNs in-person, and been involved in multiple elements of the project, allowing a stronger connection, we believe, compared to telehealth contact alone. This participation with and knowledge of the community health program also allowed the team to create content directly applicable to the situations in which the CHNs worked daily.