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Introduction: The educational technology of massive open online courses (MOOCs) has been successfully applied in a wide variety of disciplines and are an intense focus of educational research at this time. Educators are now looking to MOOC technology as a means to improve professional medical education, but very little is known about how medical MOOCs compare with traditional content delivery. Methods: A retrospective analysis of the course evaluations for the Medicine as a Business elective by fourth year medical students at Southern Illinois University School of Medicine (SIU-SOM) for the 2012-2015 academic years was conducted. This course was delivered by small group discussions for 2012-2014 and delivered via MOOC technology in 2015. Learner ratings were compared between the two course delivery methods using routinely collected course evaluations. Results: Course enrollment has ranged from 6-19 students per year in the 2012-2015 academic years. Student evaluations of the course are favorable in the areas of effective teaching, accurate course objectives, meeting personal learning objectives, recommending the course to other students, and overall when rated on a 5 point Likert scale. Ratings show no statistically significant difference between the small group or MOOC format versions of the course (p = 1.00 for all comparisons). Discussion: Students found this elective to be an effective means of meeting their personal learning objectives when delivered in a small group discussion format or by using MOOC technology. The primary advantage of this new course format is flexibility of time and place for learners, allowing them to complete the course objectives when convenient for them. The course evaluations indicate this is a change that is acceptable to the target audience. Conclusions: This study shows that learner evaluations of a fourth year medical school elective course do not significantly differ when delivered in small group discussions or via MOOC technology. This suggests that MOOCs may be a reasonable format to deliver medical school courses.