Asynchronous distance learning programs in health informatics are becoming more prevalent, but there is little research on the best practices of asynchronous learning technologies. There are virtually no data on the value of video of the instructor compared to an audio slide presentation. We conducted a randomized controlled trial in which we showed the same slide presentation to two groups of students. One group saw a video of the instructor giving the lecture and the other group saw the same presentation with audio only. Our results show that adding video to an audio presentation does not lead to greater satisfaction or greater learning. Students may think they want the video, but those who have it are not uniformly pleased with it. These results demonstrate that despite the intuitive appeal of streaming video, the addition of a video to an audio presentation may not be worth the extra expense and effort. © 2003 Elsevier Ireland Ltd. All rights reserved.