The aim of this study was to Design, Implementation, Evaluation and comparison the e-learning course of medical education based on Koschmann third and fourth paradigms. The method of this study was quasi-experimental and mixed (quantitative and qualitative). The statistical population included all MSc students of electronic courses in the School of Management and Medical Education of Shahid Beheshti University of Medical Sciences in Tehran. Using the available sampling method, 60 people were selected as a sample and randomly divided into three groups. Research data were collected using questionnaire of satisfaction, motivation, academic achievement test and interview. Data were analyzed in the quantitative part using multivariate analysis of covariance and Tukey post hoc test and in the qualitative part were analyzed and categorized using the analogical content analysis method of texts obtained from interviews. The results of research in both sections on the one hand showed the effectiveness of designs based on the third and fourth paradigms compared to conventional method in e-learning course in medical education in all three variables of academic achievement, motivation and satisfaction and on the other hand The results showed that the design based on the fourth paradigm was more effective than the design based on the third paradigm in the variables of academic achievement and motivation. According to the obtained results, the design method for teaching (third paradigm) and the method of teaching Computer Supported Collaborative Learning (fourth paradigm) are considered as a new knowledge in providing education in electronic medical education courses