The integration of semantic web methodologies and e-learning technologies is a challenge that has attracted a lot of attention for a decade. Given this, the purpose of this paper is the definition of a new e-learning semantic web methodology for the development of courses for health professionals in both distance and residential learning modes. ELSE is an ontology-based system which allows the construction of customized e-learning courses according to the needs and learning preferences of the user. It integrates semantic search methodologies and e-learning technologies. The underlying methodology relies on a reference domain ontology and teaching multimedial interactive modules, referred to as Reusable Learning Objects (RLOs), which are annotated according to the concepts of the ontology. The user can specify his/her training needs by selecting a set of concepts from the ontology, and the SemSim semantic search engine allows the identification of the set of RLOs that satisfy the user request at best, in efficient way. SemSim is a semantic similarity method which has been extensively experimented with and shows a higher correlation with human judgment with respect to the most relevant similarity methods defined in the literature. The set of RLOs is successively reorganized according to the learning preferences of the user. ELSE has been developed within a project of the CME (Continuing Medical Education) program - ECM for Italian participants - whose goal is the introduction of new methodologies and tools to keep updated health professionals and, in particular, medical specialists, in order to ensure effectiveness, safety, and efficiency of the national health service. ELSE has been tested and validated in the domain of osteoporosis, and the overall judgment about the system is very positive, both in terms of usability and effectiveness of customization. The system has been developed in cooperation with the ECM provider SPES S.c.p.A., accredited by the Italian Ministry of Health.