# Effect of an Online Continuing Professional Development Course on Physicians’ Intention to Approach a Colleague in Difficulty: Mixed Methods Convergent Study

## TL;DR

An online course increased doctors' willingness to help colleagues in distress, showing that training can improve peer support in healthcare.

## Contribution

This study demonstrates that an online CPD course effectively boosts physicians' intention to approach colleagues in difficulty using validated tools and mixed methods.

## Key findings

- The course increased average intention scores from 3.88 to 4.92 (P<.001).
- Beliefs about capabilities were the strongest predictor of postcourse intention.
- 41% of participants reported acting on the behavior four months later.

## Abstract

Burnout and psychological distress are prevalent among physicians. Peer support appears to play a protective role, yet little is known about training interventions that motivate physicians to approach peers in difficulty, as such effects are often overlooked or assessed using nonvalidated tools.

We evaluated the effects of an online continuing professional development (CPD) course designed to increase physicians’ intention to approach a colleague in difficulty.

Physicians who completed a 1-hour asynchronous online CPD course between March 2022 and May 2024 were invited to participate in this mixed methods convergent study. The e-learning course aimed to increase physicians’ confidence in approaching colleagues in difficulty by recognizing signs of psychological distress, offering support, and referring them to appropriate resources. Participant characteristics were collected, and behavioral intention to approach a colleague in difficulty along with its determinants were measured pre- and postcourse using the validated CPD-REACTION tool. Differences in mean pre-post intention scores were assessed using 2-tailed paired t tests (n=466) and generalized estimating equations. Factors associated with postcourse intention were examined using multivariate analysis (n=466). Four months later, the proportion of physicians reporting adoption of the behavior was calculated (n=61). Qualitative responses to open-ended questions were analyzed thematically using behavior change models, and behavior change techniques used in the course were identified. Quantitative and qualitative results were triangulated. We reported results following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and SRQR (Standards for Reporting Qualitative Research) guidelines for quantitative and qualitative analyses, respectively.

Among 792 participating physicians, 466 (58.8%) completed online questionnaires pre- and postcourse. The average participant age was 48 (SD 12.4) years; 43.5% (332/762) were women, and 86% (655/762) were specialists. The average precourse intention score was 3.88 (SD 1.73) and average postcourse intention score was 4.92 (SD 1.40), for an adjusted mean difference of 1.06 (95% CI 0.93-1.20; P<.001). Factors associated with postcourse intention were beliefs about capabilities (β=0.52; P<.001), social influences (β=0.27; P<.001), and moral norm (β=0.26; P=.03; R2=0.22). Four months later, 41% (25/61; 95% CI 28.6%-54.3%) of participants reported having approached a colleague in difficulty. Frequently reported reasons for intention to adopt behavior were beliefs about capabilities, beliefs about consequences, and knowledge. Quantitative and qualitative results converged on beliefs about capabilities but diverged regarding beliefs about consequences. A total of 7 behavioral change techniques were identified in the CPD course: goal setting, increasing competence, planning, persuasive communication, behavior-related information, modeling, and behavioral experiments.

This online CPD course increased physicians’ intention to approach a colleague in difficulty. The results highlight beliefs about capabilities as a key determinant of this behavioral intention. The study suggests that online learning has strong potential to raise awareness about peer support and ultimately build a culture of care among health care workers.