Effect of an online continuing professional development course on physicians' intention to approach a colleague in difficulty: a mixed-method convergent study (Preprint)

BACKGROUND Burnout and psychological distress are prevalent among physicians and can compromise patient safety. Peer support seems to play a protective role against psychological distress, especially among young physicians. However, little is known about training to motivate physicians to approach peers in difficulty, as its effects are often overlooked or evaluated with non-validated tools. OBJECTIVE We assessed the effects of an online continuing professional development (CPD) course aiming to increase physicians' intention to approach a colleague in difficulty. METHODS Physicians who completed a one-hour asynchronous online continuing professional development course on approaching a colleague in difficulty between March 2022 and May 2024 were invited to participate in this mixed-method convergent study. This e-learning course was designed to increase physicians’ confidence in approaching colleagues in difficulty through recognizing signs of psychological distress, offering support, and referring them to appropriate resources. We collected data on participant characteristics and measured their behavioral intention to approach a colleague in difficulty and its determinants pre- and post-course using the validated CPD-REACTION tool. We assessed differences in pre-post mean intention scores using paired t-test (n=466) and identified factors associated with post-course intention through multivariate analysis (n=466). Four months later, we calculated the proportion of physicians who reported adopting the behavior (n=61). Qualitative responses to open-ended questions were analyzed thematically using behavior change models. We also identified behavior change techniques used in the course. Qualitative results were triangulated with quantitative results. We report results following STROBE (quantitative) and SRQR (qualitative) guidelines. RESULTS Of the 792 participating physicians, 466 (58.8%) completed questionnaires pre- and post-course. Average age of participants was 48 ± 12.4 years, 43.5% were women, and 86.0% practiced in a specialty. Average pre-course intention was 3.88 (SD=1.73) and average post-course intention was 4.92 (SD=1.40), for a mean difference of 1.04 (95% CI: 0.91; 1.17, p<.0001). Factors associated with intention post-course were beliefs about abilities, social influences, and moral norm (R2=0.22; p<0.05). Four months later, 41.0% (95% CI: 28.6% to 54.3%) of participants reported having approached a colleague in difficulty. The three most frequently reported themes as sources of change in intention were belief about abilities, belief about consequences, and knowledge of behavior. Quantitative and qualitative results converged on beliefs about abilities but diverged on beliefs about consequences. Seven behavioral change techniques were found in the online CPD course: 1) Goal Setting, 2) Increasing Competence, 3) Planning, 4) Persuasive Communication, 5) Behavior-Related Information, 6) Modeling/Demonstration by Others and 7) Behavioral Experiments. CONCLUSIONS This online CPD course increased physicians' intention to approach a colleague in difficulty. 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 healthcare workers.