Discovering novel barriers to eBook implementation

Medical errors when managing inpatient paediatric patients with diabetes mellitus can lead to significant morbidity and mortality, necessitating improvement in training of medical trainees. Previous educational interventions have focused on time and resource intensive methods, restricting their applicability to teaching in time-limited scenarios. We chose a blended learning approach to create and implement a novel eBook for use by trainees and then aimed to determine the efficacy and potential barriers to that implementation.

We grounded our work in complex adaptive systems theory and used the framework of complex adaptive blended learning system (CABLS) to shape both our implementation and evaluation. We utilised an embedded mixed methodology to quantitatively evaluate efficacy via knowledge acquisition and self-reported confidence and to qualitatively evaluate barriers via open-ended questions.

Between 2022 and 2023, the study enrolled 72 learners and 12 educators. There was no statistically significant difference in change in knowledge acquisition and self-reported confidence between learners who did and did not have access to the eBook. Learners and educators identified several unique and novel barriers to eBook implementation, which were mapped to the CABLS framework.

Our results on the efficacy of implementation are inconclusive, possibly due to the small participant size and implying a need for multi-institutional evaluation. Our qualitative results demonstrated previously unknown barriers to eBook implementation. This knowledge can assist other medical specialties as they implement their own eBooks. We also hope to use these barriers to improve implementation in our next iteration: the outpatient setting.