Bridging the gap: using an asynchronous e-Learning module to improve internal medicine residents' confidence and...

Ambulatory blood pressure monitoring (ABPM) is considered a reference standard for diagnosing hypertension and is recommended for out-of-office blood pressure assessment, yet internal medicine residents receive limited training in its interpretation. We conducted a needs assessment to identify gaps in hypertension and ABPM education and developed an asynchronous e-learning module to address these deficiencies. We then evaluated its impact on residents' self-reported confidence and preparedness in outpatient hypertension management.

We conducted a single-center quality improvement study among internal medicine residents (PGY1-4) at the University of Toronto between July 2024 and January 2026. A baseline needs assessment evaluated prior exposure to ABPM, confidence in interpretation, and preparedness to diagnose hypertension. An e-learning module was developed, consisting of a structured "Five Steps of ABPM Interpretation" framework and case-based learning. A post-intervention survey assessed self-reported confidence, preparedness, and educational value. Descriptive statistics were used to summarize outcomes. Between-group comparisons of categorical outcomes were performed using chi-square tests.

Sixty-two residents completed the baseline survey, and 26 completed the module and post-intervention survey [1]. At baseline, 56.5% (35/62) reported no prior exposure to ABPM interpretation. Only 22.6% (14/62) felt comfortable interpreting ABPM reports, and 32.3% (20/62) felt prepared to diagnose outpatient hypertension. Following the intervention, 84.6% (22/26) of residents reported feeling comfortable or very comfortable interpreting ABPM, and 92.3% (24/26) reported feeling prepared or very prepared to diagnose hypertension. Learner satisfaction was high, with over 90% of participants reporting that the module was educationally valuable, easy to use, and effective.

An asynchronous, case-based e-learning module was feasible, well-received, and associated with higher self-reported confidence and preparedness in ABPM interpretation among internal medicine residents. The observational nature and potential for both response and selection bias limits generalizability of the study.