The Effect of E-learning on Anxiety Among Junior Doctors in Emergency Departments: A Randomized Controlled Trial (Preprint)

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Abstract
BACKGROUND Stress and anxiety among junior doctors working in emergency departments may negatively affect well-being, patient safety, and job retention. Evidence-based interventions to mitigate anxiety in this population are crucial but limited. OBJECTIVE The objective of this study was to investigate whether adaptive e-learning on acute patient conditions reduced anxiety levels in junior doctors when on call in emergency departments. METHODS This was a pragmatic, multicenter, open-label randomized controlled trial with parallel assignment. The study was conducted between January 1st and July 1st, 2025, across five emergency departments with 24/7 services in the Capital Region of Denmark. The participants were defined as foundation-year junior doctors or residents, with front- and middle-level shifts, and were recruited within the first 3 months of their employment. Participants were randomized to standard onboarding (control) or standard onboarding plus access to an adaptive e-learning program covering 13 acute medical conditions (intervention). The primary outcome was change in anxiety levels measured by the 6-item State–Trait Anxiety Inventory (STAI-6) from baseline to 6-week follow-up. RESULTS Of 550 eligible participants, 233 (42%) junior doctors, from 22 departments, were randomized, and 172 (74%) completed follow-up. The mean (95% CI) age of participants was 30.9 (30.4–31.5) years. At baseline, 71 of 233 participants (30%) had anxiety levels above the predefined threshold (STAI-6 > 15.5), indicating potential clinically relevant anxiety. Baseline anxiety was higher among female than male participants (13.9 [SD, 4.3] vs 12.1 [SD, 3.8]; P = .002) and among rotational doctors from internal medicine departments than doctors employed directly in the ED (adjusted difference, 1.76 [95% CI, 0.57-2.95]; P = .004). There was no significant difference in the reduction in anxiety from baseline to 6-week follow-up in the full cohort between the intervention group (mean change, −1.8; 95% CI, −2.5 to −1.1) and the control group (mean change, −1.2; 95% CI, −1.8 to −0.7). In the subgroup of junior doctors with elevated anxiety levels at baseline, a significant reduction was seen in the intervention group (mean change, −3.9; 95% CI, −5.1 to −2.7) compared to controls (mean change, −2.3; 95% CI, −3.4 to −1.3). CONCLUSIONS In this randomized controlled trial, adaptive e-learning did not reduce anxiety in the overall cohort but was associated with reduced anxiety among junior doctors with elevated baseline anxiety. This RCT demonstrates that targeted educational interventions can benefit high-risk subgroups of junior doctors with elevated anxiety levels. CLINICALTRIAL ClinicalTrials.gov NCT06842394; https://clinicaltrials.gov/study/NCT06842394

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