Table 6 Qualitative views on the e-learning programme (first two themes from semi-structured interviews presented in this table, third presented in-text below)

Time and setting

Time outside clinic time was favoured to not disturb clinic schedule. Weekday evenings were the most popular time. The course was mostly completed in chunks, at their own pace.

“It worked better for me doing it in chunks” Participant B

Practical aspects of the course

The mode of delivery of the course was well accepted by the participants. They were happy that it was online.

“It was very good, very convenient in the sense that I could do it from home or in my clinic if I wanted to. I didn’t have to travel to a venue.” Participant G

The e-learning programme was described as easy to access, including in areas with low broadband connection or on different operating systems. Some minor difficulties were reported (e.g. slight confusion during initial connection for one participant; e-learning website down one half day when the hosting server was down; and one participant found not very clear how many lessons had been completed).

The e-learning programme was described as well-presented and very easy to access from a laptop. One interviewee reported that the references font was too small to be read on tablets. The interactivity was thought to work well and the use of quizzes was particularly praised.

“Quizzes made me think and made me have to recall what I’d been looking at and listening to so I thought they were really good. They helped to reinforce the learning.” Participant D

Engagement with the content

Participants found there was sufficient content, the e-learning programme was thorough whilst not being overwhelming and being accessible to the participants with little academic background.

“A lot of content and it was very relevant to clinical you know to practice of osteopathy and the type of patients one sees. And you explained the concepts very well which being an older practitioner, someone that qualified a long time ago I guess a lot of these concepts were not around then so it was good to have your programme there which introduced a lot of these concepts in a very clear manner” Participant G

Participants were satisfied with the content and the coverage of the e-learning programme and found the content clear.

“There were things within the content that I’d certainly come across like the flags etc. before on other courses but actually it was a much more interesting approach to the flags that I’ve come across before” Participant I

Quizzes were found helpful to engage with the content and made participants study and reflect. They helped the absorption of the information delivered. Seeing results was found gratifying.Consideration for quiz improvements: providing a record of previous attempts when participants take quizzes multiple times; distributing them more across the e-learning programme (e.g. Unit 5: management considerations had no quizzes); and using more learners’ experience in the questions.

“The last quarter [of the e-learning programme] I thought “Gosh there’s a lot there” in the last chunk which I felt was clinically very relevant” Participant G

Extra work done

Nearly half of participants interviewed spent more than the estimated 6 h taking the course (range from 8 to 12 h).

“I did go back to a couple of the modules just to understand them again. I did a couple of modules further on and I thought “oh I think I need to go back to the basics” so I went back to the earlier modules a couple of times” Participant E

The extra work also included the ‘Extra content’ folder, accessed by all but one of the participants. It also included taking notes and reading them back or taking screen pictures as memos and looking at them later. One participant mentioned that a handout would have been useful.

“I estimate eleven hours [of online work]: I went back over bits; I made notes when I went along as well” Participant B