Evidence from the realist review has been used to create a decision support resource for those wishing to develop Internet‐based learning courses. The resource consists of a series of important questions for course developers to ask and address when considering implementing and designing an Internet‐based learning course. Each of the questions in the decision support resource links back to contextual influences that have been shown to influence learner engagement. Addressing each and everyone one of the questions in the decision support resource will not guarantee that a course will always be success. This is not possible as there is always a complex myriad of other different contexts to contend with – such as learner types, their needs, their training levels, Engaging with Physicians, it is important to understand why some physicians are reluctant to participate in the quality improvement process.

First, because of recent regulatory changes, physicians are preoccupied with concerns about losing their autonomy and seeing a drop in income levels. They are also struggling with increased patient loads and dealing with the onslaught of new regulations and requirements—all without any guidance on how to survive the new value-based care environment. A McKinsey report highlights four other key concerns and barriers:
Physicians feel overwhelmed and ill-equipped to implement change. They also lack an understanding of how their behavior contributes to healthcare waste and inefficiency.
Hospitals and payers believe that employing physicians is the primary means of securing alignment. Instead, a holistic approach by combining multiple alignment levers (e.g., personal autonomy, clinical autonomy, colleagues, IT department) would be more effective.
Organizations have the misconception that compensation is one of the most important drivers for physicians.
Having great leadership and creating a focus on a shared vision are critical components to encouraging physician buy-in. Rather than viewing healthcare’s problems as just that—problems—they should be seen as challenges that can be overcome. To do this effectively, someone needs to come along, point out the vision, and then lead the physicians in the right direction.

In addition to great leadership, physicians also need to see the organization as a partner, a partner they can believe in. A partner that will help them. A partner that will not only work to improve the lives of their patients, but all of the lives the organization comes into contact with, including the lives of the physicians. According to research by Gallup, a healthcare partner like this will foster, Engaging with Physicians by giving physicians the following: confidence the health system can be trusted to deliver on its promises.
Internet‐based learning is increasingly being used to teach a wide range of topics to many different types of healthcare professionals.

The literature indicates that Internet‐based learning can be just as efficacious as more traditional forms of education and training (e.g. such as face to face lectures or courses). The greater challenge with Internet‐based learning is knowing when to use it, for whom and for which types of learning goals – in preference to traditional forms of education. In other words, the knowledge gaps in Internet‐based learning are in implementation and no longer in proving efficacy. The realist review conducted in this report set out to address these very questions on implementation. Building on existing understanding of Internet‐based learning by health care professionals, it has found that engaging learners, both initially to get them to start a course and then to continue to completion is a far bigger challenge that than course design and content. The data in the studies included in this review indicate that many Internet‐based learning course developers possess the necessary expertise to develop courses that are satisfactory to learners and can change their knowledge levels. Few however consider the issue of Engaging with Physicians and as a result many experience poor uptake and large numbers of dropouts from their courses