Background: Online continuing education is a convenient and cost-effective option for professional development with the potential to speed the translation of evidence to clinical practice. Integrating innovative technology with online course design that reflects best practices in adult education and knowledge translation is one promising approach to meeting this need. Understanding how available technology and course design interact to promote learning in an online environment and what impact these factors have on therapists’ intention to implement new skills in clinical practice will better inform online continuing education design.

Purpose: The purpose of this grounded theory study was to understand the processes that pediatric physical therapists use to learn a hands-on clinical assessment in a self-paced asynchronous online continuing education course that utilized an innovative interactive media player.

Method: Data was concurrently collected and analyzed using a constructivist grounded theory approach informed by the Diffusion of Innovations Theory. Nineteen pediatric physical therapists from three organizations who completed an online course on the Segmental Assessment of Trunk Control were recruited using theoretical sampling. Two researchers analyzed transcripts of semi-structured individual interviews and open responses to learning module prompts using constant comparative analysis and a consensus coding process consistent with grounded theory.

Results: The online course design provoked cognitive dissonance for learners when they attempted to assimilate new information on posture control assessment and treatment with their clinical experience. Three approaches to reducing this dissonance emerged: accommodating new concepts without practice change, waiting for others to provide solutions to implementation challenges, and experimenting or adapting information for practice
change. The development and resolution of cognitive dissonance was an iterative process embedded within participants’ reflective clinical practice. Individual clinicians often demonstrated more than one approach to resolving the dissonance at any given point in time.

Conclusion: Designing online learning experiences that provoke cognitive dissonance using innovative technology may be effective in enhancing clinicians’ awareness of gaps in knowledge and practice, confidence in trialing new practice behavior, and motivation to engage in the sustained effort necessary for translating evidence to real-world clinical settings. Instructional designers must also recognize the personal and organizational factors that color the contextual lens through which healthcare professionals consider how and when to use information learned online in clinical practice."