Four million physician-hours per year — that’s the conservative estimate of time US physicians spend completing mandatory online training modules annually. At average compensation rates, that translates to roughly $800 million in lost productive time, before accounting for overhead, deferred clinical encounters, or the cognitive fragmentation that comes with toggling between compliance tasks and patient care.
Writing in JAMA, emergency physician Michael Gottlieb argues that the current model warrants reassessment. The format — often static slide decks, dense policy excerpts, and minimal interactivity — may not reflect established principles of adult learning or cognitive science. He draws on Richard Mayer’s Cognitive Theory of Multimedia Learning and foundational adult education frameworks to suggest that passive, undifferentiated content delivery is a limited vehicle for behavior change. He also cites a 2025 systematic review that found little evidence that repetitive annual review of unchanged content meaningfully alters clinical behavior or improves outcomes.
“The annual ritual of clicking through slides, answering perfunctory quiz questions, and electronically attesting to completion sends a subtle message that documentation is valued more than thoughtful learning.” — Michael Gottlieb, MD.
Gottlieb highlights a gap between institutional intent and educational outcome. When the primary institutional objective is documentation of completion — satisfying accrediting bodies and legal counsel — clinicians may reasonably prioritize efficiency over engagement. He acknowledges the legitimate regulatory rationale for standardization, but cautions that conflating completion with competence may create a false sense of security rather than genuine improvement.
The challenge is also structural. Regulatory training requirements tend to accumulate over time — each mandate defensible on its own, each added to a growing stack — while health systems have limited incentive to revisit requirements that provide regulatory protection. Redesigning toward more interactive formats, such as case-based learning, spaced repetition, or CME-aligned activities, is feasible but requires deliberate organizational prioritization. Specialty-tailored content and test-out options are among the alternatives Gottlieb raises, though each carries implementation considerations.
His recommendation is targeted: health systems, accrediting organizations, and physician leaders should audit existing requirements, quantify their opportunity costs, and redesign them using established adult education principles. The goal is not to eliminate accountability, but to ensure that required training meaningfully advances patient safety, professional development, or system performance.
No conflicts of interest were disclosed.
Source: JAMA