This randomized controlled trial investigates whether an adaptive e-learning program on acute and time critical medical conditions can reduce state anxiety and improve the competence of junior doctors working in emergency departments. Junior doctors assigned to frontline shifts will be enrolled and randomized into two groups: an intervention group receiving the e-learning program within the first six weeks of employment and a control group receiving standard onboarding with delayed access to the program. The primary outcome is the change in state anxiety levels, assessed using the State-Trait Anxiety Inventory (STAI-6). Secondary outcomes include perceived self-efficacy during shifts and self-assessed competency improvements.

The healthcare system is under increasing pressure due to demographic changes, including a growing elderly population and a shrinking workforce. This intensifies the challenges of recruiting and retaining healthcare professionals, particularly in high-stress environments like emergency departments. Junior doctors often face significant anxiety during their early careers, which is associated with higher rates of burnout, decreased job satisfaction, and early career attrition Transitioning from medical education to clinical practice is a critical period marked by high levels of stress and anxiety. Research highlights that new doctors frequently report feeling inadequately prepared for the demands of clinical work, particularly in acute care settings where decision-making is both time-sensitive and impactful. Anxiety during this transition is not only detrimental to individual well-being but also impacts patient safety and care quality.

Prior interventions, including simulation-based training and e-learning programs, have shown promise in reducing stress and improving clinical competence among healthcare professionals. For example, adaptive e-learning platforms have demonstrated efficacy in tailoring content to individual learners' needs, enhancing knowledge retention, and fostering confidence in clinical skills.

Building on this evidence, the MINDED trial (MedIcal juNior Doctors Emergency Department) aims to evaluate the impact of an adaptive e-learning program tailored specifically for junior doctors in emergency medicine. This program is designed to improve their theoretical knowledge and practical competencies, thereby reducing anxiety and enhancing performance during emergency shifts. By addressing both psychological and educational needs, the trial seeks to contribute to a more resilient and competent workforce in acute care.

Objectives

1. Primary Objective: To assess the impact of the adaptive e-learning program on reducing state anxiety levels in junior doctors.
2. Secondary Objectives: To evaluate improvements in perceived self-efficacy during shifts and competency following the intervention.

Hypotheses

1. Participation in the adaptive e-learning program will significantly reduce state anxiety compared to controls.
2. The adaptive e-learning program will enhance both objective and subjective medical competence among participants.

Inclusion Criteria:

• Junior residents in front- or middle-level shifts in emergency departments across the Capital Region of Denmark.
• Employed between January 1, 2025, and April 31, 2025.

Exclusion Criteria:

• Prior exposure to the adaptive e-learning program.
• Denying participation.

The aim of this study is to generate data on how an e-learning programme may or may not effect STAI on younger doctors in general. Thus, the individual focus is less important and will not be discussed with other researchers.