Embedding e-learning in postgraduate medical education: system-level barriers and enablers in Hong Kong

INTRODUCTION: E-learning is increasingly central to postgraduate medical education (PGME), yet system-level barriers may hinder its integration. In Hong Kong, the Academy of Medicine (HKAM) has invested in a learning management system and faculty development, but uptake among Academy Colleges remains uneven. This study examined barriers and enablers across Colleges to inform system-level implementation. METHODS: We used a sequential exploratory mixed-methods design. Phase 1 involved semi-structured interviews with one e-learning lead from each of the 13 participating Colleges, which were analysed thematically. Phase 2 comprised a survey of 266 education committee members, of whom 88 responded (33.1%). Items were rated on a five-point Likert scale (1=strongly disagree to 5=strongly agree), with optional free-text comments. RESULTS: Five themes emerged, namely, (1) limited strategic urgency; (2) gaps in faculty capability and trainee readiness; (3) weak system enablers; (4) lack of recognition and resources; and (5) the need for system-level strategies. The survey corroborated these findings, with the lowest ratings for information technology (IT) support and incentives and the highest for a clear HKAM policy (mean, 4.20) and inter-College benchmarking (mean, 4.01). System enablers received the lowest overall score (mean, 2.89); recognition and resource allocation also scored poorly (mean, 2.87). Strategic buy-in was moderate (mean, 3.53), highlighting a contrast between strong demand for central direction and limited operational support. CONCLUSION: Sustainable PGME e-learning requires integrated action across motivation, capability, and opportunity. Leadership signalling and recognition are needed to strengthen motivation; tiered faculty development and trainee orientation to build capability; and coordinated IT support, workflow integration, and resource sharing to expand opportunity.