The Essentials: Upskilling a National Health Workforce in the Identification and Treatment of Eating Disorders

ABSTRACT

Objective

Health practitioners report limited skills and lack of confidence in managing and treating people with eating disorders. The purpose of this study was to evaluate the national rollout of comprehensive basic training in identification, assessment, treatment, and management of people with eating disorders to clinicians.

Methods

The Essentials: Training Clinicians in Eating Disorders is a core competency eLearning program. As part of a nation‐wide multidisciplinary workforce training strategy, 7500 course places were provided free of charge to public and private health care professionals across all jurisdictions of Australia between January 2020 and March 2022.

Results

A total of 7370 health professionals enrolled during the study period. All learning outcomes showed improvement with large effect (Cohen's d = 1.2–2), with the largest improvements for self‐reported knowledge of requirements for working with children and adolescents. Effects did not depend on years of working with eating disorders suggesting that the training was beneficial across levels of experience. Those who started with very low knowledge of eating disorders or higher willingness to treat eating disorders were most likely to complete the course. Most participants reported that the course was relevant to their clinical practice, that they expected their clinical practices to change, and that they would recommend the course to other health professionals.

Discussion

The strategy to provide government‐funded core competency training in eating disorder care to healthcare professionals met key objectives by reaching health professionals eligible to provide government‐rebated services in public and private settings across all jurisdictions including regional and remote areas.

Summary.

• Over 7000 health professionals received evidence‐based core skills training in eating disorders through a federally funded scheme.

• Self‐reported knowledge, skills, and confidence to assess and treat individuals with eating disorders increased posttraining with large effect.

• Training reached all key clinicians involved in eating disorder care nationally, including hard‐to‐reach groups such as nurses, general practitioners, and psychiatrists.

1. Introduction

Eating disorders affect approximately 4% of the population in Australia (Deloitte Access Economics ^{2020, 2024}). Eating disorders affect not only an individual's health, but may have consequences for social, vocational, and economic quality of life, and significant impacts on family, carers, and supports (Harris and Barraclough 1998; van Hoeken and Hoek ²⁰²⁰; Mitchison et al. ²⁰¹²). Early identification of eating disorders and timely access to evidence‐based interventions is critical to reducing harm and improving outcomes (Andrés‐Pepiñá et al. ²⁰¹⁹; Kalindjian et al. ²⁰²²).

Rates of detection of eating disorders in Australia are low, and appropriate intervention is delayed (Bryant et al. 2022; Worsfold and Sheffield ²⁰¹⁸; Hamilton et al. ²⁰²²). Clinicians frequently self‐report limited skills and lack of confidence in managing and treating people with eating disorders (Cooper and Bailey‐Straebler ²⁰¹⁵; Lakeman and McIntosh ²⁰¹⁸; Maguire et al. ²⁰¹⁹), which may result in lower rates of referral and reduced services for patients (Maguire et al. 2023). A national survey found that 97% of clinicians had received insufficient or no training in eating disorders to enable them to provide treatment with confidence (National Eating Disorders Collaboration ²⁰¹³). Most University training programs in the health professions—including medicine, medical specialities, nursing, and all allied health—have little or no eating disorders curriculum components (National Eating Disorders Collaboration ²⁰²⁴). Review of primary care encounters in Australia (Ivancic et al. 2021) found that less than 1% was for eating disorders, and the majority of these contacts were initiated for other issues, illustrating the opportunity for improved detection and management. Less than one in four people seek treatment (Hart et al. 2011), therefore the community is reliant on health care providers to bridge the treatment gap. Without adequate training, it is not surprising that clinicians may lack confidence in treating people with eating disorders, can be resistant to treating people with eating disorders, and can even have negative attitudes toward people presenting with eating disorders (Maguire et al. 2019; McNicholas et al. ²⁰¹⁶).

1.1. Government Investment to Improve Eating Disorder Care

In 2019, the Australian Government made a landmark change to its public health system, Medicare, to increase access to community healthcare services for people with eating disorders. The Eating Disorder Treatment and Management Plans scheme (Commonwealth Government of Australia ²⁰¹⁹) provides increased public funding as a rebate toward private practitioner fees for service, resulting in a lower cost for the consumer. The scheme provides up to 40 sessions of mental health consultation and 20 sessions of dietetic services to meet the level of care required to deliver evidence‐based treatment. Coinciding with the increased rebates for services, funding was allocated for a credentialing program for specialist mental health and dietetic treatment professionals working in eating disorders (National Eating Disorders Collaboration and Australia and New Zealand Academy for Eating Disorders ²⁰²⁰), and to widely disseminate evidence‐based introductory eating disorders training to general health and mental health care professionals. The key objectives for this introductory training were to improve clinician willingness, knowledge, skills, and confidence to treat people with eating disorders in routine practice, to attract new healthcare professionals to the field of eating disorders, and to ensure access to high‐quality training across the country, especially to regional and rural Australia.

1.2. Core Competency Training for Health Professionals

The Essentials: Training Clinicians in Eating Disorders (Maguire et al. 2019; InsideOut Institute for Eating Disorders n.d.; Brownlow et al. ²⁰¹⁵) is an online learning course that provides health professionals with a comprehensive grounding in evidence‐based approaches for understanding, identifying, diagnosing, and managing people across all diagnostic categories of eating disorders. The Essentials was designed and written by a team of experts in eating disorders care, including psychologists, psychiatrists, general practitioners (GPs), nurses, and dietitians working in inpatient, outpatient, and primary care settings. It was developed in line with best practice, which included conducting literature reviews and gaining expert consensus on content, including consultation with a panel of people with a lived experience of eating disorders, carers, and supporters. To promote engagement, retention, and learning, the course is interactive, including instructional videos (e.g., a GP explaining the key components of a medical assessment), roleplay videos (e.g., how to weigh an individual with an eating disorder), and clinical case examples. All modules include downloadable resources such as fact sheets, clinical practice guidelines, clinical measures (e.g., EDE‐Q), and perspective pieces from individuals with lived experience experts to better illustrate concepts. Each module concludes with a summary of key messages and a brief quiz to consolidate learning. The Essentials has been evaluated as part of state‐based service change initiatives (for a full review and introduction to the Australian healthcare setting, see Maguire and Maloney ²⁰²¹), and found to be effective in meeting the educational needs of health professionals working with people with eating disorders across the wide geographical spread of the region (Maguire et al. 2019; Brownlow et al. ²⁰¹⁵). Therefore, The Essentials was determined to be fit for purpose for a larger scale national rollout to provide comprehensive basic training in eating disorders to Medicare providers and other health practitioners in line with federal healthcare transformation policies.

The current study evaluates The Essentials eLearning program, as part of a nation‐wide multidisciplinary workforce training strategy to improve the knowledge, skills, and confidence of healthcare providers in their awareness, interactions, and treatment of people with eating disorders. Key considerations include completion rates, effectiveness of the eLearning across disciplines, years of experience, service type and geographical spread, and program usability.

2. Method

2.1. Participants and Procedure

The national roll out of The Essentials as core competency training between 2020 and 2022 consisted of an initial allocation of 5000 funded course places for both public and private health care practitioners, however, funding was expanded due to high demand and a total of 7500 places were allocated. Public practitioners were employed in public health or mental health services. Private practitioners included community‐based clinicians such as psychologists and dietitians, and primary care clinicians such as GPs and practice nurses. Eligibility to provide services to people with eating disorders under Medicare was a requirement for private clinicians accessing a funded course place. To ensure equitable distribution across jurisdictions, including rural and metropolitan settings, allocation of funded places was based on population. State‐based eating disorder organizations and state government departments coordinated the advertisement and allocation of course places. The Essentials is also available as a pay‐per‐use service and was accredited as an introductory training addressing all core competencies as part of the national eating disorders credentialling program in 2020 (National Eating Disorders Collaboration and Australia and New Zealand Academy for Eating Disorders ²⁰²⁰).

All course registrants from Australia who were enrolled in The Essentials course between the period of January 1, 2020 and March 31, 2022 were invited to participate in the evaluation study, including clinicians enrolled under the funded program and clinicians who paid for their course. Participation was voluntary—it was not a requirement to receive a funded place in the course—and informed consent was collected via an online form. This research was conducted in line with the principles of the Declaration of Helsinki and with approval from the Sydney Local Health District Human Research Ethics Committee (X20‐0179 and 2020/ETH01089).

2.2. Measures and Materials

Participant demographic and workplace characteristics were collected at course registration. Variables such as gender and ethnicity provided the user a nondisclosure option by being able to select “I prefer not to say.” A precourse questionnaire assessed ratings of current willingness, knowledge skills, and confidence to treat people with eating disorders (1 = very low/not at all to 5 = very high/confident/willing) with changes in these ratings assessed via postcourse questionnaire. Participants were also asked to rate how relevant the course was to their practice, whether their learning needs were met and whether they would make any changes to their clinical practice. Open text responses about the most and least helpful topics in the course and suggestions for course improvement were also collected. Course progress was identified as, Module 1 completion = Introductory level, to Module 3 completion = Industry Standard and, Module 5 = Comprehensive.

2.3. Course Material: The Essentials

The five modules that comprise the course are summarized in Table 1, and a complete list of all module components is available in Supporting Information. Completion of all modules takes approximately 17.5 h (~3.5 h/module). The Essentials was hosted on Litmos (Litmos Learning Management System n.d.), a Learning Management System for designing and delivering eLearning programs. The course was uploaded in Sharable Content Object Reference Model (SCORM) format.

TABLE 1.

Modules and learning objectives of The Essentials online training course.

Module	Learning objectives
Understanding eating disorders	Outline the background information associated with eating disorders Identify diagnostic criteria and key features of the illness that comprise the eating disorders Comprehend key diagnostic issues Understand the experience of people with eating disorders, their carers and families
2Assessment	Comprehend and apply the special considerations for history taking for people with eating disorders Identify the requirements for medical assessment Identify what constitutes a detailed mental health and risk assessment Outline the stage of change model and how it related to eating disorders Recognize the components of an activity assessment Identify and use key tools useful in a nutritional assessment and early treatment
3Preparation for treatment	Identify key aspects of treatment planning Effectively set goals and deliver timely psychoeducation Identify the roles of team members Recognize key aspects of treatment and recovery Determine the most appropriate option for treatment Consider legal and ethical issues in more detail Identify indicators for referral to specialist services or to inpatient care
4Treatment approaches	Recognize the key aspects of the evidence‐based therapies, for example, Family‐Based Therapy for children and adolescents (FBT), Cognitive Behavioral Therapy Enhanced for eating disorders (CBT‐E), Maudsley Model of Anorexia Treatment for Adults (MANTRA), Supportive Specialist Clinical Management (SSCM), and the principles of motivational interviewing and trauma‐informed care
5Management	Identify the key concepts in working with patients in inpatient, day patient and outpatient settings

2.4. Analysis

Matched pre‐ and postcourse ratings were compared using paired sample t‐test to evaluate changes in self‐reported knowledge, confidence, skills, and willingness. Potential sociodemographic moderators of improvement in self‐rated knowledge were examined using multinomial logistic regression for categorical variables. Linear mixed model analysis was undertaken on the primary outcomes of knowledge and confidence ratings. Sensitivity analyses were undertaken using repeated measures ANCOVA. Alpha for all tests was set at 0.05. SPSS software version 28 was used for descriptive, paired t‐tests for evaluating the effect size of the learning outcomes (Cohen's d), and simple regression statistical analyses, and R Studio version 2023.12.1 (build 402), and R packages lme4 and sjPlot were used for linear mixed effect model analysis and tables. Open‐text responses were coded by author S.O. and consolidated by J.M.W., D.M., and P.M.

3. Results

3.1. Participant Characteristics

A total of 7370 participants who enrolled for The Essentials course during the study period consented to participate in the evaluation study. Participant demographic and clinical characteristics are displayed in Table 2. Three‐quarters of participants were female, and most participants (90%) accessed government‐funded places in the course. Participants represented a range of disciplines; however, most (85%) were from mental health and health services. Over a quarter of participants (28%) reported 10+ years of general clinical experience, however, 44% of participants reported they had no experience treating people with eating disorders. Geographic spread of participants aligned closely with the population spread of Australia—almost two thirds worked in metropolitan areas and one third were from rural and regional areas.

TABLE 2.

Sample demographic and clinical characteristics (N = 7370).

	N	%
Identified gender
Female	5555	75.4
Male	513	7.0
Other gender identity	65	0.9
Prefer not to say	68	0.9
Missing	1169	15.9
Age
18–30	1410	19.1
31–40	1492	20.2
41–50	1086	14.7
51–60	585	7.9
61–70	162	2.2
71–80	13	0.2
Missing	2622	35.6
Australian state
NSW	2015	27.3
VIC	1949	26.4
QLD	1449	19.7
WA	775	10.5
SA	411	5.6
ACT	307	4.2
TAS	217	2.9
NT	125	1.7
Missing	122	1.7
Lived experience
Consumer	492	6.7
Carer	383	5.2
Consumer and carer	223	3.0
None	4664	63.3
Missing	1608	21.8
Discipline
Psychologist	2440	33.1
Dietitian	1059	14.4
Nurse	1014	13.8
Social worker	868	11.8
General practitioner	781	10.6
Other	553	7.5
Occupational therapist	218	3
Psychiatrist	120	1.6
School counselor	106	1.4
Pediatrician	55	0.7
Physician	21	0.3
Fitness professional	15	0.2
Missing	120	1.6
Sponsored by government
Yes	6614	89.7
No	756	10.3
Eating disorder cases past 6 m
None	2490	33.8
1–5 people	3833	52.0
6–9 people	479	6.5
Over 10 people	562	7.6
Missing	6	0.1
Years of eating disorder experience
None	3241	44.0
1–2 years	1895	25.7
3–5 years	1084	14.7
6–9 years	486	6.6
Over 10 years	658	8.9
Missing	6	0.1
Years of clinical practice
None, I am just starting	1214	16.5
1–2 years	1550	21.0
3–5 years	1529	20.7
6–9 years	1028	13.9
Over 10 years	2043	27.7
Missing	6	0.1
Employment area	7220
Metropolitan	4629	62.8
Regional/rural	2426	32.9
Not current employed	165	2.2
Missing	150	2.0
Employment sector
Public	3184	43.2
Private	2318	31.5
Both	867	11.8
Missing	1001	13.6
Employment setting
Primary care	3073
Private practice	1667	22.6
General practice clinic	729	9.9
Headspace clinic	624	8.5
Public hospital network	53	0.7
Secondary or tertiary health	3021
Community mental health	1014	13.8
Hospital setting—medical	864	11.7
Hospital setting—psychiatric	508	6.9
Community health center	430	5.8
Eating disorder service	174	2.4
Emergency department	31	0.4
Other	1157
Education/teaching	329	4.5
Student	252	3.4
Not currently employed	62	0.8
Other	514	7
Missing	119	1.6

3.2. Participation and Completion Rates

Of the total cohort, 99% of participants (n = 7268) who enrolled in the course then commenced the course, 1% were nonstarters. Of this cohort, 74% (n = 5411) completed the first module Understanding Eating Disorders (Introductory level), 64% (n = 4649) completed modules 1–3 (Industry standard level), and 58% (n = 4224) completed the entire course (Comprehensive level). Apart from Module 1, which had a 74.4% completion rate, most learners completed a module once it was commenced, with an over 90% module completion rate for modules 2–5, see Figure 1.

FIGURE 1.

Participation and completion by module (N = 7268).

Full completion rates by discipline were broadly consistent with the participation rates by discipline: Psychologists (35.4%, n = 1487), Dietitians (15.9%, n = 667), Nurses (13.2%, n = 554), Social workers (11.5%, n = 482), and GPs (10.7%, n = 451), with other medical professional disciplines (psychiatrists, pediatricians, and physicians) accounting for a smaller proportion of completions. Completion rates showed significant differences by industry sector. On average, participants working in a private practice setting were more likely to complete the course (OR = 1.49, p < 0.001) than those working in the public sector. Full data for rates of completion by profession and completion rate analyses are available in Tables S1 and S2.

3.3. Survey Data

3.3.1. Reasons for Enrolling

Half of the participants (51%) reported enrolling in The Essentials for continuing professional development, and almost a third (32%) reported they enrolled to learn specific ED therapies. The remainder enrolled to gain confidence (14%), or because it was required for their roles (3%), with a small proportion not specifying a reason (1%).

3.3.2. Learning Outcomes

Of the participants who completed the entire course, those who completed both pre‐ and post‐survey (i.e., matched sets) are included in the analyses (n = 4128). To evaluate the effectiveness of the training program across participant personal and professional backgrounds, two linear mixed‐effects models were used which included time (pre‐ and post‐measure) by professional discipline, and time (pre and post) by years working with people with an eating disorder interaction, and controlled for various demographic factors (for full models, see Tables S3 and S4). Mental health professionals were the reference group to which other disciplines were compared.

All learning outcomes showed significant improvement with large effect (Cohen's d = 1.2 to 2). Self‐rated knowledge of eating disorders increased from pre‐ to post‐training by an average of one point (e.g., low to moderate, or moderate to high; 0.98, 0.96–1, p < 0.001). The largest improvements were in self‐rated knowledge on the specific requirements for working with children and adolescents with eating disorders (Cohen's d = 2). Compared with mental health professionals, significantly greater improvement was observed for medical professionals (0.19, 0.10–0.28, p < 0.001) and other allied health (0.17, 0.08–0.26, p < 0.001). The effect of the training program on self‐reported overall knowledge did not depend on years of working with people with eating disorders (−0.06, −0.14–0.03, p = 0.21), suggesting that the training program was similarly impactful across levels of experience.

The least change was in willingness to treat and manage eating disorders, however, this was already moderately high at course commencement (M = 3.7) and therefore showed only a small increase post‐training (0.24, 0.22–0.27, p < 0.001). Participants most likely to complete the course were those who initially reported a very low knowledge of eating disorders and those who reported a higher willingness to manage and treat eating disorders.

Ratings for confidence to assess and treat eating disorders significantly increased from pre‐ to post‐training (1.2, 1.17–1.22, p < 0.001). Compared with mental health professionals, significantly greater improvement was observed for medical professionals (0.14, 0.04–0.24, p = 0.005) and other allied health workers (0.14, 0.05–0.23, p = 0.003). The effect of The Essentials on overall confidence did not depend on years of working with people with eating disorders, further suggesting that the training program is beneficial across levels of experience (−0.05, −0.14–0.04, p = 0.25). Full data for pre‐ versus post‐funded survey comparisons are displayed in Table 3.

TABLE 3.

Pre‐ and postevaluation self‐reported learning outcomes (N = 4174).

Evaluation outcome	Pretraining	Posttraining	Diff.	95% CIdiff	t	p	Effect size
	M (SD)	M (SD)	M (SD)				Cohen's d
Willingness to treat people with an ED	3.73 (1.01)	3.97 (0.78)	0.24 (0.89)	0.22, 0.27	17.54	< 0.001	0.26
Overall knowledge of EDs	2.72 (0.76)	3.70 (0.64)	0.98 (0.78)	0.96, 1.00	81.71	< 0.001	1.39
Confidence in assessing and treating people with EDs	2.48 (0.84)	3.67 (0.63)	1.19 (0.81)	1.17, 1.22	95.01	< 0.001	1.59
Skill level in assessing and treating people with EDs	2.44 (0.79)	3.33 (0.64)	0.89 (0.77)	0.87, 0.92	74.89	< 0.001	1.23
Knowledge on types, diagnosis, and epidemiology of EDs	2.61 (0.82)	3.74 (0.66)	1.13 (0.85)	1.10, 1.15	85.98	< 0.001	1.51
Knowledge on early recognition and screening for EDs	2.57 (0.83)	3.76 (0.66)	1.19 (0.86)	1.17, 1.22	90.16	< 0.001	1.59
Knowledge on prevention, stigma, and misconceptions in EDs	2.73 (0.85)	3.92 (0.67)	1.19 (0.88)	1.16, 1.22	87.01	< 0.001	1.54
Knowledge in conducting a comprehensive assessment for an ED	2.27 (0.85)	3.58 (0.69)	1.31 (0.85)	1.28, 1.33	99.66	< 0.001	1.67
Knowledge on assessing a client's motivation to change	2.85 (0.82)	3.77 (0.68)	0.92 (0.83)	0.89, 0.94	71.13	< 0.001	1.21
Knowledge on best practice treatment for EDs	2.46 (0.83)	3.81 (0.67)	1.35 (0.88)	1.33, 1.38	99.75	< 0.001	1.79
Knowledge on setting treatment goals with regards to ED	2.33 (0.79)	3.67 (0.67)	1.34 (0.85)	1.32, 1.37	102.47	< 0.001	1.83
Knowledge on creating a treatment team for a person with an ED	2.38 (0.89)	3.76 (0.72)	1.38 (0.95)	1.35, 1.40	94.06	< 0.001	1.69
Knowledge of the common therapies used in people with ED	2.52 (0.82)	3.86 (0.68)	1.35 (0.89)	1.32, 1.37	97.71	< 0.001	1.78
Knowledge on the specific requirements for working with children and adolescents with EDs	2.16 (0.81)	3.65 (0.70)	1.49 (0.88)	1.46, 1.52	110.10	< 0.001	1.96
Knowledge on inpatient management for EDs	2.12 (0.92)	3.57 (0.74)	1.45 (0.91)	1.42, 1.47	102.94	< 0.001	1.71
Knowledge on outpatient management for EDs	2.30 (0.82)	3.72 (0.67)	1.42 (0.84)	1.39, 1.45	108.96	< 0.001	1.89

Note: Only included those who have completed pre‐ and postmeasures in analyses (N = 4174). All significant at p < 0.0001 level.

3.3.3. Areas of Course Identified as Most and Least Helpful

Participants were given the option to report what they found most helpful and least helpful about the course as an open‐text response. Basic content analysis identified the main areas participants found helpful were the comprehensive course content, the practical strategies offered in assessment and treatment of people with eating disorders, and the interactive mix of learning materials such as videos, case studies, roleplays, online lectures, quizzes, and downloadable resources. The areas identified as least helpful were the time investment needed, with some participants finding the actual time spent to complete the course was longer than the estimated time (17.5 h) and proposed an increase to the access time for learners or to make the content more concise. Participants made technical suggestions such as adjustable playback speed on videos, the option to select modules in any sequence, and the addition of a bookmark function to track the history of learning. Participants also suggested additional specific content to include, and the addition of e‐forum or real‐time sessions where learners can discuss content. Full results are available in Tables S5 and S6.

3.3.4. Course Acceptability

Over 90% of participants who completed the postcourse evaluation (n = 4208) reported that the course met their learning needs either moderately or completely and 99% agreed that they would recommend the course to other health professionals. Most participants reported that the course was relevant to their clinical practice (96%) and that they expected their clinical practices to change after completing the course (98%). Full results are available in Table S7.

4. Discussion

As part of a national strategy to increase access to care for individuals with eating disorders across the health system, government‐funded core competency training in eating disorder care was provided to health care professionals via eLearning in all jurisdictions of Australia. The Essentials: Training Clinicians in Eating Disorders was designed to upskill even the least experienced clinicians in working with people with eating disorders, so that people presenting in any location, and at any level of care, can be greeted with awareness, understanding, and a pathway to appropriate support. Results of this evaluation demonstrate The Essentials was effective in achieving broadscale reach and improving self‐reported knowledge, skills, and confidence across a range of disciplines and years of experience to treat people with eating disorders.

A primary objective was to target health professionals eligible to provide government‐funded services in both public and private settings. The top five professions to undertake the course were key clinicians involved in eating disorder care—psychologists, dietitians, nurses, social workers, and GPs. Psychologists and dietitians are central to community care for eating disorders, and the course reached 20% of the total Australian workforce of dietitians (who were also most likely to complete the course) and 8% of psychologists (Australian Government, Jobs and Skills Australia: Labour Market Insights ²⁰²⁴; Australian Institute of Health and Welfare ²⁰²⁰). Nurses and social workers also undertook the course in large numbers despite limited time for professional development in the busy public system. Over 10% of participants were GPs, representing 2.5% of the total GP workforce (Australian Government Department of Health and Aged Care ²⁰²⁰)—an important outcome to highlight, as GPs are known to be time‐poor and difficult to engage in training, particularly when a significant time commitment is required (Aouad et al. 2024). GPs are often the first point of contact in the health system for individuals with eating disorders, and most eating disorder treatment and management plans in Australia are initiated by GPs (Maguire et al. 2023). GPs are therefore critical to early identification, facilitation of services, and coordination of care. For those GPs who did not complete the entire course, it is possible that the early modules, which address identification and assessment, may have satisfied the core learning needs for their clinical practice. Psychiatrists undertook the course in lower numbers, however, these participants represent 3% of the total psychiatry workforce (Australian Institute of Health and Welfare ²⁰²⁰), a limited pool of specialists who are in huge demand in both public and private services. The involvement of psychiatrists in the training is important for the Australian health care system, as psychiatric review is required to access the full complement of federal government‐supported treatments, and psychiatrist availability is a reported barrier (Maguire et al. 2023).

The objective to reach health professionals across all jurisdictions was achieved, and one third of participants were working in rural and regional areas. Clinicians in regional areas may face increased demands to treat high acuity patients due to a lack of access to specialist services, including shortages of mental health clinicians in local services, long wait lists for psychologists, and very limited access to psychiatrists (Australian Institute of Health and Welfare ²⁰²⁰; Australian Government Department of Health and Aged Care ²⁰²⁰). Providing evidence‐based online training for clinicians in regions where they have limited access to local training opportunities, and they may need to provide care for individuals with eating disorders with little support, is therefore a priority. The program also achieved the objective to attract new health care professionals to the field of eating disorders—most health professionals who participated reported less than 2 years of experience treating people with eating disorders. Years of treating people with eating disorders did not necessarily equate with years of general clinical experience; almost a third of the participants had over 10 years of general clinical experience, and therefore the course attracted interest over a wide range of clinical expertise.

The completion rate of 60% compares favorably to the low to mid‐range (10%–43%) rates reported for online education of healthcare professionals generally (Martin et al. 2018; Jacobsen et al. ²⁰²²). Completion rates were higher for health professionals employed in private settings than public, an effect which could be driven by the large representation of psychologists and dietitians in the private category, and the direct relevance of the final modules (treatment and management) to their practice. It may also indicate that health professionals in public services need more dedicated work time allocated to professional development. Those working in public health settings may have limited work‐hour allocation to complete professional training, and organizational support and strong leadership to prioritize workplace learning is needed (King et al. 2021).

On average, participants starting the course reported a high willingness, but only a moderate degree of knowledge and confidence to treat eating disorders. Across professions, and levels of experience, those who completed The Essentials reported significant increases in their knowledge, skill, and confidence to treat eating disorders with no significant difference between groups, indicating that the course is suitable for a broad spectrum of health care providers. As the course is comprehensive, but introductory, increasing basic knowledge and confidence to treat eating disorders across all areas of the health system was the primary objective, as they are critical to improving outcomes for this high‐risk population that often delay seeking care (Miskovic‐Wheatley et al. ²⁰²³).

The main reasons for enrolling in the course were for continuing professional development and to learn therapy skills. The very low number of participants who reported being required to do the course by their employer suggests that there is a strong demand for evidence‐based core skills training in eating disorders. There was no relationship between reasons for enrolment and completion rates; however, those who started the training with a higher willingness to treat eating disorders were more likely to complete the training, likely indicating higher motivation from the start. High willingness to treat coupled with interest in learning treatment and management skills may have been a driver for course completion, as these were the topic of the final modules. Across all levels of willingness, reasons for enrolment, and disciplines, most course completers reported that the course was relevant to their clinical practice, and that they expected to make changes their practice because of their learning. For clinicians who want to develop professional skills further than the introductory level, the course introduces them to a suite of eating disorder eLearning courses (InsideOut Institute for Eating Disorders n.d.). In New South Wales, participants can also use these courses as prerequisites for state‐funded face‐to‐face training in specific clinical skills and ongoing case‐based learning, as research suggests training in therapeutic interventions does not consistently transfer to practice change without on‐going supervision to support skill use (Frank, Becker‐Haimes, and Kendall ²⁰²⁰).

Key areas for course improvement noted in the current evaluation include balancing information comprehensiveness with study time commitment, providing additional technical functionality and choice for learners, and quick responsiveness to technical issues. For future course development, it will also be important that the content continues to be revised with emerging evidence, that the delivery is updated to meet current learning needs, and with the ongoing inclusion of the voice of lived experience (Spencer, McKimm, and Symons ²⁰¹⁸; Scott et al. ²⁰²¹). The Essentials was developed in consultation with those with a lived and living experience of eating disorders, and their families, carers, and supports, and an important development principle was the safe and sensitive presentation of information. Nearly 20% of participants in the current evaluation reported their own lived experience of an eating disorder, and continued attentiveness to how we can best “protect and empower the significant minority” (Bachner‐Melman et al. ²⁰²¹, 1881) of clinicians with a lived experience of an eating disorder will remain a priority.

Updating content to include the emerging evidence in historically under‐researched demographic groups, such as males (Ganson, Murray, and Nagata ²⁰²¹), First Australian peoples (Burt et al. 2020), the LGBTQA+ community (Parker and Harriger 2020), neurodiverse individuals (Cobbaert and Rose 2023), and people from different cultural backgrounds (Burke et al. 2021), will be essential, especially as awareness of the risk of eating disorders in more diverse and often marginalized populations grows (Burke et al. 2020; Alexander et al. ²⁰²⁴). Online training has the potential to meet this need quickly and economically and to provide the workforce with the updated information they need to ensure evidence‐based care represents the whole community. High workplace turnover in health service professionals (Haywood et al. 2024; Brabson et al. ²⁰²⁰; Penwell et al. ²⁰²⁴) means there will be an ongoing need for introductory training in eating disorders as part of workforce development and should receive ongoing commitment.

4.1. Strengths and Limitations

This research provides further evaluation of The Essentials in a significantly larger sample than previously reported (Maguire et al. 2019), improving representativeness across geographical location, disciplines, and years of experience. At over 7000 participants, this cohort presents one of the largest online workforce development evaluations in the field.

However, there are limitations to note. Learning outcomes were self‐reported, and no a priori metrics were set to determine meaningful change in outcomes. Determining how effectively knowledge and skills were transferred to everyday practice was not assessed. Private clinicians accessing a funded course place were required to confirm their eligibility to provide services to people with eating disorders, but linkage with data to verify Medicare item usage was beyond the scope of this study. The evaluation included those who accessed funded places and those who paid for the course, and differences in motivation to complete the course between these groups were not evaluated. Most of the cohort accessed government‐funded places in the course, precluding evaluation of financial cost impacts on accessibility and cost‐effectiveness, but future research to assess the overall cost‐effectiveness is warranted. Future research to assess the success of transfer of learning and practice change across settings could include monitoring increased usage of Medicare items, or time series analysis of funded training activities with administrative health data linkage to quantify service change‐related benefits to patients.

In conclusion, this study was conducted in Australia but has relevance for other countries regardless of differences in how healthcare is organized or funded. Eating disorders are not niche—they are common (Haynos et al. 2024), and to provide timely and effective treatment they need to be re‐conceptualized as core business across the health system (Maguire and Maloney 2021; National Eating Disorders Collaboration ²⁰²¹). Eating disorders are everyone's business, and professionals at all levels of the health system need to be able to recognize the warning signs and know how to respond appropriately, and with care.

Author Contributions

Danielle Maloney: conceptualization, project administration, writing – original draft. Shu Hwa Ong: formal analysis, writing – original draft. Jane Miskovic‐Wheatley: conceptualization, investigation, methodology, supervision, writing – review and editing. Kelly M. Dann: writing – original draft, writing – review and editing. Morgan Sidari: formal analysis. Ashlea Hambleton: investigation, methodology. Peta Marks: conceptualization, project administration, writing – review and editing. Sarah Maguire: conceptualization, project administration, writing – review and editing.

Ethics Statement

This research was conducted in line with the principles of the Declaration of Helsinki and with approval from the Sydney Local Health District Human Research Ethics Committee (X20‐0179 and 2020/ETH01089).

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1.

Data S2.

Data Availability Statement

Data are available within the article or its Supporting Information.