Doctor of Physical Therapy Education in a Hybrid Learning Environment: Reimagining the Possibilities and Navigating a "New Normal"

Comparison of face to face and online delivery of a dementia-specific experiential learning activity

During the COVID-19 pandemic, healthcare professions shifted from face to face(F2F) to online educational delivery methods. Research evaluating the effectiveness of online educational delivery is mixed.The purpose of this study was to compare the effectiveness of a dementia-specific experiential learning activity(ELA) delivered to Doctor of Physical Therapy(DPT) students face to face(F2F) versus online. Participants included a sample of DPT students (n = 171) from four consecutive cohorts. In this quasi-experimental, single-site two-factor design study, students participated in either a F2F(n = 84) or online version (n = 87) of an ELA. They completed a dementia survey pre-(T1) and post-ELA(T2). Pre- and post-survey analysis demonstrated significant improvements between T1 and T2 for both groups. The interaction of group by time F(1,169) = 287.61, p < 0.01 indicates a main effect for groups over time. Analysis did not demonstrate significance between versions for T1 or T2. The interaction of time by group F(1,169) = 1.08, p = 0.30 indicates there was not an interaction of time by group.This study provided strong evidence that students benefitted from the dementia-specific ELA regardless of delivery method. Both methods proved equally effective, as there was no statistically significant difference between them. Programs may consider online experiences to increase schedule flexibility and content accessibility.

A Comparative Analysis of Physical Therapy Anatomical Knowledge and Retention: Human Donor Dissection Versus Virtual Laboratory

INTRODUCTION

Despite a long history of using human donor dissection (HDD) for physical therapy (PT) anatomy education, there are no PT guidelines that require HDD. The purpose of this quantitative causal-comparative study was to determine if Doctor of Physical Therapy students who used HDD had different grades both within anatomy and within courses that require retention and application of anatomical knowledge (kinesiology and a foundational musculoskeletal course) compared with those who used virtual 3-dimensional anatomical software (VAS).

REVIEW OF LITERATURE

Numerous factors affect the decision to use HDD within PT anatomy, and few PT studies have compared the effectiveness of VAS to HDD.

SUBJECTS

All students who took anatomy in an entry-level PT program from 2018 to 2021 (232 total students, 115 who used HDD in 2018-2019 and 117 who used VAS in 2020-2021).

METHODS

Mann-Whitney tests were used to compare anatomy grades (course, written examination, and practical examination) and future grades in kinesiology and a foundational musculoskeletal course for students who used HDD or VAS.

RESULTS

Physical therapy students who used VAS had statistically significant higher anatomy course grades (VAS 93.81% ± 4.99% to HDD 92.20% ± 4.53%) and higher practical examination grades (VAS 97.43% ± 2.91% to HDD 93.55% ± 4.39%) compared with those who used HDD. However, there were no significant differences between groups on written anatomy examinations (VAS 89.42% ± 7.21% to HDD 90.40% ± 4.94%), kinesiology grades (VAS 91.86% ± 4.52% to HDD 92.80% ± 4.27%), or foundational musculoskeletal grades (VAS 89.50% ± 3.89% to HDD 89.77% ± 3.83%).

DISCUSSION AND CONCLUSION

The causal-comparative study design prevents concluding that PT student grade differences were due exclusively to either anatomy laboratory method. It does provide preliminary evidence that the PT anatomy laboratory method did not practically affect anatomy performance or long-term application of anatomy knowledge in future coursework.

A Comparison of Physical Therapist Educational Outcomes Before and During the COVID-19 Pandemic: A Multicenter Study

INTRODUCTION

The purpose of this study was to analyze and compare educational outcomes of Doctor of Physical Therapy (DPT) graduates before and during the COVID-19 pandemic.

REVIEW OF LITERATURE

Reports show increased stress, anxiety, and burnout during the COVID-19 pandemic, which may have negatively affected academic performance. Historically, academic performance is predictive of National Physical Therapy Examination (NPTE) scores. Yet, there is little evidence analyzing student outcomes during the pandemic.

SUBJECTS

Doctor of Physical Therapy graduate records (N = 1,897) were retrospectively collected from a multicenter convenience sample consisting of 5 blended programs. Records were sampled from existing "prepandemic" graduates of Fall 2018-2019 (n = 988) and "pandemic" graduates of Fall 2021-2022 (n = 909).

METHODS

A causal comparative and correlational study design was used. Grade point average (GPA) and NPTE scores were collected. A general linear model examined differences between groups, and a multiple linear regression examined predictors of NPTE performance.

RESULTS

Grade point average was a significant predictor of NPTE score (r2 = 0.56; P < .01) for the overall sample and for the prepandemic and pandemic cohorts (r2 = 0.38, P < .01; r2 = 0.45, P < .01, respectively). Grade point average was not significantly different between the groups (P = .09), nor did it significantly influence differences in NPTE scores (P = .13). Pandemic graduates displayed a significantly lower NPTE pass rate (85.1%) compared with prepandemic graduates (89.7%; P < .01). Pandemic graduates experienced higher rates of academic difficulty (20%; P < .01) and had a approximately 5 times higher likelihood of not passing the NPTE.

DISCUSSION AND CONCLUSION

This is the first study to report on DPT graduate outcomes spanning the COVID-19 pandemic. Similar to previous studies, GPA remained the most significant predictor of NPTE scores. Pandemic graduates demonstrated significantly lower NPTE scores and higher rates of academic difficulty (GPA < 3.0). Continued monitoring of NPTE performance is warranted between prepandemic, pandemic, and postpandemic cohorts across modes of program delivery.

Accessibility in health professions education: The Flexner Report and barriers to diversity in American physical therapy

Health professionals do not reflect the broader racial/ethnic diversity of the United States. Historical barriers to accessing health professions education have played a major role in initiating and perpetuating these disparities. Sociologists of professions have highlighted the role of educational reform in professions' efforts to enhance their status, but have overlooked the central role of government bodies in facilitating or impeding these strategies. The Flexner Report (1910) enhanced the status of medicine, but only after state medical boards adopted its recommendations, leading to the closure of half of the nation's medical schools and limiting opportunities for marginalized populations to enter the medical profession. Physical therapy leaders have espoused Flexner's precepts in seeking to advance their field's professionalization. In doing so, they consistently overlooked the more insidious impacts of Flexnerian approaches on student and practitioner diversity. This article examines how physical therapy's Flexnerian ambitions disrupted its parallel efforts to increase the field's racial/ethnic diversity. I argue that physical therapy leaders' focus on enhancing their profession's status and indifference toward facilitating educational access and mobility played a significant role in the field's racial/ethnic homogeneity. To increase practitioner diversity in the future, especially following the 2023 US Supreme Court decision (600 U.S. 181) restricting race conscious affirmative action, health professions must do more to address barriers to student access. This will involve moving away from the Flexnerian model and pursuing approaches that have helped more diverse and inclusive health professions, like nursing, to achieve greater educational opportunity and mobility.

Effectiveness of social distancing measures and lockdowns for reducing transmission of COVID-19 in non-healthcare, community-based settings

Social distancing measures (SDMs) are community-level interventions that aim to reduce person-to-person contacts in the community. SDMs were a major part of the responses first to contain, then to mitigate, the spread of SARS-CoV-2 in the community. Common SDMs included limiting the size of gatherings, closing schools and/or workplaces, implementing work-from-home arrangements, or more stringent restrictions such as lockdowns. This systematic review summarized the evidence for the effectiveness of nine SDMs. Almost all of the studies included were observational in nature, which meant that there were intrinsic risks of bias that could have been avoided were conditions randomly assigned to study participants. There were no instances where only one form of SDM had been in place in a particular setting during the study period, making it challenging to estimate the separate effect of each intervention. The more stringent SDMs such as stay-at-home orders, restrictions on mass gatherings and closures were estimated to be most effective at reducing SARS-CoV-2 transmission. Most studies included in this review suggested that combinations of SDMs successfully slowed or even stopped SARS-CoV-2 transmission in the community. However, individual effects and optimal combinations of interventions, as well as the optimal timing for particular measures, require further investigation. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.

The impact of modifications in cadaver dissection time on student learning outcomes in a doctor of physical therapy program

Human anatomy is a foundational component of medical and allied health professional education. Doctor of Physical Therapy (DPT) programs are required to teach anatomy, however the pedagogies used are at the discretion of faculty and institutions. Cadaver dissection may have been the predominant instruction methodology in DPT programs in the past; new technology provides alternative interactive teaching methods. This paper describes the modifications in an anatomy curriculum over 5 years in one DPT program, and the impact on student perception and learning outcomes. This was a retrospective, quantitative study that utilized a survey to collect data on student perceptions about the anatomy pedagogy; the learning outcomes analyzed were grades and licensure exam pass rates. We report on outcomes for five cohorts within one DPT program. IRB approval was obtained for the research. Despite the decrease in cadaver laboratory time after 2016, students' final exam grades in Gross Anatomy improved and the first time pass rate for the national licensure exam increased. Most students rated cadaver laboratory and the active learning assignments that replaced traditional cadaver laboratory time as valuable to their learning; however, there were differences in opinions between cohorts. Although the outcomes might not reflect a direct result of dissection time, the study confirmed that using alternative methods for teaching anatomy did not hinder student performance. Using innovative pedagogy allows educators to achieve student success in spite of decreased gross dissection time.

Doctor of Physical Therapy Education in a Hybrid Learning Environment: A Case Report

OBJECTIVE

The purpose of this case report is to describe the implementation and report early outcomes of a 2-year (6-trimester), hybrid doctor of physical therapy (DPT) program.

METHODS

The case report describes management of (1) academic affairs, (2) student affairs, (3) faculty affairs, and (4) institutional affairs for an accredited, fully hybrid, 2-year DPT program. In the hybrid program, students from across the country participate in synchronous and asynchronous online learning and travel to campus twice per trimester for immersive blocks of in-person laboratory instruction. The case report describes how the program structures the hybrid learning environment and reports outcomes from the first 2 graduated cohorts.

RESULTS

Program outcomes assessment revealed that 97% to 98% of students/graduates reported being somewhat or very satisfied with the 2-year hybrid DPT program at the end of DPT year 1, at graduation, and at 1 year after graduation. Clinical instructors reported that 84% of students were prepared or well-prepared for clinical education. At 1 year after graduation, 20% of graduates were enrolled in or had completed residency, National Physical Therapy Examination (NPTE) pass rate was 97%, and employment rate was 99%.

CONCLUSION

Hybrid DPT education is feasible and may provide opportunities for more flexible and accessible delivery of DPT education. Outcomes of this case report suggest high student satisfaction, increased student/graduate diversity, and graduate outcomes comparable with national averages as reported in the Commission on Accreditation in Physical Therapy Education aggregate data.

IMPACT

This case report provides early evidence that hybrid DPT education-a type of blended learning that uses both face-to-face and online instructional strategies-is feasible, with student satisfaction and student/graduate outcomes comparable with national averages. Hybrid education may provide educators, programs, and institutions the flexibility to innovate in ways that address some of the immediate and long-term challenges facing physical therapist professional education while maintaining standards of excellence.

Back to the Future: Maximizing Student Learning and Wellbeing in the Virtual Age

The virtual age of learning is no longer a concern of the future. It is here. The Fall 2021 Webinar Audio Series (WAS) of the International Association of Medical Science Educators (IAMSE), titled "Back to the Future: Maximizing Student Learning and Wellbeing in the Virtual Age," was designed to help health science educators equip themselves with tools to teach the next generation of health care professionals successfully. From September 2, 2021 to September 30, 2021, the Fall 2021 Series was broadcast live to audiences at academic institutions worldwide in five weekly webinars. This five-part webinar series explored theories and best practices in delivering content over virtual and online media while simultaneously promoting a positive learning environment and enhanced student wellbeing.

Digital Entry-Level Education in Physiotherapy: a Commentary to Inform Post-COVID-19 Future Directions

Currently, the coronavirus disease 2019 (COVID-19) severely influences physiotherapy education which is based mostly on face-to-face teaching. Thus, educators have been compelled to adapt their pedagogical approaches moving to digital education. In this commentary, we debate on digital education highlighting its effectiveness, the users' perspectives, and its weakness in the context of physiotherapy teaching aimed at informing post-COVID-19 future directions in this educational field. Existing evidence on digital education produced before COVID-19 supports its implementation into entry-level physiotherapy education. However, some challenges (e.g. social inequality and evaluation of students) threaten its applicability in post-COVID-19 era, calling educators to take appropriate actions.

Teaching Psychomotor Skills in a Virtual Environment: An Educational Case Study

In March 2020, most physical therapy schools across the globe transitioned to online learning in response to the COVID-19 pandemic. This change posed unique challenges not only because it required adapting to new technology in a short period but, more importantly, it involved developing ways to teach hands-on psychomotor and clinical skills virtually while maintaining the quality of instruction. In response to the rapid transition, the physical therapy program at MGH Institute of Health Professions (IHP)designed and implemented a novel and effective coaching model to address the challenges. The model was developed based on experiential learning theory, constructivism, a coaching framework, and andragogical principles of feedback and reflection. Not only did the model meet its objectives of effectively teaching basic psychomotor skills in the virtual environment, but it may also have andragogical benefits that can be applied to traditional face-to-face methods. This case study describes the theoretical underpinning of the model, its development and implementation, the perceived effectiveness for learning psychomotor skills in a virtual environment, and the potential for broader relevance to future models of physical therapy education.

Effectiveness of blended learning in pharmacy education: An experimental study using clinical research modules

BACKGROUND &OBJECTIVES

Though there are studies to evaluate the effectiveness of blended learning in pharmacy education, most of them originate from USA and have used previous year students' scores as control. Also there is less research in comparing use of self -regulated learning strategies between blended and other learning strategies. Primary aim was to evaluate the effectiveness of blended learning on knowledge score using clinical research modules. Secondary objective was designed to compare the use of self-regulated learning strategies between blended learning, web-based e-learning and didactic teaching.

MATERIALS AND METHODS

A prospective cluster randomized trial was conducted with didactic teaching as control and web-based e-learning and blended learning as interventions. The target population was final year Pharm D students. Outcome was assessed using a validated knowledge questionnaire, a motivated strategies for learning questionnaire and a feedback form. All statistical analyses were carried out using Statistical Package for Social Science (SPSS) Version 20.

RESULTS

A total of 241 students from 12 colleges completed the study. Mean knowledge score of students in blended learning group was higher than those in the didactic teaching and web- based e- learning program (64.26±18.19 Vs 56.65±8.73 Vs 52.11±22.06,p<0.001).Frequency of use of learning strategies namely rehearsal, elaboration, organization and critical thinking was statistically significantly higher in the blended learning group compared to those of didactic and web-based e-learning group (p<0.05) But there were no statistically significant difference of motivational orientations between didactic and blended learning group except strategies of extrinsic goal orientation and self-efficacy. Students preferred blended learning (86.5%) over didactic and web-based e-learning.

CONCLUSION

Blended learning approach is an effective way to teach clinical research module. Students of blended learning group employed all motivational and learning strategies more often than students of the didactic and web- based e-learning groups except strategies of intrinsic goal orientation, task value, control of learning belief and help seeking.

Priorities for reorienting traditional institutions of higher education toward online teaching and learning: Thinking beyond the COVID-19 experience

The purpose of this study is to suggest priorities for reorienting traditional institutions of higher education (IHE) toward online teaching and learning beyond the COVID-19 experience. This research applied the qualitative research method. Data collection sources included both a systematic literature review relating to how COVID-19 informed online distance learning across the globe and an analysis of circulars germane to the pandemic that were issued by the Ministry of Education (MOE) in Saudi Arabia and by Prince Sattam bin Abdulaziz University (PSAU). Guided by those two types of data, that is, review of the literature in general and the MOE and PSAU circulars in particular, and also illuminated by their own experiences of online teaching during the lockdown, the researchers were able to put forward those priorities. For the systematic review of the literature, five steps were performed: (1) identifying search terms and developing and applying a search strategy; (2) screening the obtained research papers, removing duplicates and papers outside the focal point, and establishing inclusion/exclusion criteria; (3) assessing the research papers against the inclusion/exclusion criteria; (4) data extraction; and (5) data synthesis. Although this article does not suggest traditional IHE should go entirely digital, it highlights the need for IHE to ensure access to online learning content, develop more partnerships with community, develop online self-study skills, get students to shift from passive to active learning, and a need to reconsider current e-assessment. Additionally, the study emphasizes the need to provide additional support for faculty members, how university buildings should be gradually reopened, controlling factors influencing online learning outcomes, and addressing the issue of dropouts in IHE. Finally, the study underlines the need to add further emphasis to the importance of integrating blended learning in the university curriculum and navigating toward developing global distance learning programs.

COVID-19 AND DENTAL DISTANCE-BASED EDUCATION: students' perceptions in an Italian University

BACKGROUND

The aim of the study was to analyze the perception of dental faculties students regarding the complete transition to distance-based education (DE) and the adaptation of this educational strategy, due to Covid-19 pandemic. A questionnaire to be completed anonymously was submitted online to students attending the faculties of Dentistry and Oral Hygiene at Sapienza, University of Rome, after the end of distance lessons. The collected data were processed statistically, providing descriptive data and analysis of correlation of the most significant parameters, using Chi-squared test, Cramér V and Pearson φ2, Goodman and Kruskal's γ and λ and Kendall's τb. The level of statistical significance was p < 0.05.

RESULTS

A total of 314 students participated in the survey. The overall level of satisfaction on a ten- point scale was 5.39 ± 2.59 for Oral Hygiene students and 6.15 ± 2.98 for Dentistry students. The most common complaints were the lack of a structured online curriculum, less interaction with professors and a lower level of attention. On the basis of the responses, scored using Likert-type Scale, oral Hygiene students reported statistically higher level of physical fatigue(p = 0.0189), a lower level of attention (p = 0.0136) and of the quality and quantity of acquired knowledge during distance education (p = 0.0392), compared to Dentistry students. Level of perceived stress and quality and quantity of acquired knowledge (γ = 0.81 and τb =0.56) and quality and quantity of acquired knowledge and fear of a decrease in knowledge (γ = 0.76 and τb =0.54) are associated variables.

CONCLUSION

Students' feedback is essential to solve the key issues emerged from the questionnaire. New educational models should be define in order to ensure that distance education could be effective, meeting the learning needs of the students, and could not be a merely "online shift" of traditional methods, used as an alternative of live education.

Flipped classroom versus traditional teaching methods within musculoskeletal physical therapy: a case report

Background and Purpose: The flipped classroom method is a popular way to use technology to assist with the delivery of educational experiences. Yet there is insufficient information regarding student opinions or outcomes about the flipped classroom method within physical therapy. The purpose of this case report was to describe student opinions and outcomes of the flipped classroom teaching and traditional lecture/lab methods of teaching within musculoskeletal physical therapy.Case Description: Thirty-six (36) first-year physical therapy students enrolled at a regional physical therapy program completed an anonymous internet-based survey regarding their impressions of traditional and flipped classroom teaching methods. Flipped classroom and traditional teaching methods were both used within the same musculoskeletal course. The survey was created to aid in planning subsequent courses and asked questions about student's preferred teaching method (flipped, traditional, or both equal) across a variety of categories. Student exams scores, using the same question bank, were compared to the year prior as a quantitative outcome measure.Outcomes: Twenty-nine (29) students (81%) completed the survey. Generally, students preferred the flipped classroom. Compared to the previous year, test scores for all content areas were similar (± 4%) except cervical spine which was improved (>10%). When asked outright, 28/29 students preferred the flipped teaching method.Discussion and Conclusion: Student opinions indicate the flipped classroom is preferable to traditional methods yet objective outcomes appear similar. Physical therapy educators seeking ways to improve the student experience using technology in the classroom may consider utilizing the flipped classroom method.

Evaluation of a Novel e-Learning Program for Physiotherapists to Manage Knee Osteoarthritis via Telehealth: Qualitative Study Nested in the PEAK (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis) Randomized Controlled Trial

BACKGROUND

The delivery of physiotherapy via telehealth could provide more equitable access to services for patients. Videoconference-based telehealth has been shown to be an effective and acceptable mode of service delivery for exercise-based interventions for chronic knee pain; however, specific training in telehealth is required for physiotherapists to effectively and consistently deliver care using telehealth. The development and evaluation of training programs to upskill health care professionals in the management of osteoarthritis (OA) has also been identified as an important priority to improve OA care delivery.

OBJECTIVE

This study aims to explore physiotherapists' experiences with and perceptions of an e-learning program about best practice knee OA management (focused on a structured program of education, exercise, and physical activity) that includes telehealth delivery via videoconferencing.

METHODS

We conducted a qualitative study using individual semistructured telephone interviews, nested within the Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis randomized controlled trial, referred to as the PEAK trial. A total of 15 Australian physiotherapists from metropolitan and regional private practices were interviewed following the completion of an e-learning program. The PEAK trial e-learning program involved self-directed learning modules, a mock video consultation with a researcher (simulated patient), and 4 audited practice video consultations with pilot patients with chronic knee pain. Interviews were audio recorded and transcribed verbatim. Data were thematically analyzed.

RESULTS

A total of five themes (with associated subthemes) were identified: the experience of self-directed e-learning (physiotherapists were more familiar with in-person learning; however, they valued the comprehensive, self-paced web-based modules. Unwieldy technological features could be frustrating); practice makes perfect (physiotherapists benefited from the mock consultation with the researcher and practice sessions with pilot patients alongside individualized performance feedback, resulting in confidence and preparedness to implement new skills); the telehealth journey (although inexperienced with telehealth before training, physiotherapists were confident and able to deliver remote care following training; however, they still experienced some technological challenges); the whole package (the combination of self-directed learning modules, mock consultation, and practice consultations with pilot patients was felt to be an effective learning approach, and patient information booklets supported the training package); and impact on broader clinical practice (training consolidated and refined existing OA management skills and enabled a switch to telehealth when the COVID-19 pandemic affected in-person clinical care).

CONCLUSIONS

Findings provide evidence for the perceived effectiveness and acceptability of an e-learning program to train physiotherapists (in the context of a clinical trial) on best practice knee OA management, including telehealth delivery via videoconferencing. The implementation of e-learning programs to upskill physiotherapists in telehealth appears to be warranted, given the increasing adoption of telehealth service models for the delivery of clinical care.

Teaching Online during the COVID-19 Pandemic: A Phenomenological Study of Physical Therapist Faculty in Brazil, Cyprus, and The United States

The COVID-19 pandemic led to a global transition from in-person to online instruction leaving many higher education faculty with little time or training for this responsibility. Physical therapist education programs were especially impacted since a large part of the development of skills rely on face-to-face onsite practice. This phenomenological study explored the perceptions of physical therapist educators in three countries—Brazil, Cyprus, and the United States, who transitioned to an entirely virtual medium of teaching during the pandemic. Sixteen faculty participated in 1:1 semi-structured interviews. Trustworthiness of qualitative inquiry was ascertained using triangulation, thick descriptions, and peer reviews. Four major themes emerged from analysis of participants’ interview data: adapting pedagogy in real-time, expected excellence, limitations of the medium, and informing future teaching practice. All participants described teaching during the pandemic as one of the most challenging experiences of their professional careers. Despite available resources, faculty noted challenges in making authentic connections with students, adapting to technological interruptions, assessment of student understanding of content, and managing work-life balance. Despite the challenges, faculty worked collaboratively with peers to innovate new approaches of creating social, cognitive, and teaching presence. Unique opportunities arose from the pandemic to enhance future teaching practice.