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Friday, 28 February 2020 06:18

Online education in physiotherapy: need to get with the times!!

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There is always a bit of initial resistance. Always. Any idea or change is always resisted at first. People like routine in their lives and we all know the property of inertia in matter. That equally applies to individuals as well. There are some great examples of scepticism, resistance and inertia against products we now take for granted in our life.

“The horse is here to stay but the automobile is only a novelty – a fad.” — President of the Michigan Savings Bank advising Henry Ford’s lawyer, Horace Rackham, not to invest in the Ford Motor Company, 1903

“The Americans have need of the telephone, but we do not. We have plenty of messenger boys.” — Sir William Preece, Chief Engineer, British Post Office, 1876

“There’s no chance that the iPhone is going to get any significant market share.” — Steve Ballmer, Microsoft CEO, 2007

Cars, telephones and iPhones, things that are routine, things that even a 3 year old feels are a necessary element of their life. But in the early stage of their development and lifecycle, these products also were considered unworkable.

So why am I talking about all this in Physiotimes?

Recently, I came across a discussion forum where I found there was substantial resistance to the idea of online education in physiotherapy. There were a variety of views put forth of which some were relevant concerns e.g. physiotherapy is a hands on profession and practical skills cannot be taught in an online medium while others were simply voices of inertia and resistance to change.

In recent years, Harvard, Yale, Stanford, MIT, Princeton, Penn, Edinburgh and dozens of other elite universities have jumped into the market for online education, signing up anyone, anywhere who wants to sign up for free Web-based courses. Primarily these courses are focussed on business, management, sales and marketing, software and web based technologies, mobile app development etc. However, in 2012, in a survey of 4,564 faculty members across all types of colleges and universities, 66 percent expressed concern about the quality of online education, saying they believe what students learn is "inferior or somewhat inferior" to what they learn in a classroom. A pervasive argument that has been utilised by educators is that online education is a monologue, as opposed to a dialogue that can’t replicate “learning as a collective enterprise…a collaboration [where] students and teachers come together and create an immediate and vital community of learning.” Within this article, I will categorise these educators as traditionalists.

But then there are innovators, rebels, thinkers and revolutionaries who break away from the norms and follow their mind. To quote Shaheed Bhagat Singh – “Any man who stands for progress has to criticize, disbelieve and challenge every item of old faith”. So yes, maybe today healthcare education provided online is not as good as offline face to face interaction because of the practical, human element. Does this justify the argument that we rebuke anyone trying to promote online education in health care professions? Does it prove the argument that online education pedagogy cannot grow and refine to provide a learning experience which is even more enhanced than face to face teacher contact?

So what makes for a great classroom experience? A great teacher who has an engaging personality is the key to a positive learning experience for the students. No matter what the subject, how big the class size or the level of education, a teacher who can provide a compelling narrative with clear objectives for each session can promote positive behaviours and change in the classroom. Additionally being a subject matter expert, facilitating two way conversations, promoting independent thinking and being passionate about knowledge transfer can go a long way in influencing student’s lives. They are excited about influencing students’ lives and understand the impact they have.

But do we all get such positive classroom experience? How many conference presentations have we attended were there are 1000’s of attendees and yet most of them are tuned off, not listening or even dozing off. How many classes have we all been a part of where we have been bored to death by powerpoint, not really understanding a word of what the teacher is on about and yet the teacher has droned on? In my undergraduate days, I remember not really being interested in attending classes and yet having to sit through boring seminars that made no sense to me and I did not feel had any practical relevance to my learning and development. Yet, students are not able to question, not able to put their point forwards and not able to influence their own learning and so they just mentally space out. Even though they are physically in the classroom, in their minds, they are probably on a beach somewhere having fun with friends.

Great teachers are able to appreciate and evaluate their own performance as a teacher to identify how the students are engaging with their content and be able to adjust their content, presentation and style to the needs of the students. A great teacher can identify whether a particular topic or point is being understood by students or not and they can stop and reiterate that point or respond to questions in real time. And this the traditionalists argue is the crux of why online education can never be the same as a physical classroom experience.

But that is exactly the point I feel that online education has the potential to measure and respond to students’ behaviour much more easily and quickly when education is digital than when it is face to face. Even in this early stage of online education, various platform exists which can provide teachers with the data as to how students are engaging with their content. Analytical tools are available which will allow teachers to understand which aspect of their program do students consider important and yet have to focus harder on (having to pause, rewind and replay), which content they ignore (a video package which most students will fast forward through or skip after watching a few initial minutes) or how long it is taking for students to complete an exercise. The possibilities of this are endless. In addition, with the development of machine-human interfaces, it may be possible to measure physiological responses to the content (e.g. heart rate or eye movements). There are already software available which can monitor how long the user had kept the eyes on the screen as opposed to gazing around in the room. While such technology is not yet being utilised in education portals, it’s only a matter of time before this can be incorporated into the portals. There are already several education portals which provide teachers with such useful analytical tools to enhance their user engagement, but in my opinion, there is immense potential in development of such technology which can only enhance both the teacher’s and student’s experience in online education.

Another challenge for a teacher in a traditional classroom setting is to identify and maintain appropriate pace and tempo of content delivery which takes into account the fast paced learners as well as those who find the concepts complicated and need greater basic explanation prior to developing an understanding of the concepts being taught. But a classroom setting is not the most appropriate for it as it forces a one size fits all teaching style, where a teacher is allowed only so much flexibility to cater to the different learning styles and pace of the students. Even the best teacher in the world must deal with this trade off, which boils down to the following question: Should I slow down to help more students understand, or speed up to cover more material? Therefore if there are a large number of students in a class, the outcome will always be suboptimal for the students and subsequently the teachers. Online education provides a perfect solution to deal with this challenge. It allows teachers to design courses which can be tailored to suit the pace of the learners. Beginners may be provided with some basic concepts which the advanced learners may already be aware of and thus skip them to move on to more advanced topics straight away for e.g. in an exercise prescription class, the beginners may need to review concepts related to the physiological response of various body systems (musculoskeletal, cardio-pulmonary, neurological) to exercise and physical activity while more advanced learners may already be aware of these concepts and may want to skip these to move on directly to formulate strategies for appropriate evidence based exercise prescription in relation to specific conditions.

When it comes to learning styles, people fit into three main categories (or a combination of any of the three). These learning styles include auditory, visual and kinaesthetic. Auditory Learners are equipped to learn best through their sense of hearing. Potential characteristics of an auditory learner include enjoyment in reading aloud, ability to explain topics well to others, ability to follow spoken directions well and enjoyment in giving oral reports or being on stage. Visual Learners have the ability to work best by utilizing their keyed-in sense of sight. Visual learners tend to need quiet study time, be good at spelling, enjoy things like color and fashion, understand charts and diagrams well and rely upon visual aids during lecture. Kinaesthetic learners are those who learn best through experience or performing tasks. These types of learners tend to be like engaging in role play activities that aid in learning.

Physiotherapy education with its practical components would need more kinaesthetic approach to demonstrate the manual and physical concepts. Practical application is very important to the kinaesthetic learner. To engage kinaesthetic learners in the online environment it’s important to get the balance of theory to practice right. Teachers should consider breaking theoretical lectures up into chunks interspersed with practical exercises that model the theory being applied to real world situations wherever possible. Interactive technology such as gaming interfaces, drag and drop technology, interactive flash animations, simulations with 3D graphics, or virtual reality environments are likely solutions to provide answers to mimic the kinaesthetic need for the practical components of physiotherapy.

Finally, an important element of classroom education is “collaborative, collective community of learning” which the traditionalists say is missing in provision of online education. It is true that at the moment, much online learning today is a “monologue, not a dialogue,” little more than YouTube-like videos of lectures “assessed” by simplistic post-lecture quizzes that measure engagement and comprehension at the end of the course. Online learning is moving beyond this primitive, one-to-many broadcast model to become a social, collaborative, personalized and interactive experience that generates two powerful, mutually reinforcing success accelerants: first, the long-term desire to learn, to better one’s position in the world; and, secondly – crucially – the moment-by-moment pleasure of participating in a learning experience that’s continually exciting, rewarding and creates a valuable sense of social connection. Having participated in some MOOC’s in which over 12000 students from over 100 countries have participated and collaborated, the social constructivist approach that I have experienced there cannot be matched by any face to face classroom experience.

So far I have focussed on the factors which the traditionalist teachers and students have discussed as barriers to online education in physiotherapy and provided counter arguments to highlight that not only overcome these barriers but also provide an enhanced teacher and student experience which cannot be matched by any in-person classroom session. In addition to these, there are some very practical reasons as to why online education has been widely accepted in other fields such as management, sales and marketing, business, web technologies etc.

Online platforms provide massive outreach to teachers to provide their content to students in all corners of the world. An average face to face class has about 50 students and if that course is run twice a year, a teacher can teach about 100 students per year. Over the course of their 40 year career, that teacher will be able to teach 4000 students in the face to face medium. One of the courses that I am a part of has over 53,000 students enrolled in it. Consider yourself being a teacher of such a course. Imagine the satisfaction you would gain from it and to think that course was created and published online about 4 months ago. In order to match this reach, the teacher in above face to face example would have to teach that course twice every month (24 times a year) for at least 40 years to reach 48,000 students. Consider yourself being a teacher of such a course and consider isn’t online teaching better?

For students, online education provides a medium to satisfy their learning needs to meet their personal development plan without the additional costs of travel and accommodation. It allows them to learn at their own pace, in their own time without any considerable impact on their professional and personal lives.

In summary, while I acknowledge that online education will never be exactly the same as sitting in the classroom with classmates. But the experience will be close enough to promote real learning, and to personalize instruction to each student more precisely than any classroom training could based on real world simulation and high tech data analytics. In addition, providing education via engaging, compelling interactive technology will help the best teachers fulfil their destinies on geographic and numerical scales few ever imagined.

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