Digital learning designs can support teaching and learning in physical therapy education, but the effects on learning and outcomes are not fully understood. A new systematic review has contributed to our understanding.
Digital and online learning is changing both the way we learn and the way we are taught. Digital learning can improve quality, improve sustainability and enable inclusive education for all, and different types and approaches are used. Over the past ten years, physiotherapy training has gradually integrated a digital learning approach at all levels of professional development. However, which approach is best specifically for physical therapy?
Learn more about digital learning and physiotherapy
Physiotherapy curricula are characterized by a combination of theory, competence training and learning in practice. So far, digital learning has not been fully accepted by our profession and has been criticized for not being justified from a theoretical learning perspective. This is interesting because there has long been evidence of how effective the use of digital learning is for health education. Before the Covid-19 pandemic, there was little research into digital learning in the physical therapy profession, but interest has grown significantly since then, for obvious reasons. A new systematic review aims to restore this balance by identifying and examining the effectiveness of digital learning designs in physical therapy education.
A Breakdown: Commonly Used Digital Learning Designs
Digital learning designs use many different technologies and there are different methods. The language used is difficult and confusing to understand. Below is a breakdown of the most commonly used digital learning strategies.
Blended learning
Blended learning is the well thought-out integration of personal learning experiences in the classroom with online learning experiences. Many students and teachers are already doing this. It is basically using the integration of face-to-face / simultaneous (synchronous) and flexible-time learning activities (asynchronous) together. Simply put the combination of learning the same things at the same time as others and learning the same things as others in your own time.
Examples of blended learning models
Upside Down Classroom Model: In an upside down classroom, the traditional personal lecture is given in front of the classroom and classroom learning is active, collaborative and focused. After class, they pursue and consolidate their knowledge
Blended Learning On & Off Campus: An example of blended learning design is that, for example, students will have access to digital learning resources before class in class and / or after class in the classroom traditionally offered. Another example is that the learning activities in the classroom are given and answered by digital learning technology and software.
Hybrid learning: One group of students follows the course on campus and at the same time another group follows the course remotely through digital technology. Hybrid learning can combine synchronous learning with asynchronous learning elements.
Distance learning
Distance learning is planned learning that takes place in a different location than the classroom and requires special course design and communication methods through electronic and other technologies, as well as formalized organizational and administrative arrangements.
Examples of distance learning models
E-Learning Courses: A structured course offered electronically with different elements: live or recorded lecture content, videos, quizzes, simulations, games, activities and other interactive elements. E-learning can also be made possible as a virtual classroom – a type of online learning in which there is simultaneous live interaction between teachers and participants.
Mobile learning: Variant of e-learning, in which the lessons take place via mobile devices.
Distance learning / home learning: A course to be offered online, not intended for face-to-face meetings with students who are not supposed to work on assignments in the same room and are not attending lectures or Virtual classes with video or audio communication to participate.
Massive Open Online Courses (MOOC): A Massive Open Online course is an online course that is aimed at unlimited participation and open access over the Internet. MOOC integrates the connectivity of social networks, the enablement of a recognized expert in a field of study, and a collection of freely accessible online resources. The learners are usually adults and organize their participation themselves according to learning goals, previous knowledge and skills as well as common interests
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Methods
This systematic review was carried out in accordance with the PRISMA guidelines and pre-registered with PROSPERO. The studies included in the review were RCTs and cohort studies that met the following criteria; A study population of physical therapy students in a physical therapy education program assessed the learning outcomes of a digital learning design and compared the results to traditional classroom teaching. and reported on students' final grades and self-reported learning outcomes.
Eight databases were used to search for research to be included in the review. The full search strategy can be checked. The search period was from 2010 as digital learning in physical therapy became at a time that was becoming more and more central to education.
The risk of bias was assessed with the Cochranes Risk of Bias Tool. The outcome measures used were student satisfaction, student perception of learning, learning outcomes, and the use of a statistical narrative description when the data could not be analyzed. A total of 22 studies were used in the review analysis, which included 2,186 students from a range of undergraduate and postgraduate programs.
A complete breakdown of all included studies is available.
These results clearly cannot be generalized beyond physical therapy training and various modules, and the availability of the internet and access to technology limit this as well. Due to the nature of the research and the lack of a consistently used definition of digital learning methods, comparing study designs is challenging. In addition, several unvalidated outcome measures are used to report student satisfaction and outcome.
Clinical significance and takeaway messages
The main reason for this systematic review is that blended learning showed at least the same, if not statistically better learning outcomes than conventional methods . Of the various blended learning approaches, the upside down classroom was the most widely used and also had the greatest positive effect on learning outcomes.
Brief summary of the results of this systematic review
Blended learning is likely to be more effective than traditional teaching in physiotherapy training, both in acquiring knowledge and in acquiring practical skills
The students preferred turning the classroom, interactive websites / apps and self-produced videos instead of traditional classroom experiences, which was also reflected in better learning effects
More consistent experimental design studies that include statistical methods are required to report the results
Teacher experience is often not considered in this research
MCQs provide a useful and effective learning tool
The results of this systematic review are similar to the results of other medical professionals, but contradict others. The upside down classroom is the most frequently used approach for blended learning but there is no uniform definition which makes it difficult to summarize the results in a systematic overview.
Interactive website and app-based blended learning showed improved learning outcomes compared to traditional methods as the students acquired new skills and knowledge. This is partly due to the interactive design of mobile / internet learning activities which make it easy to align with learning outcomes and the type of assessment method used. They also enable authentic learning, localized learning, and contextual learning because of its affordability, accessibility, and portability . However, in order to maximize benefits, different learning materials and technologies need to be integrated to complement each other.
The creation of own content for pupils leads to an improved pupil satisfaction as well as a higher perception of learning . This is likely because it facilitates and supports student self-directed learning, independence, intrinsic motivation, and responsibility. The output, as with the creation of content, also clearly shows and communicates a learning result. An example of this are the content development projects used by Physiopedia.
In summary, this systematic review shows significant effects on student learning in favor of the interventions with mirrored classrooms, interactive websites / apps and student videos . The caveat, however, is that larger controlled studies are required to fully understand the nuances that lead to improved learning outcomes.
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