EME 6059: Blended Learning Environments

ADDITIONAL NARRATIVE:

Most, if not all, literature on blended learning in Physical Therapy (PT) education discusses it in the context of acquiring psychomotor skills. The blending usually involves online delivery of content, providing theories and demonstrating techniques, while F2F meetings are reserved for demonstration of proficiency and testing of those techniques / psychomotor skills. This project is unique in that it focuses on teaching a process, and having students engage in the process and practice it repeatedly in preparation for the clinical education phase of the curriculum.

Clinical Decision-Making (CDM) requires 2 types of knowledge – content knowledge and structural knowledge. Content knowledge includes knowing the diagnosis, the etiology of a disease and the treatment for a specific disease or condition. Structural knowledge, on the other hand, is a form of a mental model that is created from knowing how the different domains of content knowledge interact with each other in a clinical problem. This course allows for a systematic acquisition of structural knowledge by novice students.

Experts (instructors) and novices (students) use different methods for CDM, with the former group exposed to more content and structural knowledge. Deductive reasoning is a top-down process where individuals predict consequences based on their ability to logically reason, arriving at a treatment plan. Inductive reasoning, on the other hand, is a process used in decision making which is described as a bottom-up process where individuals form hypotheses and theories based on the individual’s ability to recognize meaningful patterns and connections and uses these to arrive at a treatment plan. Novice practitioners use deductive reasoning, and expert practitioners use inductive reasoning. (Shin, 2019). This course, in a way, allows for students to undergo deductive reasoning individually, but then progresses on to experience inductive reasoning in the small group F2F session.

Inductive reasoning is the basis for the Hypothesis-Oriented Algorithm for Clinicians.

Background on Reform-Based Science Education:

The design of the course is consistent with the principles of reform-based science education which advocates for constructivist, inquiry-based methods. This course design combines and maximizes the benefits of both the traditional teacher-centered lecture-driven class (during individual, asynchronous engagement with content) and that of student-centered activity-based learning environment that includes opportunities for collaboration among students (during the small group F2F session). Repeated over time, the latter shifts from being a novel activity to a habit on clinical decision making for effective clinical practice. The design of this course does not ascribe to superiority of reform-based versus traditional science instruction, or vice-versa, but rather, it maximizes the use of both to develop effective and reflective practitioners.

Background Information on Doctor of Physical Therapy Programs:

Doctor of Physical Therapy (DPT) programs are lock-step and cohort-based which commonly take over 2 years to complete (with 3 years as the most common program length). Physical Therapy science courses (i.e. orthopedic PT, neurologic PT, cardiovascular-pulmonary PT, geriatric PT, etc.) are heavily sequenced in the second year, with learning objectives increasing in complexity over time. This proposed course can be a stand-alone course sequenced immediately before the clinical education portion of the curriculum. Or, the structure of the course can be included in a few units of a specific physical therapy science course. Finally, this course can be part of a course series on clinical decision-making in physical therapy which can be used for all physical therapy science courses in the second year, when basic courses in PT examination and intervention has been covered during the first year..

COURSE: Clinical Decision-Making in Geriatric Physical Therapy

COURSE GOALS:

After completion of this course, the student will be able to:

1. Use inductive reasoning (Hypothesis-Oriented Algorithm for Clinicians) when engaged in clinical decision-making to develop a physical therapy plan of care

2. Integrate individuals’ social and environmental contextual factors (including but not limited to- psychosocial, cognitive, cultural, values and beliefs) into appropriate intervention selection and plan of care development and modification

3. Seek available evidence from peer-reviewed sources to guide physical therapist practice

4. Select, perform, and interpret objective test and measures across ICF domains based on a client's clinical presentation to guide patient management

5. Identify and carry-out evidence-based physical therapy interventions consistent with the plan of care

COURSE STRUCTURE:

Summary of Weekly Learning Activities:

The image below describes and sequentially enumerates the weekly learning activities. In the image below, GREEN BOXES indicate learning activities completed individually and asynchronously online, while PINK BOXES indicate F2F activities.

The course is a 4 credit course, with 2 hours spent by the student engaging with online content individually (asynchronously) and 2 hours spent face-to-face in the classroom. Content for asynchronous delivery can be instructor-developed or instructor-curated. These videos will be processed using technology such as Ed Puzzle so that it can be embedded with formative / guiding questions.

During the first hour of the first F2F session, the course instructor explains the structure of the course and the course expectations, and a lecture on Inductive Reasoning / Hypothesis-Oriented Algorithm for Clinicians. Students will, then, be asked to form groups of 4. In the second hour of the first F2F session, by the end of the class, the group will be asked to submit a completed Initial Examination form using a documentation template based on the case provided.

During the next face-to-face session, in the first hour, selected groups will present their Initial Examination forms to the class with opportunities for question-and-answer after each presentation. Before going to the next part of the F2F class session, the instructor will provide a wrap-up / summary of the important points discussed. In the second hour of the F2F session, groups are provided the next case, then sit together to produce a completed Initial Examination form for case #2 (i.e. Lesson 2).

This 2-hour F2F session consisting of (1) oral reports / case presentations of discussions from last week and (2) small group F2F clinical decision making (CDM) session of new cases for discussion next week repeats every week.

Summary of Assessments

(NOTE: A review of the course revealed that there are an excessive number of formative assessments (i.e. rubrics). To streamline formative assessment, #2 and #4 can be eliminated, #5 and #6 can be combined, and #3 should remain. Refer to the "Final Project Narrative" above for a more exhaustive discussion of these changes.)

FORMATIVE ASSESSMENTS:

1. student responses to formative questions embedded in the online videos

2. rubric to assess infographic / annotated bibliography / recorded audio or video created by the student referring to their assigned journal article from a peer-reviewed source

3. rubric to assess individual reflection after the small group F2F CDM session

4. rubric to assess individual critiques of completed Initial Examination forms by other groups

5. rubric to assess individually prepared exercise prescription (i.e. 3 exercises based on the Initial Examination completed during the small group F2F CDM session)

6. rubric to assess completed Initial Examination forms / oral reports

SUMMATIVE ASSESSMENTS - also used as a basis for progression to the Clinical Education portion of the program

1. Objective Standardized Clinical Examination (OSCE), OR

2. Comprehensive Written Examination

Materials

Click on the button "Understanding by Design (UbD) Template" which highlights alignment of learning activities, goals and assessments. Page 2 specifically identifies formative assessments and summative assessments. This subpage also includes "Elements of Effective Instruction." This document highlights the effectiveness of combining online and F2F learning activities.

Click on the button below for a sample of online materials specific to Lesson 1. This repository also includes an "Understanding by Design (UbD)" rubric, which can be used to design specific rubrics for specific learning activities.