An overnight shift towards remote teaching and learning of musculoskeletal physiotherapy in Karelia University of Applied Sciences in Finland

Article accepted

This article has been accepted for publication. Peer reviews and author responses are available at the end of the article.


Background: Musculoskeletal physiotherapy (MSK) is learned and practiced in a classroom with the guidance of a physiotherapy teacher. In Karelia University of Applied Sciences, a flipped classroom approach has been implemented and developed actively since 2017 in MSK courses in physiotherapy education. However, the COVID-19 pandemic changed everyday life very fast all over the world. Karelia, like all other schools, moved all activities into remote mode very quickly and "normal" teaching methods had to change. Aim: This article describes how the change from contact to remote teaching was implemented in MSK courses in the physiotherapy programme at Karelia in Finland, using a flipped classroom approach. The article also highlights students’ experiences of remote teaching in these courses, although theoretical analysis and discussion on the impact on students' learning is not considered in this Research Note. We are planning to continue exploring the impact and practice of this remote teaching approach, which is becoming the new normal. Conclusion: Well-planned pedagogical manuscript implemented with a flipped classroom approach seems to work well in teaching physiotherapy theory and skills remotely. Carefully planned learning tasks and individual feedback are particularly important for learning during remote teaching. Video and text material in theoretical and practical MSK topics seemed to support students’ learning during the remote teaching and video feedback especially, could be used more in the future.


Thank you for a very interesting article describing your experiences in moving physiotherapy teaching online in response to the pandemic. I very much appreciate the opportunity to read your paper, as an academic facing the same challenges. There is a wealth of learning to be gained from the paper in terms of how you have described the approaches taken to meet the challenges of practical MSK teaching and in particular reading the student perspectives. You have opened up the idea of how we teach and assess practical skills in a way that is relevant beyond the current crisis.

My comments and queries below are aimed at making the paper more practically useful and directly applicable to the reader. The questions below are the ones I had while reading the paper, and so it would be great if some of them could be addressed to make the piece more informative.

I suggest including an abstract would help orientate the reader to the paper.

I feel what I’m missing in the paper is a sense of the context.

Consider adding detail on:

University (size and scale), numbers of students, level of degree, year/stage of students (had they undertaken placement yet? Have they had previous MSK teaching?), staff-student ratios. Did any students have additional learning needs and if so how were these accommodated?

Is this a single MSK module being described? How many ECTS? What were the usual assessments (formative and summative) and how were these changed?

I think the learning activities could be more tangible and accessible for the reader if you could provide more concrete examples (just like the case-based approach you describe using with your students). For example, I’d like to see a worked example of how you used flipped classroom methods in traditional teaching versus online, using a table or diagram, and the information from the “pedagogical manuscript”.

“Flipped classroom and learning approach enabled students to deepen their learning together by discussions and teamwork during online lectures”. How was the teamwork managed during online lessons? Were online ‘breakout rooms’ used? Did students work in the same groups throughout? Did they engage in the same groups outside of contact lessons?

“Students were engaged in providing teaching materials and learning from each other. For assessing practical skills and getting feedback students provided video-recordings demonstrating their manual therapy and mobilization techniques. Especially videos as learning materials supported remote learning process and most students were able to practice skills with classmates in their own environment.” MSK skills: Did the students source and post videos on a discussion forum? In what way did the shared learning occur? How did they practice with classmates?

“Video-recording and reviewing their own work helped students self-evaluate their practical skills and note the successful and correctable details, which are normally more difficult during the lessons. The teacher also reviewed the videos and gave written feedback to each student.” Describe more about how the students produced and submitted their own videos- was there clear guidance for what had to be submitted and how often? How was the self-evaluation conducted – was there a reflective submission involved? How often was feedback provided? How burdensome was this for teachers?

How were the practical skills assessed? Were the videos used to provide a summative assessment for clinical competence?
I think it would also be useful to present your views and perspectives on whether the summative assessment used are ‘fit for purpose” and likely to be acceptable for assessing competencies for professional accreditation purposes.

Regarding the case-based learning was there any patient involvement in presenting this material, or any use of the ‘patient voice’?

Thank you again for the sharing of your experiences – the paper has the potential to springboard some really valuable conversations about the “new normal” we find ourselves in for MSK physiotherapy.

Thank you for the opportunity to review this paper which outlines the processes, implementation, and initial outcomes of rapidly moving aspects of a Physiotherapy curriculum into the virtual, online domain. 

The title alludes to the time pressures involved in these changes and highlights a topic which is certainly pertinent to most physiotherapy education programmes during a global healthcare pandemic. 

This commentary article provides a clear background to the obvious challenges of timescale and demand, which is framed to align with flipped classroom pedagogy.  It can certainly add to the growing body of work being collated by educators addressing the challenges of remote learning, however, there are a few areas which could be improved. 

Throughout the piece there are quotes from students; were these quotes taken from a range of students or just one or two? Including pseudonyms to highlight these quotes would improve transparency here.     

Perhaps some detail about the size of the cohort this method was applied to would provide more context – it appears easy to innovate, but how easy to upscale this innovation to larger cohorts? 

“Remote learning was useful because the questions to be considered were answered.” – this is a powerful quote.  What is it about remote learning that facilitated this thought?  Are students unable to engage in questioning as much in the classroom?  The anonymity of the online platform has the potential to reduce the fear of negative peer perception when posing questions and/or prevent dominant personalities shaping the conversations.  Perhaps in online sessions, students feel safer or have more opportunity to engage. 

The use of video and visual aids to supplement practical skill teaching is clear.  The novel aspects of this paper involve the use of student-created videos for self-assessment, learning and teacher-led formative feedback.  It would be helpful to consider the logistics of how these videos were created and the risks associated with unsupervised practice whilst doing so – for instance, who were they practising these skills on, were appropriate contraindications considered, are students able to modify the techniques rather than copy a video they have just watched?  Using case-based learning is a sensible way to further examine the students’ understanding, however.   

It is interesting to note that students found feedback on their online work ‘extensive and rewarding’.  Written feedback in this group seems to have been perceived as more individual, and relevant.  This raises some questions about student perceptions of feedback in ‘live’ practical skills teaching.  Most faculty staff would be used to ordinarily giving feedback during practical classes, but perhaps the cognitive load of performing the technique/skill itself as a novice diverts the student attention and the value of this feedback ‘in action’ is reduced.  Is formative feedback more accessible and powerful when students can view themselves on screen after the initial performance? 

The paper concludes with the positive outcome that certain skills can be showcased and learned by students in a remote fashion.  There is an important statement in this conclusion about teachers learning to trust students to be responsible for their own directed learning.  It seems clear that this cohort of students was sufficiently resilient to do this.  It offers an opportunity for physiotherapy education to reassess what is currently thought of as ’essential’ content and skills for developing independent clinicians of the future. 

The section pertaining to ‘Thoughts for what next…’ could be more imaginative in terms of how this process has influenced practice and could further do so in future.  For example, if student videos provide sufficient formative feedback with regards to competence in performance, is there an argument to reduce the need for summative assessment of practical skills within our curricula?  Students hone these skills to be ‘ready’ for clinical placement; assessing placement could be viewed as duplicating skills assessment.  Would it be pertinent therefore to reduce/remove practical skill assessment in the classroom? 

It would be useful to consider the previous experience of this group of students too.  Have they experienced practical teaching elsewhere on the programme?  Are they already comfortable with basic handling skills? Will a new cohort of students who have no practical experience respond as well to the remote style of learning in a similar way? 

The student voice is relatively clear through this paper, but it would also be useful to share the experience of staff/faculty.  It is clear that students have adapted well, but they may have done so because it was not a change for them. Changing behaviours of staff who have done things one way for several years can be more challenging.  What were the challenges encountered during this shift of activity?  How were barriers overcome?  Do staff feel that this is a sustainable development over the longer term? Is it feasible to expect that all students can participate in remote learning of this fashion, or could there be challenges with regards to inclusivity? 

Finally, there are a couple of sentences which could be re-worded to improve the grammar and thus the clarity.  The first sentence in paragraph 8 is an example. 

Papers of this nature are an important resource for educators during the current climate.  Sharing ideas of how to support education in ways that feel very alien to the ethos of a hands-on profession will be vital as we move forward during a time of rapid re-design.  There are many lessons to be learned and I appreciated the opportunity to review this paper.  I would be very happy to continue the discourse around the points I have raised above. 

Conflict of interest statement

The authors report no declarations of interest.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.