Review (Heather Talberg) – Responding to COVID-19: LUNEX university’s decisions and actions to continue physiotherapy education

Thanks for the opportunity to review this work.

I think this is a relevant piece which will be of interest and relatable back to several contexts.

The 3 key challenges were well defined, although I think broadly speaking, challenge 1 and 2 both relate to pedagogy – and should be grouped under this heading.

I think the piece can be strengthened by the following additions and discussion points.

  1. Delivery of content as a blended learning option – whilst the feasibility of converting traditionally formatted material and practical resources to online/open access content is discussed, the challenge of ensuring learning and relevant learning is not sufficiently addressed. There needs to be a distinction between the teaching (pedagogy) and the learning. Bringing students back for face to face practical revision only addresses one aspect of the curriculum. Other than final module assessment – what other ways were employed – or can be considered moving forward to a blended approach to ensure engagement, carryover of pure theoretical content into clinical scenario’s etc and ensure students felt prepared to re-enter the programme and the clinical platform.
  2. Whilst a lot of attention is focused on the teaching aspect it might be valuable to understand if any changes in the assessment were considered in line with this shift.
  3. The table presented – to show that failure in practical components reduced- is not clear. It would be helpful to label the timing of the modules differently to better understand if they were delivered and assessed pre or post-shutdown.
  4. While the authors allude to the module approach of the programme there is no information on how the modules are designed or aligned. For example, are some modules all theoretical like perhaps focused on the basic sciences or are all modules designed around core areas in physiotherapy – containing then components of both physiotherapy content and basic sciences. I felt there needed to be some distinction or reference to what modules were generically easier to move to an online format and if certain years of the programme coped better with the shift. This coping may have been simply related to better time management and planning – or did senior years understand the level they needed to engage with material online better than students just entering the programme.
  5. Was any formal feedback received from students in this period to substantiate what you saw as successes or challenges? You also note that student use of videos was surprisingly low- I’m not sure if this was of extra resources or specific practical elements. This statement is seemingly in contrast with the opening rationales around video-based learning, which implied that practical marks improved with the observation of recorded material. It makes the reader wonder then was the improvement in practical marks rather because of the smaller one on one teaching that happened on return rather than the utilization on resources/ physio tutor material in the online period.

There are some grammatical issues which need some re-looking and carefully editing of sentences in parts.

One thought on “Review (Heather Talberg) – Responding to COVID-19: LUNEX university’s decisions and actions to continue physiotherapy education

  1. Thanks for the opportunity to review this work. I think this is a relevant piece which will be of interest and relatable back to several contexts.

    • Thank you for your positive comments and insights for the development of the manuscript.

    The 3 key challenges were well defined, although I think broadly speaking, challenge 1 and 2 both relate to pedagogy – and should be grouped under this heading.

    • Thank you for the suggestion and while we agree that these are both pedagogy related, we believe that the two aspects should be treated independently. Particularly we identified distinct challenges to each scenario and think that to add value to the application of these, we have kept the challenges separate.

    Delivery of content as a blended learning option – whilst the feasibility of converting traditionally formatted material and practical resources to online/open access content is discussed, the challenge of ensuring learning and relevant learning is not sufficiently addressed. There needs to be a distinction between the teaching (pedagogy) and the learning. Bringing students back for face to face practical revision only addresses one aspect of the curriculum. Other than final module assessment – what other ways were employed – or can be considered moving forward to a blended approach to ensure engagement, carryover of pure theoretical content into clinical scenario’s etc and ensure students felt prepared to re-enter the programme and the clinical platform.

    • Thank you for these comments. We have added the following information to this section for clarity:
    ‘The module assessments were continued as per their accreditation, but in some cases were delayed. During the initial shutdown period, no students were allowed on site, and any examinations during this time were delayed until students were back on campus. Modules that are prerequisites for clinical placements were prioritised and these assessments were completed as close as possible to their previously scheduled dates. No additional/unscheduled assessments were included to monitor the students’ progress during this time. On return to campus, lecturers used additional revision sessions to ensure a successful achievement of module learning outcomes’ (p.8, line 22- p.9, line 4)

    Whilst a lot of attention is focused on the teaching aspect it might be valuable to understand if any changes in the assessment were considered in line with this shift.

    • The nature of the assessment procedures at LUNEX and the intensive, block teaching approach (in combination with imposed regulations to assessment by the Ministry) meant that limited alterations could be made to the assessments. We have made reference to this in the revised manuscript as per the comment above. (p.8, line 22- p.9, line 4)
    The table presented – to show that failure in practical components reduced- is not clear. It would be helpful to label the timing of the modules differently to better understand if they were delivered and assessed pre or post-shutdown.

    • The table is indicating the change from the winter semester 2019 to the summer semester 2020 and indicates only the change between the two semesters. All modules presented were delivered in both semesters, so it provides a direct comparison from pre-lockdown to post-lockdown. The table heading has been updated for clarity: ‘Change in failure rate (Δ) of theoretical and mixed modules between the winter semester 2019 (pre-lockdown) and summer semester 2020 (post-lockdown) for comparison.’ (p.8, lines 16-17)

    While the authors allude to the module approach of the programme there is no information on how the modules are designed or aligned. For example, are some modules all theoretical like perhaps focused on the basic sciences or are all modules designed around core areas in physiotherapy – containing then components of both physiotherapy content and basic sciences.

    I felt there needed to be some distinction or reference to what modules were generically easier to move to an online format and if certain years of the programme coped better with the shift. This coping may have been simply related to better time management and planning – or did senior years understand the level they needed to engage with material online better than students just entering the programme.

    • This is an interesting comment. We have added some more content regarding the differing focus of modules (theoretical or practical) as follows:
    ‘The modules may be entirely theoretical modules (for example research methods and the basic sciences courses, or a combination of both theoretical and practical content in the applied physiotherapy modules.’ (p.4, lines 1-2)
    We have also added examples of the modules that were primarily theoretical: ‘…(for example Scientific Foundations, Physiology, Anatomy II)…’ (p. 9, lines 19-20).

    We do not have specific feedback from the student groups as to how they approached the move to online/blended study, so we have now made a suggestion to investigate this in the future:
    ‘Further research investigating the students’ preferences in the methods of delivery should be considered before implementing these changes in the future.’ (p.10, lines 23-24).

    Was any formal feedback received from students in this period to substantiate what you saw as successes or challenges? You also note that student use of videos was surprisingly low- I’m not sure if this was of extra resources or specific practical elements. This statement is seemingly in contrast with the opening rationales around video-based learning, which implied that practical marks improved with the observation of recorded material. It makes the reader wonder then was the improvement in practical marks rather because of the smaller one on one teaching that happened on return rather than the utilization on resources/ physio tutor material in the online period.

    • We did not obtain specific feedback from students, but rather some of our reflections are based on informal discussions with students following their return to campus. The point regarding the students use of video is made to highlight some of the limitations of online learning (these have been described in detail within the research i.e., Appanna, 2008; Wong, 2013). The majority of the video resources provided for the students were recordings with voice-overs of the lecture slides, rather than practical components.

    The practical classes are routinely delivered in small groups, regardless of restrictions relating to COVID-19. We have added a sentence to address this as follows: ‘Small group teaching is the regular method for the practical content in the modules (even pre-COVID-19) and, as such, we do not expect the group sizes to have resulted in the improvement identified.’
    (p.8, lines 12-14)

    There are some grammatical issues which need some re-looking and carefully editing of sentences in parts.
    • We have conducted a thorough reading of the revised manuscript and correct the grammatical issues identified.

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