Review (Jill Morgan) – An overnight shift towards remote teaching and learning of musculoskeletal physiotherapy in Karelia University of Applied Sciences in Finland

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. 

One thought on “Review (Jill Morgan) – An overnight shift towards remote teaching and learning of musculoskeletal physiotherapy in Karelia University of Applied Sciences in Finland

  1. Thank you for very valuable advice and collegial discussion of issues brought up in this paper.

    We have made changes as we feel is appropriate and possible based on this work. We clarified the context of the paper and wrote a more detailed description of the remote teaching period. We specified the logistics of how the videos were created and how the risks and contraindications were considered during the remote teaching period. You had very interesting question about the written feedback. We think that it might be possible that formative feedback is more powerful when students can view themselves on screen after the initial performance, and this is something that could be explored further. We checked the grammar and concentrated to the clarity of the text.

    The purpose of this paper was to describe the change, and we are unable at this point to elaborate some of the issues brought up for the following reasons: the invitation to submit the paper, in our understanding, focused on a description of what has changed, hence we took the opportunity in a very short time and at the very busy time to write the paper as a discussion starter. Secondly, we have not interviewed or explored in depth students’ or teaching faculty’s feelings, experiences or opinions on the remote flipped learning approach, and therefore would not want to speculate on those. We are however encouraged by the students’ spontaneous responses, and also your interest and valuable comments, and are hoping to continue the development of this teaching mode and research into its impact on learning as well as teaching.

    We are very grateful for your time and advice and look forward to further discussion and further work on this important and continuing change and challenge of educational provision for all of us.
    Regards
    The authors.

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