[The following notes were generated by Andrea Belovich, PhD.]
The fourth seminar in the Fall 2021 IAMSE Web Seminar Series, “Back to the Future: Maximizing Student Learning and Wellbeing in the Virtual Age,” was presented on September 23rd, 2021 by Dr. Kendra Gagnon, Clinical Professor and Chair of the Department of Physical Therapy at Baylor University. In her presentation, entitled, “Hybrid Healthcare Education – Innovating for the Future and Rethinking Student Support,” Dr. Gagnon showcased examples of recommended practices for promoting collaborative hybrid and online learning as applied in Baylor University’s Doctor of Physical Therapy (DPT) . As one of the first fully hybrid DPT programs in the United States, Baylor University had implemented many innovative online and distance learning strategies prior to the changes induced by the SARS-CoV-2 pandemic. From this perspective, Dr. Gagnon challenged the audience to consider which elements of pre-pandemic teaching and learning should be retained by health professions education programs in a post-pandemic world, and which elements could (or should) be changed as we seek to return to “normal.”
Dr. Gagnon first framed the webinar by acknowledging hybrid education as a quickly evolving method of health care education delivery, and emphasized that student engagement and professional identity formation is possible to achieve in an online environment, though it requires intentionality in order to succeed. For the purpose of her talk, Dr. Gagnon offered working definitions of several terms often encountered when discussing hybrid learning, drawn from both the Babson Survey Research Group and the Commission on Accreditation of Physical Therapy. Dr. Gagnon defined the term “hybrid education” as a delivery method that utilizes both online and face-to-face learning strategies as a way to maximize both learning environments. This is distinct from “online education,” where all instruction occurs online, either synchronously or asynchronously. “Blended learning” refers to the method whereby asynchronous online learning is used to enhance student learning between face-to-face sessions without replacing face-to-face time. Finally, Dr. Gagnon defined “flipped learning” as a type of blended learning in which students receive content online, then use face-to-face time for active learning based on the online content.
Next, Dr. Gagnon discussed the community of inquiry framework  the Baylor DPT program uses to deliver hybrid learning. This framework describes the importance of establishing three different types of presence when teaching online. The first is Teaching Presence, which involves structuring learning to help students understand what information they are learning and where they need to go to get that information. This includes activities such as constructing syllabi with objectives and organizing the curriculum into a learning management system (LMS)). Cognitive Presence refers to students’ ability to “create meaning” from the information they are learning, which involves collaboration between learners to build upon previous knowledge and exchange ideas. The third presence is Social Presence, which involves the humanization of learning and is essential for students to feel like they are part of a community of learning.
Dr. Gagnon then gave examples of how the hybrid DPT program at Baylor builds each of these presences in their program. To exemplify how teaching presence is built, she provided an overview of how learning is structured in terms of curriculum organization and delivery. The first year of Baylor’s two-year, accelerated DPT program splits each trimester into two 5-6 week-long minimesters of online learning (which includes both synchronous and asynchronous methods) that are interspaced with 1-2 week-long face-to-face lab sessions on the Waco campus. During the second year, the trimesters allow 31 weeks of face-to-face clinical experience interspersed with in-person labs and online ministers. In this way, the hybrid learning structure is leveraged to help students manage the heavy load of didactic and clinical training that would otherwise require three years to complete.
Dr. Gagnon next shared examples of how the online learning components of the minimesters are structured and delivered. She focused on the standardized use of their LMS (Canvas) to build a stable, familiar learning environment for all online learning. Therefore, the LMS becomes the “classroom,” minimizing students’ cognitive load by removing the need to constantly learn how to navigate different learning environments. Content is delivered both as asynchronous, 10-minute “lecturettes,” and as synchronous live class sessions with software (Zoom) to facilitate breakout rooms, gamification, polling, and embedded quizzes. To further enrich and humanize the online learning environment, video assignments and video discussion boards are used between classes. The use of video assignment platforms (Bongo) allows students to record and demonstrate a learned skill for assessment, while platforms such as Flipgrid allow students to replace text-based discussion boards with personalized video responses.
To help members of the audience think more intentionally about using technology to build teaching presence in online learning, Dr. Gagnon shared the Substitution Augmentation Modification Redefinition (SAMR) framework. Technologies that enhance learning either serve as a direct replacement for in-person learning with no added functionality (substitution), or as a direct replacement with a functional improvement (augmentation). In contrast, technologies that are considered to be transformative also introduce the possibility for significant task redesign (modification), and/or allow the creation of new tasks that were previously impossible (redefinition).
Next, Dr. Gagnon shared an example of how she promoted cognitive presence during the transition of her pediatrics physical therapy lab to an online lab during the COVID-19 pandemic. To support cognitive presence (i.e., students’ construction of knowledge and making of meaning during learning), she used the online platform Padlet, which enabled each lab competency to be visually grouped with its associated materials, activities, and assignments to simulate the “feel” of a lab experience. To further promote collaboration and interaction between students, group video assignments and activities were also implemented to help students create a community of learning. Flipgrid again was used to allow students to upload skills demonstration videos during lockdowns and receive video feedback from faculty on their performance. The group-focused nature of the pediatrics physical therapy lab also supported the development of social presence in online learning by building on online community. To avoid the “divide and conquer” phenomenon that often occurs in group work, students were required to upload “group selfies” or screenshots of the group working together, which supported synchronous collaboration and accountability.
Dr. Gagnon also shared evidence that professional identity formation is possible to achieve through online learning. She shared a student’s reflection video from a Telehealth final exam with a patient family over Zoom. This student’s reflection included commentary about how the activity helped her develop confidence in her skills and in her professional identity as a physical therapist. To further showcase the value of intentionally structuring online learning, Dr. Gagnon shared data showing high levels of student engagement achieved as a result of this approach to asynchronous learning.
During the final segment of the webinar, Dr. Gagnon expanded the idea of creating community online when an entire program is hybrid. As a cohort-based program, community is already an inherent part of the Baylor accelerated DPT program. However, students in this program are located across the country, which makes community building more challenging. To compensate, the DPT program uses orientation videos and group activities (such as creating a map of students’ locations) as well as the formation of academic teams with assigned faculty coaches. Students with diverse abilities are intentionally grouped after taking strengths finder and emotional intelligence assessments and are given resources to promote a culture of reflection. Faculty coaches are also given training and resources to help build a shared understanding of roles and values in the teams. Dr. Gagnon discussed the non-academic and institutional support resources available to help students. These virtual resources and support systems were strengthened during the COVID-19 pandemic, which represented a positive example of change that will, hopefully, persist in a post-pandemic world.
Finally, Dr. Gagnon shared the preliminary outcomes of the Baylor DPT program, which closely matched or exceeded the average outcomes of other accredited DPT programs. This included graduation rate, licensure pass rate, and one-year employment rate. However, the Baylor DPT program has a much higher percentage of minority students, both enrolled and graduated, than the national average. Based on student feedback, Dr. Gagnon suggested that the accessibility of the program helps remove barriers to minority and first-generation students and may promote increased diversity amongst students in the program.
Dr. Gagnon also shared opportunities and challenges of using hybrid education for the healthcare professions. Opportunities include scalability, flexibility, the ability to use time as a resource, the promotion of a diverse student body, and a greater ability to recruit faculty across the country. However, Dr. Gagnon acknowledged that cost is a challenge, either due to the technologies, online program managers, and faculty travel for in-person lab teaching. Student workload and workflow must be appropriately managed, faculty development must be intentionally implemented, and faculty/student issues must be intentionally managed from a distance. Integrating experimental and community-based learning and service can also be a challenge.
To conclude the webinar, Dr. Gagnon provided the audience with a rich variety of resources and references for more information about successful online teaching and learning.
- Gagnon, K., Young, B., Bachman, T., Longbottom, T., Severin, R., Walker, M. (2020) “Doctor of Physical Therapy Education in a Hybrid Learning Environment: Reimagining the Possibilities and Navigating a ‘New N’” Physical Therapy, 100(8): 1268-1277. https://doi.org/10.1093/ptj/pzaa096.
- Garrison, D.R., Anderson, T., and Archer W. (1999). “Critical inquiry in a text‐based environment: computer conferencing in higher education.”Internet and Higher Educ. 2(2-3): 87-105. https://doi.org/10.1016/S1096-7516(00)00016-6