Teaching Clinical Skills Online: Lessons from USC’s Division of Biokinesiology and Physical Therapy

Hundreds of postsecondary institutions across the country have been forced to close their campuses  and move classes online due to the spread of Coronavirus disease (COVID-19). All institutions are addressing difficult issues and obstacles, but health care education programs may be facing one of the most daunting challenges as they grapple with how to effectively teach hands-on clinical skills in an online format.

Teaching clinical skills in an online format is not entirely new, but how it is accomplished during this unprecedented and turbulent time in history may be a challenge for institutions with little to no experience in online education. The USC Division of Biokinesiology and Physical Therapy, however, was prepared to address this challenge and effectively teach online.

Dr. Julie Tilson, PT, DPT, MS, NCS, professor of clinical physical therapy, attributes much of the Division’s preparedness to the design of its hybrid program, which allows students to continue actively engaging in online courses even in unusual circumstances, like this period of self-isolation. Dr. Tilson serves as director of DPT@USC, the hybrid online/on-campus pathway of USC’s top ranked Doctor of Physical Therapy (DPT) program.¹ The hybrid pathway of the USC DPT program was launched in 2018. In this program, students attend classes online to develop foundational knowledge, clinical reasoning skills, and begin to develop hands-on clinical skills. Hands-on clinical skills are refined in on-campus immersion clinical education experiences throughout the three-year program.

See DPT@USC in action

Classroom teaching in the hybrid program is divided into three components: asynchronous content, live session content, and immersion content.

Recorded in a studio, asynchronous content features faculty working with patients and actors to demonstrate various physical therapy techniques. Multiple camera angles allow students to view procedures from different perspectives. Special effects are used to overlay anatomical drawings and to animate skeletons, giving students a chance to see what happens inside the body during a technique—a benefit that wouldn’t be possible in a traditional classroom setting.

Using pre-recorded content has other benefits, according to Dr. Clarisa Martinez, PT, DPT, MS, assistant professor of clinical physical therapy with the USC Division of Biokinesiology and Physical Therapy. Dr. Martinez specializes in teaching evidence-based practice content. She explained that pre-recorded content has “given us a chance to model how you would talk about research with a patient, and how you would weigh the patient’s perspective, and help them make decisions based on research evidence.”

Asynchronous content can also be reviewed by the student at any time, repeatedly if necessary, and on their schedules—a feature that is considered a game changer among Dr. Tilson and her colleagues.

During live class sessions, students delve deeper into asynchronous content and verbalize their thought processes. Live sessions are hosted in Zoom in a ratio of approximately 12 students to 1 faculty member. Dr. Noriko Yamaguchi, PT, DPT, GCS, CSCS, clinical assistant professor of clinical physical therapy, hosts live sessions for several courses that teach hands-on clinical skills. She uses polling, breakout rooms, and share screen features to promote meaningful discussion with students about the physical skills they are learning in preparation for immersions and clinical education experiences. Students are tasked to record themselves conducting physical skills at home and they discuss those experiences in Dr. Yamaguchi’s class—identifying strengths and providing direct feedback for skill development.

Outside live sessions, students in the hybrid program are tasked with practicing the same physical skills on community volunteers. This could be a friend, family member or a student in another discipline.

The hybrid pathway includes twelve on-campus immersion experiences that range from three to fourteen days. Students receive detailed feedback from instructors on the techniques they have been practicing at home and demonstrate competency in hands-on practical examinations.

Dr. Yamaguchi emphasized that in both immersions and live class sessions, student-to-faculty ratios are low, engaging students as active learners. This allows faculty to assess each student’s learning and empowers students to find their voice and confidence as future physical therapists.

Based on their collective years of experience, faculty at the USC Division of Biokinesiology and Physical Therapy have advice for others new to teaching physical skills in an online environment.

Get Organized Early

Faculty can take a number of steps to get ready for their online classes weeks before they begin. 

An effective way professors can plan ahead is by creating a lesson plan that is optimized for an online environment. When adapting a lesson plan previously used on-campus, professors can identify portions of the lesson where certain technological features and tools would promote student engagement. Clearly outlining when technology will be used can make online delivery feel less foreign and more fluid.

“A thoughtfully adapted lesson plan helps to guide you in terms of what to do, and when you’re going to need that breakout room or when you are going to post a talking point in a chat box,” said Dr. Yamaguchi, PT, DPT, GCS, CSCS.

Promote Participation and Discussion

Breakout rooms on Zoom are just one way to foster group participation. Professors teaching clinical courses online can use a range of tools to achieve the same outcome. Some of these tools—like polling and chat boxes—are built into Zoom or other video conferencing software. Planned discussions and shared documents can also help to kick off conversation in class. But it doesn’t need to end there. Professors should seek to provide a forum for students, where they can support one another, pose questions and share feedback—and students should take advantage of this.

“Reconsider how you approach content. Incorporate discussion-based classes vs. strictly lecture-based classes, utilize tools such as polling, chat, and breakout rooms to promote engagement,” said Dr. Eric Robertson, PT, DPT, OCS, FAAOMPT.

Make Use of Visuals

Utilizing visual tools during lectures can really make a difference when introducing complex clinical techniques to students who aren’t in the same room as their instructor. Rather than using words to try and describe how a particular technique should be administered, professors can demonstrate that technique.

Another option is to share video clips, images or graphs related to the topic at hand. This way students can engage with visual content versus just auditory.

The computer screen or webcam shouldn’t limit a professor’s creativity. Instead, professors should think about how their devices can enhance creativity and the delivery of course content.

“Don’t forget to move. The online experience is not restricted to sitting in front of a computer. The versatility of online devices allows the camera to move for both faculty and students. You can ask for different angles, movements, and activities,” Dr. Chris Sebelski PT, DPT, PhD, OCS, CSCS. 

Making resources available after class allows students to review any video clips or images shared in class on their own time. Students should be encouraged to keep revisiting the content until they’ve fully grasped the concept it aims to exemplify.

Encourage Students to Practice at Home

Professors can give students advice for how to practice techniques at home since they aren’t able to practice as much in-person as they would traditionally on-campus.

“Embrace creativity. If your students don’t have equipment, such as crutches or canes to practice with, encourage them to be creative and find substitutes that can be used,” said Dr. Michael Andersen, PT, DPT, OCS, GCS.

Practice Makes Perfect

For professors to leverage digital tools, they must first have the ability and comfort level to use them. This can only come from hours of practice. Know that any challenges experienced along the way do not signify defeat.

“Press all the buttons, find out what happens, try to break stuff when you’re on your own, and that way when you’re in front of the students you can work yourself out of challenging situations,” said Dr. Martinez, PT, DPT, MS.

Tune in to Your Students

According to Dr. Yamaguchi, another way that professors can enhance online learning is to be observant. Noticing students’ facial expressions and body language is just as important online as it is in person. While a professor may not be able to see a student fully on camera, they should ask themselves if there are other ways to tell if that person is confused about a particular concept or is restless and in need of a break.

Advocate for the Benefits of Online Learning

More people may feel comfortable pursuing a professional education online now, as long as they can feel connected.

“Maybe people who wouldn’t have considered going to school before, because it wasn’t accessible, might think about it now because more people are modeling it,” said Dr. Martinez, PT, DPT, MS. 

And this could push governing bodies around the world to develop strategies to bridge the digital divide. 

With hybrid learning, Dr. Yamaguchi sees an opportunity to improve the diversity of the PT profession.

“Physical therapy has a huge diversity problem,” she said. “So, for USC, being able to offer really high-quality PT education to students from across the country without having them uproot their lives and move to LA, which is super expensive, is important.”

After this current crisis, Dr. Tilson predicts that we may begin to see changes to education and health care delivery. Globally, experts in the educational and medical fields are having discussions about how the coronavirus pandemic will reshape our future and how we can be better prepared for the next unprecedented event.

“I think it would be naïve to think that there won’t be a next time,” Dr. Tilson said.

And if there’s one takeaway for education stakeholders, Dr. Tilson said, “I’m hoping that there’s more open-mindedness about how people can teach and how people can learn.”

Citation for this content: USC’s hybrid DPT program

¹https://www.usnews.com/best-graduate-schools/top-health-schools/physical-therapy-rankings

Last updated October 2020