Not letting a good crisis go to waste – learnings from a fully online professional placement

Figures & data

Table 1. Outline of unit activities mapped to Assessment of Physiotherapy Practice (APP).

Module (week) focus	Case	Activity	Platform	Mapped to APP criteria
Introduction to unit and Acute Physiotherapy	N/A	Introduction to unit	Online recording	N/A
	N/A	Introduction to assessment	Online recording	N/A
	N/A	Introduction to the module	Online recording	N/A
	N/A	Standards and expectations of placement	Online recording	N/A
	N/A	Clinical Reasoning	Online recording	N/A
	N/A	Learner Expectations	Discussion board	2
	Fractured neck of femur	Medical notes	Online quiz	6
	Laparatomy	Postoperative risks and education	Discussion board	20
		Progress notes	Written submission	6
		Discharge planning	Discussion board	18
	Stroke (infarct)	Case analysis (WHO ICF)	Written submission	10, 11
	Total Knee Replacement (TKR)	Critique – observation of student performance	Discussion board	2
	Stroke (hemorrhage)	Series of case related tasks	Marked assignment	10, 11, 13, 18
	N/A	Synchronous discussion – questions arising from online recordings	Zoom	5
	Caseload prioritisation	Synchronous discussion	Zoom	5
	Case review - (TKR)	Synchronous discussion	Zoom	5
Acute Physiotherapy	N/A	Introduction to the week	Online recording	N/A
	Chronic Obstructive Pulmonary Disease (COPD)	Problem list	Written submission	10, 11
	Guillain Barre Syndrome (GBS)*	Clinical Impression Handover	Uploaded Recording	5, 10
		Assessment plan	Written submission	8, 10
		Problem list and goal setting	Discussion board	11, 12
	Rotator Cuff Repair*	Discharge plan	Written submission	18
	Anterior Cruciate Ligament (ACL) Repair*	Discharge plan	Written submission	18
	Acute cardiac	Clinical Reasoning	Online quiz	10
	Bowel surgery	Discharge plan	Discussion board	18
	Lobectomy	Series of case related tasks	Marked assignment	6, 10, 11, 13
	Case Review – COPD	Synchronous discussion	Zoom	5, 10, 11
	Case Review - (GBS)	Online debate	Zoom	5, 11, 19
	Case Review (Bowel surgery)	Synchronous discussion	Zoom	18
Sub acute and inpatient rehabilitation	N/A	Introduction to the week	Online recording	N/A
	Cardiac and Pulmonary Rehabilitation	Program development	Uploaded recording	13, 14, 15, 16, 17
	Stroke	Critique – observation of student performance	Discussion board	2
	Parkinson’s Disease	Medical and surgical management	Written submission	19
		Patient interview, physical examination and outcome measures	Discussion board	7, 8,
		Rehabilitation aims and intervention plan	Written submission	13
	Multiple sclerosis	Clinical reasoning – linking findings to neuropathophysiology	Discussion board	10
	Lumbar decompression	Discharge letter	Written submission	6, 18
	Fractured neck of femur	Identification of community needs	Discussion board	11, 17
	Cerebellar Stroke*	Interdisciplinary teamwork	Discussion board	4
	Stroke	Problem based assessment of gait (documentation of obsevations, hypotheses, impairment oriented tests)	Marked assignment	8, 9, 10
	Case Review (Parkinson’s)	Synchronous discussion	Zoom	5
	Case Review (Cerebellar Stroke)	Synchronous discussion	Zoom	5
	Case Review (Multiple sclerosis)	Synchronous discussion	Zoom	5
Community based physiotherapy	N/A	Introduction to the week	Online recording	N/A
	N/A	Digital Health Agenda: a physiotherapist’s role	Online recording	N/A
	N/A	Treating without your hands	Online recording	N/A
	N/A	Introduction to telehealth	Online certification	2
	Colles fracture	Clinical reasoning	Online quiz	10, 11
	Acute low back pain	Critique – observation of student performance	Discussion board	2
	Rotator Cuff Repair*	Progress report	Written submission	6
	Cerebellar Stroke*	Moving from face to face to telehealth interaction	Discussion board	17
	ACL repair* (2 weeks post op)	Assessment plan	Online quiz	8
	Hip pain	Series of case related tasks	Marked Assignment	8,10,13,17
	Application of telehealth	Synchronous discussion	Zoom	5
	Quiz reviews	Synchronous discussion	Zoom	5
	Case review - (Cerebellar stroke)	Synchronous discussion	Zoom	5
	Case review (rotator cuff repair)	Synchronous discussion	Zoom	5
Community based physiotherapy	ACL repair* (3 months post op)	Plan for telehealth consultation	Written submission	13
	Knee osteoarthritis	Research translation	Discussion board	19
	Shoulder	Plan of patient interview	Discussion board	7
	Guillain Barre Syndrome (GBS)*	Goal setting and the interdisciplinary team	Discussion board	4, 12
	Radiculopathy	clinical reasoning and reflection	Written submission	13, 16, 20
	Acute ankle sprain	Development of exercise program	Written submission	14, 15
	Acute disc	Problem list	Written submission	11
		Intervention plan	Written submission	13
	Whiplash	Series of case related tasks	Marked assignment	8, 10, 11, 13
	Case review (osteoarthritis)	Synchronous discussion	Zoom	5
	Case review (ACL repair)	Synchronous discussion	Zoom	5
	Case Review (GBS)	Synchronous discussion	Zoom	5
	Case review (shoulder)	Synchronous discussion	Zoom	5
	Case review (radiculopathy)	Synchronous discussion	Zoom	5

Table 2. Activities for the Guillain Barre Syndrome (GBS)* case.

The case: Mrs P is a 63 year-old woman who was admitted to hospital for treatment and management of rapidly progressing neuromuscular weakness in the setting of a recent chest infection (URTI). Mrs P has had multiple investigations since admission and subsequently been diagnosed with Guillain-Barré Syndrome (ascending inflammatory demyelinating polyneuropathy). Mrs P presented to the Emergency Department yesterday afternoon, from where she was transferred to the Neurology ward in the evening. Today she was moved from the ward to the High Dependency Unit (HDU) for closer monitoring of her condition. You will be set a series of tasks to complete for this case over the course of this week. You have been provided with the following information to help in your analysis of the case: Medical admission form Clinical progress notes Pathology results Medical imaging (CXR, CT angiography and CT Brain) Observations chart Medications
Clinical Impression Handover	You have been asked to review Mrs P’s notes in advance of conducting the initial physiotherapy assessment. Before you begin your assessment, your supervisor wants to hear what you have learnt about the patient from reading and analyzing the information provided and the clinical impression you have formed of Mrs P. This will involve you providing a verbal handover to your supervisor. You will record yourself completing this 5-minute clinical impression handover. This handover acts as part of helping your supervisor to make judgments about your information gathering and analytical skills, to identify gaps in your understanding and competencies, and whether you are safely prepared to see the patient.
Assessment plan	Your supervisor has now asked to review your plan for your initial assessment. You have access to the same information as yesterday to help in your analysis of the case and decision making: You will provide a typed plan of your initial physiotherapy assessment (patient interview and physical examination). The plan will logically and clearly outline what you aim to assess based on: the information you currently know about Mrs P your knowledge of Guillain-Barré Syndrome, and your understanding about the role of the physiotherapist in this setting. You will also provide justification for your plan (i.e. explain your rationale and reasons for the structure of your plan, the questions (or topics) you explore and the tools, measures and tests you plan to perform).
Problem list and goal setting	You have previously provided a plan for your assessment of Mrs P who was admitted yesterday with Guillain-Barré Syndrome (ascending inflammatory demyelinating polyneuropathy). You have now completed that assessment and obtained these findings. You should use those findings and information previously available to you to help in the next stages of analysis of the case and decision making. (1) Compare the assessment plan you created yesterday to the findings released today. To help your learning for the future, identify and make note of any assessment areas that you overlooked. Consider why those areas might be important to include in this initial assessment. Bring any questions you have to the synchronous session on Thursday. (2) Write a discussion post of no more than 400 words (plus references) that covers the following 3 questions: o Write a prioritized problem list for Mrs P o For the problem you have ranked as the highest priority (i.e. the main problem), provide justification for your decision and support with appropriate evidence. o Write at least 3 short-term person-centered goals for Mrs P that are relevant to this immediate and next few days of physiotherapy intervention. (3) Review the posts from other members of the cohort. Identify one post that offers a different perspective to your own (e.g. has identified a different main problem, has offered a different rationale for the same main problem, has considered something that you did not and this helps you to understand the patient in a different way and so on) and write a constructive post in response to your “professional colleague.” Aim to respond to different posts if you can.
Online debate	Mrs P’s current main problem is her respiratory status. Agree or disagree?

Table 3. Participants.

	# of students completing survey	# of students enrolled in unit	# of students completing first placement
Placement offering 1	6	10	10
Placement offering 2	9	14	0
Placement offering 3	1	7	0

Table 4. Survey results.

Question	Mean (sd)	Mode
With respect to the University’s graduate attributes, this unit has facilitated the development of:
Professional skills	8.25(1.39)	9
Self directed learning skills	8.88 (0.86)	9
Future-ready skills	8.50 (1.22)	9
Overall, I am satisfied with this unit.	8.31 (0.92)	8
This unit has started to help me to prepare for the physiotherapy workforce.	8.44 (1.32)	9
I felt supported by staff.	8.69 (1.04)	9
I felt connected with my peers and felt a sense of belonging.	8.38 (1.45)	9
This unit effectively used online resources and media to achieve its learning outcomes	8.19 (1.33)	8
Online discussion board platforms encouraged me to interact with educators and other students on a regular basis.	8.13 (1.54)	8
The scheduling of “synchronous” (live) sessions in this unit helped me to be motivated, engaged and part of a learning community.	8.25 (1.68)	10
The unit assisted me to apply aspects of the Assessment of Physiotherapy Practice (APP) in preparation for other clinical placements.	8.69 (1.21)	10
The unit was well organized.*	8.50 (0.98)	8
The unit helped me to develop my clinical reasoning.*	8.86 (1.06)	10
The workload was appropriate for this unit.*	7.93 (1.58)	9
The unit content was easy to navigate and find on Canvas.*	8.79 (1.01)	9
The assessed case for each week gave an opportunity to explore a clinical case in depth and bridge theory to practice.*	8.43 (1.05)	8,9
The clinical cases allowed me to focus on different tasks to develop my clinical reasoning.*	8.57 (1.18)	8, 10
The feedback provided to me by staff was helpful and developed my further understanding of the cases.*	8.36 (1.11)	7,8
The activities set each week in the live synchronous sessions assisted my ability to clinically reason in real-time.*	8.43 (1.05)	8

* only 14/16 participants responded to these questions.

Table 5. Responses to question: Considering both the limitations associated with the COVID-19 crisis and the aims and objectives of the unit, please comment on your experiences during this unit and their influence on your professional growth and development.

I think this unit would be a good stand alone subject. It will never replace hands on practical experience.

I thought the activities were in line with the type of thinking we will need for our future work as a Physio. I struggled with the workload as daily activities required more time in order to complete them to a satisfactory level, which would leave very little time in the day where you can switch off, which negatively impacted on my experience overall. Given the online limitations however, I think the work would have benefitted my professional development.

I thought this unit was a great way to consolidate what we had learnt in the first year of the course and apply it to real cases. I think it was extremely valuable to my learning. It also improved my confidence in tackling more complex cases.

Exposure to different cases was helpful.

This unit gave me the opportunity to revise different aspects of physiotherapy we have learnt so far, as well as grasp clinical practice from an acute, subacute and community setting.

This unit was a great alternative to placement and was invaluable in consolidating my knowledge from the first year of the course. However, I feel upset that this unit takes place of a real placement because I do not believe that 4 placements is enough, when other universities have 6

Considering the circumstances, it was a great way to continue clinical placement learning.

I like that I was provided with cases from multiple patient populations. This allowed me to consolidate my knowledge in all areas.

Influenced me to develop strategies which I will need to use on placement and during my career.

My experience was good. There was a constant workload, which influenced my professional growth.

It was good to have variety of cases, and real (or real-like) notes, referral letters, and scenarios. It gave me a taste of what I can expect.

Given the situation I think this unit was really well done. I think it was a great predecessor to placement, and I definitely feel more confident going into a hospital environment with the extra practice of problem lists, clinical thinking etc. I think aspects of this unit could definitely be incorporated into “normal” learning, I enjoyed the realness of the cases and I think that was very beneficial to my learning

Table 6. Responses to question: In my opinion, the strengths or best aspects of this unit were.

Online sessions and weekly assessed tasks.
The feedback/going through cases in the meetings and the real-life notes/cases. I also liked watching videos of other Physio students.
The ability to integrate theory we have learnt in the course to real cases and get detailed feedback. The live sessions were also great and you could tell staff had put a lot of effort into making them educational, engaging and enjoyable
Discussing conditions with the educators
I liked getting to practice my clinical reasoning and complete realistic tasks related to clinical practice.
The teaching staff were dedicated and helpful, you can tell they spent so much time preparing cases and giving students feedback that will assist their learning. I really enjoyed the online synchronous sessions as a chance to discuss cases in real time. I enjoyed Sarah’s debate for GBS and shed light onto the focus of acute treatment versus sub-acute settings
The daily feedback from supervisors and ongoing meetings
I like that I was provided with cases from multiple patient populations.
Formative tasks which encouraged consistent learning and prompt feed back which allowed you to put that in place for the next task.
The online communication ability.
Variety of cases, real notes and scenarios.
I enjoyed having something to do each day, having regular deadlines without being extremely overworked kept my motivation up each day to complete the tasks, rather than having 5 days to do everything and leaving it all to the last minute. I also enjoyed the variety of cases, I feel much more confident in the cardio and neuro areas after this course and have enjoyed the final few weeks primarily focusing on musc.

Table 7. Responses to question: In my opinion, areas of this unit that could be improved are….

Cases could be released at 12am rather than 8am
I found the group prioritizing task a lot more tedious than it was helpful. Prioritizing is an important skill but I don’t think assignment helped me learn how to do it. It just drained a lot of time, and in my opinion was unnecessary. Perhaps prioritization could be an individual activity instead.
Sometimes the feedback was not detailed enough to know what I should be doing differently/what a correct answer would look like. Also, the prioritization group assignment could be improved. I found that I put a lot of time and effort into this project and thought my contributions were well considered and of high quality, but did not feel this was reflected in my mark. Therefore, more guidance on the expectations for the assignment, and possible some mid-way feedback would be appreciated, considering it was worth 40%.
Assessed cases released earlier would decrease stress. I found the workload for this unit heavy therefore quality of work was poor.
I think this subject is a great and necessary intro into placement, however, it was too long. I realize due to COVID it had to be 5 weeks to supplement a face to face placement, but I think in the future it could be condensed and possibly incorporated with another subject as a pre placement preparation.
Sometimes feedback was vague and did not explain the correct answer to a question in detail (e.g. in the lower back tasks) it would’ve been helpful to be told specifically what we should’ve included in our answer. I found these tasks challenging but did not feel overly competent in answering these questions, even after receiving feedback, and talking about them in the live sessions
Feedback from the summative task would be really beneficial to my learning
Informing when tasks will open up prior to the day
Some more feedback on the assessed cases and feedback on the caseload assignment
Answers or opinions of treatments for all cases.
Exploration of clinical guidelines or recommended practices
I wasn’t a huge fan of the caseload assignment, I think it felt a bit forced to write 3 posts on the same group of people, by the end I think we were all vigorously agreeing with each other to make up the word count. In saying that, I liked the concept of prioritizing, maybe it would have been better to have 2–3 different caseloads given to us throughout the 5 weeks and we had to do one post on each as a group.

Table 8. Responses to question: If I were to give advice to another student who is considering taking this unit in the future, I would say….

Stay on top of your work and prioritize assessment.
Quit your job if you can otherwise you will burn out. Be strict with your time and don’t spend more than 1.5hrs on the small cases, even if the work isn’t your best, just get it done. Start the assessed case before Thursday at 4pm.
Don’t spend too long on one task, and focus your time on the clever case. Think of it as a chance to consolidate everything you’ve learnt over the course
Keep in contact with other students for support and work together
It’s really useful as a pre-placement preparation, and could help make the first placement less overwhelming.
Be organized with your week. Keep in touch with other students to stay motivated and connected. Don’t spend too long on each task
Prepare your week and have a daily schedule and keep track of daily task completion times
Be organized.
Work consistently.
Be organized with your time.
Prepare early. Find clinical guidelines, textbooks or high quality resources that cover a variety of things and save them.
Set yourself aside 3–4 hours each day dedicated to this subject. Try to get everything done early in the day so you have your afternoon free and can enjoy the benefits of learning from home rather than procrastinating and stressing about a 5pm deadline.