Technology-enhanced learning (TEL) can engage students with learning and offer benefits in knowledge acquisition due to the flexibility of learning it provides. There is difficulty ascertaining best practice for the implementation of TEL in physiotherapy education. This study aims to address this through a case study with pre-registration students using a virtual learning environment (VLE) to supplement their learning. Seventy-nine students were enrolled onto a Movement & Exercise module and had access to the VLE resources. Data were captured by online survey, student focus groups, learning analytics data and comparison of examination results with a previous cohort who did not have access to all the resources. Survey data demonstrated that most students were satisfied with the resources and that they facilitated knowledge acquisition. Thematic analysis from the focus groups resulted in five higher order themes: (1) Content quality, (2) Interaction and accessibility, (3) Learning goal alignment, (4) Satisfaction with resources and (5) Suggestions for the future. Learning analytics data revealed students accessed the resources predominantly before examination periods. There were statistically significant improvements in mean examination marks compared to the previous cohort. In conclusion, satisfaction with the TEL resources was high, and there may be some positive effect on knowledge acquisition.
Technology-enhanced learning (TEL) has been described as using computer technologies to support learning locally or remotely (Gordon
Any online facility or system that directly supports learning and teaching. This may include a formal VLE, e-assessment or e-portfolio software, or lecture capture system, mobile app or collaborative tool that supports student learning. This includes any system that has been developed in-house, as well as commercial or open source tools. (Universities and Colleges Information Systems Association [UCISA]
The implementation and use of TEL in HE has grown, driven by policy from UK Government (DfES
TEL’s impact on learning through offering new forms of engagement, ownership of learning and knowledge acquisition is poorly understood (Laurillard
Recent systematic reviews in physiotherapy education have demonstrated a minimally positive to neutral effect on knowledge acquisition, critical thinking and practical skills (Macznik, Ribeiro, and Baxter
In the United Kingdom, rising living costs and academic fees have led physiotherapy students to balance academic work, personal commitments and paid employment, alongside long commutes to university and clinical placements. TEL provides a flexible opportunity for students to access resources at their own convenience away from the classroom. If TEL is to be used in HE, the instructional design theory (IDT) (Gibbons and Rogers
Considering the dearth of literature on optimal modes of TEL delivery within physiotherapy programmes and wanting to identify how TEL resources impact on our students, a series of student engagement groups were conducted by the lead researcher to capture feedback on how TEL could support them during their studies and help narrow the focus of our study. The feedback was mixed with students commenting that they did not feel fully engaged with TEL and wanted more interactive resources to facilitate their learning, especially whilst on clinical placements. The feedback directed the researchers to examine the effectiveness of TEL in a Movement & Exercise module, with specific focus on exercise medicine, a topic students use considerably on clinical placements, for first year Physiotherapy students at King’s College London (KCL). KCL is a world leading public research university with over 30 000 enrolled students: 24.4% of King's undergraduates are privately educated, and in the 2016/2017 academic year, the university had a domicile breakdown of 67:12:20 of UK:EU:non-EU students, respectively (HESA
The research questions were as follows:
How satisfied were students with the KEATS Movement & Exercise module TEL resources?
Do the KEATS Movement & Exercise module TEL resources improve students’ knowledge acquisition of theoretical and clinical components of exercise medicine?
The study took place within the Academic Department of Physiotherapy at KCL. Ethical approval for this study was obtained from the Biomedical Sciences, Medicine, Dentistry and Natural & Mathematical Sciences (BDM) Research Ethics Panel at KCL (LRS-15/16-2727). All subject data were anonymous and students were informed that by either participating or not in the study would not jeopardise their position on the Physiotherapy programme.
All first year Physiotherapy, both BSc and MSc (Pre-registration), students (
A variety of TEL resources were created and made available for the students over the 2015/2016 academic year (Sept 2015–Aug 2016). These included interactive PowerPoints (PowerPoint 2016, Microsoft Corp, Redmond WA, USA), quizzes and screencasts, which required the student to complete case studies, click on hyperlinks, watch short video clips and answer questions related to the module. Other resources such as journal articles, lecture recordings, videos, past exam papers and condition-specific exercises in PDF format were also included as well as links to relevant pre-existing online resources. To follow a blended learning approach (Graham
A triangulation approach incorporating mixed methodology was used to improve the validity of results (Denzin
IBM SPSS Statistics for Windows Version 22.0 (IBM Corp., Armonk, NY, USA) was used for statistical analysis of examination results, with descriptive statistics calculated for each item of the survey. Learning analytics data were also analysed using descriptive statistics. Thematic analysis was completed using NVivo Pro 11 software (QSR International, Melbourne, Australia). Focus groups were audio and video transcribed by the lead researcher, and copies of transcripts were sent to randomly selected participants to verify the accuracy of the transcription. Inductive analysis was used for initial coding followed by axial coding using the LORI framework (Leacock and Nesbit
Forty-three (55.1%) students responded to the survey, with 42 students completing all questions. All respondents had accessed the TEL resources KEATS page; 97.6% agreed or strongly agreed that they were satisfied with the resources, whilst 76.7% agreed or strongly agreed that the resources were engaging and interesting; 97.6% of respondents agreed or strongly agreed that the resources helped them with their practical and written exams, and 100% agreed or strongly agreed that the resources were useful in aiding knowledge of exercise medicine (see
Question | CL | SE | |
---|---|---|---|
Content of resources were up-to-date, accurate and of an appropriate detail | 41/43 (95.3) | 0.890–1.016 | 0.0322 |
Resources were relevant to module learning outcomes and aims | 42/43 (97.7) | 0.9317–1.0218 | 0.0228 |
Resources provided prompt feedback, specific to your response and helped direct your learning needs | 36/43 (83.7) | 0.7269–0.9476 | 0.0563 |
Resources were engaging and interesting | 33/43 (76.6) | 0.6412–0.8937 | 0.0644 |
Resources were clearly presented and videos/images clearly displayed | 42/43 (97.7) | 0.9317–1.0218 | 0.0228 |
Resources were easy to access and navigate on all platforms | 36/43 (83.7) | 0.7269–0.9476 | 0.0563 |
Resources helped with OSCE exam | 41/42 (97.62) | 0.9301–1.0223 | 0.0235 |
Resources helped with written exam | 41/42 (97.62) | 0.9301–1.0223 | 0.0235 |
Resources helped in preparation for or during placement | 18/42 (42.86) | 0.2789–0.5782 | 0.0763 |
Resources were useful in aiding knowledge of exercise medicine | 42/42 (100) | 1.000–1.000 | 0 |
SE, standard error; OSCE, objective structured clinical examination, KEATS, King’s E-Learning and Teaching Service; CL, confidence limit.
Fourteen students attended the focus groups (female,
Within the theme of content quality, students discussed the importance of the TEL resources having an appropriate volume of content that was manageable for learning as well as being interesting:
…the lectures on here the ones like ‘health benefits of exercise’ and ‘ageing and exercise’ because we had so many lectures…they would just tell us everything but these were just good for just summarising what we actually needed to know and fully understand. (FG 3; Participant 3)
It was just nice to like you know have an interactive quiz…it was interesting, it was different to what we usually like have in terms of educational resources. (FG 3; Participant 1)
Students also highlighted the diversity of resources being positive in terms of engagement and supporting knowledge and understanding. The students all agreed that the variety of TEL resources meant that different learning preferences were supported, with videos and quizzes emerging as preferred resources to facilitate learning. This was identified clearly by a student with dyslexia:
I think erm just having the diversity of all different resources that we could access…I’m dyslexic and I’ve found videos much easier, I just can’t keep looking at lectures, I struggle completely…I kind of think it accommodates er everyone’s different learning styles as well… (FG 3; Participant 4)
It’s nice to have them all there and like so you can use a combination of all of them. (FG 1; Participant 2)
Finally, students agreed that having TEL resources provided by the department meant that they could ‘trust’ that these were appropriate and helpful for their learning as they had been ‘vetted’:
Coz YouTube is a weird and wonderful world sometimes and you don’t want to be looking at something that’s wrong. So that’s what I mean by vetted. It’s come from something through you guys and you’re sort of going ‘yeah, stamped approval, that’s quite a good video’. (FG 3; Participant 4)
I think P1 or someone was saying because (lecturer) put them on there you feel like actually they’re right so you can trust that and use it and whereas if I just picked a video off YouTube I’d be worried it would be just some random person being like yeah do this or something like that. (FG 1; Participant 3)
Some students stated that easy-to-access and navigate module resources increased ease of use and willingness to use the resources:
I found it was quite good they had lists for everything it’s perfect to follow enough if you kind of know what you’re looking for; if it’s supplementary resources that’s what it says, if it’s the timetable that’s what it says…. (FG 2; Participant 3)
Not all students found the resources easy to use and three students identified issues relating to compatibility when using different platforms such as Apple™ products, and difficulties with use on mobile phones in areas with limited internet connection:
Erm, some of them I don’t think worked. From what I remember, I remember having difficulty, but that could have been the compatibility on my laptop. (FG 2; Participant 2)
If you’re on your phone its quite a lot to have to like log in coz it wants you to like log in to your King’s [internal account] and log into your module or something and by the time you’ve logged in a few times it’s just and it’s so small on your phone. (FG 3; Participant 3)
If you had an iPad which was like, had 3G network then that’s fine. When you’re on most of the trains here there’s not Wi-Fi is there? Obviously, there’s a bit on the tubes but it varies. (FG 3; Participant 3)
Many students stated that the resources gave them greater autonomy over their learning because they could access them at home or during long commutes to university or placement:
I could log onto the computer there [on placement] and log onto KEATS there and then go into the, go into the resource and then use it and I could do that on my lunch break and do that after work and it was really, really helpful. (FG 2; Participant 1)
Yeah, it’s useful if you’re ill as well if you have to have a few days off so you can don’t have to kind of like you don’t have so much pressure to catch up or learn off peers or contact your lecturer to try and go through stuff you can just kind of go on lecture capture or look at home. (FG 2; Participant 4)
Learning goal alignment pertains to the resources resonating with learning objectives for the module (Leacock & Nesbit,
And also through the ‘ageing and exercise screencast’ that was an exam, that was a question in our exam, erm not that we knew that at the time. So I found that really beneficial…coz I’d basically had written out an answer… (FG 2; Participant 2)
So yeah especially for OSCEs we’d be like, watch the videos and know exactly what was going on and what was expected and see other people do it, it really, really helped. (FG 2; Participant 3)
For students who had been on clinical placement, the TEL resources were discussed positively in terms of aiding preparation and facilitating knowledge acquisition, predominantly for musculoskeletal (MSK) placements. Students could also see how the resources were beneficial for other placement specialities. Students yet to go on placement saw potential for the resources to support them:
And I also used it [the resources] before erm placement, coz I went to MSK and there was a lot of stuff on there, the external stuff on there about like strength, training strength vs endurance and all those types of things so that exercise prescription for my patients I used it for things like that as well, so I found it really good for that. (FG 2; Participant 3)
…but if you have like MSK outpatient erm placement or just rehab in general that you can always kind of refer back to it, to what’s on there which I think will be helpful, especially coz I was in elderly and the ageing and exercise was really beneficial last time. (FG 3; Participant 2)
Students from all focus groups highlighted that having all the resources in one place enabled greater efficiency of learning, reducing time spent searching for appropriate resources elsewhere:
But I do think the online thing is great for accessibility because it’s not as time consuming. (FG 3; Participant 4)
…I like the pictures that they use on the PowerPoints and you can’t find them on google and so you can go onto the lectures and find them and saves you like hunting around for them. (FG 1; Participant 2)
Students identified positive aspects of specific TEL resources contributing to their overall satisfaction. Some students identified the quizzes and videos as most preferred, whilst others discussed the positive aspects of having the variety of resources:
I think they combine together to help overall. It was quite nice to just be able to flick between them all just to help your understanding which obviously is going to help in the exams… (FG 1; Participant 3)
Negative feedback from all groups highlighted a lack of consistency with the quality of lecture captures and a lack of clarity about using the Frequently Asked Questions Forum:
I think some of the lecture captures weren’t particularly great but I don’t think that was to do with the module I think that’s to do with the actual lecture capture. (FG 2; Participant 2)
Yeah the FAQ coz I remember looking at it and it’s like ‘you can’t access this unless you post a question’…so that was a bit of a confusing thing so I never used it because I didn’t know how to use it. (FG 1; Participant 1)
Students gave suggestions for specific conditions they would like further resources on and highlighted the need for a clearer link between the supplementary resources, lectures and learning objectives for the module:
…so obviously you’ve got all of the lectures in the order that they were given in but then maybe if they were grouped in terms of like topics instead. (FG 2; Participant 2)
And then linking, er like the lecture objectives up to the relevant supplementary resource. I think that’s quite beneficial and important. (FG 1; Participant 3)
The Moodle Learning Analytics Tool captured data from 15 December 2015 until the end of the academic year. Data identified that the module was accessed 10 548 times by the students and used predominantly between 11 and 5 pm with a smaller peak at 8 pm. The most accessed resources were the strength training quiz, module news, updates forum and module handbook. There were noticeable peaks in usage in the weeks preceding written and practical exams (see
The examination results demonstrated a statistically significant improvement in the mean mark for the practical and written exams as well as overall module grade (
Mean mark 2015 no resources (SD) | Mean mark 2016 with resources (SD) | Mean difference (95% CI) | ||
---|---|---|---|---|
Module grade | 67.6 (7.3) | 75.1 (7.57) | −7.570 (−9.992 to −5.147) | 0.000 |
OSCE exam (practical) | 72.9 (10.64) | 81.8 (9.50) | −8.883 (−12.155 to −5.611) | 0.000 |
Written exam | 67.6 (9.67) | 70.8 (9.06) | −3.141 (−6.185 to −0.096) | 0.043 |
SD, standard deviation; CI, confidence interval; OSCE, objective structured clinical examination.
Signifies statistically significant difference.
The study evaluated student satisfaction and knowledge acquisition using TEL resources on two pre-registration physiotherapy programmes at a London University. Results showed that all students accessed the TEL resources and the majority were satisfied with the resources. Satisfaction with the resources related to their role in the preparation for practical and written exams, and facilitation of autonomy over learning.
The ability to access the resources anytime, anywhere gave the students the opportunity to structure learning around other commitments. Students’ expressions of satisfaction with the TEL resources reflect findings from research regarding students’ perceptions of the ideal environment for a student in today’s world and managing the demands of the university alongside other commitments (Douglas
The TEL resources acted as a repository of information which students could easily access at any time and any place. Flavin (
Many comments in the focus groups related to the alignment of the resources with module learning objectives and facilitation of learning goal attainment through students passing the exams. This is consistent with previous research reporting that time, academic deadlines and personal priorities contribute to how students perceive TEL resources to be beneficial (Henderson, Selwyn, and Aston
There are several limitations to this study. A cohort design was used because it was ethically and logistically difficult to restrict access to the resources for some students within a cohort. Students in the previous cohort also had access to some resources such as lecture capture, lecture slides and past exam papers, as provision of these pre-dated the development of the TEL resources. The majority of participants in the focus groups were female. Whilst this may lead to the risk of a greater representation of female views, evidence is inconclusive regarding gender differences in attitudes towards TEL (Mayer-Smith, Pedretti, and Woodrow
Considering the variety of educational settings, a standard pro forma for implementing TEL in health care education may be ineffective. Further cohort and case studies are needed with clear and focussed aims and methodology to understand the different ways TEL can be implemented in individual academic institutions, based on student wishes and needs. The learning analytics data provided insight into the type and frequency of resources used; however, future research should aim to capture how students utilise and access the online technologies within the module so that further use and development of TEL resources can be tailored to the individual student and module. The need also remains to evaluate the cost effectiveness of TEL in health care education.
Satisfaction with the TEL resources was high, and there may be some positive effect on knowledge acquisition but caution should be taken when interpreting these findings due to confounding variables. Nevertheless, findings indicate that with additional TEL resources, students could synthesise the information provided to support their knowledge acquisition of exercise medicine and achieve excellent grades. Students reported benefiting from the variety of TEL resources, which met individual learning preferences and facilitated autonomy of learning anytime, anywhere. The resources enabled students to meet learning objectives by guiding them to pertinent information to support knowledge acquisition and may be useful in other areas of health care education.
This study was supported by Professor C. Sackley’s NIHR Senior Investigator award. The authors would firstly like to thank the students who participated in this study and contributed to making it a success. They would also like to acknowledge and thank Dr Lindsay Bearne for running one of the focus groups, Dr Michael Flavin for his methodological advice and Mr Nabil Asif for his technological support.