This study examined the effectiveness of the addition of an online resource to usual teaching in improving performance of practical skills in physiotherapy students. There was a trend towards students who had access to the Physiotherapy eSkills Training Online resource scoring higher in the practical examination than students who had usual teaching only. The higher marks were accounted for mostly by the components of ‘rationale for the practical skill’ and ‘effectiveness of the practical skill’. Furthermore, the students perceived that the online resource was very useful for learning practical skills.
The Physiotherapy eSkills Training Online resource was delivered in addition to usual teaching which consisted of high face-to-face teaching hours, supported by demonstration of, practice of, and specific feedback about practical skills. This usual teaching is already effective given that the average practical examination mark before implementation of the online resource was 18 out of 25. In light of this, the trend towards a 1.6 mark increase represents a 23% increase out of the 7 remaining marks. This improvement is probably the result of the resource being online since it enabled the opportunity to view, revise and consolidate the exact practical skills required, in the physical and social context of the students’ choice. These results raise the question of whether the Physiotherapy eSkills Training Online resource could be used to decrease the labour intensive tutorial system of teaching physiotherapy students the practical skills required for managing patients with neurological disorders. Future research to examine whether face-to-face teaching can be streamlined by utilising this online resource as a replacement for some of the small group teaching is warranted.
The improvement observed in the total practical examination mark is accounted for largely by an increase in the components ‘effectiveness of the practical skill’ and ‘rationale for the practical skill’. There are no similar findings reported in the literature about e-learning. There could be several reasons that students' ability to effectively perform the practical skill was enhanced by the Physiotherapy eSkills Training Online resource, the most important of which is likely to be the observation of therapist-patient simulation via online video-clip streaming. Video modelling has been demonstrated to improve performance of skills ranging from gymnastics in healthy individuals to smiling in people who have facial paralysis
[10, 11]. Moreover, patient simulation has been demonstrated to increase knowledge compared with text-only electronic formats in health education
. It is encouraging that the students’ ability to provide a rationale for the practical skill was also improved. This may be as a result of the Physiotherapy eSkills Training Online resource containing supporting text describing the aim, rationale, equipment, key points, common errors and methods of progression; and a downloadable PDF document incorporating the online text information as well as the video-clip of the therapist-patient simulation. Importantly, the resource relates each practical skill to the specific impairments and activity limitations of neurological conditions in a clinical context. There is evidence that e-learning incorporating clinical scenarios improves knowledge acquisition and retention
. There was no increase in marks in the components ‘specificity of instructions and feedback’ or ‘progression of the practical skill’ despite the inclusion of these aspects in the Physiotherapy eSkills Training Online resource. However, prior to the implementation of the online resource, the average mark for feedback was 2.8 out of 4 and for progression was 3.2 out of 4, leaving less room for improvement than other components.
The Physiotherapy eSkills Training Online resource was well utilised with 91% of students in the experimental group using the online resource for learning practical skills. There was strong agreement that the resource contributed to improvements in practical skills, and assisted in exam preparation. Students also agreed that the resource would be useful for clinical practice both as a student and as a new graduate.
These findings are consistent with previous findings that online educational delivery can result in positive learning experiences for students
[6, 9, 14] and supports the suggestion that self-controlled video modelling enhances learning
There are several limitations to this study. Firstly, it was a non-randomised trial because it was ethically and logistically difficult to restrict access to the Physiotherapy eSkills Training Online resource for some students and not others in the same cohort, so the control and experimental blocks occurred at different times. However, the blocks were run in consecutive years, and no changes to the usual teaching occurred. Secondly, there was no blinding of participants, teachers or assessors. To minimise the consequences of lack of assessor blinding, the same standardised marking schema and assessors were used for the practical examination in each block. Thirdly, the number of participants in the study was small, leading to a lack of statistical power. A fully powered study would need a total of 162 participants to detect a mean difference of 1.6 marks, with a standard deviation of 3.6, at a significance level of 0.05. Fourthly, the frequency with which the experimental group accessed the Physiotherapy eSkills Training Online resource was not quantified. Finally, the students were assessed within 2 weeks of the end of teaching, so the question of whether the online resource was also effective in improving performance of practical skills during clinical practice remains. These factors suggest that the results should be interpreted with caution.