-: Thank you for joining us.
My name is Kellie Gossman.
I'm an assistant professor
with the division of physical therapy education.
-: I'm Sara Bills.
I'm also an assistant professor
in the division of physical therapy education.
-: And I'm Steph Langel an instructional designer
with the office of e-learning.
-: All right, so today we are going to share our experience
with content delivery redesign
where we created 10 e-learning modules
that focused on certain steps of psychomotor skill learning.
We're also gonna share some examples of virtual activities
that help to facilitate each of those steps.
So the background of this story is kind of starts with me.
So I imagine many of you are joining us
because you teach a course
that involves students learning psychomotor skills.
And you can appreciate that teaching these skills
in a normal year is not an easy task.
The skills you teach may be complex
and often involve cognitive elements
in addition to motor skills
that your students are learning for the first time.
When you add a pandemic that limit students time,
exposures to others, and just other additional barriers,
obviously stress being one,
it definitely adds an extra layer to the instructor
on how to deliver materials effectively.
To not only encourage learning, but also
to encourage practicing in a variety of ways.
The background involves a course
that I coordinate in the fall
for first year physical therapy students.
It's a foundational skills course
or what we sometimes call PT 101.
As you can see depicted in my picture on the screen
there are many categories of skills
that the students learned in this semester
but there are actually several skills
in each of these categories
that the students are expected to perform in lab.
They're again, going to use it
throughout our physical therapy curriculum
and they're going to use it in their PT career.
So these skills are somewhat timeless.
The concepts don't change, but many skills need
to be adapted to individual patient needs.
So there's obviously a big cognitive piece of learning
some of these skills.
I had actually used the e-learning modules previous
to the pandemic for some of these skills
including general survey and range of motion.
So I was very eager to compliment these
for having e-learning modules for some of the other skills.
I'm gonna let Steph talk briefly just
about what is an e-learning module
in case that's a new term for you.
-: Well, the term e-module
can be used to describe numerous virtual modalities.
In this case we're specifically talking
about interactive content
that was created using articulate storyline three.
These are reusable learning objects that incorporate videos,
animations, quizzes, and targeted feedback
to really guide learners through the content.
One of the benefits of using this tool is that
it houses both the content and the practice in one location.
And so the learner isn't trying to navigate
between these different parts.
Another benefit of this tool is that it allowed us
to have a little bit more flexibility
when it came to those interactions
so we were able to target them to those learning objectives.
And we'll see some examples of these modules later on.
So you will have a visual for that as well.
This is a modality that we have used
in the office of e-learning for many years.
And we in fact have a scorecard
and a lot of development assets that you can use as well
to help you for your development.
And then as Kellie mentioned
she has created modules using this format before.
So it was a modality that was kind of made sense.
-: And the pandemic kind of gave me that little gentle shove
that I needed to start that process
of content delivery redesign.
When I knew I was gonna work with a small group of experts,
which are obviously pictured in here
in speaking with me today, it helps me to know
that it was gonna lighten the load.
So is it easy?
Yes.
But as far as determining
what skills might work best for the modules
or how to kind of prioritize that content,
I'm gonna let Sara talk more about this.
-: All right, thank you, Kellie.
Well, we were fortunate that all three of us entered
into this project with a background
in motor learning deeper theory.
Steph brought her expertise, particularly
with practice and feedback in the online environment.
And then also her creativity helped.
It was so valuable when it came to conceptualization
which is a step that I'll expand upon a little bit later.
As physical therapists, Kellie and I came with experience
in motor learning theory as well.
So PTs are movement experts.
We use our in-depth knowledge of motor control
and motor learning in our daily clinical practice.
And we teach our students how to use motor learning theory
in their daily clinical practice.
We break down complex movements.
As movement experts, we break down that movement
into its component parts and then we design
an intervention utilizing
the right practice and feedback schedules
so that our patients have their motor skill acquisition
and retention for that matter.
So as three of us came together,
something became very clear to us.
The pandemic, the situation was new
but the theories that we needed to lean on
in order to teach these psychomotor skills in a pandemic
were not new.
So for an example, we could lean on a primary tenant
of motor learning theorists that states skills
are best learned using a sequenced
and stepped teaching approach.
So we're very eager to share with you our stepped approach
that we used but first one more piece
of theoretical backgrounds, if you will humor me here.
So the early work by Fitts and Posner theorized
that there's three phases of skill development.
The cognitive phase is where the novice learns
what to do and in what sequence, right?
So demonstration and explanations
are really necessary in this phase
and the retrieval of information and the steps
and the skills requires a great deal of effort
by the learner or by the novice.
And as the learner moves into this associative phase,
and finally at the autonomous phase,
the skill becomes more routine, more fluid
and it demands less conscious thought.
Our e-modules will, were built
to initiate that cognitive phase of learning.
If we told you here today
that it would take the learner all the way
through the autonomous phase
I think you should question our credibility, okay?
So presented here are the steps that we use to initiate
that cognitive phase of motor skill development
in the online environment in a physical therapy course.
I'll define each step and then Steph will provide you
with the examples from our modules.
So preparation is key when planning these e-learning modules
that teach psychomotor skills.
In planning our modules we had to inventory
what skills needed to be taught.
We had to break those skills down
into their smaller component parts
to decide which skills belong together in a module
and which skills were just too big
to complete in one single module, right?
We had to break some things apart.
So in other words, we had to be aware of the cognitive load
when building these modules, recognizing
that there is a limitation to working memory.
We also needed to consider
the learners' skill level and their needs.
And luckily Kellie and I
had taught this content pre pandemic.
And so we knew what the learners struggled the most with.
And sometimes we'd have to remind ourselves
to come back to that content
that they really had the hardest time with
prior to these e-learning modules.
It's very easy to get distracted by all that stuff could do
and so sometimes we had to remind ourselves,
okay that's flashy and that's me,
but we gotta come back to what the learner actually needs.
-: In terms of the experience of developing these modules,
planning and preparation really is a key step.
So we work collaboratively
for a significant amount of time prior
to filming or storing the development in the software.
And that allowed us time
to focus on kind of that big picture.
So we were able to look at
the scope and sequence of the project,
as well as the details
of how are we going to word this piece of information?
Are we keeping that consistent?
How are we going to present this content?
Taking the time upfront to ensure
that we had the scaffolding
and all of those components in place
before the development started really saved time
and limited the amount of revisions that we had later on.
-: All right we'll go on to the next step, conceptualization.
So this is where the learner is provided
with the cognitive elements of the skill.
So examples would include, this is where
we teach them the purpose of the measurement.
And we might also orient them to the equipment used.
Have them review the relevant anatomy.
Of course go through the procedural steps
and then common mistakes.
-: This is an example from one of our modules.
And when it came to presenting content
as Sara mentioned before,
we really want to lighten the load,
the cognitive load as much as possible.
And so that meant letting the narration be
the main content delivery method
while the visual supported those key points.
And this helps students from becoming overwhelmed
with information and really focus their attention
on the explanation being given, rather than trying
to read ahead or trying to put all these pieces together
when the narration is going to that job for them.
We also worked to chunk the information
into small, easily to digest pieces.
Again, lightening that cognitive load.
And once we had a piece of content, we would then follow it
by an interaction which broke it up.
It allowed the learner to be an active participant
in this content and also kept them engaged
throughout the piece.
Another example of how we used conceptualization
would be this weight-bearing status piece here.
And it's just an example of how we used a slider interaction
to give more context to these terms
and showing how they related to one another.
Building that contextual vocabulary
and showing how it relates to one another
is a large part of this step.
-: All right, so visualization is where
the learner sees the skills performed by an expert.
And of course, we'd been doing this in person for years.
The expert stands at the front of the lab
and demos the skill and then the students repeat it back.
But there's a real benefit to using video
in these e-learning modules
'cause of course we can slow the motion down,
we can zoom in on something that's real important.
We can use different angles
so the students can view it from different angles
and of course the students have the ability
to start, stop and replay any parts
that are more challenging for them.
-: Then in addition to those benefits
another benefit that they have is
that we can actually add in animation as needed.
So we did add this into all of the three videos
that would be overkill wasn't needed
but in cases like the gait patterns here,
adding the additional visualization
really deepens understanding and emphasizes details
that would be hard to capture with the demonstration alone.
-: And real quick, I will just say,
when it comes to those gait patterns
that's probably one of the trickiest things
I've taught students and as a, as an instructor,
I felt like I even learned it better
by having some of these visualizations.
So it was a great demonstration of that so yeah.
-: Another nice thing about having the videos
is that we're able to break down the processes more.
So again, it's about breaking it down
into those really easily digestible chokes.
And so in this example for the blood pressure procedure,
we actually had two videos works.
We had kind of the physical.
Here, you are with the patient.
And then we also had another one focusing on
what you hear while you're taking the blood pressure.
So, because there were multiple complex components
of this process.
So bring out those steps, let's learn
to understand it one piece at a time.
-: And I would just like to offer a shout out
to Jeff Gossman, Kellie's husband,
because we did the majority of our filming
during the pandemic.
We used the two of them so that we could produce the videos
without any masks.
And then that second video Stacey Christensen was involved
and that was post vaccines.
So we were lucky to get that in.
So next was verbalization.
So this is where the learner watches
the video with narration.
And this step also allows the learner
to review written steps.
And then the learner really should verbalize elements
of the skills.
So for example, we can ask or prompt the student
to describe the correct steps and the sequence.
We can also have them practice explaining
the purpose and the procedure in layman's terms
because we know that students have difficult time
transitioning from scientific language to layman's terms.
-: And in the modules and as part of verbalization,
we included written reviews of procedures
in addition to those videos because while having the videos
as a reasonable asset is invaluable,
sometimes students are looking
for a quick resource or overview
and it also just served as a nice reinforcement
of the video procedure that they just saw.
That also was helpful for taking notes as well.
In fact, to assist students with the verbalization process
we provided handouts that aligned with each module
that could serve as a note-taking guide.
And then in this example, again,
it's an example of verbalization,
where we had a very complicated decision making process,
which was how to determine a manual muscle testing grain
and we broke it down into more manageable chunks
as a flow chart for the students.
And again, just presenting
that information in multiple ways
reinforces those key ideas and helps reach all students.
So if they didn't understand it the first time
that the information was presented,
they have another opportunity to understand.
-: In the e-modules, knowledge checks with feedback
provide opportunities for students
to practice the cognitive aspects of the skill prior
to coming in for in-person labs.
So Steph will show you some of the examples.
-: So this is one example where you can see
a practice interaction for students
where they had to place the steps of a procedure in order.
And as mentioned before these steps,
these interactions really allow learners
to test their knowledge of what they have just learned.
They're able to build connections
between this concept and previous concepts
and they become more of an active learner
when they're using these interactions.
It keeps them engaged in the content
and also really helps target those misconceptions
before they become solidified.
In this case, it takes the learner
through a decision-making process
for what they need to use later in lab.
And so they have that confidence.
They know what that decision process is
before they have to apply it in person.
And then here is another example.
We can see a practice interaction for students
where they had to take a patient.
There we go.
Where they had to take a patient's wheelchair measurements
that were given to them and then actually decide
what the dimensions should be.
So they have to do those calculations
which is an activity that they're going
to be replicating in lab.
But again, having it here builds that confidence.
And also by using that case study format,
we're able to show how this content
is going to be used in real life as well.
We use case studies
throughout the entire modules quite frequently.
The second example that you see here is one where
the learner has to decide what comes next to a patient exam.
Again, that makes it more authentic.
It's very clear.
Shows the learner how they're going
to be using this information
and it makes them go through that process
in a kind of safe online environment with feedback.
Because of course, anytime
that we had any sort of interaction,
we wanted to include feedback.
So we know that learners are building skills
with these modules.
This is the very beginning of their learning phase of these.
And so having the ability to try again,
get that redirection, and then finally
if they still are not successful,
they are able to get detailed feedback and an explanation
on why they chose or why the correct answer is correct.
-: All right, so we still needed
to have the students come to in-person labs
to be able to have a hands-on practice
again, as we've mentioned.
But the e-learning modules did help them optimize
their time in lab.
The comments not show, oh there is, look at that.
The comment on this slide is actually from a student.
And so they did report that they had a good understanding
and they were prepared for lab.
Me as the instructor, I had more time as well.
I did not have to go over
the how-to instructions for everybody.
They could spend more time just practicing, right?
I think the other good thing
is not only could they have that more repetition
to really try to master the skills, but they had time
to get feedback from their lab instructors
which is crucial for them to master those skills.
Another benefit of the e-learning modules
is I had usually eight different lab instructors
kind of spread out during each lab period
and I shared the e-learning modules with them.
So they prepared for lab that way
and it helped ensure consistent messaging.
I was still available on Zoom for questions
but again there was just this clarity with the team
with these e-learning modules.
So you can also see just a few more comments
from the students on this slide
from my course evaluations.
I'm happy to report I had no negative responses.
In conclusion though, the modules really did help
to not only prepare, but the examples
of those therapists performing the skills
gave them this goal to strive for when attempting to master.
And again, you go back and use the examples when practicing.
So it really served as this valuable resource
for assessments where they were being graded
by their lab instructor on the performance.
So even though we created these modules during a pandemic
with goals of limiting contact with others,
maximizing that time in the virtual environment
these will continuously prove to be helpful
and useful in a post pandemic world.
The efficiency of learning the parts
of psychomotor skills virtually
while receiving that feedback really did help form
that cognitive knowledge needed
for those complex physical or motor skills.
So many skills are still going to require in-person sessions
to master them but I'm gonna challenge you and say
why not rethink how you teach psychomotor skill acquisition?
Thank you.
And we have just a few other slides
but we welcome questions as well in the chat.
-: If you would like to view these modules in their entirety,
you can always visit the UNMC e-gallery
which is linked here and we'll share
the presentation and believe out.
The UNMC gallery houses over 100,
actually hundreds of modules that are open access.
You can use in your classes if you'd like
and they're all developed
by UNMC students, staff and team and faculty.
We also have on there, the module scorecard
and other development resources.
So if you want to read modules like this yourself
we have a lot of modules.
We have a lot of resources that you can use
to help you throughout that development process.
Little tips and tricks that we've learned along the way
but also research-based methodology.
And then you can also contact elearnlab@unmc.edu
for more information
Any questions?
-: Hi, great presentation.
Can you talk about how you created your videos
and how you shot those and edited those for your module?
-: So I was obviously a star of the videos.
We did have a videographer that came.
He was from UNL and he came and shot.
So I did have to create a script, create video shots
like angles ways I really wanted to capture those skills.
Me obviously being the content expert,
I knew how those skills needed to be performed.
So it was easy for me to just kind of jump into that
but I really did outline exactly what we needed
to be shot throughout the day.
So I don't know if that, does that answer your question.
Thank you for that.
-: And then you forgot to mention
I was the off-screen narrator.
-: Yes, thank you.
So obviously, yes, we recorded everything.
Before Sara was reading the script
so that I was timing the video just right.
It really took a lot of people to get this created.
It was a beautiful team.
I mean, there's a question that
have you considered interprofessional approach
to a model, module?
And actually the course that I'm teaching
is becoming an interprofessional course.
I'll be teaching both physical therapy
and occupational therapy students.
And when we were developing these modules,
we actually had that in mind.
We tried to limit the use of physical therapy.
We tried to have more clinician rehab language.
So these modules I'm happy to say
are actually very considered, I would say interprofessional.
-: And if you do go to the e-gallery
that Kellie hopefully link there, you will see
that many of the modules are interprofessional by nature.
So it's certainly possible to take a module
and make it for an interprofessional purpose.
Just in this case, we had a course
that we were designing for.