Active digital pedagogies as a substitute for clinical placement during the COVID-19 pandemic: the case of physiotherapy education
Authors: Wojniusz Slawomir , Thorkildsen Vibeke Dehli , Heiszter Silje Therese , Røe Yngve 
Published: December 2022

Abstract
Background
In March 2020, campuses at Norwegian academic institutions were closed due to the COVID-19 pandemic. All in-person teaching had to be replaced by digital alternatives. The closure also affected clinical placements in physiotherapy programs, which in some cases had to be replaced by online alternatives without patient contact. The aim of this study is to evaluate the benefits and challenges of using digital pedagogies to accomplish the learning outcomes of clinical placements.

Methods
Forty-four final-year physiotherapy students at Oslo Metropolitan University had their clinical placement substituted by an online alternative centered around two main educational activities conducted online in small groups: 1) clinical case seminars and 2) digital lectures followed by webinars where students discussed and solved tasks related to the lectures. Additionally, as a part of this alternative placement, students had to conduct a physiotherapy assessment of a family member/housemate and summarize the findings in an anonymized medical record. At the end of the placement, all students wrote a short essay reflecting on their learning process. Students’ written reflections were anonymized and subjected to a qualitative analysis.

Results
Forty-three out of 44 participating students completed their essays. Although students expressed disappointment in missing out on clinical placement, they were surprised by how much learning the online alternative provided. The most valued activities were clinical case seminars where clinical cases previously experienced by the students were discussed. The seminars appeared to facilitate students’ engagement in professional discussions and to enhance their clinical reasoning skills. Seminars also seemed to strengthen students’ belief in their own and their fellow students’ capabilities. Group discussions focusing on topics related to digital lectures were also appreciated. Interestingly, the activity that most closely mimicked a clinical setting – physiotherapy assessment of family member/housemate – was rarely mentioned in the students’ essays. As expected, students most regret not meeting real patients and missing out on the new clinical experiences such encounters would provide.

Conclusions
Despite lack of direct patient contact, students in physiotherapy education evaluated that an online alternative placement was highly clinically relevant. Peer-to-peer discussions of clinical cases appeared to be especially valued. The fact that students themselves had to take the main responsibility for preparing the seminars and leading the discussions was an important pedagogical aspect of the online alternative. The findings indicate that in learning of clinical skills, physiotherapy students take benefit of autonomous, student-centered interventions. Further research should investigate how digital technology-enhanced learning can be used to improve quality of ordinary clinical placement, in physiotherapy- and health education.