Hybrid Education
Does It Work for O&P?

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"Blended learning is a hybrid of classroom and online learning that includes some of the conveniences of online courses without the complete loss of face-to-face contact."

—Alfred P. Rovai and Hope M. Jordan, "Blended Learning and Sense of Community: A Comparative Analysis with Traditional and Fully Online Graduate Courses," The International Review of Research in Open and Distance Learning, August 2004.

When The O&P EDGE asked O&P educators and practitioners for their opinions about online learning, most agreed the benefits include flexibility, asynchronous delivery, and convenience. They also agreed, however, that such learning does not allow for the face-to-face interaction that occurs in a traditional classroom setting.

The instantaneous feedback from a trained educator throughout the educational process during student interaction is lost, says Matt Parente, MS, PT, CPO, curriculum coordinator of the Newington Certificate Program (NCP) in Orthotics & Prosthetics, Connecticut, and clinical program director of the University of Hartford, Connecticut, master of science in prosthetics and orthotics (MSPO) program. "The student does work with a certified clinician in the field, but that doesn't mean the clinician has a background in education," Parente says.

Christopher Hovorka, MS, CPO, LPO, FAAOP, co-director of the Georgia Institute of Technology (Georgia Tech), Atlanta, MSPO program, agrees."The cons are the loss of the critical face-to-face interpersonal interaction between faculty members and students," he says. "That interaction is critical because it provides a greater ability for faculty members to adjust their teaching style and approach to each student in order to maximize the student's learning.

"Face-to-face learning is optimal," he continues, "particularly in teaching students abstract concepts like clinical patient evaluation and treatment formulation, and when mentoring students in their faculty-directed research. When I attempt to teach those concepts online, the outcome is not as effective."

A true bond between student and instructor is never achieved virtually, according to Chad Duncan, PhD, CRC, CPO, associate professor and program director for the MSPO program at Alabama State University (ASU), Montgomery. With the online approach to education, "You possibly never develop a true cohort," he says.

Robert Rhodes, MPA, CO, FAAOP, assistant professor and director of the Eastern Michigan University (EMU), Ypsilanti, O&P master's degree program, and Frank Fedel, MS, CES, EMU assistant professor, agree that the ability to instantaneously assess aggregate student responses and synchronous discussions are limited in the online education model. "Students thrive on immediate feedback, and the ability to provide it online is not optimal yet," Rhodes says. In addition, the affective domain, which they say is "critical" to the teaching profession, is not able to be addressed effectively, since students are not interacting physically with each other when learning in a virtual setting. Perhaps most importantly, Fedel says, "The lack of a student's physical presence during clinical and technical procedures deprives them of critical kinesthetic and aural feedback that can occur in an on-ground setting."

Ray Burdett, PhD, MS, CO, CPed, says communication is more difficult with online learning, not just for students, but also for educators. "Students have a harder time asking questions, and instructors have a harder time knowing if a student is having problems," says Burdett, who is director of the MSPO program at the University of Pittsburgh (Pitt), Pennsylvania. Some students also do better in a traditional classroom setting because of their learning styles, he says.

When The O&P EDGE asked students how they feel about online learning, their responses varied.

Eric Katz, CP, LP, is about halfway through the MPO distance learning program (DLP), a collaboration between NCP and the University of Hartford. A student's motivation level can be a big disadvantage to online learning, says Katz, who completed his prosthetics certificate in a traditional classroom setting through NCP, which is affiliated with the University of Hartford. Online education allows students to "attend class in the comfort of their own home, office, or wherever they would like to be," he says. However, he adds, "A student can easily fall behind if he or she does not follow the weekly schedule."

Amy Gibson is a student in the master of prosthetics-orthotics (MPO) program at the University of Texas Southwestern (UT Southwestern), Dallas. She says answers to her questions to faculty members don't come fast enough via online learning. "You're unable to get quick answers to your questions," says Gibson, who has also worked as a prosthetic technician for the last three years. "And there's less involved learning."

Jaime Perez Pineda, a first-year student in the UT Southwestern MPO program, says one barrier to learning in the online environment stems from whether the student understands how the online classroom works. "If the user is not familiar with an online learning program, it can be hard to maneuver for the professor and the student," he says.

Melissa Burner, who is completing her first year of EMU's O&P graduate program, agrees with Hovorka, saying that the lack of face-to-face interaction can be a barrier to learning online. She completed an online undergraduate course in world literature, and while the topic was fascinating, never seeing her teacher or her classmates was "a huge detriment from what I was able to draw from the course." She says she missed the stimulation of real human interaction and "the organic feel of real-time brainstorming."

Online Learning Has Its Place

For all of its drawbacks, most O&P practitioners and educators agree that there is a place for online learning in practitioner education programs. John Michael, MEd, CPO, LPO, FAAOP, FISPO, associate director of the Northwestern University Prosthetic-Orthotic Center (NUPOC), Chicago, Illinois, says he has been a "friendly skeptic" toward online learning. After gaining experience with a structured hybrid learning program, however, he has grown less skeptical. "Online education certainly reduces time constraints," Michael says. Unlike traditional learning, where all students gather at the same time and place, online learning offers more flexibility. "We don't all have to be in the same spot at the same time. We can eliminate the need for classroom space and reduce costs. We can improve access and, to some degree, we can bypass some brick-and-mortar limitations."

Online learning can reach just about anyone who is willing to learn and has the necessary tools—electricity, a computer, Internet access, and a certified host facility, Parente says. Online and traditional learning also can be effectively complements to each other.

Susan Kapp, MEd, CPO, LPO, associate professor and director of the UT Southwestern MPO program, says its O&P program requires students to be on campus. However, she adds, "Much of our prosthetic and orthotic didactic content is provided online and followed up by review and discussion." While key lectures are delivered live, students always have access to the electronic version for study and additional review. All course documents, such as syllabi and schedules, articles, links, assignments, and measurement forms are also available to students online, she says.

"One advantage to this format is that students and faculty have access to the most current curriculum in one location," Kapp says. "Changes are easily made, and all users have immediate access to new material."

UT Southwestern instructors use an electronic discussion board even though they see their students nearly every day, Kapp says. "This is just another tool to provide learning opportunities. Patient and laboratory experiences are taught in the traditional manner, but we find that students are better prepared because they have the ability to view demonstrations and read lectures beforehand."

According to Parente, the core of O&P practitioner education programs has stayed fairly consistent over the years. "The lecture classroom portion is the same, whether you are sitting in the classroom or in your kitchen," he says.

For NCP's distant learning program, all lectures are recorded and delivered to students through a learning management system called Blackboard, along with supplemental notes, readings, and assignments, Parente says. "At the end of the semester, the student comes to our facility to take a comprehensive practical exam to assure us they have...obtained the necessary knowledge to complete the course," he says.

At Georgia Tech, instruction and teaching are best when performed across a variety of platforms rather than when they are focused on a single approach, Hovorka explains. "This approach provides a better opportunity to address a variety of learning needs…since not all students learn in the same manner or mode."

Georgia Tech does not emphasize online learning in its graduate programs, however, because there is not enough data to show that online learning is "any more effective than our current curricular approaches to faculty instruction and student learning," Hovorka says. The school needs more data to justify a "significant change in our approaches, which currently have been very effective and successful in producing graduates who are highly knowledgeable and who are sought out and perform well in the O&P clinical and research arenas," he says.

Advantages of Hybrid Education

NUPOC has adopted a hybrid or blended-learning model for its O&P practitioner education program. About 144 O&P students graduate from NUPOC's education program every year, according to Michael. When classes begin, students are required to travel to Chicago and spend their first week on campus attending orientation and completing a series of activities that help build a sense of cohesion as a class. During orientation, each student is issued a new computer and practices accessing the online course management system, he explains. Labs fees cover the costs of the computer and software, and the school has a full-time information technology expert on call seven days a week.

The face-to-face interaction and the online component "blend" well together for students and faculty at Northwestern, Michael says. The program's "self-pacing" component is also popular with students. "Our students like that they...can repeat portions of a challenging lecture as many times as they wish." Because students master fundamental concepts prior to coming to campus, Northwestern can focus on the development of technical and clinical skills, fitting educational models, and related psychomotor skills from the first to the last day of their Chicago experience.

ASU's Duncan says the jury is still out when it comes to determining whether online and traditional learning go hand in hand. "I personally do better as a student in the traditional classroom," he says. "I need the engagement."

There is a certain advantage for traditional students when their courses are taught simultaneously online, Duncan says. "The traditional student can engage in class and then go home and watch the class again to clarify something."

Presently, ASU has one hybrid course, Duncan says. "We're primarily focusing on getting accredited. As we move forward and our curriculum evolves, we'll be thinking about what would be the most effective ways to blend online learning with the traditional curriculum."

Like Duncan, EMU's Rhodes and Fedel are still undecided. "We had two classes that were offered online, but they were converted to lecture classes after students provided feedback that they did not think the material was best covered online," Fedel says.

EMU's O&P education program uses the Internet for the initial presentation of material, student self and peer assessment, and material review. EMU currently does not have plans to offer an online learning component, Rhodes says. "We do not think that an evidence-based critical thinking requirement is suited to the traditional hybrid or blended-learning format. However, the use of ever-improving technologies in the delivery of information and evaluation is necessary."

Pitt offers one online class in its MSPO curriculum, an O&P business practices course offered during the final term of the program, Burdett says. It allows students to do their final clinical internship away from school. Offering the school's entire program in a blended setting would be difficult, he says. "The amount of laboratory time needed is extensive, so there will always be in-class time needed."

Burdett says he could envision a scenario in which the school offered students the option of completing the first term of its five-term program online. This is when a lot of background information about pathology, biomechanics, research methods, kinesiology, and professional issues is presented. The three middle terms, however, would be difficult to offer online because the primary O&P laboratory courses are offered during that time, he says.

The majority of educators interviewed for this article agree that students who are highly motivated to learn benefit the most from the hybrid education model.

"I have found over the last five years of teaching that motivated and well-organized students tend to do better than non-motivated students [in the online learning environment]," Duncan says. "One could say this about the traditional classroom, but there's a huge difference. In the traditional classroom, there's structure when students meet. This structure and meeting allows the instructor to visually and interactively evaluate the students." Virtual learning is different, he says. "You can't glean non-verbal feedback. You can only judge by the questions [students] ask or lack of questions they ask."

According to Michael, students who excel in a blended-learning format generally share four characteristics: they are more mature, self-motivated, are better independent learners, and have better time-management skills.

Students must have strong self-discipline to learn in a virtual environment, Burdett agrees, "especially for those who have other obligations such as work or family."

Hybrid Model Becoming More Popular

Hybrid or blended-learning models have been in use for decades, but they have become much more popular over the last ten to 15 years as Internet technology has advanced.

"[Internet technology] has been the leading mover of the blended model," Duncan says. "Advances in the speed of the Internet and better online teaching packages such as Blackboard and Moodle have made online education more attainable."

Convenience and a decreased need for physical space are also factors that make hybrid learning popular, educators say.

"One reason why online combination approaches to learning are popular," Hovorka says, is that "[such] approaches have the potential to free up physical space for other uses when students are engaged in online learning."

Online or Traditional: Which Is Better?

University of Hartford student Katz completed the coursework for his undergraduate degree as a seated student at the University of Arizona, Tucson. While attending the university, he completed several online courses. "The [online] classes I took did not have weekly meetings, e-mails, conference calls, or videos," he remembers. "There were just reading assignments, questions to be answered, and essays to be written, all of which were due at the end of the semester. There was no [regular] communication between the teacher and student. If we had a question, an e-mail would be sent to the professor and answered within a week or two."

Though Katz, now 29 years old, prefers being a student in a traditional classroom setting, he says that it is unrealistic for him to continue his education in that manner. "Now that my life has begun, it would be almost impossible for me to stop everything, move, complete school and a residency, then move back and start where I left off. As a current distant learning student who has already completed prosthetics as a seated student, I feel confident with the education I'm receiving in the field of orthotics."

UT Southwestern students Gibson and Pineda favor hybrid education programs. "I enjoy having the online resource as a study reference, and the ability to quickly upload, rather than print, my assignments is an advantage," Gibson says.

Nothing can replace a person teaching a course live, Pineda adds. "I took an online psychology course in undergrad, and I don't remember learning much," he says. "I can't imagine having all information solely and completely online again, especially with how hands-on and clinical an O&P course can be."

Burner says she prefers EMU's hybrid classes because they combine the best aspects of traditional and online classes to streamline education. "I have found that hybrid classes offer the perfect balance of social interaction in the classroom with the wealth of the Internet's resources in an online component," she says.

Michael says contemporary students and teachers don't have to choose one over the other. "We're wise to keep both, blended and traditional learning, alive and thriving."

Betta Ferrendelli can be reached at

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