Online education was not common in Sri Lanka until the COVID-19 pandemic, where, out of necessity, many universities adapted online teaching-learning activities, including institutions with undergraduate physiotherapy degree programmes. This study’s main objective was to explore the experience of online learning among physiotherapy undergraduates during the COVID-19 pandemic.
The study results indicate a significant increase in time spent on online learning during the pandemic and the most prominent reason for this result maybe that the universities had adapted to delivering online lectures (e.g. 53% of the participants mentioned Zoom or similar platforms). These results are similar to a study conducted in the United Kingdom [8]. Hence, it appears that, despite the economic ranking of a country, the pandemic, which caused limited choices to continue higher education, led to a rapid transition of higher education to an online provision in both developing and developed countries [11].
Equipment readiness is having a device and high technological readiness for online learning [4]. According to this study, 98% of participants owned a device to attend online classes where 51% had a mobile phone or 48% had a laptop. However, about 62% of the participants indicated that they had internet connection problems during classes. These result are similar to studies conducted in other Asian countries [4, 12], Poland [7] and the United Kingdom [8]. In fact, studies conducted in both Malaysia and Thailand on student readiness for online learning indicated that the highest indicator was obtained for equipment readiness [4]. With regards to participant information technology skills, our study results indicated that 78% have a moderate level of skill, a finding similar to a study conducted among Malaysian physiotherapy undergraduates [4]. Hence, though Sri Lanka is deemed a lower middle income country, its undergraduates’ information technology skills appear to be in par with more developed countries such as Malaysia, which may possibly be due to exposure to information technology skill training at schools in Sri Lanka. In fact, in 2002, the National Policy on Information Technology in School Education was introduced in Sri Lanka [13] which may have led to these results. It is recommended to have an introductory session on information technology and different online teaching-learning platforms as a part of the first-year university curriculum which may further enhance the knowledge related to online learning and related platforms.
In this study, 46% of the participants indicated that video tutorials had been used before the COVID-19 pandemic as an online learning tool. Most of the participants from a study in the United Kingdom too mentioned that they had used YouTube as an online learning method before the pandemic [8]. The reasons for the similarity in these results maybe that videos make education interesting, engaging, easy and conceptual [14]. Therefore, students appear to use these additional learning tools in both developing and developed countries.
In this study, though 25% of the participants indicated being able to be at home as an advantages of online learning, 28% indicated that technical problems (e.g. unstable internet connectivity, power failures, using different online education systems such as zoom) are one of the barriers to such learning. In Sri Lanka, only three universities offer physiotherapy degree programmes, and students from many parts of the country attend these programmes, whilst staying at hostels, away from home. This is a challenging situation for many students, including the added financial expense of staying away from home. Online education has given them an opportunity to stay at home and learn at their own pace. Yet, technical facilities such as internet connectivity might not be good in rural areas as it is in the cities. Therefore, when students access online classes from their home environment, especially in rural areas, there is a higher possibility of technical problems. Therefore, solutions to this factor should be considered when delivering online teaching or distance learning programmes in the future.
Active learning should be used for teaching-learning activities. The students’ engagement will be high in an active learning process. This can be achieved through interactive sessions during online classes which encourage students’ critical thinking. According to the study results, most participants (58%) indicated that online classes through live tutorials via zoom or a similar platform are effective compared to other methods (such as pre-recorded lectures, online question banks) because there is a possibility for student-teacher interaction. Also, 50% of the participants mentioned the opportunity to interact via speech as one of the factors for interactive sessions. However, a higher mean score was obtained for the criteria “I would like the online teaching to be more interactive”. This result is similar to a study conducted in the United Kingdom [8]. These indicate that lecturers should utilise different teaching strategies to make online classes more interactive. It is recommended that lecturers include small group discussions, online case simulations and quizzes to increase students’ engagement and interaction during online classes.
In this study, the perceived effectiveness of online learning versus in-person learning, in terms of increases in knowledge, clinical skills, and social competence were compared. A higher mean score was obtained for in-person learning compared to online learning in all of these domains. Nearly 78% of the participants mentioned that online classes cannot replace learning experience of practical classes or clinical training. A possible explanation for this might be that during in-person learning, students have opportunities for peer-to-peer interactions, group discussions, patient interactions, to learn from practical demonstrations by teachers, and to get live feedback during practical classes from teachers - this is of course other than live learning of the various clinical conditions. These factors contribute for social competence too. Social competence is defined as the ability to handle social interactions effectively [15]. However, it is not possible to have most of these factors in virtual classrooms. Similar findings were reported in studies conducted in other countries as well [7, 8].
According to the study results, 79% of the participants mentioned that online classes could not replace practical classes’ learning experience. Video demonstrations are commonly used for practical skill demonstration during online classes in Sri Lanka for physiotherapy programmes in pre-COVID time. However, in an in-person practical class, Peyton's teaching approach is often used for skills acquisition in health professions’ education [16]. This approach includes four main steps: demonstration, deconstruction, comprehension, and performance [16]. These steps include the teacher conducting a demonstration, without describing it verbally, of a particular technique, then repeats the steps of the technique; during this step, a teacher describes all necessary sub-steps (deconstruction) of the technique, and finally, a student explains each sub-step of the technique while the teacher follows the student’s instructions (comprehension). Physiotherapy practical classes are mainly focused on hands-on skill training. The students should be able to demonstrate those skills by themselves at the end of the class. This is hardly possible to achieve through virtual classes. Further, performing a live video demonstration by a teacher in a virtual class requires many infrastructure facilities and resources. This might not be readily available for every teacher. Therefore, this factor should be considered in a practical based course such as physiotherapy when its instructions are done via online education. Similarly, 78% of the participants mentioned that online classes did not replace clinical-based teaching. In a clinical setup, the traditional approach of Halsted’s teaching approach [17], “see one-do one” is often used for clinical teaching in Sri Lanka. In this approach, the teacher demonstrates and describes a procedure, and afterwards, the students practice the procedure [16]. This approach cannot be done in virtual classes. Tele-rehabilitation is used to provide clinical services for patients who need physiotherapy in some developed countries during the pandemic. In Sri Lanka, tele-rehabilitation is not widely available. There are many reasons such as technical issues, lack of knowledge among people to use tele-rehabilitation, lack of facilities in hospitals to deliver tele-rehabilitation for patients, etc. Therefore, it is not possible to arrange clinical classes using this virtual option during a pandemic in Sri Lanka. This might be the possible reason that online classes did not replace clinical-based teaching during the pandemic in Sri Lanka.
With regards to the future, the results indicate that most students prefer a hybrid teaching-learning method. Students indicated that they preferred to stay in the comfort of their home when learning theoretical parts which also has a financial saving for them. But they did indicate that for practical and clinical sessions, in-person teaching would be the best because skills acquisition is best in such a context of patient, peer and teacher interactions. Despite this preference for a certain component of online learning in the future, the students did have some reservation about it, such as the difficulty to concentrate constantly for hours in front of a screen, poor internet connection, lack of devices necessary for learning, family distractions, social isolation, and difficulty to study whilst always being at home.
The factors that influence the future learning preferences among physiotherapy undergraduates were assessed too. Participants were likely to select a preferred learning method based on the following factors: learning effectiveness, interactive classes, a stimulating learning system, an engaging learning system, provision to prepare for future professional tasks, and the effectiveness of the learning management system. On the other hand, the following factors were less likely to be associated with a future preferred learning method: study year, gender, internet connection, and options to ask questions. The Ranganathan et al. s’ results [4] indicated that gender did not influence online readiness too. The present study results indicated that students choose a future preferred learning method based on the effectiveness of online sessions in making them active learners and critical thinkers, not based on external barriers such as internet issues. Active learning include an interactive approach to education and training designed to engage learners as they strive to acquire and understand knowledge, [18].