Blended learning, a hybrid form of education that uses a combination of traditional on-site classes with online lectures and coursework, is becoming a more popular format used by schools and institutions for both higher education and continuing education. With the recent transition in O&P education from certificate programs to master’s degree in prosthetics-orthotics (MPO) programs, Northwestern University Prosthetics-Orthotics Center (NUPOC) is preparing to launch its new MPO program in July using a blended learning format.

The MPO blended learning program will replace NUPOC’s existing blended learning certificate program that began in 2007. At its inception, the blended learning program initially was envisioned as a way to increase the number of students that could be accepted into the school’s O&P program, and it also represented a new way to bring in additional funding for the school, Mark Edwards, MHPE, CP, director of professional and clinical services for Ottobock, said.

“With new technology developing and having the ability to use the Internet and web-based learning as a means to deliver a portion of the curriculum, the faculty thought offering parts of the curriculum online through interactive web-based learning was a valuable option. NUPOC could enroll an additional class to increase tuition revenue to help with faculty salaries, and professional development, add materials, add support staff and grow our revenue stream to raise the level of the program moving forward,” said Edwards, who was the director of prosthetics education at NUPOC during the development of the blended learning program.

The blended learning format also would give students the option of continuing to work during the online portion of the course. This, in turn, would then decrease the length of time that students would be away from not only their jobs but also their families.

After initially developing the infrastructure and hiring technical support staff as well as an instructional designer, the appropriate hardware and software for recording, capturing, and archiving the lectures as well as allowing online interaction with the students was obtained and installed. The planning and development of the program process took approximately 1 year. The final format for the blended certificate program consisted of 5 months of online education followed by 2.5 months of onsite education.

Approximately 750 students have graduated from NUPOC’s blended learning certificate program in the past 5 years. The blended learning format has seemed to be particularly suited for NUPOC’s diverse mix of traditional and nontraditional students, Steven A. Gard, PhD, executive director of Northwestern University Prosthetics-Orthotics Center, director of Jesse Brown VAMC Motion Analysis Research Laboratory, and a research associate professor in the department of physical medicine and rehabilitation at Feinberg School of Medicine, said.


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“The blended format has been received well by students. Students respond positively to it, and all indicators are that they perform just as well or better than they did previously when we had the exclusively on-site education,” Gard said.

As expected, Gard noted that many of the students who enroll in NUPOC’S blended learning program tend to be older and already have full-time jobs and positions, families and homes. In addition, some of the students often are in the process of transitioning from other positions or even careers.

“It is not unusual to have people come in with little or no experience in orthotics or prosthetics,” Gard said. “We recommend that students try to get some experience, even if it is volunteering in a local O&P clinic just so they have a better understanding of what the career involves and what they are getting into.”

The expanded, 21-month MPO program will keep roughly the same format as the previous certificate program. However, significant content will be added and the scope of most of the classes will be expanded.

A maximum of 48 students will be accepted in the MPO program per year. Students also must meet prerequisites such as having a 4-year college degree and successful completion of various courses in physics, biology/life sciences, and chemistry.

Online challenges

Prior to beginning the online portion of the program, students are required to attend a mandatory orientation. In addition to receiving an in-depth overview of the program objectives and expectations, students will get to meet faculty and fellow classmates, and then become familiar with the campus and surrounding area. To help ensure success and avoid any technical issues that may arise, students also receive a new laptop computer preloaded with all of the necessary software to complete the online coursework.

“When we first started the blended learning format, we would have 48 people show up with their own computers. We were having everybody try to go through loading software and invariably there was always a handful of people with a computer that just was not accepting the software,” Chris Robinson, MBA, CPO, ATC, FAAOP, assistant director of orthotics education and assistant professor of physical medicine and rehabilitation at Northwestern University Prosthetics-Orthotics Center, said. “We found out it would be much more efficient to actually incorporate giving everybody a new laptop computer and creating a student lab fee so that when students came on site, everybody got the same brand new computer loaded with the software.”

Online content for the MPO program will be delivered via various formats such as recorded lectures and required reading that were used in the certificate program. Students also have opportunities to interact online with faculty and peers through instant messaging, discussion boards, videoconferencing and chat session.

Unlike the lectures for the certificate program, all of the lectures for the MPO program will be filmed in a studio without students present.

“That is something else we learned. Previously, we thought that recording lectures as they were given in class, such as lectures on various concepts of orthotic and prosthetic education, fabrication lectures, and things of that nature, made perfect sense,” Robinson said. “In retrospect, we found out it was a more effective learning tool to have a lecture recorded with the lecturer speaking right to the camera so that students viewing that lecture feel the lecturer is talking directly to them, and the quality would be better as well.”

Another benefit to recording online lectures in a studio rather than live in a traditional classroom is that cameras can be focused directly on objects, providing an up-close view. In addition, because watching a lecture online is different than sitting in a classroom and listening to a live lecture, other techniques and media can be used to help keep students involved and engaged.

For example, students can participate in on-line polling. Using different audiovisual technology such as videos and animations can help break up lectures, and interactive highlights within a PowerPoint presentation can also be incorporated into lectures.

Another important consideration for keeping students interested and engaged is to shorten the length of online lectures compared with classroom lectures. 
Thomas P. Karolewski, CP, FAAOP, supervisor of orthotics and prosthetics at Hines VA Medical Center and a previous director of prosthetics at NUPOC, noted studies have reported that “the average medical school student has a 15-minute attention span.” For lengthy online lectures, that can represent what he described as “a lack of attention span in the middle,” the lecture needs to be limited to 30-45 minutes with student tasks in the middle to maintain attention span. Furthermore, students can be even less engaged if a lecturer speaks in a monotone voice or appears non-charismatic on camera.

Karolewski also noted that establishing a social aspect of online education for students represents a huge challenge and one that most of the research in distance education has been directed lately. “One of the benefits of a brick and mortar setting is that you get to talk to students face to face every day. There is a social gathering aspect to school,” Karolewski said. “How do you establish that social aspect, the social benefits, to online learning?”

Predicting student success

Some research has indicated that some characteristics and factors may predict a student’s success in blended learning. For his master’s thesis, Desmond J. Masterton, MS, CO, CPed, director of orthotic education at Northwestern University Prosthetics-Orthotics Center, examined such predictors, with a focus on students at NUPOC.

“One of the things that spurred my interest in this for my master’s thesis was that the graduate program at Northwestern University School of Education and Social Policy does a nice job of tying in educational content as well as experiential learning,” Masterton said. “The natural progression for me was to tie in predictors of success in our program with the educational content that I was going through in my master’s process.”

After conducting an extensive literature review, Masterton identified seven factors as potential predictors of student success in NUPOC’s blended learning program:

• Demographics (age, gender, work experience, parental education)

• Educational attainment (bachelor’s or master’s degree, coursework, grade point average [GPA])

• Technical proficiency

• Self-regulation or self-efficacy

• Learning style

• Student engagement, and

• Faculty engagement.

His research indicated that for student demographics, the only predictor of success in the blended learning program was gender, with females tending to perform better than males. Masterton noted that this finding was consistent with the medical literature for undergraduate education.

For educational attainment, one of the highest correlations of predictors of success in the program was undergraduate GPA.

“Within the cohort of students that I looked at here at NUPOC, GPA or previous GPA was the highest correlation of success,” Masterton said.

In contrast, technical proficiency did not have much impact on predicting student success at NUPOC. Masterton noted that students in the NUPOC course who responded by survey indicated they considered themselves as technically proficient.

Self-regulation or self-efficacy, which Masterton defined as students’ ability to achieve their educational goal while balancing other aspects of their personal lives, was identified by students as being the most challenging aspect of attending the blended learning program.

“A number of our students, they are working full-time, they have families, they have an online education program that they are going thru, which is rigorous, and they found it a challenge to juggle those different aspects of their lives,” Masterton said.

In regard to learning style, Masterton found that across the board, all of the students described themselves as learning by doing. Students reported that although the online portion of the blended learning program provided them with the concepts of O&P practice, it really did not “click” until they began the on-site classes and were able to start actually practicing what they had been learning.

Masterton found that the final two factors, student engagement and faculty engagement, were somewhat intertwined, with both being key in regard to a learning environment. Basically, the more engaged students are in the learning process, the more they will get out of it. “Students said that one of the biggest positive aspects of the program both online and on-site is engaging with their fellow classmates, faculty, and educational models, and being in direct content with the actual educational process,” Masterton said. “They thought that was the best part: being actually able to see things, touch things, feel things; assess, formulate, make, and fit the orthoses and prostheses.”

Financing options

The combined annual tuition and laboratory fees for the MPO program at NUPOC is approximately $30,500. The majority of students typically will be able to qualify for financial aid or federal student loans. Students also may use their own money or resources, or some students are able to borrow money from family members. Organizations and private facilities can be another source for students to obtain funding for their tuition.

“We have had students who will actually be sponsored by the facility they are working for,” Robinson said. “Sometimes a facility will pay for a student’s education and then in return the student will have signed a contract to work for that company for a certain length of time once they finish their educational process.” — by Mary L. Jerrell, ELS

Disclosures: The sources for this story have no relevant financial disclosures.

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