This is part three of a series on how COVID-19 is affecting physical therapy. Part one addresses outpatient physical therapy. Part two addresses hospital-based physical therapy. This article is about how the virus has affected students not in their final year of physical therapy school.
With COVID-19 causing cancellations around the world, schools have been upended for current physical therapy students who suddenly had their campuses closed and classes switched online.
Some students have remained in their dorms or housing located near school, while others have left campus to move back in with their parents or other relatives and friends. Some students have ended up in alternate time zones or with poor internet connections that can make attending online courses difficult.
Others have had to take care of sick relatives or deal with the stresses of living alone for an undetermined period of time. Dr. Samantha Brown, PT, DPT, GCS, Assistant Director of Clinical Education and Assistant Professor, at Ithaca College, said, “Some [students] are doing okay with it, though it is not an ideal situation, and some are really struggling. I think it is more work for both faculty and students doing courses remotely. None of our courses were designed to be taught this way. There are many students who are having a lot of anxiety about the current pandemic making it very difficult to focus on schoolwork. There are also students who are taking care of siblings, parents, or other family members. And even some are working to support their family because parents were laid off or can’t work due to health conditions. It’s a complicated situation.”
She added, “It is so much more than simply putting a class online – there are so many variables and it is important to consider each student’s situation individually. We also have to be cognizant of students’ mental health during this very stressful time.”
For students who have children at home, switching to online learning while having to care for children is extra challenging.
Dawnette Waters, a first-year student at South College, and the host of the Moms in PT School Podcast, said, “My biggest fear [is] not being able to keep up with the accelerated demands of my program, while also maintaining my 6-year-old’s classwork and activities until my husband [comes] home later in the evening. Even with a detailed schedule of our daily tasks, she usually finishe[s] her work earlier than expected. This [means] her screen time (and my mom guilt) was drastically increased to keep her occupied while I was in class and/or studying.”
Aside from students’ personal difficulties, there is also the matter of how to quickly transfer a very hands-on curriculum to online learning. The main question for programs according to Dr. Randy Kolodny, PT, DPT, MA, an Assistant Professor at in Seton Hall University’s Department of Physical Therapy, is, “How do you teach clinical skills?”
While he pointed out you can teach many psychosocial skills online, clinical interventions are different. Seton Hall has had those students who are living with others practice certain hands-on skills, but for others, this is impossible.
During this period of uncertainty and social distancing, he said, “The only thing we can control is to try to protect one another.”
Many schools are giving students “incompletes” for this semester, and plan on making up the labs at a later date. Some schools are rearranging their curriculums, moving courses that more easily lend themselves to online instruction sooner, and pushing back classes that require more hands-on learning.
According to Dr. Kevin Wong, PT, PhD, MS, an Associate Professor of Rehabilitation and Regenerative Medicine at Columbia University, “The most difficult thing is the uncertainty of timing.”
It is unclear when schools will be able to reopen and what changes will need to take place for them to do so safely. He added, “We forget that the very basics [of physical therapy] aren’t that easy when you’re first trying to learn it. You’re responsible for someone’s else health – some things have to be reserved for an in-person class, even if it’s three straight weeks of eight-hour labs.”
Brown stated her program is currently surveying its students to get a sense of what is working well and what is not so they can make improvements should class have to remain online for the fall semester.
The Commission of Accreditation in Physical Therapy Education (CAPTE) has issued several statements on COVID-19, stressing “there are unique circumstances for each program and for their individual students.”
Additionally, the American Council of Academic Physical Therapy has put out several resources for both students and educators during this time.
There are two main methods of virtual instruction: synchronous classes, where everyone convenes at the same time through a channel such as Zoom to hear a live lecture, and asynchronous classes, where students watch prerecorded lectures on their own.
There are pros and cons to both of these options.
For synchronous lectures, Dashaé Smallwood, a second-year physical therapy student at Duke University, notes many professors ask their students to keep their cameras on so that classes feel more “real.”
Asynchronous classes allow students to go at their own pace, however, many acknowledge that it can also be easier to zone out.
Sarah Falbo, a second-year physical therapy student at a school in Pennsylvania, admitted that it is harder to find the motivation to study without being surrounded by her peers.
In addition to classes, exams have also gone online. While it isn’t technically difficult to administer a test online, the challenging part is maintaining the test’s integrity. Many schools have taken to reminding students of their honor codes.
Wong called upon instructors to do things differently, "You have to assume people can cheat and build a different kind of test." He said he personally makes some of his exams open book and allows students to talk to one another because they “learn best from that.”
Some courses use platforms such as ProctorU and ExamSoft, which claim to virtually proctor exam takers. Still other instructors insist students place their phones behind them for Zoom calls so instructors can monitor their laptop screens and make sure they’re not looking things up. However, this requires students to have access to multiple devices, and as one professor pointed out, it doesn’t mean students can’t still cheat by placing notes somewhere hidden by their cameras.
Many schools are looking to the physical therapy programs at schools such as Baylor University and the University of St. Augustine, which utilize hybrid models of learning combining online distance learning with in-person sessions.
These schools are already used to employing virtual classrooms and are in many ways better equipped to handle the current climate than traditional schools.
Savanna Van Diest, a student at Baylor University Hybrid DPT Program, notes she is proud of her program for “reaching out to assist other programs with the transition to online learning.”
However, these programs aren’t unaffected by the virus. Their hands-on components will still have to be made up eventually.
Dr. Peyton Sykes, PT, DPT, a Core Faculty Instructor at the University of St. Augustine for Health Sciences, Flex Doctor of Physical Therapy Program in Austin, Texas, said, “For those skills that require equipment or where safety becomes a concern, like learning to perform spinal thrust manipulation as an example, those skills will be assessed once on-campus instruction resumes. We have to continue to uphold our standards to ensure that our students are entering the clinical world, whether an internship or after graduation, proficient in the skills necessary to provide the highest quality care.”
Van Diest said she is comforted knowing she is not alone with her struggles as a student: “We are trying to figure out a new normal together. If you are a student who is dealing with fears and anxieties about moving online, don't worry! You're not alone. Your faculty feel it too and there are hundreds of other students just like you who are trying to adapt to this new way of life. It will take time to figure out what works best for you, and that is ok. Something I wish I would have been told is that ‘You won't have it all figured out right away.’ Your life just got turned upside down, and it's okay to grieve a little. The truth is we all are in some way. So my words of encouragement to you are to take one day at a time while giving yourself a little grace. You're going to figure this out too.”
Brown had similar thoughts, saying, “I think we are going to see a lot of changes in PT education and practice because of COVID-19 – both in pedagogy and in actual clinical practice. Physical therapists are always up for a challenge, and this is one we will certainly take head on!”
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