Physical therapy training online? It can be done—and done well

Physical therapy training online? It can be done—and done well
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When James Gordon first heard the idea of creating an online version of USC’s residential Doctor of Physical Therapy (DPT) program, he didn’t think it would work.

“My initial reaction was ‘nope, it can’t be done’,” said Gordon, the associate dean and chair of the university’s Division of Biokinesiology and Physical Therapy. “This is a very hands-on profession and most people wonder how you can train physical therapists using online technologies.”

But since last fall, when USC launched its hybrid online/on-campus DPT@USC program, the benefits of blending physical therapy with digital education have become clear. Students can participate from around the country without having to move to Los Angeles.

Each week students watch and interact with produced video and interactive exercises at their own pace, preparing for weekly online class sessions. Anatomical videos help students visualize physiology and techniques in ways that no textbook or live demonstration can. Videos feature animations of nerve, tendon, and muscle movements superimposed on actual bodily movements, helping students visualize movement dynamics from every perspective.

Weekly online live classes are led by USC faculty, and designed to ensure students understand concepts and how to apply them in clinical settings. During live sessions and afterwards students can access asynchronous content to reinforce what they discussed. Live classes are capped at 12 students to ensure quality engagement among participants and professors. “Faculty love this kind of teaching,” says Gordon. “Teachers thrive in small groups.”

A central challenge of teaching physical therapy in a hybrid environment is to ensure students acquire hands-on diagnostic and clinical skills. Some of this is accomplished in live sessions, including in some courses, reviewing self-filmed videos of students practicing techniques. However, every student is assessed for every key skill in person at regular multi-day “immersions” held at the USC campus. There, students practice hands-on skills and complete the same rigorous assessments as their counterparts in the residential program. Likewise, DPT@USC students spend the same amount of time as residential students doing clinical work under the supervision of licensed physical therapists — roughly 50 weeks in clinics over the three year program.

“I don’t see this as a fundamentally different way to teach,” said Gordon. “It’s just one pathway to get that same education, except this one is built around technology. I think we’re really looking at the future of all education here.”

Using technology to increase access to top quality education

Gordon sees USC’s leadership in building the hybrid DPT@USC as part of its mission to increase access to the highest quality of physical therapy instruction. Physical therapists are in high demand, driven by demographic trends and the growth in chronic illness. The Bureau of Labor Statistics expects the ranks of physical therapists to jump by 28% by 2026, much faster than the 7% growth rate for all occupations.

At the same time physical therapy is, like other medical professions, specializing. For most of the 20th century, physical therapists helped people recover from debilitating diseases like polio and stroke. Today, however, physical therapists can specialize in orthopedics, neurology, pediatrics, sports medicine, and acute care. They can focus on issues associated with balance and the vestibular system, child development, pelvic floor disorders, oncology, and wound care.

Growing demand and increasing specialization creates a practical challenge. How can the profession ensure students from around the country can access the kind of faculty and resources that a top-ranked program like USC offers? Some colleges have reacted to increased demand by rushing to start new programs, hoping to attract nearby students.

Gordon believes a better path for the profession is to expand capacity at high-quality schools, creating hybrid programs like DPT@USC and establishing a national presence. “We believe that starting new programs is the wrong way to meet the growing need for physical therapists. Unfortunately, most new programs are too small and have insufficient resources. Physical therapy is a much more complex discipline than it used to be. Educating physical therapists requires large faculties with a breadth of expertise. Good programs need to be getting larger, not smaller.”

USC’s use of digital education allows it to extend the reach of renowned faculty and researchers to the communities where prospective students live, without requiring them to uproot their families to live in Los Angeles. This shows, Gordon said, how technology can advance societal and institutional goals. “First, increased access means greater student diversity. Second, we want our program to have national reach, to train the very best practitioners, who we believe, will transform healthcare. We want our program and our graduates to be positioned to partner with the emerging 21st century health systems around the country.”

Using digital education and data to reengineer physical therapy education

When people think of physical therapy, they think of hands-on skills, but clinical decision-making skills are just as important. “Scientific evidence related to our patients is literally at our fingertips,” said Gordon. Learning how to understand the patient’s situation, holistically, and apply evidence-based practices is non-negotiable. “It’s not just about knowing where to put your hands or how to manipulate a joint,” said Gordon. “It’s about using the right kind of interpretation of current evidence, the patient’s particular issues, and data to make the right clinical decision.”

Here again, Gordon thinks digital learning will advance the quality of practitioner education. In increasing the time that faculty can spend in small groups assessing how students apply information to real-world scenarios, “the shift to online learning can actually help us do a better job preparing our students to be intelligent, sophisticated clinical decision makers.”

The role of physical therapists in communities around the country is only going to grow, along with their potential to help solve some of the thorniest issues in health care. Physical therapists can assist the growing number of middle-aged Americans with chronic diseases including diabetes, obesity and arthritis. “Physical therapists can play a critical role helping keep these individuals productive and happy as they age,” said Gordon. “Chronic pain is a huge problem in our society and we are experiencing a major crisis of opioid addiction. Clearly we need to change medical practice, and one obvious solution is physical therapy to improve movement and reduce pain without relying on medications.”

USC’s program also instills in students a sense of civic engagement and social impact. Students are required to participate in service learning, including through partnerships with programs such as Fit Families, which helps families at high risk for diabetes, and organizations like the The National MS Society and the Special Olympics.

Gordon believes, the profession’s increasing sophistication and demands on its educators is to the good. High quality and elite programs are being pushed to rethink how learning occurs, how to maximize students’ efficiency in and out of class, and to ensure they are prepared to create future improvements in patient care. All in all, Gordon concludes, developing a 21st century physical therapist “is a much more advanced process than it was forty plus years ago when I became a physical therapist.”

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