What a year, am I right?
Transitioning to web-based work has been one of the major changes I admittedly had a difficult time buying into. I’m still having a hard time with it, but now that’s more related to the technical side of things and less related to trying to see the benefit. It took a while, but I definitely see the benefit.
We started a new post-graduate certificate course at the University of Limerick in January. This particular module, called Sustainable Posture, Seating, and Wheelchair Mobility Provision Across the Life Course, was set to include a full week of on-campus labs to cover the components of the hands-on assessment, selecting a seat support, back support, and head support, as well as wheelchair skills training. We had 20 incredible clinicians enrolled in the course, all of whom were working full-time, and we had planned to bring them in to complete these labs in two separate groups over two consecutive weeks.
This may have been an ambitious plan, but we felt that the hands-on component of this course was essential for many reasons. Think, for example, about the consequences that so many of our services users face when they do not receive a comprehensive hands-on assessment for their new seating system. Add onto that the wait times that keep getting longer and the additional impact of poor positioning when compounded with the effects of the virus.
However, due to many pandemic-related reasons, just a week before labs were to begin, we realized it wasn’t possible to safely host all students on campus over these two weeks.
So, what do we do? We know that hands-on training is essential, but we are simultaneously unable to have face-to-face labs.
We know that demonstrations, lectures, and theory are important, but they do not and will never be sufficient for developing the necessary hands-on skills we need as clinicians.
You can teach someone how to find the ischial tuberosities - show them a pelvis, point to them in pictures, explain the importance of knowing what and where they are - but that doesn’t do much good if they never get a chance to put their hands on another person’s body and actually feel the ischial tuberosities.
Consider the amount of practice it takes to confidently and efficiently measure hip flexion, or the pelvic-thigh angle. Managing the lower limb, aligning the goniometer with the anatomical points, feeling and watching for signs that you have reached end range as the pelvis rocks back or hitches up, and then reading those tiny numbers on the goniometer without changing the position you’ve determined to be correct. Whew!
Talking it through only gets you so far without practice.
And how likely are we to actually practice with real-life patients during an appointment with family members and other health care members watching us when we’ve only ever talked about it? If we’re being honest - not very.
So, what to do for these students enrolled in a highly competitive and specialised certificate at a leading university?
Well, the only answer seemed to be virtual labs that include the essential hands-on components but did not require students to travel to UL. Yes, it seemed like a novel idea, but now that it’s over, it’s hard to believe we hadn’t thought of it sooner.
Each student was essentially assigned to be in a group of 2-3 based on their location so we could prevent travel between counties when possible and keep students who were working in the same clinic area together. A few students chose to ‘self-study’ due to their work schedule - they practiced the hands-on components with a family member or colleague after watching the lab session recordings. A small group met on campus as they had no other students living or working near them and did not have any of the necessary equipment available.
When labs began, I was in my office here in Sligo with a plinth, Hugo the skeleton, Scott my husband (in the perfect outfit, might I say!), products generously loaned to me from local suppliers (huge shoutout to HC21, LCS, and Momentum!), and of course my goniometer. We had the camera set-up so that my ‘patient’ demonstrations on Scott could be viewed clearly and we periodically asked students to turn on their camera to demonstrate their skills.
One of the best parts of this was that we were essentially able to crowd-source product for our discussion on head supports, back supports, and seat cushions.
Each group had different products available for these sessions, which gave us an opportunity to discuss a wide range of key parameters for each product!
And since we weren’t in-person and able to clearly see the students perform each skill or provide feedback directly, we asked each student to record themselves completing the key components of the lab sessions and we then provided detailed feedback for each and every one.
While it can be incredibly frustrating to be a student these days, when you are expecting one thing to happen and at the last minute that changes to something completely different, we felt that these virtual labs went very well and that there is huge potential for this style of training to be utilized in various ways.
In a more anticipated fashion, we’ve also been expanding our virtual comfort zone with our ten-week 24-hour postural care mentorship programme.
As I’ve mentioned before, and I’m sure to mention again and again, this was not ever something I thought would be interesting or beneficial to me or the clinicians I work with. And I was so, so wrong.
The biggest piece that was missing from the UL certificate program for me was the actual hands-on patient assessments. Practicing on your peers and colleagues is the perfect place to start, but it’s a completely different experience when you have someone with complex body shape distortion and numerous structural limitations in front of you. Thankfully, those hands-on patient assessments are what I’ve come to emphasize with my mentees, making this certificate and mentorship the ideal combination for clinicians (at least in my opinion!).
When asked about the virtual assessments, one clinician who completed both the mentorship and the UL certificate felt that “having the assessment session and then a debrief a week later was key in embedding reasoning and reflecting.” In other words, it’s not enough to have a one-off clinical day or a full theory-packed seminar. She went so far as to say she would “100%” recommend the additional mentorship, and that she recommends it to her OT and PT colleagues who are interested in postural management, adding:
“It really pulled a lot of things together for me and improved my clinical reasoning no end! I think mentorship in postural management needs to be key going forward to upskill clinicians. It would be great to see it reflected in any clinical standards that may be published in the future”
How amazing is that?! Having feedback from clinicians, especially those who are willing to pilot a new program or course with us, has really given us a sense of direction in terms of what matters and what helps. The hours of headaches and heartaches that went into shifting our mindset regarding what it means to be hands-on has undoubtedly been worth it.
Beyond the need for this model during the current pandemic, we have a clear vision as to how this approach can be used for so many opportunities moving forward. From upskilling a group of clinicians working together in a clinic or specialty centre, to collaborating with our international colleagues who aren’t able to connect with others in the field due to their location or resources - we absolutely need to continue prioritizing hands-on training, but now we can confidently make that hands-on training virtual.
With so many web-based learning experiences popping up over the last year, we would love to hear from you -
What went well? What would you like to see change? How can we continue to make web-based learning engaging and interactive while solidifying skills?