BackgroundBlended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear.ObjectiveThis study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program.MethodsThe economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost.ResultsThe incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions.ConclusionsUnder the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context.

Background Although telehealth is becoming more popular for delivery of care for individuals with musculoskeletal pain, to our knowledge telehealth has not been used to manage Achilles tendinopathy. This research aimed to explore the experience of participants and physiotherapists with gym-based exercise interventions for Achilles tendinopathy monitored via videoconference. Methods A qualitative, interpretive description design was performed using semi-structured interviews (8 participants) and a focus group (7 physiotherapists). Participants and physiotherapists were interviewed about their experiences of the use of telehealth during a gym-based exercise intervention incorporating different calf load parameters for Achilles tendinopathy. We employed an inductive thematic analysis approach to analyse the data. Results Three themes identified from both participants and physiotherapists included i) acceptability of telehealth; ii) enablers to adherence with telehealth; and iii) barriers to adherence with telehealth. Two extra themes arose from participants regarding adherence with gym-based exercise, including enablers to adherence with the exercise intervention, and barriers to adherence with the exercise intervention. Both participants and physiotherapists expressed overall satisfaction and acceptability of telehealth monitoring of gym-based exercise. Conclusion Gym-based exercise intervention for Achilles tendinopathy involving weekly telehealth monitoring was acceptable to both participants and physiotherapists. Potential enablers and barriers were identified that may improve adherence to this type of intervention.

BackgroundCase-based learning (CBL) typically involves face-to-face interaction in small collaborative groups with a focus on self-directed study. To our knowledge, no published studies report an evaluation of Web conferencing in CBL.ObjectiveThe primary aim of this study was to explore student perceptions and attitudes in response to a remote-online case-based learning (RO-CBL) experience.MethodsThis study took place over a 2-week period in 2013 at Monash University, Victoria, Australia. A third year cohort (n=73) of physiotherapy students was invited to participate. Students were required to participate in 2 training sessions, followed by RO-CBL across 2 sessions. The primary outcome of interest was the student feedback on the quality of the learning experience during RO-CBL participation. This was explored with a focus group and a survey.ResultsMost students (68/73) completed the postintervention survey (nonparticipation rate 8%). RO-CBL was generally well received by participants, with 59% (40/68) of participates stating that they’d like RO-CBL to be used in the future and 78% (53/68) of participants believing they could meet the CBL’s learning objectives via RO-CBL. The 4 key themes relevant to student response to RO-CBL that emerged from the focus groups and open-ended questions on the postintervention survey were how RO-CBL compared to expectations, key benefits of RO-CBL including flexibility and time and cost savings, communication challenges in the online environment compared to face-to-face, and implications of moving to an online platform.ConclusionsWeb conferencing may be a suitable medium for students to participate in CBL. Participants were satisfied with the learning activity and felt they could meet the CBL’s learning objectives. Further study should evaluate Web conferencing CBL across an entire semester in regard to student satisfaction, perceived depth of learning, and learning outcomes.

BackgroundCase-based learning (CBL) is an educational approach where students work in small, collaborative groups to solve problems. Web-conferencing software provides a platform to present information and share concepts that are vital to CBL. Previous studies have found that participants were resistant to change associated with implementing e-learning; however, strategies to reduce this resistance have not been explored.ObjectiveThis study was designed to explore student preconceptions and understanding of remote-online case-based learning (RO-CBL).MethodsThe study took place during the Bachelor of Physiotherapy program at Monash University, Victoria, Australia, in 2013. The entire third-year cohort (n=73) was invited to participate. The primary outcome of interest was students’ preconceptions of RO-CBL, collected via pre- and posttraining surveys.ResultsOf the 73 students, 66 completed both surveys (attrition rate 9.6%). Three key themes relevant to student preconceptions of RO-CBL emerged: flexibility in time and location of CBL, readiness or hesitation to change to a Web-based format, and the value of training in RO-CBL that included a demonstration and trial run. Thirty-four percent of the participants were hesitant to move to an online format.ConclusionsThis study explored students’ preconceptions of Web-based learning and evaluated the change in students’ attitudes after training. The results suggest that educational designers should not assume that students are confident and competent in applying these technologies to professional educational activities. By identifying students’ needs before implementation, training sessions can be designed to target these needs, and improve the understanding of RO-CBL and how it works in practice. This may reduce resistance to change, enhance students’ satisfaction, and ultimately improve the learning experience.

Health professional education is experiencing a cultural shift towards student-centered education. Although we are now challenging our traditional training methods, our methods for evaluating the impact of the training on the learner remains largely unchanged. What is not typically measured is student-centered value; whether it was ‘worth’ what the learner paid. The primary aim of this study was to apply a method of calculating student-centered value, applied to the context of a change in teaching methods within a health professional program. This study took place over the first semester of the third year of the Bachelor of Physiotherapy at Monash University, Victoria, Australia, in 2014. The entire third year cohort (n = 78) was invited to participate. Survey based design was used to collect the appropriate data. A blended learning model was implemented; subsequently students were only required to attend campus three days per week, with the remaining two days comprising online learning. This was compared to the previous year’s format, a campus-based face-to-face approach where students attended campus five days per week, with the primary outcome—Value to student. Value to student incorporates, user costs associated with transportation and equipment, the amount of time saved, the price paid and perceived gross benefit. Of the 78 students invited to participate, 76 completed the post-unit survey (non-participation rate 2.6%). Based on Value to student the blended learning approach provided a $1,314.93 net benefit to students. Another significant finding was that the perceived gross benefit for the blended learning approach was $4014.84 compared to the campus-based face-to-face approach of $3651.72, indicating that students would pay more for the blended learning approach. This paper successfully applied a novel method of calculating student-centered value. This is the first step in validating the value to student outcome. Measuring economic value to the student may be used as a way of evaluating effective change in a modern health professional curriculum. This could extend to calculate total value, which would incorporate the economic implications for the educational providers. Further research is required for validation of this outcome.

With an approximate payback period of 4 years, coupled with strong and positive NPV values, physiotherapy education in Australia is a financially attractive prospect and a viable value proposition for those considering a career in this field.

Objectives:The objective of this study was to evaluate web-conferenced case-based learning (WCBL) through the student experience across a semester of learning. Also, learning was evaluated via unit examination and compared to the previous year's cohort, which utilized face-to-face case-based learning (F2F-CBL). Methods: This study took place over the first semester of the third year of a Bachelor of Physiotherapy program at Monash University, Australia in 2014. Having experienced 2 years of weekly F2F-CBL activities since commencing the program, students were transitioning to WCBL for the duration of this study. Primary outcomes included measures of satisfaction, attendance, communication, issues with information technology, and perceived depth of learning, with data collected via a post-unit survey. The secondary outcome was student learning, evaluated with the unit examination results. Results: 76/78 students completed the post-unit survey (non-participation rate 2.6%). Although 95% of participants reported that WCBL was a valuable addition to the teaching activities of the unit, students reported a range of new challenges and rewards from the transition to small-group WCBL activities. Strong themes emerged encompassing adaptation of communication, increased responsibility for learning, technical difficulties, and learning in a remote environment. Overall, 92% of participants agreed that they were satisfied with WCBL. The unit exam result was comparable for the 2013 (F2F-CBL) and the 2014 (WCBL) cohorts [Mean (standard deviation) 2013 (%) 75.97 (9.56) n = 73; 2014 (%) 76.74 (6.57) n = 78, effect size [95% confidence interval (CI)] = 0.09 (−0.23-0.41)]. Conclusions: Web conferencing may be a suitable medium for students to participate in collaborative CBL activities. Furthermore, study should evaluate the financial implications of implementing WCBL across an entire semester with regard to student and facility costs.

risk factors underwent semi-quantitative synthesis. The GRADE approach for prognostic factors guided assessment. Results Across 66 included studies, 81 unique risk factors were identified. 64% and 49% of studies had high risk-of-bias from attrition and confounding. Semi-quantitative syntheses identified limited high-quality evidence that cruciate ligament, collateral ligament, meniscal, chondral, dislocation, fracture, and multi-structure injuries increase symptomatic osteoarthritis odds. Ten risk factors for structural osteoarthritis underwent meta-analysis (sex, rehabilitation for ACL tear, ACL reconstruction (ACLR), ACLR age, ACLR body-mass-index, ACLR graft source, ACLR graft augmentation, ACLR+cartilage injury, ACLR+partial meniscectomy, ACLR+total medial meniscectomy). Very-low quality evidence suggests increased odds of structural osteoarthritis related to ACLR+cartilage injury (OR=2.31; 95%CI 1.35,3.94), ACLR+partial meniscectomy (OR=1.87; 1.45,2.42), and ACLR+total medial meniscectomy (OR=3.14; 2.20,4.48). Conclusion Limited high-quality evidence suggests that various knee injury types (not just ACL tears) increase symptomatic osteoarthritis. Risk factor heterogeneity, low-quality evidence, and inconsistency in risk factor and osteoarthritis definition make identifying modifiable targets for preventing symptomatic post-traumatic knee osteoarthritis challenging.