One of a Kind: A Hybrid Doctorate in Physical Therapy

The intent of this article is to acquaint the reader with an exciting new program being offered by Nova Southeastern University at its Tampa (Florida) Student Education Center, the Hybrid Entry-Level Doctor of Physical Therapy (DPT) Program.

Nova Southeastern has had a presence in the Tampa area for almost 30 years, primarily offering graduate degree programs in education, business, and psychology. In 2009, after moving in to a new campus facility, the university began to explore ways to enhance the growth of programs in Tampa. With the nationwide growth in the health care services industry, NSU's Health Professions Division saw Tampa as a logical area for expansion of their programs. As a part of that expansion, the hybrid DPT program was introduced to the Tampa Student Educational Center.

Hybrid instruction, a combination of online and traditional classroom instruction, is one of the latest trends in higher education. The word “hybrid” generally brings to most people's minds a car that runs on a combination of gas and electricity. For those of us in higher education, the word hybrid means something very different—the relatively new model of hybrid instruction.

In order to be effective, hybrid instruction must be a carefully planned blend of both traditional classroom instruction and online learning activities. Hybrid classes do, indeed, combine the best of both formats of instruction (Singh, Mangalaraj, & Taneja, 2010). Students are still able to make a meaningful connection with their instructors, as well as their classmates, but they are no longer required to travel to campus on a regular basis in order to attend classes because a significant portion of the classwork can be completed via the Internet.

For instructors to make their classes ready for the online/hybrid format, many must adjust their class's content. Lecture materials are usually the first part of the curriculum that needs to be modified.

Many instructors find that, in doing so, they are often making their materials more effective than they were in their traditional classroom instruction. More than likely the reason being that rather than having students sit in a lecture hall taking notes, instructors can teach through more activity-based assignments such as case studies, self-tests, tutorials, and online group projects, all of which takes place over the Internet (Poirier, 2010).

There are still individuals in higher education who are against the hybridization of learning, but there are several obvious advantages of hybrid instruction (“How to Succeeed, 2009). From a facilities standpoint, it cuts down on traffic on campus and frees up valuable classroom space. Some important educational benefits are how hybrid courses help improve writing and computer skills (Renes & Strange, 2011). Hybrid classes have been shown to encourage self-directed learning, time management, problem-solving, and critical-thinking skills in those who participate in the programs (Cole & Kritzer, 2009). While these additional benefits are certainly important, one “elephant in the room” remains: Does hybrid instruction allow for quality subject-matter knowledge similar to that of traditional classroom instruction, especially in such a hands-on field as physical therapy?

Even though it is still a fairly new concept in distance education, many instructors are reporting good success with hybrid courses. Cole and Kritzer (2009) report that students in most hybrid program are required to do more work on their own. This kind of active learning seems to result in better test performance and subject mastery. Students in hybrid programs are also more likely to participate in group discussions. Collaboration online with other students is fostered because there is not only ample opportunity to prepare a response, but also because they are not physically speaking in front of a group. Hybrid class participants tend to be more outgoing and responsive because they are speaking online versus in a classroom setting. Even though students seem more confident about being involved with discussions online, it is important to keep in mind that it is because of the actual on-campus classroom component, and the face-to-face interaction that takes place there, that students are more likely to find success in a hybrid course than in a strictly online class (Fox, 2010).

Along with the obvious academic advantages, hybrid courses are making it easier for many people to get a quality education. Since hybrid programs require only limited on-campus attendance, it means these kinds of college programs are now more accessible to more people in more places.

The HEDPT Program is a recent expansion of NSU's main campus (Ft. Lauderdale, Florida) Physical Therapy Program, and offers the same curriculum in a unique combination of online and on-campus instruction—the hybrid model. The faculty and staff are experienced professionals with extensive clinical and educational backgrounds who are excited to use technology in order to bridge the gap of distance and time. In the HEDPT, both the online and on-campus institutes are planned to be engaging and dynamic so that all students are active participants in the learning process.

The inaugural class of a unique hybridlearning program in physical therapy began in May 2011 at the Tampa Student Educational Center of Nova Southeastern University, with students combining onsite instruction with online classes.

Twenty-three students enrolled for the first semester of the 4-year hybrid entry level program, which culminates with a doctorate degree in physical therapy from NSU's College of Allied Health and Nursing. A second group of students will start the program next year, according to college officials.

It's one of the first programs of its kind in the nation, according Mary Blackinton, associate program director of the NSU physical therapy program.

“Most professional education in the medical field is steeped in the tradition of face-to-face learning,” said Dr. Blackinton, a physical therapist since 1983 and an educator in the field for the past 16 years. “We've taken the theoretical part and the introduction to skills and are delivering them using online technologies.”

So what happens in the NSU hybrid education model? According to Blackinton (M. Blackinton, personal communication, November 1, 2011), students are given reading assignments and resources, and then asked to apply the information in either a case, paper, project, or quiz. Often, the information in a text is supplemented with digital media such as Tegrity video, Powerpoint slides, YouTube video, or email from the faculty. This helps tell the student what the faculty thinks is important. The assignment of the week is designed to help students learn the material. When the students submit assignments, they receive feedback, which is designed to further help with the learning. Learning is an iterative process that occurs through interaction with information, faculty, and classmates. “The role of the faculty moves from the “teller” of the information to the “stacker” of the information—using a combination of resources and feedback to stack the learning deck, so to speak,” says Blackinton.

Another aim of the program developers was to serve students who work and have family responsibilities, and therefore do not always have the ability to attend college classes during traditional hours.

“This format also allows students to live in other places and come here for four intensive days a month,” Blackinton said.

And the hard work will pay off if today's salaries for physical therapists are any indication. The typical salary for a graduate in the field is between $60,000-$100,000, Blackinton added.

“This innovative program provides qualified, nontraditional students such as working adults the opportunity to become physical therapists,” Blackinton said. “Our blended learning design creates a strong, interactive learning community supported by the outstanding technological resources of NSU.”

Blackinton states that the goals for NSU's graduate physical therapists are to:

• practice competently and collaboratively in all aspects of patent/client management as defined by the Guide to Physical Therapist Practice across the lifespan and in all practice settings;

• assume the roles of administration, delegation, supervision, management, and consultation to ensure autonomous practice that is safe, ethical, and legal;

• engage in health promotion, wellness, and disease prevention activities for patients, clients, and the community at large using appropriate educational and change strategies;

• contribute to the body of knowledge in physical therapy and apply an evidence-based approach to patient/client management; and

• demonstrate cultural competence in providing services to all populations, including the underserved.

The program maintains a new student orientation webpage that helps students prepare for an orientation in Tampa as well as for becoming a student at NSU. The site includes links to important documents such as the new student checklist, instructions on obtaining an NSU e-mail account, equipment and book lists, a tentative 4-year academic calendar, and a schedule for the orientation. There are also links to the American Physical Therapy Association so that students can sign up to become a student member (a program requirement), links to hotels in the Tampa area who offer NSU HEDPT students discounts, and links to other NSU resources. Representatives from the admissions department, NSU bookstore, card services, student affairs, financial aid, and the College of Allied Health and Nursing administration attend the orientation in order to greet students and their families in Tampa. Obviously, students in the HEDPT program receive a comprehensive introduction to their studies.

The HEDPT program is for individuals who want more flexibility in attaining their DPT degree because of financial, geographical, and/or family demands. This unique hybrid program combines the best of both worlds in that online learning for flexibility plus face-to-face campus-based classes at the Tampa SEC once per month (4 days each month) are combined for instruction, practice, and feedback on hands-on skills.

The curriculum includes the same courses as the main campus traditional program, but it is distributed over 4 years instead of 3. The fourth year of the program consists of full-time internships in all areas of physical therapy practice. The total tuition for the 3-year program is prorated over 4 years for the HEDPT program so that the total cost is the same.

This program is an expansion of the Commission on Accreditation of Physical Therapy Education (CAPTE) approved NSU entry level DPT curriculum offered on the main campus in Ft. Lauderdale. The program admits students who are self-directed learners interested in online learning, comfortable with technology, and who want flexibility in attaining a DPT degree. Renes and Strange (2011) have indicated that this is the type of student who typically thrives in the type of environment the HEDPT students will be exposed to. The prerequisites and other entrance requirements are the same as the Ft. Lauderdale program.

Students apply to the Nova Southeastern University HEDPT program through the Physical Therapy Centralized Application System (PTCAS) at www.ptcas.org.

The entry-level doctor of physical therapy program selects students based on cumulative grade point average, prior academic performance, work experience, references, interview, completed application and recommendations. The general requirements include:

• a bachelor's degree from a regionally accredited college or university;

• a minimum of 2.9 cumulative grade point average on a 4-point scale;

• a minimum of 2.9 prerequisite and science grade point average on a 4-point scale and a grade of C or better in each of the prerequisite courses;

• completion of all required coursework before matriculating into the PT program;

• the three recommendations (one must be from a physical therapist) on the required PTCAS evaluation form;

• previous experience acquired in the field of physical therapy on the required PTCAS experience form (optional but highly recommended);

• Graduate Record Examination scores from the Educational Testing Service no later than March 1 of the entry year; and

• a phone or in-person interview when all other requirements are met.

The white coat ceremony symbolizes the transition of physical therapy students into the profession of physical therapy, and is based on the tradition established by Hippocrates who administered an oath to students before their medical studies began. Faculty participate by “coating” each student and together they recite the physical therapy oath. A symbolic torch is lit, representing the park of intellectual curiosity that remains in the heart of physical therapists throughout their lifetime. Students also profess their commitment as physical therapy students to the Code of Ethics and Core Values of the American Physical Therapy Association.

The 23 physical therapy students from NSU's Tampa Student Educational Center took part in the ceremony on Saturday, October 22, 2011. Students were ceremonially cloaked with their white coat by faculty from the physical therapy program. A celebration followed at the SEC with a motivational charge delivered by keynote speaker Diana Ickes, who is recognized by the American Physical Therapy Association as an emerging leader in the profession.

“The White Coat ceremony marks the special day these students recite the oath of commitment to the physical therapy profession and to the communities in which they will serve,” said Richard E. Davis, dean of NSU's College of Allied Health, which runs NSU's physical therapy programs. “This special day conveys to the students the importance of caring as well as curing,” he said.

Blackinton added that the 23 students of NSU's new Hybrid Entry Level Doctor of Physical Therapy Program represent a diverse group of individuals engaging in a new and exciting method of physical therapist education that combines online and in class learning.

The students range in age from 22 to 38; reside in nine different counties in Florida; and hail from four other states (Maryland, Illinois, Michigan, and Wisconsin). The majority work at least part time, some work full-time.

Clinical experiences are the culminating activities in the HEDPT program. Melissa Riba, assistant professor and clinical director of the Tampa program, facilitates these activities. The clinical experiences come in two forms. The first part starts in the second year of the program and is referred to as integrated clinical experiences. These are activities that take place during the 4-day weekends on campus. The second part includes three traditional internships that span the fall and winter semesters of the fourth year of the program.

Student reaction to the innovative HEDPT program has been very positive. A common reaction is voiced as surprise in the camaraderie that is developed. The students work together so closely, both online and on-campus, that special relationships quickly develop. They have a feeling that although they are at an off-campus site, they have the feel of being part of a larger entity. Also, the opportunity to maintain full-time and, more frequently, part-time employment during the first 3 years of the program is a large plus. Balancing a job, school, and a family life is a challenge, but is doable for many of the students.

Blackinton sees the future of the HEDPT program as being a very bright one. She has pledged that the program staff will continuously learn everything they can about hybrid education and to make this program a leader in hybrid education for health professions programs. The staff has accepted an invitation to present at the American Physical Therapy Association's annual conference about hybrid education. They are passionate about doing educational research about the processes that occur in hybrid education in professional schools such as physical therapy. Research questions dealing with topics such as how much debt students leave a hybrid program with versus a traditional program are being considered.

“I think,” says Blackington, “that we owe it to our students and to our profession to do good research, to use good pedagogy in whatever we do, and to continually evaluate ourselves and make our program stronger and better.”