Distance Education in Occupational Therapy: Comparison of On-Campus and Hybrid Student Outcomes

To accommodate a changing student population, distance education has been on the rise at the postsecondary level (Farber, 2013; Zacharis, 2015). Development of communication technologies has led to an increase in the number of students enrolled in online courses (Farber, 2013). Several studies have revealed positive perceptions from faculty and students regarding online education (Farber, 2013; Seirup et al., 2016; Zacharis, 2015). It was reported in 2015 that 71% of academic leaders believed student learning outcomes in online education were the same or superior to outcomes of those receiving on-campus education, which was a significant increase from only 57% in 2003 (Allen & Seaman, 2013).

As student learning needs continue to change and are varied based on program of study, several education delivery modes provide options for online learning that can maintain positive outcomes. Allen and Seaman (2013) described four primary education delivery modes based on the amount of the course that is delivered online. In the traditional model,0% of content is delivered online. In the web-facilitated model, 1-29% of content is delivered online to supplement a face-to-face format. In the blended/hybrid model, 30-79% of content is delivered online to reduce the number of face-to-face meetings but still allow critical handson learning. In the online model, at least 80% of content is delivered online with minimal face-to-face meetings. These varied education delivery models allow a wider range of students the ability to access postsecondary education.

Allowing at least some courses to be delivered online has proven beneficial for various healthcare programs. In the nursing field, McCutcheon et al. (2015) found that teaching clinical skills using a blended/hybrid model provided students with the same necessary knowledge as a traditional pathway. Hollis and Madill (2006) demonstrated that blended/hybrid delivery models allowed students more flexibility and autonomy in their learning. Providing access to distance learning can promote student independence while producing the same academic and professional outcomes.

In occupational therapy, the number of programs offering some form of distance education continues to increase. For the 2017-2018 academic year, 80% of doctoral-degree-level occupational therapy programs offered some type of distance education, up from 50% in 2013 (American Occupational Therapy Association [AOTA], 2018). In addition, the percentage of each program that is offered at a distance continues to increase with 5% of schools in the 75-100% range in 2017-2018 (AOTA, 2018). Despite this increase in distance education in occupational therapy, research literature concerning student learning outcomes in distance education models is limited. The purpose of this study was to compare the performance outcomes of doctoral students in an on-campus occupational therapy pathway with those in a hybrid pathway.

This study used a retrospective, between groups comparison method to explore differences between various learning and graduate outcomes of on-campus and hybrid pathway students within an entry-level doctor of occupational therapy program. Approval was obtained from the institutional review board of the university at which the investigators were employed. Study participants were students enrolled in an entry-level occupational therapy program at a private university in the Midwest region of the United States. Inclusion criteria included students who graduated in 2016 and 2017 from one of three pathways—the on-campus pathway and one of two hybrid pathways. Students in the web-facilitated, on-campus pathway received most of their instruction in a face-to-face format and had access to supplemental materials on a course website. Students in a hybrid pathway followed the same curriculum at the same pace as students in the on-campus pathway but participated in lectures and exams online rather than in a classroom like their on-campus peers. Both groups participated in face-to-face labs taught either at the host institution by the course instructors (for on-campus pathway students) or at satellite locations by adjunct faculty with expertise in the content area who regularly and directly collaborate with course instructors (for hybrid pathway students).

A total of 114 students from the on-campus pathway and 54 students from the hybrid pathways were included. See Table 1 for the number, gender, and mean age of the participants in each cohort.

The following assessment outcomes were collected for each participant: student grade point average (GPA) at the end of each academic year, overall cumulative GPA, fieldwork performance evaluation (FWPE) overall scores and subsection scores for two Level II fieldwork experiences, and National Board for Certification in Occupational Therapy (NBCOT) practice exam scores. This data was collected from the university’ online collection warehouse and clinical education office. Additionally, the NBCOT exam pass rates were obtained from reports solicited from NBCOT by the program director. Data were entered in the Statistical Package for the Social Sciences software. An independent t test was used to analyze whether a significant difference occurred in the outcome variables. The significance level was set at .05.

There were no significant differences between on-campus and hybrid cohorts for all GPA, FWPE, and NBCOT measures. The mean age of students in the hybrid cohort was significantly older compared to the on-campus cohort (27 versus 23 years of age, respectively; p <.001). These results indicate no differences in student performance between on-campus and hybrid content delivery formats (see Table 2).

The purpose of this retrospective between group comparison study was to determine if differences exist between occupational therapy student performance in on-campus and hybrid pathways. Overall, the study findings suggest student outcomes in a doctoral-level occupational therapy program were comparable. Specifically, no significant differences were found between the cohort groups for GPA, FWPE, and NBCOT measures. This indicates content delivery formats for occupational therapy curricula are consistent and do not affect student outcomes. These findings validate the previous study that determined hybrid education is an effective alternative for occupational therapy graduate level education (Mu et al., 2014).

The indicators chosen to measure student performance are common measures within the profession of occupational therapy. Student GPAs are routinely monitored to gauge student progress in a curriculum. The FWPE is required as a measure of entry-level competency on fieldwork. The NBCOT practice exam scores were monitored by the program included in this study as a measure of student competency prior to starting the doctoral experiential component of the curriculum.

A 2013 ad-hoc report on the future of occupational therapy education suggested the profession investigate the effectiveness of various teaching and learning strategies on student outcomes particularly to determine the right balance between on-campus and distance teaching (AOTA, 2013). At the time of this writing, there are 23 programs offering a component of their curriculum in a distance format at the doctoral level and numerous programs at the master’s degree level (AOTA, 2020). Distance programs allow flexibility for nontraditional students to change career paths. This may explain why a difference was noted in the average age of students in the on-campus (23 years) and hybrid (27 years) cohorts. Future research could explore why this difference in average age exists and if this difference is universal across other hybrid programs.

When considering the findings of this study, it is important to note the program included in this study has a significant history and background to support distance and hybrid teaching and learning. Successful distance and hybrid programs require substantial infrastructure to support the technological demands of both faculty and students as well as collaborative relationships with the satellite locations. Faculty must be adequately trained in pedagogical methods to address the unique needs of both campus and hybrid learners. Additionally, a variety of personnel, including adjunct faculty, teaching assistants, and lab assistants, play a vital role in the success of education delivered in a hybrid model.

A limitation of this study was the disproportionate number of participants in the on-campus cohort compared to the hybrid cohort. Caution should be taken when generalizing the results. This is the second known study demonstrating parity between on-campus and hybrid occupational therapy student outcomes and performance (Mu et al., 2014).

The results of this study indicate no difference in student performance between on-campus and hybrid content delivery formats. These results are congruent with a previous study that found no significant difference in most outcomes for students in on-campus versus non-traditional pathways (Mu et al., 2014). This finding demonstrates the effectiveness of various content delivery formats in creating positive student outcomes. This information may be useful to various graduate level healthcare programs that are interested in adopting a hybrid model or other distance-education mode of content delivery. For occupational therapy programs, this study may provide a model for curriculum design and content delivery. Additional research is needed to evaluate different content delivery formats in other healthcare professional programs and examine learning outcomes in the affective domain.