Continuing Professional Development in Response to COVID-19: Knowledge Mobilization for Occupational Therapy and Physiotherapy via a Curated Web Site

Abstract

Purpose:

Once the COVID-19 pandemic was declared, clinicians were redeployed to prepare for increased hospitalizations. This disruption necessitated rapid continuing professional development (CPD) resources for health care providers. This mixed-method study explored the experiences of occupational therapists and physiotherapists who accessed a CPD Web site that provided educational resources related to the pandemic to refresh their clinical knowledge and skills.

Methods:

Faculty from the Michener Institute of Education at the University Health Network and University of Toronto along with 60 collaborators created a Web site to support the need for rapid CPD. An occupational therapist and physiotherapist advisory group informed the evolving design of the occupational therapy and physiotherapy content.

Results:

In the occupational therapy profession 535 users created an account between April and November 2020 (236 practicing, 283 students, and 16 did not specify) and in the physiotherapy profession 829 created an account (532 practicing, 278 students and 19 did not specify). Each user viewed an average of 53 Web pages. Three themes emerged: (1)To prepare for practice changes, clinicians value a single repository of information; (2) Web site features can either facilitate or hinder access to the needed information; and (3) Participants described diverse learning needs.

Conclusions:

The Web site design features assisted participants in preparing for redeployment and patient care. Features to encourage self-directed learning, such as the grouping of relevant topics and self-check quizzes, can enhance the user experience.

The COVID-19 pandemic was declared in March 2020,¹ resulting in rapid, large-scale changes in Canada’s health care system. Hospitals were directed to cancel services, reallocate resources, and redeploy staff to prepare for a surge in COVID-related hospitalizations.² While health care professionals engage in career-long continuing professional development (CPD) activities to maintain competence,³ redeployment can cause anxiety for practitioners asked to work outside of their area of expertise.^4,5 A resulting imperative was for a rapidly developed CPD programme to support redeployment learning needs and emerging practices; for example, the management of acute and post-acute patients with COVID-19.

Little information exists on optimal rapid resource development approaches and the impact of this type of approach to prepare clinicians to respond to an urgent large-scale disruption in practice. In response to this need, the Provincial COVID-19 Education Task Force –consisting of faculty and clinicians from the Michener Institute of Education at the University Health Network in Toronto and University of Toronto along with 60 collaborators – created the “COVIDCareLearning.ca” Web site to provide access to essential learning resources for over 15 health care professionals in Ontario. Knowledge of user experiences of the Web site can inform the development of future rapid CPD materials/resource professional developments. This study explores occupational therapist and physiotherapist experiences with a Web site designed to support CPD in rapid response to the COVID-19 pandemic.

The Web site originated as “CriticalCareLearning.ca.” The task force changed it to “COVIDCareLearning.ca” to reflect a broader spectrum of health care providers including those working in long-term care and community settings. The task force created the Web site with the support of Ontario Health to house selected resources that we organized by profession; setting (e.g., acute care, long-term care); and 13 additional themes (e.g., the science of COVID, team wellness and resilience, virtual care). Despite the name change, both web addresses direct users to the same resources.

The Web site was linked to all Ontario hospitals and promoted through senior hospital leaders, Ontario universities, professional associations, regulatory colleges, and word of mouth. The Task Force members continue to curate relevant content, which is then reviewed by the Web site administration team and uploaded to the site. Access requires a user account in which the user inputs their profession, health care region, and status (i.e., in practice, in training, or not applicable).

Initially, the occupational therapy (OT) and physiotherapy (PT) sections listed curated resources limited to critical care, which had been quickly gathered and uploaded over a two-week period. In June 2020, we received funding for a research assistant to revise the Web site content and organization of the sections to enhance their utility. An occupational therapist and physiotherapist advisory group of practising occupational therapists and physiotherapists who were not affiliated with the COVID-Carelearning.ca Web site guided the revision of the OT and PT sections to include subheadings describing key resources, additional readings, and self-check quizzes. Expanded resources were included for clinicians working outside of critical care. See Table 1 for the initial and revised organization of the OT and PT sections and examples of topics. Note that the organization and headings of the revised OT and PT sections were similar.

Table 1.

Initial and Revised PT and OT Tile Organization on the Web site COVIDcarelearning.ca

Initial PT and OT tile organization (April 2020)
Subheading
• List of resources
Topic examples: oxygen titration, cardiopulmonary assessment, and cardiopulmonary treatment.
Revised OT and PT tile organization (July 2020)
SECTION 1: Physiotherapy and COVID-19/ Occupational Therapy and COVID-19
• Selected resources
Topic examples: Understanding the COVID-19 critical care response and team-based care, PT across the continuum of care for patients with COVID-19, exercise materials for patients during the pandemic, energy conservation, and COVID-19.
SECTION 2: Skill/competency resources for acute-care physiotherapists/occupational therapists
• Selected resources
• Self-check quizzes
• Further reading
Topic examples: suctioning, oxygen titration, chest X-rays, lines and tubes, ventilators and airways, lab values, understanding critical care medications, early mobility in the ICU, and proning.
SECTION 3: Skill/competency resources across the continuum of care
• Selected resources
• Self-check quizzes
• Further reading
Topic examples: cardiopulmonary assessment, cardiopulmonary treatment, transfers and mobility, discharge planning, pain, delirium, fall risk assessment and prevention, outcome measures, pressure injury prevention, and virtual care.
SECTION 4: Links to additional resources (Web site links)

PT = physiotherapy; OT = occupational therapy.

Methods

We used a mixed methods approach to explore the experiences of occupational therapists and physiotherapists with the CPD resource.

Quantitative

A Web site administrator who was not a member of the research team provided data on the users who accessed the Web site between April 2020 and November 2020. The data included information on the users’ profession, whether they were training or practising, as well as their geographical area, log-on dates, and page views. User information was collected from those accessing both the original and revised Web site content. All users were assigned a unique identifier, and names were permanently deleted. Descriptive statistics were conducted and included the number of users by professional status and geographic area, and the number of users logging on per day and accessing a specific resource.

Qualitative

We used a cross-sectional qualitative approach via virtual focus groups to explore the utility of the Web site. Focus group recruitment began three months following the revision of the OT and PT sections in September 2020. The Web site administrator sent two email notices one month apart to occupational therapy and physiotherapy COVIDCareLearning.ca account holders. The recruitment email was also sent to the academic coordinators of clinical education in Ontario OT and PT programmes as well as to University of Toronto OT and PT status faculty. The email encouraged the recipients to forward the notice to others.

Eligible participants were account holders who identified their professional status as registered to practise. Interested participants contacted the research assistant who then provided a consent form and list of dates when they could participate in a focus group.

Three focus groups with three to six participants per group were conducted via Zoom. Questions were asked by using a semi-structured focus group guide and explored accessed resources; organization and navigation of the Web site; the value of the Web site; the value of the self-check quizzes; and suggestions for additional resources. Some participants accessed both the original and revised Web sites, allowing them to comment on both formats. The focus groups were audio-recorded and transcribed. Research team members analyzed the transcripts using conventional content analysis with the Depict model.⁶ Four team members read two of the three transcripts and identified potential codes. The team met twice to theme the codes and resolve discrepancies through an iterative process. The final code book had 28 codes grouped in three themes. (See Appendix S1 online.)

The University of Toronto Health Sciences Research Ethics Board approved the methods. Participants in the focus groups provided verbal informed consent.

Results

As of November 2020, 535 created an account under the profession of occupational therapy and 829 under the profession of physiotherapy. Of these users, 51% identified as registered to practice (236 OT, 532 PT), 41% identified as in-training (283 OT, 278), and 3% did not specify (16 OT, 19 PT). All users were from Ontario, and approximately half (51%) selected Toronto Central as their health region. Figure 1 shows the number of users logging on by date. The highest frequency of log-ins was in the first three months of the Web site’s launch and before the OT and PT sections were revised. The highest number of users logging on was 93, nine days after the Web site went live. Between April and November 2020, there was a total of 75,206 page views, and individual users viewed an average of 53 pages.

Figure 1.

Number of Users Logging on by Date.

Of the 22 self-check quizzes, an average of 148 users viewed each quiz. However, the number of views for each quiz varied considerably. For example, the quiz on activities of daily living had 32 views, and the quiz on lines and tubes had 318 views. Quiz completion statistics were not captured.

Focus group participants were four occupational therapists and eight physiotherapists. Ten participants worked in acute care or rehabilitation, and two practised in community settings. Six of the 14 Ontario health regions were represented; the majority were in the Toronto Central region. Appendix S2 online outlines participant characteristics. The focus group analysis revealed the following three themes.

(1) To prepare for practice changes, clinicians value a single repository of information

The focus group participants indicated that they appreciated having a single Web site with a comprehensive repository of information from a reputable source. One participant commented: “there was a lot of good stuff, just kind of all in one place.” (PF7)

The participants described the Web site as helping them prepare for working with COVID-19 patients or in a new practice area due to redeployment. One participant noted: “I just wanted more information … they were upskilling all the PTs in the hospital to become familiar with ICU in case we needed to redeploy.” (PF5)

The focus group participants reported experiencing anxiety because of the pandemic’s unknowns. Accessing the learning resources helped them manage their anxiety.

There was a lot of anxiety at that time and trying to get, like learn as much information as quickly as possible … Certainly [the Web site] helped me feel like at least I was able to access some like basic information. (OF2)

(2) Web site features can either facilitate or hinder access to the needed information

The focus group participants described how some Web site features helped them access the information they wanted. Participants commented that the subcategories helped them identify the resources they needed. One participant stated, “You know there’s headings, subheadings, and then within each section there’s the different resources laid out. So I found that pretty easy to navigate.” (PF7)

The self-check quizzes also helped participants navigate the resources and determine which to review in depth. One participant reported: “I just like started with the quiz and then if I like did poorly on it, I was like, OK, let’s look at this stuff.” (PF6)

Participants also described features that hindered Web site navigation. Since the site was originally titled “CriticalCareLearning.ca,” some participants were uncertain if the information was relevant to their practice. One participant described not exploring the Web site in the early stages because she did not believe it would be applicable to her work:

The first few things that you look at in terms of resource is (pause) make it look like it’s only really for critical care and acute care. And since I wasn’t working in that area at the time … I figured this isn’t really applicable to me right now. (PF7)

While participants appreciated access to information, some described the amount of information as overwhelming. One participant described:

Sometimes [there’s] so much information and you feel that you have to be, you have to know it all but there’s a lot of information … but I could see if you were moving into an area that you weren’t familiar with that it might be overwhelming. (PF3)

(3) Participants described diverse learning needs

Some participants described accessing resources specific to their profession, others wanted resources specific to their practice setting. One participant described being: “really focused on the physiotherapy piece.” (PF1) Another participant stated: “I was most interested in what they had to say about rehab.” (OF1) Others wanted to refresh particular skills, such as prone positioning, pivot transfers, and managing pressure ulcers.

Discussion

The purpose of this study was to explore the experiences of occupational therapists and physiotherapists who accessed a CPD Web site related to the COVID-19 pandemic. Data demonstrates that 768 occupational therapists and physiotherapists and 561 students accessed the site, representing approximately 4.5.% of the occupational therapists and physiotherapists registered to practise in Ontario.^{7 ,8} The Web site content initially focused on critical care and was more likely to appeal to those working in acute-care settings. However, with an average number of 53 page views between April to November 2020, data suggests that users were engaged and explored multiples pages on the site. Three themes emerged from the focus groups: (1) To prepare for practice changes, clinicians value a single repository of information; (2) Web site features can either facilitate or hinder access to the needed information; (3) Participants described diverse learning needs. Our findings provide insights on the design of future CPD resources in response to rapid practice changes.

Focus group participants reported that the Web site assisted them in preparing for redeployment and care provision. This is supported by the user data, as the highest frequency of logins was in the first three months of the Web site creation, which coincided with the beginning of the pandemic. Some participants stated that accessing the information eased their anxiety, while others reported that the amount of information made them feel overwhelmed. These findings are consistent with those of Shanafelt and colleagues⁵ whose study explored pandemic-related stress in health care workers. They found that health care workers desire access to relevant, timely resources to ease pandemic-related stress. However, caution must be taken to avoid burdening users with a perception of too many resources, especially at a time when they may be feeling overwhelmed by redeployment to an unfamiliar practice area.

Participants reported facilitators and barriers to navigating the Web site and fulfilling their diverse learning needs. The diversity in needs may be related to the self-directed nature of CPD activities in Ontario, where health care professionals must identify their learning needs and take steps to close those gaps.³ Our participants supported this premise by identifying Web site features that enabled self-directed learning.

User data indicated that, on average, 148 users accessed the self-check quizzes between July and November 2020. The focus group data provided insight into the value of the self-check quizzes, as participants commented that this feature assisted them in identifying what materials to review in greatest depth. The organization of curated materials into sections facilitated access to specific resources of interest. Jeong and colleagues⁹ described similar facilitators of self-directed learning with physicians, including a perceived relevance of the material and the presence of a structured tool for reflection. The self-check features provided some structure to facilitate self-directed learning. However, some participants in our study reported that the initial branding of the Web site as a “critical care” resource resulted in a perceived lack of relevance. Thus, resource developers should ensure that titles and dissemination of the resource accurately reflect content and learning needs of potential users.

The COVID-19 pandemic resulted in significant changes to health care and practice that required the rapid development and dissemination of CPD resources. There is a need to balance rapid access to information with user needs. Thakur and colleagues¹⁰ applied design thinking to this challenge in medical education, employing a step-wise approach including inspiration, ideation, and implementation; ideation is critical even with rapidly designed materials. In our study, stakeholder input from an occupational therapist and physiotherapist advisory group guided the ideation stage to generate ideas for content, relevant topics, and organization of the Web site. Initial stakeholder input supported and anticipated user needs, and we believe this initial input fostered greater engagement among users.

This study has limitations. First, user data included those identifying as “in training.” Students in some entry-level Ontario programmes were required to review the Web site to prepare for entry into the clinical environment, which may have impacted page view patterns. Those in training were included due to the high proportion of users in this group, but differences in user patterns between practising and in-training users were not explored. Second, a small number of participants volunteered for the focus groups and represented only six of the 14 health regions, thus the perspectives shared by participants may not be representative of all of the Web site users.

Conclusion

Our study explored the experiences of occupational therapist and physiotherapist users of a Web site developed to support COVID-19 pandemic CPD requirements. The Web site design features assisted participants in preparing for redeployment and patient care, and we noted the features such as subheadings and self-checks facilitate its use while branding limited perceived relevance. Future response to immediate CPD requirements should include design features to support self-directed learning.

Key Messages

What is already known on this topic

Health care system and practice changes can be a source of anxiety for health care professionals. Rapidly designed resources can assist them with their professional development needs.

What this study adds

Access to information in the form of a Web site can assist occupational therapists and physiotherapists in managing their anxiety about deployment or practice changes if the quantity of material on the site is not overwhelming. Features such as self-check quizzes and relevant subheadings can support user engagement in self-directed learning.