Clinician's Commentary on Coleman et al.

The World Health Organization declared the outbreak of COVID-19 to be a pandemic on March 11, 2020.² In response, Canada's health care system underwent quick, large-scale changes and rehabilitation providers, such as physiotherapists and occupational therapists, faced substantial adjustments to their daily practices. For example, outpatient clinics closed to in-person services, and many shifted to telerehabilitation.³ Meanwhile, inpatient therapists were often redeployed in preparation for an influx of COVID-19 related hospitalizations. Redeployed therapists faced significant uncertainty due to lack of COVID-specific clinical evidence and guidance causing confusion about procedures and care.⁴ Subsequently, continuing professional development (CPD) needs were high during the beginning of the pandemic.

CPD is a cornerstone of physiotherapy and occupational therapy practice and consists of instructional activities completed after formal education.⁵ It can take many forms including in-person or online courses, webinars, or specialty certifications.⁵ The most common types of CPD are in-person conferences, presentations, seminars, or workshops.⁶ Web-based education was becoming increasingly more common before the pandemic,⁷ and popularity further increased following public health restrictions imposed in early 2020.⁸

CPD helps therapists maintain competence, stay current with new and evolving topics, and adapt to new practice settings or areas of expertise.^6,9,10 To support learning, CPD should be developed through application of theoretical approaches to learning and teaching.^11–14 However, in the context of the COVID-19 pandemic there was an urgent need to increase staff to work with patients infected with COVID-19 and continuous evolution of information about the virus-related illness. At the beginning of the pandemic, CPD resource development had to be fast, and deployment had to be nimble.¹⁵ Little is known on the best approach to develop CPD resources quickly, nor on their impact.

Coleman and colleagues contribute to the literature surrounding rapid CPD development by exploring physiotherapist and occupational therapist's experiences with a rapidly developed and deployed website, “COVIDCareLearning.ca.”¹ The website provided education for 15 different health care professionals in Ontario.¹ Topics included those related to critical care, physiotherapy, and occupational therapy for patients with COVID-19, acute care skills and competencies, and links to additional resources.¹ The website was developed through a collaboration of faculty and clinicians from Toronto.¹ Though the website began as “CriticalCareLearning.ca” with a focus on critical care, it was expanded to include resources for those working in other settings, for example, in the community or long-term care.¹

Rapid practice changes and ever-evolving information about the COVID-19 virus, virus related illness, policies and procedures, and treatment options not only increased knowledge needs but often negatively affected the mental health of physiotherapists and occupational therapists. Recent research has described the negative mental health impact of the pandemic on rehabilitation providers,¹⁶ including the effect of insufficient information about COVID-19 treatment and procedures.^4,17 A single repository of resources helped managed anxiety associated with a rapidly evolving public health crisis and redeployment for the therapists in Coleman and colleagues’ study.¹ The COVIDCareLearning.ca website appears to have been helpful in easing users’ anxiety by bringing together resources in one place to support learning about COVID-19 and new environments in which redeployed therapists may find themselves with little previous experience.¹

Careful website design is important to support optimal learning. Indeed, Coleman and colleagues found that website features, such as check-in quizzes, subcategories, and amount of information available, either supported or hindered accesses to the needed information.¹ Recent work has found that web-based learning can also support flexibility in learning approaches (e.g., accessing materials at any time and pace) and repeatability (e.g., revisiting material) is helpful for retaining material.¹⁸ However, web-based learning does require learners to independently manage time, and procrastination and prioritizing other tasks can prevent engagement.¹⁸ Further, web-based learning can promote safety during times when physical distancing is necessary (e.g., high COVID-19 rates), and allows participants to access resources from anywhere limiting the effect of travel and geographical barriers which supports accessibility.¹⁸ All participants in the study by Coleman and colleagues were from Ontario and most focus group participants were from Toronto,¹ limiting the understanding of rural learners’ experiences or those from other provinces. Additionally, the effectiveness of the website for improving knowledge or skill acquisition was not assessed, limiting our understanding to the user experience. Despite these limitations, there is significant opportunity for web-based learning to reach across Canada and future work should explore the unique needs of learners outside of urban, Ontario-based centres while also examining effectiveness on knowledge and skill acquisition.

Another aspect of supportive website learning design is ensuring relevance to the learner's area of practice. Indeed, Kim and colleagues found that participants engaged in web-based learning better when the content was relevant to their practice or interests.¹⁸ Similarly, participants in Coleman and colleagues’ study reported wanting to access resources specific to their profession or practice setting, and revisiting specific skills (e.g., prone positioning or pivot transfers).¹ Participants also reported that the original website name “CriticalCareLearning.ca” hindered their learning as they were not sure if the content would be relevant to their practice even though the website had information for settings outside of critical care.¹ Ensuring the learner sees the link between the learning materials and application to their practice supports engagement and should be a key consideration in designing online learning resources.

A final consideration in online CPD development is identifying opportunities for synchronous interactions. Kim and colleagues emphasize synchronicity provides opportunities for dynamic discussions, asking questions in real-time, receive immediate feedback, and networking.¹⁸ The COVIDCareLearning.ca website is primarily asynchronous which could limit engagement with the learning material.¹ Now that pressure to get information quickly has begun to recede as we finish the fourth year of the pandemic, synchronous interactions could be achieved by adding online interactions via videoconferencing or exploring hybrid models of delivery with in-person sessions.

The results of this study and others related to online learning design can be used to inform future web-based CPD learning strategies. Websites should be carefully designed and include features to support use and engagement such as check-in quizzes and subcategories to organize large amounts of information. Relevance of the material to the learners’ practice should be highlighted. Opportunities for embedded synchronous interaction, either online or via hybrid models should be explored. Future work should also examine the needs of rural learners outside of Ontario, and assess the effectiveness of web-based CPD.