Taking CPD seriously

Now that the storm of developing, delivering and issuing certificates for the 6 week open Lower Limb Amputee Rehabilitation course is finally subsiding we wanted to take a moment to reflect on the events and the learnings we have taken from this intense and rewarding experience. We originally developed the course based around a need identified by the International Committee of the Red Cross (ICRC) to train its staff around the world on this important topic. We also wanted to involve the wider physiotherapy community and so we also had a wider set of aims for this course:

  1. Provide a valuable learning experience which is open to as many physiotherapist participants as possible irrespective of their resources and location.
  2. Develop an open set of evidence based course related resources which remain freely available after the course has finished for future discovery and reference.
  3. Foster an international community focused on sharing discipline and context related knowledge, experience and practice.
  4. Lead to a significant and positive impact on patient care.
  5. Encourage participants to consider working in this field and also in other international contexts if they don’t already.

Based on observing the forum activity during the course and reading the course evaluation responses we feel we have broadly met these aims.

The impact of group work

One amazing and unexpected aspect of this course has been the instances where groups of practitioners who work together or students in a class, all take the course together. In many cases these groups were meeting weekly to discuss aspects of the course and this undoubtedly adds enormous value to the experience for these participants. In at least two cases these groups have implemented significant changes in working practices as a result of this lower limb amputee course. This is an occurrence which gets little attention in the educational literature surrounding massive open online courses (MOOCs) but is also probably the scenario in which the highest beneficial impact occurs for both individual learning and also in impacts on practice.

The course forum

The inclusion of a discussion forum for the course was considered a key element in meeting all five of the aims of the course, particularly for those not fortunate enough to be studying in a local group. In order to encourage the maximum level of participation in this forum we chose to use Facebook (a platform that 50% of all internet users are already using) and also to make forum participation a requirement for course certification. Contributions to the forum also provided a mechanism to evidence ongoing course engagement by participants. These two decisions proved to be controversial with some participants!

Looking at evaluation form responses we can see the forum aspect of the course divided opinion between those who loved it and found it the most valuable element of the course. For example:

The Facebook discussions with physiotherapists from different countries provided an awesome experience!

And those who considered it chaotic, repetitive and unnecessary for their learning. These negative opinions of required discussion forum participation in online courses are common as Justin Johnson describes in detail based on his experiences at Duke. Our own previous experience indicates that optional forum participation with no contribution requirement or grading, results in very little or no forum participation. We believe that the high value offered by an active forum to so many of the course participants, particularly those in less resourced contexts, justified making it a required element of the course. However it is unfortunate that this requirement was missed or neglected by so many course participants and on reflection we should have been even more clear in the course instructions on what this requirement meant and why we thought it necessary.

Justin Johnson in his post raises the possibility of discussion forum participation being voluntary but rewarded by bonus marks or a bonus certificate in an attempt to get the best of both worlds (reduced volume but higher value participation). Other possibilities include using discussion forum topics that focus on personal experiences so every participant is encouraged to offer something unique rather than just to repeat previous comments. These are both options we will consider when drawing up the plans for the next open course.

Assessment and certification

Each time we have run one of these courses it has become very apparent how important the related certification is to many of the participants. Conventionally, certificates for continuing professional development (CPD) activities are almost universally certificates of attendance whether the events are live or on-line webinars or self-directed courses. This practice leads to low aspirations for participants in CPD activities (i.e. doing the minimum required to get their certificate), reduces the impact such activities have on practice and also limits the value of such certification to employers and professional bodies.

To move beyond issuing certificates of attendance (which in a large free open online course context have very limited value) it is necessary to capture evidence of both participant engagement and achievement. For this course this evidence was gathered weekly by observing participation in the related course discussion forum and at the end of the course with a written assignment and a course quiz.

The open nature of the course prevented resource access logs being used to evidence course engagement and we felt the weekly quizzes should be viewed as formative learning experiences rather than as an ongoing element of assessment. In future courses, access logs and quiz attempts (with no requirement to pass) could be used to supplement or replace forum participation as evidence of sustained engagement.

With such large participation numbers the assessment of written assignments is a challenge. However the use of assessed written assignments is still the best tool for encouraging and evidencing an individual’s engagement with the course content. To facilitate assessment and also encourage a clear and effective writing style, restricted word limits were assigned to the assignment format which some participants found challenging. For this course all written submissions were subjected to a brief review by the course team to identify passes and fails. We were overwhelmed by the quality of many of the submissions and we are now organising a more thorough assessment of the submissions to identify those worthy of public publication on Physiopedia. These will form the beginnings of the first large, open and online database of physiotherapy case studies which we feel will become an extremely valuable resource for the education, research and clinical communities.

The future

With the incredible success of the 3 free and open courses we have run to date we are totally committed to running more of these free and open courses in the future. We will be looking to move the forum and submission elements of these courses to an open and free area within the Physiopedia Members site to avoid many issues accessing certificates caused by inconsistent email entries when submitting and also to avoid the issues encountered with the use of Facebook. We will be reviewing our use of discussion forums and assessment methods as outlined above and we will also continue to push the boundaries by seeking to use the most innovative and appropriate approaches to online learning available. We hope you will continue to take part in these courses and explore with us the possibilities offered by this brave new connected world!


We would like to thank all the people who helped make this course possible through encouraging us, providing funding, developing content, moderating the forums, providing access to textbooks and agreeing to be interviewed.