Distance Learning and Leadership in Brazilian Physiotherapy Education Program during COVID-19 Pandemic

The COVID-19 pandemic has disrupted all in-person teaching learning process of clinical practice in physiotherapy education programs. Although online teaching requires different teaching skills, faculty had to totally convert their in-person classes to virtual classes rapidly and without training. To manage this crisis, a shared leadership seems to make difference in guarantee teaching learning process to happen. This Short Commentary brings the experience and perception of two physiotherapy educators who acted in the leadership during the COVID-19 pandemic. It is time to understand the importance of qualification to implement online education and the importance of a shared leadership in the teaching learning process. The time is to identify opportunities from this online educational transformation in physiotherapy programs that can be continued in the post-COVID-19 era. 

Historically, physiotherapy emerged after World War II in the face of the wide need for rehabilitation. As occurred in medical education, in almost all university settings physiotherapy undergraduate programs had been initially composed by theoretical and practical teaching based on lectures, practices training among students and supervised clinical fieldwork [1,2]. Along the years, advancement of research in physiotherapy and technological resources had contributed to the increased complexity of the teaching process. Educators’ qualification became indispensable, with a constant growth of postgraduate programs in the field [3]. Additionally, digital technologies had emerged as a new way of teaching [4,5]. 

Online teaching skills differ from in-person teaching skills, making teacher qualification necessary [6]. If implemented with adequate preparation of educators, technology and distance learning have the potential for regular practice of basic health education [4,7]. In Brazil, toward the end of 2019, the Ministry of Education permitted an increase in distance learning from 20% to 40% in in-person physiotherapy education programs [8]. Unfortunately, Brazilian education institutions have been implementing physiotherapy programs with distance learning format with a clear objective of cost reduction. A 27-fold increase in distance format programs had occurred between 1991 and 2019, with no training for educators and lack of control in student-educator proportion [3,9]. 

During these curricular changes in Brazil, in December 2019 the whole world was surprised with the Coronavirus Disease 2019 (COVID-19), firstly reported in Wuhan, China. Due to an exponential spread, in March 2020, a worldwide pandemic was been declared, and mandatory stay-at-home orders occurred in many countries [10]. Faculty had to totally convert their in-person classes to virtual classes, with an unprecedented disruption to the health education process and to healthcare systems worldwide [11-13], including Brazilian physiotherapy programs [9,14]. Innovations that have been available for years or decades, but not widely implemented in health education, were now the norm [13]. 

Although technological tools for distance learning, as synchronous, asynchronous and hybrid activities, simulated telehealth consultations, and the use of multiple platforms, have brought new ways of communicating and enabling the teaching learning process [15], most health programs were not designed to be fully (or even partially) online. Effective online teaching requires different teaching skills when compared to classroom teaching skills, making institutional investment and educator qualification indispensable items [4]. During lockdown imposed by COVID-19 pandemic, Brazilian faculty spent enormous amount of dedication, ingenuity, and hard work to migrate curricula to online environments, demonstrating commitment. However, the approaches adopted ranged from simply posting previous lectures online to a complete reengineering of the programs to make them more appropriate for the virtual environment [7,9]. In the absence of experience in effective online teaching and in the face of the need for a sudden adaptation, the appropriate leadership seems to be a differential. 

Qualified academic leadership, together with university investment, plays an important role in enabling teaching and learning to occur in the context of evidence-based practice in a physiotherapy education program [16]. Shared leadership seems to have facilitated the migration of physiotherapy education programs from in-person classes to moderate or high-quality online classes, assisting the revision of how physiotherapy skills could be achieved [17,18]. Collective wisdom and problem-solving skills were indispensable. Teamwork, collaboration and communication were key to maintaining and sustaining teaching learning process during this temporary 100% distance physiotherapist education, practice, and research. During unpredictable times, such as the COVID-19 pandemic, universities should witness and promote relevant and effective leadership behaviors [19]. 

The COVID-19 pandemic consequences for health education are still unknown. Educators once represented as knowledge holders had been reconfigured as access instruments to knowledge. Leaders of educational institutions should have the mission of recognizing the formative powers, the variability of individuals and the tools for a teaching process, and not only being a problem resolver or curricula planner. And no matter the direction of COVID-19, it is time to identify opportunities from this online education transformation in physiotherapy programs that can be continued in the post-COVID-19 era. The importance of institution investment and structure, leader and educator qualification, and student responsibility in distance learning must be discussed. It is time to understand the appropriate tools to guarantee the excellence in physiotherapy education program even in the face of increased hours of distance learning.