Influencing Physical Therapist's Self-efficacy for Musculoskeletal Ultrasound Through Blended Learning: A Mixed Methods Study.

Abstract

With the growing interest for physical therapists to incorporate musculoskeletal (MSK) ultrasound comes a need to understand how to organize training to promote the transfer of training to clinical practice. A common training strategy blends asynchronous learning through online modules and virtual simulations with synchronous practice on live simulated participants. However, few physical therapists who attend MSK ultrasound continuing education courses integrate ultrasound into clinical practice. Self-efficacy is a significant predictor of training transfer effectiveness. This study describes to what degree and how a blended learning strategy influenced participants' self-efficacy for MSK ultrasound and transfer of training to clinical practice. Twenty-one outpatient physical therapists with no previous MSK ultrasound training. Twenty-one participants assessed their self-efficacy using a 26-item self-efficacy questionnaire at 3 intervals: before asynchronous, before synchronous training, and before returning to clinical practice. Participants were interviewed within 1 week of training using a semi-structured interview guide. Quantitative analysis included descriptive statistics and repeated-measures ANOVA. Thematic analysis was used to examine participants' experiences, and "following the thread" was used to integrate findings. Self-efficacy questionnaire mean scores increased significantly across the 3- time points ( F [2, 40] = 172.7, P < .001, η 2 = 0.896). Thematic analysis indicated that asynchronous activities scaffolded participants' knowledge, enhanced their self-efficacy, and prepared them for synchronous learning; however, it did not replicate the challenges of MSK ultrasound. Synchronous activities further improved self-efficacy and helped participants better calibrate their self-judgments of their abilities and readiness to integrate MSK ultrasound training into clinical practice. Despite individual-level improvements in self-efficacy, interviewees recognized their limitations and a need for longitudinal training in a clinical environment. A blended learning approach positively affects participants' self-efficacy for MSK ultrasound; however, future training designs should provide learners with additional support during the transition phase.