Comparison of On-Campus and Hybrid Student Outcomes in Occupational Therapy Doctoral Education

Keli Mu; Brenda M. Coppard; Al G. Bracciano; J. Chris Bradberry

doi:10.5014/ajot.2014.685S02

Abstract

We compared the graduate outcomes of doctoral students in a traditional on-campus occupational therapy program with those in a hybrid program. Participants were 81 students from an on-campus program and 13 students from a hybrid program. Graduate outcomes were measured with student grade-point average (GPA) at the end of each academic year, cumulative GPA, Fieldwork Performance Exam, National Board for Certification in Occupational Therapy (NBCOT) practice exam scores, and final NBCOT pass rate. Consistent with previous research, our results revealed no significant differences on most outcome variables, suggesting that hybrid programs are an effective delivery model for postsecondary higher education. These findings may provide guidance to occupational therapy programs in curriculum design, content delivery, and program refinement and development. Replication of this study is needed with a larger sample and inclusion of qualitative data. Future studies should compare the affective domain of graduate outcomes in on-campus and online or hybrid programs.

The increasing sophistication of technology has fostered the rapid growth of online education at the postsecondary level. Online education is increasingly becoming an instructional norm in higher education (Allen & Seaman, 2013). In a survey of 2,800 colleges and universities, 69.1% of chief academic leaders said that online learning is a critical strategy for delivering education (Allen & Seaman, 2013). In 2002, the total number of students enrolled in one or more online courses was only 570,000. By 2012, the number of students taking at least one online course had grown to 6.7 million (Allen & Seaman, 2013), despite overall decreased enrollments in higher education (Supiano, 2012).

Numerous studies have compared traditional face-to-face instruction with instruction that uses technology (e.g., Clark, 2002; Hong, 2002; Johnston, 2008; Means, Toyama, Murphy, Bakia, & Jones, 2009; Phye, 1997; Rogers, Mulholland, Derdall, & Hollis, 2011). These studies found no significant differences between the effectiveness of traditional face-to-face instruction and instruction using technology (Allen & Seaman, 2013).

Terminology

Allen and Seaman (2006) identified four primary delivery models based on the percentage of the program delivered by technology (Table 1):

Traditional courses deliver 0% content using Internet technology.
Web-facilitated courses deliver 1%–29% of content using technology such as course management systems or course web pages. Syllabi and assignments are commonly posted on course websites for easy student access.
Hybrid courses deliver 30%–79% of content using Internet technology and are recognized as being among the fastest growing enrollment sections in higher education (U.S. Department of Education, 2009). Hybrid courses tend to have fewer face-to-face sessions, and online discussion forums (i.e., discussion boards) are commonly used. The term hybrid describes a course that has components of face-to-face and online instruction (TLT Group, n.d.). The goal of hybrid courses is to optimize student engagement by taking advantage of the strengths of face-to-face and web-based environments. In contrast to face-to-face courses with online supplementary materials, the instructor and students in a hybrid course interact with each other online.
Online courses deliver 80% or more of content using Web-based technology. Often, online courses have no face-to-face class sessions. Interaction among students and with the instructor is conducted using technology (e.g., web conferencing, discussion forums, email). Assignments are submitted to the instructor in an online manner (e.g., via course management system).

Table 1.

Terminology Related to Content Delivery Formats

Format	Description	Proportion of Content Delivered Online, %
Traditional	No online technology is used—content is delivered orally or in writing.	0
Web facilitated	Web-based technology is used to facilitate face-to-face courses—usually using a course management system or course web pages to post syllabus and assignments.	1–29
Blended or hybrid	Blending of online and face-to-face delivery is used. A substantial proportion of content is delivered online. Discussion forums are typical, and there are fewer face-to-face sessions.	30–79
Online	Most or all of the content is delivered online. There are typically no face-to-face sessions.	80–100

Source. Allen and Seaman (2006, 2013).

View Large

Table 1.

Terminology Related to Content Delivery Formats

Format	Description	Proportion of Content Delivered Online, %
Traditional	No online technology is used—content is delivered orally or in writing.	0
Web facilitated	Web-based technology is used to facilitate face-to-face courses—usually using a course management system or course web pages to post syllabus and assignments.	1–29
Blended or hybrid	Blending of online and face-to-face delivery is used. A substantial proportion of content is delivered online. Discussion forums are typical, and there are fewer face-to-face sessions.	30–79
Online	Most or all of the content is delivered online. There are typically no face-to-face sessions.	80–100

Source. Allen and Seaman (2006, 2013).

Student Learning Outcomes

In many studies that have compared undergraduate and graduate students in traditional versus online courses, the outcomes are often measured by student and faculty self-reports, test grades, and final course grades (e.g., Allen et al., 2006; Clark, 2002; Farber, 2013; Fredda, 2000; Hong, 2002; Johnston, 2008; Means et al., 2009; Neuhauser, 2002; Phye, 1997; Richardson, 2004; Van Schaik, Barker, & Beckstrand, 2003; Weiss, Schreuer, Jermias-Cohen, & Josman, 2004). Collectively, these studies’ findings revealed no significant difference in learning outcomes between students who were enrolled in traditional and online programs. The no-significant-difference phenomenon, Russell (1999) and other researchers have argued, may be attributed to lack of control for extraneous variables such as students’ existing knowledge and academic achievement and different delivery modes being delivered by different instructors (Hollis & Madill, 2006; Russell, 1999). Overall, however, these outcomes research studies have agreed with academic leaders’ beliefs by finding no significant differences between the effectiveness of traditional instruction and instruction using Internet technology (Allen & Seaman, 2013).

Online Education in Occupational Therapy

Distance education is commonly used in occupational therapy education. According to the Academic Year 2011–2012 AOTA Academic Programs Annual Data Report (American Occupational Therapy Association [AOTA], 2012), 50% of doctoral-level programs and 60% of master’s-level programs in occupational therapy and 56% of occupational therapy assistant programs reported offering some type of distance education to their students. To maintain and ensure the high quality of occupational therapy, educators in occupational therapy, as is the case for those in other professions, face the issue of how to replicate what happens in face-to-face courses in an online environment (Teeley, 2007).

Similar to other research studies, student learning outcomes in occupational therapy have been examined using student and faculty satisfaction and grades in didactic courses. Additionally, researchers in occupational therapy have also examined critical reasoning of occupational therapy students enrolled in online or distance education programs (Doyle & Jacobs, 2013; Farber, 2013, Mitchell & Batorski, 2009; Richardson, 2004; Simons, Baron, Knicely, & Richardson, 2002). In spite of the increased research studies on student learning outcomes, the literature on overall graduate outcomes in occupational therapy between on-campus and hybrid programs is still limited.

The purpose of this study was to examine and compare graduate outcomes between a traditional and a hybrid entry-level doctorate of occupational therapy (OTD) program. Specifically, we compared students’ grade-point average (GPA) at the end of each academic year, cumulative GPA on graduation, Level 2 Fieldwork Performance Evaluation (FWPE), grade on the National Board for Certification in Occupational Therapy (NBCOT) practice exam, and actual NBCOT pass rate.

Context of the Study

Participants in the study were enrolled in an entry-level OTD program at the urban campus of a private university in the Midwest. This university was founded in 1878 and consists of eight colleges and schools with more than 50 undergraduate and 20 graduate programs. This institution has a history of successful development of distance and professional doctoral education. In 1999, the university offered the first entry-level OTD program in the United States in response to professional and health care trends and to meet the needs of society (Runyon, Aitken, & Stohs, 1994). Currently, the entry-level OTD program is offered in 3 yr across eight semesters. The OTD curriculum emphasizes entry-level occupational therapy competencies, with a focus on occupation, professional identity, and practice; Ignatian values; and leadership. The detailed OTD curriculum can be found in the Appendix.

To address the shortage of occupational therapists in an underserved state, the university partnered with a public institution in that state to deliver a hybrid entry-level OTD program to students residing in the state. The hybrid entry-level program launched in fall 2008 and is a complete replication of the traditional program offered on campus at the university. A lecture capture system is used to record all lectures delivered on campus by faculty and to link lecture files for the hybrid student cohort to view and study. The students in the hybrid cohort interact with instructors and other students through the learning management system and other approaches such as email, Skype, and web conferencing. Courses that require laboratories are taught to the hybrid cohort by adjunct occupational therapy faculty at the partnering university in the state in which the students reside. All adjunct faculty are experienced practitioners or educators in occupational therapy and are employed by the university. Before instructing the lab components of the courses, all adjunct faculty completed a rigorous orientation and training pertaining to instructional methods, online teaching and learning, evaluation and assessment of student learning, and classroom management.

Method

This study used a retrospective, between-groups comparison method to examine whether a significant difference occurred between the graduate outcomes of on-campus and hybrid programs. Before the study, approval was obtained from the institutional review board of the university at which the investigators were employed.

Study participants were entry-level OTD students who graduated in 2011 and 2012 from both the traditional and hybrid programs. A total of 81 students from the traditional program and 13 students from the hybrid program took part in the study. The number, gender, and mean age of the participants from each cohort are displayed in Table 2.

Table 2.

Student Demographic Information in On-Campus and Hybrid Cohorts

Class	On-Campus Cohort (M age = 22)		Hybrid Cohort (M age = 31)
Class	Male	Female	Male	Female
2011	3	33	0	5
2012	4	41	1	7

View Large

Table 2.

Student Demographic Information in On-Campus and Hybrid Cohorts

Class	On-Campus Cohort (M age = 22)		Hybrid Cohort (M age = 31)
Class	Male	Female	Male	Female
2011	3	33	0	5
2012	4	41	1	7

The academic performance of the participating students was collected, including student GPA at the end of each academic year, overall cumulative GPA, Level 2 fieldwork performance, grade on the NBCOT practice exam, and final NBCOT pass rate. In occupational therapy education, the Accreditation Council for Occupational Therapy Education requires students to complete two 12-wk hands-on fieldwork assignments during their education and training. Students’ performance in Level 2 fieldwork is measured with the FWPE (AOTA, 2002).

The NBCOT test is a standardized assessment. Currently, the NBCOT test consists of two test item formats: multiple-choice questions and clinical simulation scenarios. In addition to the actual NBCOT test, NBCOT also offers online practice examinations. Graduates of occupational therapy programs can take the practice exam before taking the actual test. Before graduation, all students in the university’s occupational therapy program are required to take the NBCOT practice exam. Data from the NBCOT practice exam consisted of scores from the online multiple-choice and clinical simulation tests. An independent t test was used to analyze whether a significant difference occurred in the variables of interest. The significance level was set at .05.

Results

Results of the statistical analyses of the collected data are summarized in Table 3. As illustrated in Table 3, no significant differences were found in student 1st-yr GPA, overall cumulative GPA, first- and second-level fieldwork performance, grades on the NBCOT practice exam multiple-choice and clinical simulation sections, and overall NBCOT pass rates. Although the difference in cumulative GPA is close to significant, it did not reach a statistically significant level. A significant difference, however, was found in end-of-1st-yr and end-of-2nd-yr student GPA, with the traditional program students having a higher mean GPA.

Table 3.

Comparisons of Outcome Variables Between the Two Cohorts

Variable	On-Campus Cohort		Hybrid Cohort		p
Variable	Mean	SD	Mean	SD	p
GPA
1st yr	3.49	0.33	3.35	0.44	.131
2nd yr	3.74	0.19	3.56	0.26	.002*
3rd yr	3.76	0.18	3.61	0.24	.008*
Cumulative	3.67	0.21	3.51	0.30	.057
FWPE
1	138.7	12.89	136.6	10.6	.56
2	137.4	14.16	143.8	14.25	.11
NBCOT
Practice multiple choice	454.4	21.27	453.1	13.57	.82
Practice simulation	491.5	20.16	491.7	16.01	.98
Final pass rate, %	100		100

Note. FWPE = Fieldwork Performance Exam; GPA = grade point average; NBCOT = National Board for Certification in Occupational Therapy; SD = standard deviation.

*Significant at .05 level.

View Large

Table 3.

Comparisons of Outcome Variables Between the Two Cohorts

Variable	On-Campus Cohort		Hybrid Cohort		p
Variable	Mean	SD	Mean	SD	p
GPA
1st yr	3.49	0.33	3.35	0.44	.131
2nd yr	3.74	0.19	3.56	0.26	.002*
3rd yr	3.76	0.18	3.61	0.24	.008*
Cumulative	3.67	0.21	3.51	0.30	.057
FWPE
1	138.7	12.89	136.6	10.6	.56
2	137.4	14.16	143.8	14.25	.11
NBCOT
Practice multiple choice	454.4	21.27	453.1	13.57	.82
Practice simulation	491.5	20.16	491.7	16.01	.98
Final pass rate, %	100		100

Note. FWPE = Fieldwork Performance Exam; GPA = grade point average; NBCOT = National Board for Certification in Occupational Therapy; SD = standard deviation.

*Significant at .05 level.

Discussion

The purpose of this study was to examine and compare graduate outcomes of entry-level OTD on-campus and hybrid student cohorts. In general, study findings revealed no significant differences in students’ overall GPA, Level 2 FWPE, NBCOT practice tests (online multiple-choice and clinical simulation tests), and actual final NBCOT certification exam pass rate. Overall, the study findings suggest that the graduate outcomes of occupational therapy students in traditional and hybrid programs are comparable or the same. Such comparability and sameness exist in both knowledge as measured by didactic coursework and the NBCOT practice exam and the psychomotor dimensions as measured by laboratory course grades and FWPE, indicating that hybrid education is an effective alternative for occupational therapy professional education and training. Although caution is advised, the study findings may be applicable to other health care professions.

The significant findings regarding end-of-2nd-yr and end-of-3rd-yr GPAs are surprising and contradictory to the results for the other variables of interest. Whether such significant findings are due to the actual student performance outcomes or other extraneous variables is unknown. The significant finding may be caused by Type 2 error, given the small and disproportionate sample of the study. Future research studies are warranted to further examine such significant findings.

Caution needs to be taken when interpreting the study findings because of several limitations. First, the number of the participants from the hybrid program was small and disproportionate. For this reason, global generalizations from this study cannot be made. Moreover, with the small sample, Type 2 error may have occurred. Future studies need to include a large sample.

Second, although both knowledge and skill and psychomotor dimensions of the graduate outcomes were compared, the comparison between the two cohorts on the affective domain of Bloom’s taxonomy (Anderson et al., 2000) needs to be examined in future studies. Qualitative data need to be collected or qualitative research conducted to overcome such limitations. Finally, in this study only NBCOT pass rate was compared, not the actual scores obtained by graduates, due to their unavailability. Comparisons of the actual scores obtained by graduates on the NBCOT exam would be more informative and beneficial. Future research needs to explore ways to conduct such discrete comparisons.

Implications for Occupational Therapy Education and Practice

The findings of this study have the following implications for occupational therapy education:

The findings of this study may be useful to other occupational therapy schools or programs in determining whether to adopt a hybrid program and may serve as a model for curricular design and content delivery.
This study may provide new or developing occupational therapy programs with an approach to assess the performance of cohorts to determine academic effectiveness and clinical ability in the curriculum.
As need for greater accountability and accreditation requirements increases, this study provides a basis for occupational therapy programs to explore and implement creative solutions for education delivery and curricula to meet the unique needs and learning styles of their service area and constituents.
Implementation of hybrid models of education provides a mechanism to control escalating higher education costs and circumvents the limitations imposed by traditional brick-and-mortar classrooms while meeting students’ learning needs and interests.

Acknowledgment

We thank faculty and staff in the Department of Occupational Therapy, School of Pharmacy and Health Professions, Creighton University, and our partner at the University of Alaska Anchorage. Their willingness, bravery, dedication, and commitment made the hybrid program and this study a reality.

Appendix. Creighton University Entry-Level Doctorate of Occupational Therapy Curriculum Effective Fall 2013

Year 1
Fall: Semester 1 OTD 302 Occupations and Occupational Therapy (3) OTD 306 Health Conditions (3) OTD 314 Occupation and Health: Population Perspectives (3) OTD 316 Professional Practice and Ethical Formation Seminar (LAB) (4) OTD 341 Neuroanatomy (3)	Spring: Semester 2 OTD 300 Research Proposal (3) OTD 317 Occupational Therapy in Mental Health (LAB) (4) OTD 318 Level IA Fieldwork: Mental Health (.5) OTD 324 Applied Kinesiology (LAB) (3) OTD 339 Clinical Anatomy (3) OTD 340 Clinical Anatomy Lab (1.5) OTD 355 Physical Rehabilitation I: Evaluation (LAB) (3)	Summer: Semester 3 OTD 356 Physical Rehabilitation II: Neurorehabilitation (LAB) (4) OTD 333 Upper Extremity Evaluation and Intervention I (LAB) (3) OTD 390 Level IB Fieldwork: Physical Rehabilitation (1.5)
Total credits = 16 5 classes, 1 lab	Total credits = 18 7 classes, 4 labs	Total credits = 8.5 3 classes, 2 labs
Year 2
Fall: Semester 4 OTD 400 Research Project Implementation I (1.5) OTD 403 Neuro-Occupation (2) OTD 423 Occupational Therapy with Older Adults (LAB) (3) OTD 433 Upper Extremity Evaluation and Intervention II (LAB) (3) OTD 435 Occupational Therapy with Children and Youth I (LAB) (3) OTD 442 Critical Analysis of Occupational Therapy Practice (3) OTD 460 Clinical Education Seminar I (1.5) OTD 490 Level IC Fieldwork: Pediatric or Selected Practice Setting (1)	Spring: Semester 5 OTD 401 Research Project Implementation II (1.5) OTD 406 Management and Program Development (3) OTD 417 Disability and Healthcare Policy (3) OTD 436 Occupational Therapy with Children and Youth II (LAB) (4) OTD 457 Physical Rehabilitation III: Interventions and Outcomes (LAB) (4) OTD 461 Clinical Education Seminar II (1.5) OTD 491 Level ID Fieldwork: Pediatric or Selected Practice Setting (1)	Summer: Semester 6 OTD 481 Level IIA Fieldwork (12)
Total credits = 18 8 classes, 3 labs	Total credits = 18 7 classes, 2 labs	Total credits = 12 1 class
Year 3
Fall: Semester 7 OTD 564 Professional Identity and Ethical Perspectives in the Ignatian Tradition (first 3 weeks only; online format) (3) OTD 574 Professional Competency (last 12 weeks only; online format) (0.5) OTD 571 Level IIB Fieldwork (last 12 weeks only) (12)	Spring: Semester 8 OTD 600 Professional Rotation (16) OTD 601 Capstone (1)
Total credits = 15.5 3 classes	Total credits = 17 2 classes
Curriculum Summary
8 semesters 3 academic years 123 credits 36 classes 12 labs 43.5 weeks of clinical experiences • 4 Level I fieldworks • 2 Level II fieldworks 1 professional rotation

Note. OTD = doctorate of occupational therapy.

View Large

Appendix. Creighton University Entry-Level Doctorate of Occupational Therapy Curriculum Effective Fall 2013

Year 1
Fall: Semester 1 OTD 302 Occupations and Occupational Therapy (3) OTD 306 Health Conditions (3) OTD 314 Occupation and Health: Population Perspectives (3) OTD 316 Professional Practice and Ethical Formation Seminar (LAB) (4) OTD 341 Neuroanatomy (3)	Spring: Semester 2 OTD 300 Research Proposal (3) OTD 317 Occupational Therapy in Mental Health (LAB) (4) OTD 318 Level IA Fieldwork: Mental Health (.5) OTD 324 Applied Kinesiology (LAB) (3) OTD 339 Clinical Anatomy (3) OTD 340 Clinical Anatomy Lab (1.5) OTD 355 Physical Rehabilitation I: Evaluation (LAB) (3)	Summer: Semester 3 OTD 356 Physical Rehabilitation II: Neurorehabilitation (LAB) (4) OTD 333 Upper Extremity Evaluation and Intervention I (LAB) (3) OTD 390 Level IB Fieldwork: Physical Rehabilitation (1.5)
Total credits = 16 5 classes, 1 lab	Total credits = 18 7 classes, 4 labs	Total credits = 8.5 3 classes, 2 labs
Year 2
Fall: Semester 4 OTD 400 Research Project Implementation I (1.5) OTD 403 Neuro-Occupation (2) OTD 423 Occupational Therapy with Older Adults (LAB) (3) OTD 433 Upper Extremity Evaluation and Intervention II (LAB) (3) OTD 435 Occupational Therapy with Children and Youth I (LAB) (3) OTD 442 Critical Analysis of Occupational Therapy Practice (3) OTD 460 Clinical Education Seminar I (1.5) OTD 490 Level IC Fieldwork: Pediatric or Selected Practice Setting (1)	Spring: Semester 5 OTD 401 Research Project Implementation II (1.5) OTD 406 Management and Program Development (3) OTD 417 Disability and Healthcare Policy (3) OTD 436 Occupational Therapy with Children and Youth II (LAB) (4) OTD 457 Physical Rehabilitation III: Interventions and Outcomes (LAB) (4) OTD 461 Clinical Education Seminar II (1.5) OTD 491 Level ID Fieldwork: Pediatric or Selected Practice Setting (1)	Summer: Semester 6 OTD 481 Level IIA Fieldwork (12)
Total credits = 18 8 classes, 3 labs	Total credits = 18 7 classes, 2 labs	Total credits = 12 1 class
Year 3
Fall: Semester 7 OTD 564 Professional Identity and Ethical Perspectives in the Ignatian Tradition (first 3 weeks only; online format) (3) OTD 574 Professional Competency (last 12 weeks only; online format) (0.5) OTD 571 Level IIB Fieldwork (last 12 weeks only) (12)	Spring: Semester 8 OTD 600 Professional Rotation (16) OTD 601 Capstone (1)
Total credits = 15.5 3 classes	Total credits = 17 2 classes
Curriculum Summary
8 semesters 3 academic years 123 credits 36 classes 12 labs 43.5 weeks of clinical experiences • 4 Level I fieldworks • 2 Level II fieldworks 1 professional rotation

Note. OTD = doctorate of occupational therapy.

References

Allen, I. E., & Seaman, J. (2006). Making the grade: Online education in the United States, 2006. Needham, MA: Sloan Consortium.

Allen, I. E., & Seaman, J. (2013). Changing course: Ten years of tracking online education in the United States. Oakland, CA: Babson Survey Research Group and Quahog Research Group.

American Occupational Therapy Association. (2002). Fieldwork performance evaluation for the occupational therapy student. Bethesda, MD: Author.

American Occupational Therapy Association. Accreditation and Academic Affairs. (2012). Academic programs annual data report. Bethesda, MD: Author. Retrieved from http://www.aota.org/-/media/Corporate/Files/EducationCareers/Accredit/47682/2011-2012-Annual-Data-Report.ashx

Anderson, L. W., Krathwohl, D. R., Airasian, P. W., Cruikshank, K. A., Mayer, R. E., Pintrich, P. R., . . . Wittrock, M. C. (2000). A taxonomy for learning, teaching, and assessing: A revision of Bloom’s taxonomy of educational objectives (abridged ed.). London: Pearson.

Clark, D. (2002). Psychological myths in e-learning. Medical Teacher, 24, 598–604. http://dx.doi.org/10.1080/0142159021000063916 [Article] [PubMed]

Doyle, N. W., & Jacobs, K. (2013). Accommodating student learning styles and preferences in an online occupational therapy course. Work, 44, 247–253. [PubMed]

Farber, R. S. (2013). Distance education and teaching online: My journey from mystery to mastery. Occupational Therapy in Health Care, 27, 272–279. [PubMed]

Fredda, J. V. (2000). Comparison of selected student outcomes for Internet versus campus-based instruction (No. 00-08). Ft. Lauderdale, FL: Nova Southeastern University.

Hollis, V., & Madill, H. (2006). Online learning: The potential for occupational therapy education. Occupational Therapy International, 13, 61–78. [Article] [PubMed]

Hong, K.-S. (2002). Relationships between students’ and instructional variables with satisfaction and learning from a Web-based course. Internet and Higher Education, 5, 267–281. http://dx.doi.org/10.1016/S1096-7516(02)00105-7 [Article]

Johnston, J. (2008). Effectiveness of online instruction in the radiologic sciences. Radiologic Technology, 79, 497–506. [PubMed]

Means, B., Toyama, Y., Murphy, R., Bakia, M., & Jones, K. (2009). Evaluation of evidence-based practices in online learning studies. Washington, DC: U.S. Department of Education, Office of Planning, Evaluation, and Policy Development.

Mitchell, A. W., & Batorski, R. E. (2009). A study of critical reasoning in online learning: Application of the Occupational Performance Process Model. Occupational Therapy International, 16, 134–153. http://dx.doi.org/10.1002/oti.272 [Article] [PubMed]

Neuhauser, C. (2002). Learning style and effectiveness of online and face-to-face instruction. American Journal of Distance Education, 16, 99–113. http://dx.doi.org/10.1207/S15389286AJDE1602_4 [Article]

Phye, G. D. (1997). Learning and remembering: The basis for personal knowledge construction. In G. D. Phye (Ed.), Handbook of academic learning: Construction of knowledge (pp. 47–64). San Diego, CA: Academic Press.

Richardson, P. (2004). Student development in an online post-professional master’s program. Occupational Therapy in Health Care, 18, 107–116. http://dx.doi.org/10.1080/J003v18n01_11 [Article] [PubMed]

Rogers, L. G., Mulholland, S., Derdall, M., & Hollis, V. (2011). From all perspectives: Opinions of students and teaching staff regarding occupational therapy distance education. British Journal of Occupational Therapy, 74, 241–248. http://dx.doi.org/10.4276/030802211X13046730116579 [Article]

Runyon, C. P., Aitken, M. J., & Stohs, S. J. (1994). The need for a clinical doctorate in occupational therapy (OTD). Journal of Allied Health, 23, 57–63. [PubMed]

Russell, T. (1999). The no significant difference phenomenon. Chapel Hill: North Carolina State University, Office of Instructional Telecommunications.

Simons, D. F., Baron, J. A., Knicely, K. S., & Richardson, J. S. (2002). Online learning: Perspectives of students and faculty in two disciplines—occupational therapy and teacher education. Occupational Therapy in Health Care, 14, 21–52. [PubMed]

Supiano, B. (2012, October 9). College enrollment dropped last year, preliminary data show. Chronicle of Higher Education. Retrieved from http://chronicle.com/article/College-Enrollment-Dropped/134928/

Teeley, K. H. (2007). Multimedia in the classroom: Creating learning experiences with technology. In M. J. Bradshaw & A. J. Lowenstein (Eds.), Innovative teaching strategies in nursing and related health professions (pp. 231–248). Boston: Jones & Bartlett.

TLT Group. (n.d.). Flashlight evaluation handbook. Retrieved from http://www.tltgroup.org/Flashlight/Handbook/TOC.htm

U.S. Department of Education, Office of Planning, Education, and Policy Development. (2009). Evaluation of evidence-based practices in online learning: A meta-analysis and review of online learning strategies. Washington, DC: Author.

Van Schaik, P., Barker, P., & Beckstrand, S. (2003). A comparison of on-campus and online course delivery methods in southern Nevada. Innovations in Education and Teaching International, 40, 5–15. http://dx.doi.org/10.1080/1355800032000038859 [Article]

Weiss, P. L., Schreuer, N., Jermias-Cohen, T., & Josman, N. (2004). An online learning course in ergonomics. Work, 23, 95–104. [PubMed]

Table 1.

Terminology Related to Content Delivery Formats

Format	Description	Proportion of Content Delivered Online, %
Traditional	No online technology is used—content is delivered orally or in writing.	0
Web facilitated	Web-based technology is used to facilitate face-to-face courses—usually using a course management system or course web pages to post syllabus and assignments.	1–29
Blended or hybrid	Blending of online and face-to-face delivery is used. A substantial proportion of content is delivered online. Discussion forums are typical, and there are fewer face-to-face sessions.	30–79
Online	Most or all of the content is delivered online. There are typically no face-to-face sessions.	80–100

Source. Allen and Seaman (2006, 2013).

View Large

Table 1.

Terminology Related to Content Delivery Formats

Format	Description	Proportion of Content Delivered Online, %
Traditional	No online technology is used—content is delivered orally or in writing.	0
Web facilitated	Web-based technology is used to facilitate face-to-face courses—usually using a course management system or course web pages to post syllabus and assignments.	1–29
Blended or hybrid	Blending of online and face-to-face delivery is used. A substantial proportion of content is delivered online. Discussion forums are typical, and there are fewer face-to-face sessions.	30–79
Online	Most or all of the content is delivered online. There are typically no face-to-face sessions.	80–100

Source. Allen and Seaman (2006, 2013).

Table 2.

Student Demographic Information in On-Campus and Hybrid Cohorts

Class	On-Campus Cohort (M age = 22)		Hybrid Cohort (M age = 31)
Class	Male	Female	Male	Female
2011	3	33	0	5
2012	4	41	1	7

View Large

Table 2.

Student Demographic Information in On-Campus and Hybrid Cohorts

Class	On-Campus Cohort (M age = 22)		Hybrid Cohort (M age = 31)
Class	Male	Female	Male	Female
2011	3	33	0	5
2012	4	41	1	7

Table 3.

Comparisons of Outcome Variables Between the Two Cohorts

Variable	On-Campus Cohort		Hybrid Cohort		p
Variable	Mean	SD	Mean	SD	p
GPA
1st yr	3.49	0.33	3.35	0.44	.131
2nd yr	3.74	0.19	3.56	0.26	.002*
3rd yr	3.76	0.18	3.61	0.24	.008*
Cumulative	3.67	0.21	3.51	0.30	.057
FWPE
1	138.7	12.89	136.6	10.6	.56
2	137.4	14.16	143.8	14.25	.11
NBCOT
Practice multiple choice	454.4	21.27	453.1	13.57	.82
Practice simulation	491.5	20.16	491.7	16.01	.98
Final pass rate, %	100		100

Note. FWPE = Fieldwork Performance Exam; GPA = grade point average; NBCOT = National Board for Certification in Occupational Therapy; SD = standard deviation.

*Significant at .05 level.

View Large

Table 3.

Comparisons of Outcome Variables Between the Two Cohorts

Variable	On-Campus Cohort		Hybrid Cohort		p
Variable	Mean	SD	Mean	SD	p
GPA
1st yr	3.49	0.33	3.35	0.44	.131
2nd yr	3.74	0.19	3.56	0.26	.002*
3rd yr	3.76	0.18	3.61	0.24	.008*
Cumulative	3.67	0.21	3.51	0.30	.057
FWPE
1	138.7	12.89	136.6	10.6	.56
2	137.4	14.16	143.8	14.25	.11
NBCOT
Practice multiple choice	454.4	21.27	453.1	13.57	.82
Practice simulation	491.5	20.16	491.7	16.01	.98
Final pass rate, %	100		100

Note. FWPE = Fieldwork Performance Exam; GPA = grade point average; NBCOT = National Board for Certification in Occupational Therapy; SD = standard deviation.

*Significant at .05 level.

Appendix. Creighton University Entry-Level Doctorate of Occupational Therapy Curriculum Effective Fall 2013

Year 1
Fall: Semester 1 OTD 302 Occupations and Occupational Therapy (3) OTD 306 Health Conditions (3) OTD 314 Occupation and Health: Population Perspectives (3) OTD 316 Professional Practice and Ethical Formation Seminar (LAB) (4) OTD 341 Neuroanatomy (3)	Spring: Semester 2 OTD 300 Research Proposal (3) OTD 317 Occupational Therapy in Mental Health (LAB) (4) OTD 318 Level IA Fieldwork: Mental Health (.5) OTD 324 Applied Kinesiology (LAB) (3) OTD 339 Clinical Anatomy (3) OTD 340 Clinical Anatomy Lab (1.5) OTD 355 Physical Rehabilitation I: Evaluation (LAB) (3)	Summer: Semester 3 OTD 356 Physical Rehabilitation II: Neurorehabilitation (LAB) (4) OTD 333 Upper Extremity Evaluation and Intervention I (LAB) (3) OTD 390 Level IB Fieldwork: Physical Rehabilitation (1.5)
Total credits = 16 5 classes, 1 lab	Total credits = 18 7 classes, 4 labs	Total credits = 8.5 3 classes, 2 labs
Year 2
Fall: Semester 4 OTD 400 Research Project Implementation I (1.5) OTD 403 Neuro-Occupation (2) OTD 423 Occupational Therapy with Older Adults (LAB) (3) OTD 433 Upper Extremity Evaluation and Intervention II (LAB) (3) OTD 435 Occupational Therapy with Children and Youth I (LAB) (3) OTD 442 Critical Analysis of Occupational Therapy Practice (3) OTD 460 Clinical Education Seminar I (1.5) OTD 490 Level IC Fieldwork: Pediatric or Selected Practice Setting (1)	Spring: Semester 5 OTD 401 Research Project Implementation II (1.5) OTD 406 Management and Program Development (3) OTD 417 Disability and Healthcare Policy (3) OTD 436 Occupational Therapy with Children and Youth II (LAB) (4) OTD 457 Physical Rehabilitation III: Interventions and Outcomes (LAB) (4) OTD 461 Clinical Education Seminar II (1.5) OTD 491 Level ID Fieldwork: Pediatric or Selected Practice Setting (1)	Summer: Semester 6 OTD 481 Level IIA Fieldwork (12)
Total credits = 18 8 classes, 3 labs	Total credits = 18 7 classes, 2 labs	Total credits = 12 1 class
Year 3
Fall: Semester 7 OTD 564 Professional Identity and Ethical Perspectives in the Ignatian Tradition (first 3 weeks only; online format) (3) OTD 574 Professional Competency (last 12 weeks only; online format) (0.5) OTD 571 Level IIB Fieldwork (last 12 weeks only) (12)	Spring: Semester 8 OTD 600 Professional Rotation (16) OTD 601 Capstone (1)
Total credits = 15.5 3 classes	Total credits = 17 2 classes
Curriculum Summary
8 semesters 3 academic years 123 credits 36 classes 12 labs 43.5 weeks of clinical experiences • 4 Level I fieldworks • 2 Level II fieldworks 1 professional rotation

Note. OTD = doctorate of occupational therapy.

View Large

Appendix. Creighton University Entry-Level Doctorate of Occupational Therapy Curriculum Effective Fall 2013

Year 1
Fall: Semester 1 OTD 302 Occupations and Occupational Therapy (3) OTD 306 Health Conditions (3) OTD 314 Occupation and Health: Population Perspectives (3) OTD 316 Professional Practice and Ethical Formation Seminar (LAB) (4) OTD 341 Neuroanatomy (3)	Spring: Semester 2 OTD 300 Research Proposal (3) OTD 317 Occupational Therapy in Mental Health (LAB) (4) OTD 318 Level IA Fieldwork: Mental Health (.5) OTD 324 Applied Kinesiology (LAB) (3) OTD 339 Clinical Anatomy (3) OTD 340 Clinical Anatomy Lab (1.5) OTD 355 Physical Rehabilitation I: Evaluation (LAB) (3)	Summer: Semester 3 OTD 356 Physical Rehabilitation II: Neurorehabilitation (LAB) (4) OTD 333 Upper Extremity Evaluation and Intervention I (LAB) (3) OTD 390 Level IB Fieldwork: Physical Rehabilitation (1.5)
Total credits = 16 5 classes, 1 lab	Total credits = 18 7 classes, 4 labs	Total credits = 8.5 3 classes, 2 labs
Year 2
Fall: Semester 4 OTD 400 Research Project Implementation I (1.5) OTD 403 Neuro-Occupation (2) OTD 423 Occupational Therapy with Older Adults (LAB) (3) OTD 433 Upper Extremity Evaluation and Intervention II (LAB) (3) OTD 435 Occupational Therapy with Children and Youth I (LAB) (3) OTD 442 Critical Analysis of Occupational Therapy Practice (3) OTD 460 Clinical Education Seminar I (1.5) OTD 490 Level IC Fieldwork: Pediatric or Selected Practice Setting (1)	Spring: Semester 5 OTD 401 Research Project Implementation II (1.5) OTD 406 Management and Program Development (3) OTD 417 Disability and Healthcare Policy (3) OTD 436 Occupational Therapy with Children and Youth II (LAB) (4) OTD 457 Physical Rehabilitation III: Interventions and Outcomes (LAB) (4) OTD 461 Clinical Education Seminar II (1.5) OTD 491 Level ID Fieldwork: Pediatric or Selected Practice Setting (1)	Summer: Semester 6 OTD 481 Level IIA Fieldwork (12)
Total credits = 18 8 classes, 3 labs	Total credits = 18 7 classes, 2 labs	Total credits = 12 1 class
Year 3
Fall: Semester 7 OTD 564 Professional Identity and Ethical Perspectives in the Ignatian Tradition (first 3 weeks only; online format) (3) OTD 574 Professional Competency (last 12 weeks only; online format) (0.5) OTD 571 Level IIB Fieldwork (last 12 weeks only) (12)	Spring: Semester 8 OTD 600 Professional Rotation (16) OTD 601 Capstone (1)
Total credits = 15.5 3 classes	Total credits = 17 2 classes
Curriculum Summary
8 semesters 3 academic years 123 credits 36 classes 12 labs 43.5 weeks of clinical experiences • 4 Level I fieldworks • 2 Level II fieldworks 1 professional rotation

Note. OTD = doctorate of occupational therapy.