There are many occupations that involve development of manual skills as critical elements of their practice. These can present a major challenge when teaching employees and students during a time when social distancing is required and when travel is limited. One example would be massage therapy.

I interviewed Leena Guptha, DO, MBA, BCTMB, Academic Dean of Online Education at the Pacific College of Health and Science in San Diego, and learned how blended delivery techniques and learning experience design is resolving those challenges. Dr. Gupta shared the way that her college is making the transition to effective use of the virtual classroom, and also the lessons learned in making the transition. I believe that her experience reported here will be valuable in fields outside of health and medicine, especially the work done to prepare the on-ground faculty for virtual delivery and its integration with the hands-on sessions.

Bill Brandon: Can you tell me what you mean when you say "manual techniques" in the context in which you teach it at the college? Who uses these techniques?

Leena Guptha: We can consider that touch itself is therapeutic in a number of ways—when a person may hug their child or shake hands, there’s a connection there. In our context at Pacific College of Health and Science, touch therapy would be the touch through massage therapy with respect to the patient or client-practitioner relationship. We have formalized the training through the education of massage therapy and acupuncture. In the massage therapy context, we’re training our students to be able to do hands-on training; manipulating soft tissues; working on muscles, connective tissue and tendons; and using various different techniques and pressure to gain a therapeutic effect.

“Manual approaches” or "manual techniques" are embraced in the massage therapy field. But also to address your question, there are various professions that are involved with manual medicine and manual techniques. In the massage therapy world, there are a range of massage therapy techniques. There are also other professions that utilize soft tissue techniques. They may be doing distinctly different types of bodywork or there may be a combination. For example, myofascial technique is used in massage therapy, as well as osteopathic manipulative medicine. Some chiropractors use it, and physical therapists. So touch in itself is a much broader topic, and part of the healing process of many different modalities and professions.

BB: Myofascial technique—what does that involve?

LG: That’s a particular technique that’s gentle yet powerful at the same time. It works on muscles and on the fascia, which is the covering of a muscle. It can be applied towards fully integrated pain management as well as injuries, or to promote wellness. It's a gentle yet powerful way to mobilize the muscles and joints to promote healing.

BB: It sounds like a very useful skill for people in a variety of occupations.

LG: Yes, and it’s one that takes time to learn because it’s easy to apply a deep pressure to a person, but to apply a light pressure that affects deep tissue is where the skill lies.

BB: Before COVID-19 and before we were all working and learning from home, how was massage therapy taught at the college?

LG: In our Associates program, the didactic classes as well as the hands-on classes were taught onsite in our classroom, as is the case with many entry level programs. To clarify, “entry level” pertains to first professional degrees—for example, chiropractic, physical therapy, massage therapy, and acupuncture. It means this is the first degree in a profession that a person embarks on, including medicine. The term doesn’t fully capture the knowledge and skill level that's involved in any of those professions. There’s a difference between an entry level doctorate program for example, and a postgraduate doctorate.

BB: How can you teach these manual skill techniques in a virtual classroom where you’re not physically in the same place as the student, and where the student may be by themselves?

LG: That is ultimately the challenge in the landscape that we’re living in right now. We have some faculty who have created videos of a range of techniques, including those for self-care, Tai Chi, and Qi Gong—movement therapies. Of course, it’s not the same as being face-to-face in the classroom. So our plan during this term is to offer all our didactic classes — meaning the theory classes — online, and then we are planning to use approved protocols which have been developed by the American Massage Therapy Association, as well as the Federation of State Massage Therapy Boards and Somatic Practice Organizations, in terms of what is and what is not allowed practice-wise. We will now utilize three classrooms and the students will be six feet apart, versus conducting those hands-on classes in what would previously have been one classroom. We will also implement the protocols that are approved for practice, both in education as well as private practice. That is how we are going to accommodate the situation that we’re living in at the moment, which is supported by practices and businesses starting to open up now.

BB: How do you evaluate what the students learned, and the actual performance?

LG: That would be in the practical test.

BB: How did you prepare your faculty for this change?

LG: We launched a very comprehensive training program for all our faculty during April, so they knew how to effectively use Zoom as well as Moodle (which is the Blackboard product) to deliver didactic classes. This allows classes to be taught in an engaging manner through breakout discussions, polls, group presentations, and online quizzes or exams. The hands-on side would have to be face-to-face.

But I was also thinking about technologies that may not be ready for use. I don’t know if you’re familiar with or if you have seen 3-D animated anatomy dissection software. They’ve been produced for allied health and medical training, and have many different applications with 3-D glasses. You can see the organs of the body, and touch the heart, the stomach, the lungs, or peel away certain tissues in dissection. Although that might not be ready for mass consumption right now, I think it is an aspect that will feature in the future, well beyond the current COVID situation.

"I think this transition has taught us a number of lessons and helped our on-ground faculty to learn how to teach effectively online. Faculty are appreciating that they can develop relationships and transmit information through an online setting. That it is far more powerful than people may have thought before, and a large part of that is the ability to engage the students."

BB: What were the things that you learned as you made this transition to teaching touch therapies in your context in a virtual setting?)

LG: Actually, I think this transition has taught us a number of lessons and helped our on-ground faculty to learn how to teach effectively online. Faculty are appreciating that they can develop relationships and transmit information through an online setting. That it is far more powerful than people may have thought before, and a large part of that is the ability to engage the students. We have focused on supporting student engagement. I went to college in the 80s, when it was a very one-way system. There was a person at the front of the class, they had an overhead projector and a piece of plastic, and it was a one-way lecture. We received it, we made notes, and then we were tested on it.

Things have moved on substantially now, where the most important thing is the students being engaged in the material and learning, learning from the faculty member, learning from each other and learning by doing. As the decades have passed by, now it has been optimized, in many ways, through the need to deliver education online. That is a very significant learning and one that we carry forward to continue to expand in online education. We have a strong history in online education already, but the emergence of COVID-19 has caused us to accelerate, let's say, the number of offerings that we have online. It's a learning of the faculty themselves. It is also the acceptance of the students that I'm very happy to report. The students are very grateful that we have developed ways and mechanisms to enable them to continue with their education.

We have also accommodated for certain classes, For example, we have a class called called Applications of Interprofessional Communication. It's not in the massage therapy program but it is in our Doctor of Acupuncture and Chinese Medicine Program. Prior to COVID-19, each student would observe another medical practitioner face-to-face for about 30 hours or more. In that particular class we have accommodated by including that students can observe their practitioner in telemedicine, which has suddenly emerged very quickly in medical institutions and other areas. Also, students can interview the practitioner, they can watch videos of a surgeon; of their procedure, and also other biomedical videos. I think we've been very creative in how to accommodate our students as much as possible in the current environment that we're living in.