What to Do When Hands-on Learning Is Essential

The University of St. Augustine faces a problem unique to programs delivering healthcare training — how to help students prepare for clinical careers.

• By Dian Schaffhauser
• 07/30/20

On a recent Monday, students came onto campus in three states at the University of St. Augustine for Health Sciences to attend class. There was no other way around it. When you're studying physical therapy, occupational therapy and related "manual therapies," the clinical experience and hands-on learning with role-playing is a big part of the graduate education you need to earn your credentials.

How the university is handling its operations during the COVID-19 pandemic is a case study in what school opening could look like all over the country. USAHS did have some advantages. For one, it's not dealing with tens of thousands of students; it has between 4,000 and 5,000, divided among five separate campuses. For another, not all instruction needs to take place in person; some can be done online. USAHS has long had an online component in nearly every course, so faculty and students are accustomed to a mixed learning environment. Plus, in 2019, well before the term "COVID-19" became part of everybody's vocabulary, most applications in use by the university had been moved to cloud versions, to reduce dependency on campus data centers to keep operations running.

Adopting Cloud in 3 Stages

The evolution to the cloud came in three phases, according to Matt Moline, executive director of IT, driven by ownership of the institution. In phase one, campuses used on-premise operations at each location. That lasted until 2013, when the institution was sold to international for-profit education provider Laureate International Universities. (Since 2015, the university has operated as a "B Corp Certified" institution, which commits to higher standards of social and environmental impact than the typical for-profit school.)

Phase two consisted of moving those local IT operations the Laureate data centers for hosting. A lot of the initial cloud implementation took place during this second phase.

In early 2019, Laureate sold USAHS to St. Augustine Acquisition Corp., affiliated with Altas Partners, a Canadian investment firm. That launched phase three, when the IT organization had an eight-month period in which to migrate and transform its systems back to being "solely owned and operated and administered by the university." Moline and his unit made the case for shifting additional operations to the cloud.

The goal in each decision was to choose solutions that would ensure resiliency. For Moline that meant several things:

• Shifting to an all-laptop model, to allow people to be able to "physically just pick up their systems and go";
• Architecting the infrastructure so that nobody would have to "physically touch the equipment to keep it running"; and
• Making sure applications and data were "hosted not just in one place but in multiple places, so that if something happened to one location, it continued to operate in other locations."

As a result, IT chose cloud configurations for IT needs wherever possible. For example, the institution replaced its phone system with RingCentral, which could enable communications on people's laptops and included a private-label version of Zoom, with meeting functionality.

When coronavirus struck U.S. shores in early 2020, changing behaviors practically overnight, the university had about five days in which to make the shift to a fully online environment, like nearly every campus. "That was a very, very busy week," recalled Moline. "We provided a lot of support material, a key teaching plan, a keep-learning plan, those sorts of things."

But because of the emphasis on designing IT for resiliency, the university was starting from an obvious place of strength. People were already getting used to holding meetings from far-flung locations via RingCentral. When on-campus classes ceased, all they had to do was expand their use of it; instructors were trained up when classes needed to go online.

Through the morphing of IT to a cloud-first perspective, while certain applications have been replaced, others have survived and thrived. That included Jenzabar for the student information system and the student portal. In both cases, USAHS chose cloud-hosted versions. Now, while Moline's team manages what goes into the SIS and making sure the university network is linked to the application, Jenzabar is responsible for administering the platform itself. Anything else that needs to cross those lines is handled on a project basis.

On the learning side, the adoption of Blackboard Learn in 2019 forced faculty to redefine their courses. As a result, said Moline, "We redid almost every single course, trying to improve the quality." That paid off in 2020, he noted. "We saw a lot of benefit there."

Not much in back office operations was lost when the campuses closed. Incoming applicants couldn't do their interviews in person anymore; and campus visits gave way to virtual campus tours, which people could book online. But other than that, said Moline, "it was really just business as usual."

Lining Up for Clinical Practice

But the big question was how to achieve those practical activities that make up a big part of every student's education at USAHS. Each program went through "a healthy exercise," said Moline, "in identifying the components of learning that were required to be in-person, to ensure accreditation and make sure that our students are learning all the things that these accreditors expect them to learn."

USAHS quickly shuffled the order of courses to put the emphasis on the lecture portions, which could be completed from home. The thinking was, when campuses could be reopened, students would be ready to come in and get their clinical practice.

Until that day arrived, faculty were allowed to schedule visits to campus and book time with AV and IT staffers to video-stream demonstrations of specialized equipment. "There was at least instruction if not physical application of that, with the idea that the physical application would come later," Moline explained.

And then the school sorted out how those in-person courses would transpire. To ensure physical distancing, the number of sessions for lab classes was increased while also limiting attendance to 10 students at a time. Half-hour blocks were inserted between courses for cleaning of spaces and equipment. Students enter from one door and exit through another. Sessions run from 7:30 in the morning until about 6 at night; and Saturday and Sunday classes or assessments are part of the schedule.

On campus, face coverings are required, and during lab sessions, procedural masks, gloves and face shields are provided. Touchless temperatures are screened as people enter from a main campus entrance point; anybody who register 100.4 degrees and above goes into a private meeting with a member of the campus reentry team to discuss next steps. Anybody not already cleared to come to campus can't do so; those who are cleared get a daily wristband. Nobody unauthorized can move furniture or equipment.

Another area that had to evolve was the need for students to do education in an actual clinical setting. Those were disrupted just like the academic learning environments were. Program leaders "aggressively partnered" with clinical education partners "to identify new opportunities and shuffle around as needed," said Moline. Those efforts resulted in a "really high percentage of clinical education opportunities [for students] this summer." Now, the challenge is making sure students stay safe in those external environments.

Designing for Worst Case as Best Practice

In spite of the many upheavals, there was one benefit Moline observed: IT became "more productive," especially when it came to providing support to students. "We were much more responsive," he said. "We saw our average time to respond to tickets and average time to resolve them drop, because even though we had the same number of people, they were just able to pay attention better and be more responsive."

Now the big concern is making the student experience as good as it can be within the obvious constraints. One-on-one and small group tutoring takes place online, with a combination of RingCentral's Zoom and Calendly for scheduling. But that's just one aspect. There's still the fact that the lunchroom won't be open and that group study in the library won't be available. Even a casual visit to the library can't happen because it's open by appointment only, Moline pointed out.

Even though there's still plenty that has to be worked out for St. Augustine, on the IT side, Moline is driven by a guiding principle: that evaluating for resiliency is no longer something for the worst-case scenario. As he pointed out, "It's best practice now." There may be pushback for going with systems that are "significantly different, that may have higher costs associated with them," he said. "But as we've seen, this [time] has been disruptive. And the only reason we were able to be as responsive as we were is that we went with the most resilient systems possible."