The Potential and Challenge of Online Learning

In the last decade, the popularity, availability, and complexity of internet-based learning increased dramatically.  The most noteworthy and significant changes are in the educational and technological strategies created by developers working in advanced online education platforms.

While the massage profession may be slow to adopt advanced forms of online learning, the influence of online technology and its capability to improve learning though design is changing the overall educational landscape. We can be sure that this trend will influence massage education significantly in the near future. This powerful trend is inspiring reviews of our current (and often antiquated) theories and best practices in teaching and learning.

Educators might argue that using technology for massage education decreases the quality of learning or suppresses the “art” side of massage (the intuitive). Those that describe themselves as “kinesthetic” learners – and therefore claim that online learning does not work for them – may have yet to be exposed to the designs in online learning that in fact could work quite well for them.

Like any physical skill, the elements of massage – the palpatory and motor skills – that are the tools of the trade are still best learned through hands-on practice. Entry-level massage technique is still most effectively done with a teacher present who can guide the student in specific movement skills.

However, massage is not a sport and is much more than a series of moves. As the profession gains acceptance as a legitimate healthcare profession, there are expectations for practitioners to have solid foundations that inform their treatments. New research in learning shows that the quality of instructional design is far more important than the method of delivery (online vs. classroom) when determining outcomes.1 Consequently, an online course with very high-quality instructional design will produce superior results to a poorly designed classroom course and vice versa.

Quality in courses runs the gamut in all fields of study, regardless of method. To fully appraise how effective online learning might be for an individual or curriculum, it is important to know more about the design: who authored the course content, who designed the course, and what platform and technological design supports the course. Additionally, what educational theories ground the design and how does the course reflect that.

This article highlights key concepts in online learning that could significantly improve the competence and quality of education in the massage profession at the entry level and in continuing education.

What Does Online Learning Look Like?
First, it is very important to distinguish between e-learning and online learning. Knowing the fundamental differences allows students and educators to decipher between what is truly online and what is not. There is inconsistency in terminology but e-learning is a broad category that includes almost any type of technology-based learning and got its start in technology or computer-based training (computer, video, audio, etc). The DVD could be considered, in the most remedial way, e-learning.

However, online learning courses are taught through an internet-based platform (thus the name online). These courses are able to (but don’t always) integrate a wide range of educational and technological design because they use internet platforms that have capabilities not available in static technologies such as a DVD.

The most advanced of these platforms offer the greatest advances in competency-based learning design. This is why the most reputable universities are integrating the medium and have entire departments for online educational design and technology. In contrast, the massage profession has adopted only the most remedial of the online options available.

Currently, few courses in our profession provide a learning experience that employs advanced educational theory and technological design. There is a distinct difference in course quality between those which simply offer a downloadable PDF and an online test, with maybe a webinar or video, and the course that has more highly engaging elements such as branching scenarios, virtual learning elements, and advanced interactivity.

In this article I focus on courses taught through an internet platform and not technology-based courses (i.e. video and book-based distance education courses) because the technologies and designs I discuss are only available through more complex online platforms.

The basics:
Increasingly, educators of all types are integrating online elements into their curriculum while still conducting part of the learning activities in the classroom – these are called hybrid courses. There is huge potential for this style of learning, in which complex, cognitive instruction is done online and students engage in various activities and practice skills in class.

Online courses are either synchronous or asynchronous, meaning students either take the course at the same time or in a self-paced format on their own times, respectively. Scheduling difficulties are an obstacle to synchronous courses because everyone has to be online at the same time. Asynchronous course activities can be performed any time, to fit the learners’ schedule and pace. Consequently, flexibility is a primary advantage of asynchronous learning.

The vast majority of what are called “online” courses in massage are text and test. In this format, the learner is given written materials (ex: book or PDF) and then required to take an online test. There is no online learning per se. Instructional designers would argue these are not true online courses but distance education courses with an online test. Often erroneously called ‘online learning’, they are so pervasive many think this is all there is to online learning (thus the repeated bad reviews of online learning).


Undiscovered Potential
Online courses are prevalent now within the massage profession (mainly in continuing education), but they are usually text and test (see Box), or webinars, video, and other passive learning designs with simple online tests. As in the university setting where undergraduates are sometimes hired to write course content and tests, some courses are not designed by content experts, and more importantly, not designed by someone trained in multimedia learning theory and course design. Thus, the potential for improved learning is lost.

Unfortunately, poorly designed courses create a negative perception about online learning overall. Yet, there are outstanding learning strategies and models in online platforms that can be used in massage education.


Facilitated Courses
 A course in which you work directly with an instructor is called a facilitated course. Like a classroom, the instructor is available to interact with students – answering questions, grading or providing feedback on assignments, and providing instruction. As one would assume, online entry-level courses are more effective when an instructor is available. Most facilitated online courses in our field are offered at entry level. It is rare to find facilitated online courses in continuing education.


Simulations, Contextualized Learning, & Formative Feedback
A common pitfall in education is the failure to connect what happens in the classroom with what occurs in real life. For example, students may score high on a kinesiology test, but then not know whether a range-of-motion test involves concentric or eccentric action. Innovatively designed online courses are capable of producing realistic learning scenarios. Technological advances allow for creating fascinating and engaging learning simulations that reflect contexts students are likely to encounter in practice. These learning activities without a doubt are far more interesting than reading content from a textbook.

The more a learning activity is contextualized, the greater the potential for long-term integration of the concepts. Learning and knowledge transfer are far more effective if content is presented in a context similar to how it will eventually be used in practice. Innovative online learning designs can create simulations and scenarios where the learning activity requires the individual to apply specific concepts just the way they would in practice. This is actually quite difficult to do individually in the physical classroom.

Additionally, online technology and programming allow activities to be immediately followed up with formative feedback, which is detailed student feedback intended to modify and expand learners’ understanding. Many times in a learning activity, the student is only told if an answer is correct or incorrect, but never why. Without understanding the rationale behind their responses, they don’t have the opportunity to improve and fully understand the concepts.

Formative feedback is directly connected to the student activity at that moment and thus is highly personalized. In the classroom, individualized, formative feedback is often very difficult to provide to each student. However, instructors using high quality online instructional designs can program this feature into the course.


Virtual Clients/Patients
For several years medical schools have been using a new learning strategy called virtual patients, in which students interact with a simulated patient in an online environment. These are currently expensive and complex to produce but highly effective. I use a modified virtual patient/client format in online courses and find it exceptionally effective for teaching key clinical concepts and developing clinical reasoning skills that were otherwise escaping students in the traditional classroom.

Students report that virtual patient cases are a far more interesting way to learn. Learning to implement the core knowledge needed for advanced practice in context is a key benefit that comes with advanced online design. Students have time to consider various facets and details of a case over a longer period of time than might be possible in the classroom. Time for integration and concept application helps deepen understanding and solidify student knowledge and skills.


Adaptive Learning
Perhaps the most exciting development in the online world is the emergence of adaptive learning strategies. Providing an educational experience that fits everyone has always been a challenge. Yet most classroom learning still revolves around a one-pace-fits-all classroom presentation. In adaptive learning, course content adapts to the learner’s mastery of previous content. An online course can be designed to recognize when a student has mastered initial stages, so highly skilled students can move to more challenging parts of the course more quickly. A student who needs or wants more help with early course concepts can be presented with additional information so they can master understanding before moving ahead.

Adaptive learning strategies dramatically reduce student frustration with standardized courses. Teachers can’t deliver classroom content in a different format for each student in the classroom, but the online course can be programmed with personalized adaptive learning elements, which is an advantage for teacher and student alike.


Challenges Ahead
Incredible potential exists with effective online learning in massage therapy education. However, as with any new innovation, there are challenges. Instructor training is by far the greatest. A common misconception for online course development is that it is relatively easy, with some instructors simply posting their course content to the web and calling it an online course.

However, we know from multimedia learning theory that the instructional design strategies for an effective online course are very different from those of a classroom course. Effective teaching in the classroom doesn’t necessarily transfer to the online environment. Online teaching requires a completely different set of skills, with significant study and diligent practice.

Course development is the next challenge. In many, if not most, physical classrooms one individual is responsible for being the subject matter specialist and constructing educational activities. The successful online course requires a subject matter expert (SME), someone who understands and can produce effective multimedia instructional design (Instructional Designer), and a technology development specialist (Developer) who develops the course in an online platform and ensures it works correctly. It is rare to find these qualities in one individual.

Finally, online courses require complex and advanced software programs and training whose costs may be challenging for schools or educators. Usually a school or educator works with a company who specializes in online course development, rather than trying to produce courses in-house. There are a variety of financial arrangements that can be made with online course development and hosting companies, but it is not always easily affordable. An ideal company would have both an instructional designer and a technology expert, with the school instructor or consultant acting as SME.


Online in Massage
Although there are challenges, online strategies hold tremendous potential for stimulating and advancing education within the massage therapy field. The potential for incorporating unique and advanced instructional design strategies along with multimedia such as video, audio, and highly interactive and engaging learning activities holds tremendous promise. We are now moving past the infancy of online learning and it is time to move past the early hype of simple online offerings like webinars or ‘text and test’ courses and welcome the challenge and excitement of new learning methods that can excite students and improve their competence.


  1. Means B, Toyama Y, Murphy R, et al. Evaluation of Evidence-Based Practices in Online Learning: A Meta-Analysis and Review of Online Learning Studies. 2009.

, , , ,

Website by Techcare, LLC