Today's students in higher education are different in how they think, communicate and learn, and there are calls for a change in pedagogy that takes this into account. The use of emerging technologies has been identified as a potential facilitator of this change, particularly in a blended approach to teaching and learning. Blended learning strategies build on social constructivist principles of education, and thus provide a more engaged experience for both educators and students. This study aims to analyse the undergraduate physiotherapy curriculum in order to determine which modules are appropriate for blended learning, and which could take advantage of emerging technologies to improve practice. The study will take place within the physiotherapy department at the University of the Western Cape and all staff and registered undergraduate students will be invited to participate in the process. The overarching design of the study will be to use action research methods to create organisational change in the form of curriculum development, as well as to simultaneously study the process and results of that change. Within this design, a number of other methodologies will be used at each stage of the process, including a systematic literature review, two descriptive surveys, three workshops, document analysis of the curriculum, a Delphi study to identify appropriate modules and pedagogical strategies, and process evaluation. Permission to conduct the study will be sought from the faculty Higher Degrees Committee, the Senate Higher Degrees Committee, the Registrar of the university and the head of the physiotherapy department. The study will be conducted according to ethical practices pertaining to the study of human subjects as specified by the Faculty of Community and Health Sciences Research Ethics committee.

The emergence of information and communication technology (ICT) as a transformative and empowering medium for change is becoming increasingly evident in higher education (Katz, 2008; Siemens & Tittenberger, 2009). In addition, some studies have also suggested that today's students have different learning needs when compared to previous generations, tending towards a greater degree of independence and autonomy in how they choose to learn (Breen, Lindsay & Jenkins, 2001; Prensky, 2001b; Barnes, Marateo & Ferris, 2007). In order to respond to this, educators and curricula must be flexible enough to adapt to this changing environment (Newman & Peile, 2002). With the convergence of digital and physical spaces, one way to achieve this flexibility may be to blend different teaching and learning strategies, using emerging technologies to facilitate the process.

The use of blending in higher education has been the subject of increasing interest over the past few years, with both students and educators reporting improved teaching and learning experiences (Garrison & Vaughan, 2008). Described as a combination of the best components of face-to-face and online approaches (Bourne & Seaman, 2005), blended learning attempts to provide a more engaged experience for students and educators. In doing so, it promotes interaction and collaboration in order to achieve higher order learning outcomes (Palloff & Pratt, 2005). To highlight the idea that learning is social, Oblinger (2005, p. 22) speaks of “co-learning” and the “co-construction” of knowledge, placing an emphasis on communication and collaboration that ICT is well-placed to facilitate.

Of particular interest is the use of social software (e.g. blogs, wikis and social networks) that enable distributed groups of loosely connected people to spread more ideas, more quickly than ever before (Katz, 2008). These tools build on the principles of social constructivism, which views learning as social, interactive, contextual and reflective (Bozalek, 2007), and which will form an integral component of a blended learning approach to education. Indeed, there have been a number of calls for a change in pedagogy as a result of emerging online technologies that are changing the nature of communication and collaboration (Oblinger & Oblinger, 2005; Barnes, Marateo & Ferris, 2007). These are the emerging tools that have the potential to change the relationship between educators and students, but that require a concomitant change in both pedagogy and curricula. It should be noted however, that this change is often found to be unsettling for all stakeholders. McLean (2003) thus suggests that all staff and students are actively involved throughout the process of curriculum development.

In conclusion, institutions of higher learning must evolve as they move toward supporting the changing needs of a new generation of students. The use of ICT has been shown to facilitate this process, as it enables collaboration, improves communication and can facilitate a social constructivist approach to teaching and learning. Furthermore, it must be borne in mind that curriculum reform is a disruptive process that requires buy in from all stakeholders and as such, they must be included throughout the process.

Undergraduate physiotherapy at the University of the Western Cape is taught mainly using a didactic approach, yet there is some evidence that a blended approach to teaching and learning may facilitate better outcomes for students.

To analyse the undergraduate physiotherapy curriculum in order to identify a teaching module that is appropriate to be developed, implemented and evaluated using a blended learning approach that makes use of emerging online tools.

The objectives of this study are to:

1. Assess the strategies to be used in a blended learning approach, as well as the relevant stakeholders' attitudes towards these strategies, through:
   1. A systematic review of the literature around blended learning, social networks and clinical education
   2. A survey of students and staff to determine their knowledge, skills and attitudes towards the use of social networks to facilitate blended learning in the department. This survey will be developed and conducted in part by a 4th year research group.
   3. Additional data to achieve this objective will be obtained through my SAFRI project on the use of social networks to develop a reflective community of practice
2. Conduct an analysis of the curriculum in order to:
   1. Determine curriculum alignment as it relates to each module's outcomes and associated learning activities, using document analysis techniques
   2. Identify one module to be adapted, using the Delphi method
3. Develop the module using a blended approach, that will promote:
   1. Student-centred learning
   2. Mediated, or self-directed learning
   3. Small-group learning
   4. Inquiry-based learning
4. Implement the developed module as part of the curriculum, over the usual prescribed period
5. Evaluate the effectiveness of each stage of the process, as well as the final implementation of the module, using process evaluation

There is evidence to suggest that blended learning may have positive outcomes in terms of improved teaching and learning experiences (Beetham & Sharpe, 2007; Littlejohn & Pegler, 2007). However, there has been little research to provide evidence that a blended approach would be of any benefit in an undergraduate physiotherapy curriculum. This study will therefore provide a starting point to examine the possibilities for determining whether such changes in a physiotherapy curriculum could lead to improved teaching and learning opportunities and outcomes.

I've included this section on funding so that I can be transparent about where I'm getting it from, and what I'm doing with it. This is partly because I believe that an open project that hides it's funding isn't really open, and because other's may be interested in how much it might cost to reproduce the project. I'll fill out this section over time.

Here are some books that I've either bought, or intend buying:

• Castells, M. (2009). Communication Power. Oxford University Press. ISBN: 9780199567041
• Wenger, E., White, N. & Smith, J.D. (2009). Digital Habitats: stewarding technology for communities. ISBN: 9780982503607

• Blended learning – A combination of face-to-face and online learning experiences that represents a restructuring of the teaching and learning interaction in ways that extend the capabilities of both approaches (Vaughan & Garrison, 2008)
• Inquiry based learning – An approach to learning in which meaning is constructed through critical analysis, reflection, construction and confirmation of worthwhile knowledge (Vaughan & Garrison, 2008)
• Self directed learning – Usually informal and individualised, self-directed or independent learning is based on a guided mentoring process rather than the transmission of information (Dent & Harden, 2005).
• Small group learning – Indicative of a student-centred approach to learning, small group learning is characterised by student participation and interaction, where the size of the group is less important than it's characteristics (Dent & Harden, 2005).
• Social software – A collection of online technologies (e.g. blogs, wikis and podcasts) that enable people to have an online presence, to interact through comments and to serve as a vehicle for self-expression (Mason & Rennie, 2008)
• Student-centred learning – In this approach to learning, what the student learns is emphasised, rather than what is taught. As a result, students are given more responsibility for their education and the role of the educator changes from a transmitter of information, to a facilitator of learning (Dent & Harden, 2005).

This review of the literature establishes the theoretical frameworks upon which the study will build, thus creating a credible foundation for the work. It describes the scope of the study within those frameworks and clarifies essential concepts by drawing on the work of local and international scholars. It identifies the challenges faced, and suggests ways in which these challenges can be overcome.

No discussion on the nature of education can take place without mentioning the social and cultural context in which it occurs. Mason and Rennie (2008, p. 17) consider students to be “…distributed…participants in a socio-cultural process…”, implying that the activity of learning is less about effectively internalising facts, and more about the active participation in a community. Learning is therefore not an individualised process, but a communal one.

One theory that emphasises the role of community in learning is social constructivism, which suggests that meaningful knowledge is constructed through interaction, and by active engagement with others in the learning community (McConnell, 2006; Bozalek, 2007). Designing a student-centred curriculum that changes the student from a passive receptacle of knowledge to an engaged learner would facilitate a move towards a more collaborative teaching and learning environment (Brown, 2005). This would allow students to take more control over their learning experiences, choosing what, where and how they will learn. However, it should be noted that the educator will still have a role in the interaction, but would be a facilitator of learning, rather than a transmitter of content (Dent & Harden, 2005).

The use of social software has been identified as one way in which a social constructivist approach to education may be facilitated by enhancing communication and collaboration among students and educators (Mason & Rennie, 2008). Social software has been described as a collection of internet technologies that include wikis, blogs and podcasts, but Boyd (2006) has argued that any definition of social software must do more than describe a collection of online tools or technologies. It must include the social movement that enables people to interact with each other and with content dynamically, in a way that changes the nature of communication and collaboration. It is this conceptualisation of social software that holds the most promise as an enabler of change in higher education. Social software allows individuals and groups to collaborate, share, interact and engage with each other in near real-time, regardless of time or place. It changes the web from a static repository of content to a dynamic platform for shared discourse and collaboration, allowing loosely connected communities of practice to emerge and dissolve with the changing needs of it's users (Andersen, 2009). This concept of a community of practice as a socio-cultural theory, was developed by Lave and Wenger in 1991 in order to describe informal, situated learning through a process of participation (Somekh, 2007). Later, Seely Brown and Duguid (2002) extended it to describe distributed, loosely aggregated participants and the associated networks they form. The resultant networks of practice more accurately reflect the open relationships that exist in social networks today, and which may be considered in any discussion on the use of social software in education (Anderson, 2009). These emerging technologies, and the social and cultural norms they are disrupting, form the background against which the need for educational reform should be viewed.

Not much has changed since formalised centres of higher education began to emerge in Europe and Asia more than a 1000 years ago. Content is still aggregated for consumption in the form of professors and libraries within the walled gardens of university campuses (Salmon & Edirisingha, 2008). However, some studies have suggested that today's students think, communicate and learn differently to previous student cohorts (Downes, 1999; Barnes et al., 2007), and that their needs are no longer being addressed by the current system. In a much cited publication, Prensky (2001) has reported that this is a result of different development experiences after having grown up immersed in technology, which has influenced how they think and learn. However, a recent study among South African physiotherapy students showed that only a little over half of the students surveyed had internet access at home, indicating that the notion of “technological immersion” cannot be generalised to all students in higher education (Rowe, 2007). Breen et al. (2001) have therefore suggested that there is a need to understand the student experience of ICT and the behaviours and attitudes that it induces, rather than making assumptions about those experiences. In looking for ways to provide an educational experience that addresses the needs of a changing student body, Swail (2002, p. 16) went so far as to say that “…the rules of education are changing, and there is increased pressure on institutions of higher education to evolve, adapt or desist”.

One of the ways in which universities are trying to evolve is to introduce technological innovation into curricula. Unfortunately, the tendency thus far has been to use technology as a means of spreading more content to more students at a lower cost (Breen et al., 2001). But technology in higher education isn't merely about replacing old models of content delivery, it's about adding to them, forming a learning experience that is characterised by collaborative communication (Garrison & Vaughan, 2008). This, and other misconceptions around the use of ICT in education, or e-learning, need to be examined in greater detail, to include the rising influence of social software and it's integration into current learning systems, as well as the changing nature of today's students ( Prensky, 2001; Oblinger & Oblinger, 2005; Barnes, Marateo & Ferris, 2007; Mabrito & Medley, 2008). In considering the use of ICT in education, Pritchard (2007) has suggested that a social constructivist framework be used, in which learning is viewed as a process of interaction between what is known and what is to be learned, is social, situated and is a metacognitive process. Thus, the relationship between the use of ICT in learning and social constructivism is evident, with some suggesting that the use of social software in particular, is compatible with a social constructivist approach to learning (Mason & Rennie, 2008).

Of course there are challenges to the integration of ICT in higher education, most notably a lack of access to technology that has been identified by a number of African studies (Samuel, Coombes, Miranda, Melvin, Young & Azarmina, 2004; Rowe, 2007; Rohleder, Bozalek, Carolissen, Swartz & Leibowitz, 2008). In light of this lack of access, one area that holds a lot of promise for the integration of ICT in learning in an African context is in the domain of mobile- or m-learning. This approach takes cognisance of the enormous possibilities inherent in the fact that 83% of people in South Africa own a mobile phone (African Mobile Factbook, 2008). This must be taken into account when considering any endeavour that involves collaboration and connection, since a mobile phone is inherently a communication device. In addition, when combined with a digital camera, rich media player, gaming platform and geographical locator, a modern mobile phone is a small computer capable of far more than a mere conversation. Mobile technologies have already been shown to facilitate several different types of learning, including constructivism and collaborative learning (Salmon & Edirisingha, 2008).

If ICT in the form of social software is to be integrated into education, traditional ideas of teaching and learning may no longer be the best fit, with a blend of different teaching strategies possibly being a more suitable approach. In fact, blended learning has been identified as an educational strategy that has superior outcomes to either traditional, or online only courses (Means, Toyama, Murphy, Bakia & Jones, 2009). By combining traditional face-to-face contact with online components, blended learning offers educators and students more choice in terms of where and when learning occurs. It diversifies the resources that are available, as well as the ways in which those resources can be used, and integrates physical and online spaces so that learning can occur anywhere (Littlejohn & Pegler, 2007). If a blended approach to teaching and learning is to be adopted in physiotherapy education, the curriculum is where it must begin.

A curriculum is more than a mere syllabus, or description of content. A more comprehensive view of curriculum would serve to describe the content, teaching and learning strategies, assessment tasks and the educational environment, as well as taking into account the students and the learning outcomes of the course (Harden, 2005). Garrison and Vaughan (2005, p. 5) describe the integration of a blended learning approach into the curriculum as not simply the addition of another educational layer, but rather a “…fundamental redesign that transforms the structure of, and approach to, teaching and learning“. Thus, curriculum reform must be accompanied by a change in pedagogy that should evolve over time, and in which educators should be involved and well-supported (Mabrito & Medley, 2008). Punie, Cabrera, Bogdanowicz, Zinnbauer and Navajas (2006) have also suggested that an ICT-enabled learning experience is more likely to succeed if it is accompanied by social and institutional change. Thus, if ICT components are to be incorporated into teaching and learning practice, it will have to be done within the framework of a changing curriculum. If we accept the integration of ICT into the curriculum as one component of a blended approach, we must then decide how that integration will occur. In looking at curriculum planning, Harden (1986b) has suggested a ten step framework that includes defining the curriculum in terms of it's needs, content, learning outcomes, organisation and management.

It should be pointed out however, that curriculum reform is often an unsettling process for everyone involved, with concerns being raised regarding changing standards and varying levels of quality during the transformation. McLean (2003) thus suggests an inclusive process of curriculum change, keeping staff and students informed throughout the process. Part of the anxiety may be a fear of judgement regarding ones teaching techniques. It must be acknowledged that many different approaches to teaching and learning exist and that there may be a tendency to view various approaches as being either “right” or “wrong”. Harden, Sowden and Dunn (1984) have suggested the SPICES model (Student-centred, Problem-based, Integrated / Interprofessional, Community-based, Elective driven, Systematic) to medical curriculum planning, in which each teaching strategy is viewed as a continuum, and thus avoids the polarisation of opinion.

This section will be expanded to create a link between clinical reasoning (important for proficiency as a therapist) and reflection, and how they can be facilitated through the use of emerging online tools.

• Jones, M. & Rivett, D. (2005). Clinical Reasoning for Manual Therapists. Elsevier Butterworth Heinemann. ISBN: 0750639067

The growing recognition of the importance of digital literacy over and above the superficial notion of computer literacy, is evident when confronted with the increasingly difficult task of managing the vast information resource that is the Internet (Oblinger & Oblinger, 2005). Today's students may be comfortable with technology and digital environments, but they still struggle with the concept of digital literacy (Kingsley & Kingsley, 2009). However, the provision of adequate training and appropriate support may help to ensure that staff and students are not left behind during the process.

Social software is fundamentally changing the power differential in society, moving it away from the centralised control of powerful individuals and corporations, towards the dispersed and the disempowered. This however, assumes that the disempowered have physical and epistemological access to technology, which is far from the reality in many developing countries. The sad irony is that those who would benefit most from the vast resources of the internet, are the least likely to have readily available access (Rohleder et al., 2008; Yusuf-Khalil, Bozalek, Staking, Tuval-Mashiach & Bantebya-Kyomuhendo, 2007). With careful course design taking poor access and high costs into account, it should be possible to reduce the impact of low levels of access to technology. In addition, the significant penetration of mobile devices among the population opens up further opportunities for course development that incorporates the fact that most students have access on some level.

As new teaching strategies have emerged in medical education, including self-directed learning and problem-based learning, so have mistrust and unfamiliarity slowed down their adoption (Dent & Harden, 2001). Resistance to change from staff and students, both in terms of curriculum reform, and teaching practice will have to be overcome, since this study requires participation from all stakeholders. Measures to reduce these barriers would be to include sufficient support to both students and staff, as well as to ensure that there is an understanding of the reasons for change.

A number of existing theoretical approaches to pedagogy and curriculum development were discussed, which provide a credible framework for the study. It was also found that the nature of education is changing in terms of the expectations of a new generation of students, and that the integration of emerging technologies is a major component of that change. Blended learning was identified as a potential approach to improve teaching and learning practice, showing superior outcomes when compared with purely traditional or online approaches. However, in order for new approaches to pedagogy to be implemented, the curriculum must also change in order to take advantage of these emerging technologies. Finally, a number of challenges were presented, which must be addressed if a blended approach to teaching and learning practice is to be considered.

The study will take place within the physiotherapy department at a university in the Western Cape, South Africa.

The study population will include all registered undergraduate physiotherapy students and staff at the University of the Western Cape. No students or staff members will be excluded from the process, unless they choose not to participate.

The overarching design of the study will use action research methods to assess the outcomes of implementing a blended learning approach in a teaching module within the department (Gresty, 2007). Action research consists of “a spiral of steps, each of which is composed of a circle of planning, action, and fact-finding about the result of the action” (Lewin, 1946). Thus, the researcher not only seeks to create organisational change but to simultaneously study the process and results of that change (Baburoglu & Ravn, 1992). Denscombe (1998) has described action research as arising in order to address a practical problem and involving change that needs to be incorporated into practice. This methodological approach brings with it several challenges, not least of which is the dilemma of conducting research within a changing environment. Other challenges include negotiating control over research projects within the department, as well as questions about who will initiate projects, and when.

Other research methods that will be incorporated into the action research process include systematic review of the literature, several descriptive surveys, document analysis, a Delphi study and an evaluation of the process. Each of these designs is elaborated on in the next section.

The first stage of the study will address the first objective in the following manner:
a.) A systematic review of both local and international literature will be conducted to inform the development of a module that uses a blended learning approach within the undergraduate curriculum. It will consist of both local and international publications in fields ranging between pedagogy in higher education, healthcare education, clinical practice, curriculum development and information technology in higher education. All of the relevant articles will be independently assessed by three reviewers using an appropriate critical appraisal tool such as the Joanna Briggs Institutes System for the Unified management, Assessment and Review of Information (JBI-SUMARI). One of the challenges highlighted when using an appraisal tool such as the JBI-SUMARI is the issue of inter-rater reliability. Strategies suggested to reduce the risk of error include the use of a standard data extraction form, performing a pilot test of the extraction form and training the reviewers (Joanna Briggs Institute, 2008). Once consensus has been reached, the selected articles will be included in the review.

b.) A survey of students and staff within the department will be conducted in order to determine the attitudes towards the adoption of a blended approach to teaching and learning, to identify current teaching and learning practices, and to form a needs assessment that will inform curriculum development. Prior to conducting the survey, three voluntary workshops will be conducted within the department, focusing on the major components of the study (i.e. educational theory, information and communication technology and the process of curriculum development). The workshops will also serve to collaboratively establish a baseline understanding of commonly used terminology (e.g. “blended learning”, “didactic teaching”, “small group learning”, “social software”, etc.), in order to ensure consistency during the project. Finally, it will be made clear that the responses to the survey will not be used to judge current practice, as it is acknowledged that there are many appropriate approaches, and that different teachers use different methods. Following the workshops, the survey will be conducted using a self-developed questionnaire that will be accompanied with a cover letter to facilitate informed consent. The survey will be piloted to ensure content validity and reliability. The survey will assist the researcher in determining what staff and students require from the curriculum in order to best improve the process of teaching and learning within the department. Thus, all stakeholders will have the option to be informed, active participants in the process from the beginning. The questionnaire will be informed by the systematic literature review completed in Step 1a and will include open and closed ended questions. Data will be captured using OpenOffice and the results analysed descriptively.

a.) Document analysis will be used to map the current undergraduate curriculum to determine the alignment of module outcomes and the associated learning activities to determine which modules are appropriate for blended learning. The learning outcomes of each module will be compared to the exit level outcomes for physiotherapists, as specified by the South African Qualifications Association (SAQA) and the Health Professions Council of South Africa (HPCSA). Following a review of the relevant curriculum documents using a data capture sheet, recommendations will be made as to which modules are are appropriate to use a blended learning approach. To ensure that the data captured during this stage is trustworthy, a group from within the department will collectively analyse and determine whether the current curriculum is aligned or not.

b.) Once the appropriate modules have been identified, one module will be selected to be developed, using a Delphi study. The Delphi method has been identified as being suitable to produce information that is useful for decision making, through a series of questionnaires aimed at experts (Adler & Ziglio, 1996). It is also useful to explore the attitudes and needs of groups (Frantz, 2007). Experts in the field of physiotherapy education, pedagogy and information technology will be consulted in a series of three “rounds”. The first round will have the panel generate a shorter list of modules, as well as any concerns around the process. The second round will have panelists discuss and prioritise the list, and the third round will finalise the module that will be adapted (Sibbald, Singer, Upshur & Martin, 2009). During this process, a core group of experts from each discipline will decide on the modules and verify the progress at each stage.

The selected module will then be developed to take advantage of a blended approach to teaching and learning that encourages students to engage with the resource and with each other (Adams, 2004), making use of the feedback and results from Phases 1 and 2. It will include input from the lecturer who is responsible for teaching the selected module, as well as experts in the field, in order to ensure content validity. A constructivist approach will ensure that the module and it's related learning activities facilitate self-directed, or mediated learning and small group work, which develops personal, meaningful knowledge through interaction and discussion (Gresty, 2007).

The selected module will be then be taught by someone other than the researcher in order to avoid researcher bias. The lecturer who teaches the module will receive additional support and guidance during the process.

Process evaluation will be used throughout steps 1 – 4, as action research allows for continuous feedback from the participants throughout the process. In addition, the module will be evaluated after it has been implemented, with both quantitative and qualitative methods in a self-administered survey, using a self-developed questionnaire. It will include the voluntary participation of the lecturer and students who were involved in the module. This survey will be assessed for content validity and reliability, with a focus on internal consistency.

The results of the study will be specific to the undergraduate physiotherapy students and the curriculum of the particular department that the study will take place in. It will therefore not be generalisable to other physiotherapy / Allied healthcare departments, or even to the postgraduate students in this department. In addition, only one module will be developed using a blended learning approach, meaning that other modules will not be implemented during this study. Since there are many different modules in the undergraduate curriculum, both theoretical and practical, it might be difficult to generalise the applicability of this approach. However, this study will highlight basic principles of implementing a blended approach to teaching and learning to physiotherapy education, which may be generalisable to other modules, as well as other curricula.

Permission to conduct the study will be sought from the faculty Higher Degrees Committee at the University of the Western Cape, the Senate Higher Degrees Committee, the Registrar of the university and the head of the physiotherapy department that will be involved. The study will be conducted according to ethical practices pertaining to the study of human subjects as specified by the Faculty of Community and Health Sciences Research Ethics committee of the University of the Western Cape. There is a risk that the quality of education of some undergraduate students may suffer as a result of a changing curriculum, as new strategies of teaching and learning are implemented and evaluated. Input from the Directorate of Teaching and Learning will be sought to minimise the potential negative effects of curriculum change. Students and staff will be invited to participate in the study and informed that their participation in the project is voluntary, that they may withdraw from the study at any stage, and that there will be no negative consequences should they choose to do so. Each stage of the project will include an information sheet so that participants may make an informed choice about participating. Participants will also be required to complete a written consent form. Anonymity and confidentiality will be ensured at each stage of the project, and no personally identifiable information will be gathered. The results of the study will be made available to the physiotherapy department where it was carried out.

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