Programmatic assessments implementation in a physiotherapy education curriculum - a study protocol for a randomized feasibility-controlled study

This study protocol outlines a randomized feasibility-controlled trial at a Swiss University of Applied Sciences to evaluate the implementation and impact of programmatic assessment, comparing individual and group coaching against a control group, within an undergraduate physiotherapy curriculum aimed at shifting from behaviorist to competence-based education.

The Gist

Imagine you are learning to drive a car. In the old-school way of learning, you might spend months reading the manual and then, on the day of your test, you get in the car with an examiner who hands you a checklist. They watch you for 10 minutes, tick boxes like "turned on signal" or "checked mirrors," and then give you a simple "Pass" or "Fail." If you fail, you have to wait months to try again.

This paper is about trying a new, better way to teach and test future physiotherapists (people who help you move and recover from injuries). The researchers want to move away from that "one big scary test" and try something called Programmatic Assessment (PA).

Here is the simple breakdown of what they are doing:

The Big Idea: The "Fitness Tracker" vs. The "Final Exam"

Think of the old way of testing as a final exam. It's high-stress, happens once, and tells you if you passed or failed based on a single snapshot in time.

The new way (Programmatic Assessment) is like a fitness tracker (like an Apple Watch or Fitbit). Instead of one big test, it collects tiny bits of data all day long:

• How many steps did you take?
• What was your heart rate during a run?
• How did you sleep?

By looking at all that data over time, you get a true picture of your health. Similarly, this study wants to collect many small "check-ins" on a student's skills over a whole semester, rather than just one big test at the end.

The Experiment: Three Different Training Camps

The researchers are running a study with a group of physiotherapy students in Switzerland. They are splitting the students into three different groups to see which method works best:

1. The "Personal Trainer" Group (Individual Coaching):
   Students take small tests (like a progress quiz or a practical skill check). Afterward, they sit down one-on-one with a teacher (a coach). The teacher says, "Here is where you struggled, here is why, and here is how to fix it." The student then writes down what they learned.

   • Analogy: It's like having a personal trainer who watches your form, corrects you immediately, and helps you plan your next workout.

2. The "Team Huddle" Group (Group Coaching):
   These students take the same small tests. Afterward, they get together in a small group with a teacher to discuss their results and learn from each other.

   • Analogy: It's like a sports team watching game tape together, pointing out mistakes, and figuring out the strategy as a team.

3. The "Do It Alone" Group (The Control/Sham Group):
   These students take the exact same small tests, but nobody talks to them about the results. They get their scores, but no coaching, no feedback, and no help figuring out what to do next.

   • Analogy: It's like taking a driving test, getting your score, and being told, "Good luck next time," without anyone telling you what you did wrong.

What Are They Looking For?

The researchers aren't just trying to see who gets the highest grades. They are asking: "Is this new system actually possible to run?"

They want to know:

• Attendance: Do students actually show up for the coaching sessions? (If they don't, the system is broken).
• Completion: Do students finish all the little tasks and reflections?
• Fidelity: Do the teachers actually follow the plan, or do they get confused?

They also want to see if this new way makes students feel less stressed, if teachers are ready to do it, and if the students actually learn more than the group that got no help.

Why Does This Matter?

Right now, many schools still use the "Pass/Fail" checklist method. But being a physiotherapist is complex; it's not just about knowing facts, it's about thinking on your feet, talking to patients, and solving problems.

If this study shows that the "Fitness Tracker" approach (Programmatic Assessment) works, it could change how health professionals are taught everywhere. It would mean moving away from "cramming for the test" and toward "learning how to learn," ensuring that when a new physiotherapist graduates, they are truly ready to help people, not just good at taking tests.

In short: They are testing if giving students constant, gentle feedback and coaching helps them become better doctors than just giving them a scary final exam and walking away.

Technical Summary

Based on the provided study protocol, here is a detailed technical summary of the research.

1. Problem Statement

The current landscape of physiotherapy education faces a misalignment between the demands of modern healthcare and traditional pedagogical approaches.

• Context: Global shifts (demographic changes, environmental degradation, economic instability) require health professionals to possess high levels of agility, empathy, and competence.
• The Gap: While Competence-Based Education (CBE) is the theoretical standard, its implementation is inconsistent. Many educators still rely on behaviorist paradigms (passive learning, binary assessments like checklists) which fail to capture the complexity of professional competence.
• The Need: There is a lack of utilization of constructivist and progressive models (e.g., connectivism, heutagogy) that treat assessment as a driver of learning rather than a gatekeeping tool. Specifically, Programmatic Assessment (PA)—a systems-based approach using multiple low-stakes data points, feedback, and reflection—is underutilized in physiotherapy curricula despite its success in other health professions (e.g., medicine).

2. Methodology

This study is a randomized feasibility-controlled trial designed to evaluate the implementation of Programmatic Assessment (PA) in an undergraduate physiotherapy curriculum.

• Study Design: A randomized controlled trial (RCT) conducted at a Swiss University of Applied Sciences (Bern and Basel campuses).
• Participants: Students from the Cohort PHY25 enrolled in the BSc Physiotherapy program.
  • Inclusion: All students in the cohort willing to participate.
  • Exclusion: Other cohorts or those refusing consent.
• Intervention Groups: Students are randomly assigned to one of three groups:
  1. IG A (Individual Coaching): PA with individual coaching sessions and reflective support.
  2. IG B (Group Coaching): PA with group coaching sessions and reflective support.
  3. CG (Control Group): "Sham" PA. Students complete the same assessment data points but receive no coaching or reflective support.
• Timeline & Data Points: The intervention runs during the first semester of the 2025/26 academic year (Oct 2025 – May 2026).
  • Data Point 1 (Weeks 44–46): Progress test.
  • Data Point 2 (Weeks 49–50): Practical skills test in triads (patient, therapist, observer) with peer feedback.
  • Data Point 3 (Weeks 03–04): Second progress test.
  • Final Assessment (Week 5): Objective Structured Clinical Examination (OSCE).
• Outcomes Measured:
  • Primary (Feasibility): Session attendance, program completion rates, and implementation fidelity (adherence to design).
  • Secondary: Staff readiness, student workload (NASA Task Load Index, self-reports), student wellbeing, and learning gain (pre-post self-assessments, portfolio analysis).
• Statistical Analysis:
  • Descriptive statistics for baseline and feasibility.
  • Inferential tests (non-parametric equivalents) for group comparisons.
  • Multivariable regression to adjust for covariates (baseline performance, age, gender, motivation, site).
  • Handling of missing data via multiple imputation.
• Blinding: Educators and students cannot be blinded due to the nature of the intervention. However, outcome assessors and data analysts will remain blinded to group allocation.

3. Key Contributions

• Protocol Development: Provides a rigorous, SPIRIT-compliant protocol for implementing PA in physiotherapy, a field where such systematic approaches are less common than in medical education.
• Comparative Coaching Formats: Uniquely compares individual vs. group coaching formats within a PA framework to determine which delivery method is more feasible and effective.
• Holistic Evaluation: Moves beyond simple pass/fail metrics to evaluate the process of assessment, including staff readiness, workload, and the "learning gain" derived from the assessment cycle itself.
• Controlled "Sham" Design: Utilizes a control group that undergoes the same testing procedures but lacks the pedagogical support (coaching/reflection), allowing for the isolation of the coaching component's specific impact.

4. Results

Note: As this document is a study protocol (published March 3, 2026, with data collection scheduled through May 2026), no empirical results or data analysis are available yet.

• The paper outlines the plan for data collection, which is scheduled to be completed by June 2026, with analysis and reporting expected by July 2026.
• The document serves as a blueprint for how the results will be generated and interpreted, rather than reporting findings.

5. Significance

• Curricular Redesign: If the PA model proves feasible and effective, the findings will directly inform the redesign of the physiotherapy curriculum at the participating institution and potentially across Switzerland and Europe.
• Pedagogical Shift: The study supports the transition from behaviorist, binary assessment models to learner-centered, capability-based strategies. It aims to validate assessment as a mechanism for learning (formative) rather than just evaluation (summative).
• Health Professions Education: Successful implementation could provide a scalable model for other health professions to adopt Programmatic Assessment, addressing the global need for adaptable, competent healthcare graduates.
• Evidence Base: It contributes to the growing body of literature on PA in allied health, moving beyond theoretical advocacy to empirical feasibility testing in a real-world undergraduate setting.