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Case-based learning enables the application of theory to practice using real-life patient cases. The present study aims to compare the effect between video cases and paper cases on motivation for learning and knowledge acquisition to perform a clinical reasoning case exercise by occupational therapy students. A mixed-methods design was used with 120 students randomized into two groups. All students conducted a clinical reasoning case exercise on the same case, although in different presentation formats: paper case and video case. The quantitative measures of this study were the scores of motivation for learning from the Instructional Material Motivation Survey and the grades of a clinical reasoning case exercise. The qualitative part was based on the positive and negative aspects perceived by the participants. The results showed that the motivation for learning was significantly higher for the video case compared to the paper case, although there were no differences in the grades of the clinical reasoning case exercise between the two groups. The video cases were perceived as more relevant to professional practice and more informative in terms of non-verbal communication and context. In light of the results, teachers could use these two formats of presentation of cases with different objectives.

This study was designed to examine the effects of tracing and fading prompts to improve the handwriting of two preschoolers both diagnosed as Developmentally Delayed (DD) and one of whom had fine motor goals. The study took place in a self-contained special education public preschool classroom located in the Pacific Northwest. The results showed an increase in legibility of writing for both participants as well as an increase in independence when writing their letters. This report suggests that providing traceable prompts and methodically fading those prompts based on student performance was effective and applicable when teaching preschool children diagnosed with Developmental Delays to write their names.

An objective structured clinical examination (OSCE) has been recognised as a reliable but workload-intensive assessment method across health sciences studies. Though a variety of digital marking tools have been employed to improve marking and feedback provision for OSCEs, many of these require specialist software or maintenance. This pilot study examines the development and trialling of Microsoft Forms as a marking and feedback instrument for an OSCE within a Sport and Exercise Therapy module. This study aims to assess whether the use of a non-specialist digital tool, such as Microsoft Forms, might be able overcome limitations in current assessment procedures and ultimately provide a more effective method for marking and feedback provision for an OSCE. Results from OSCE examiners (N = 8) and students (N = 30) who participated in the pilot indicate that Microsoft Forms does have the potential to provide a more effective experience for examiners and ultimately improve upon feedback provision for students when compared with a paper-based marking tool. However, concerns around the form's ease-of-use may ultimately influence its adoption as a marking instrument above current paper-based methods.

Background: Use of Botulinum toxin-A (BoNT-A) for treatment of upper limb spasticity in children with cerebral palsy has become routine clinical practice in many paediatric treatment centres worldwide. There is now high-level evidence that upper limb BoNT-A injection, in combination with occupational therapy, improves outcomes in children with cerebral palsy at both the body function/structure and activity level domains of the International Classification of Functioning, Disability and Health. Investigation is now required to establish what amount and specific type of occupational therapy will further enhance functional outcomes and prolong the beneficial effects of BoNT-A., Methods/design: A randomised, controlled, evaluator blinded, prospective parallel-group trial. Eligible participants were children aged 18 months to 6 years, diagnosed with spastic hemiplegic cerebral palsy and who were able to demonstrate selective motor control of the affected upper limb. Both groups received upper limb injections of BoNT-A. Children were randomised to either the modified constraint-induced movement therapy group (experimental) or bimanual occupational therapy group (control). Outcome assessments were undertaken at pre-injection and 1, 3 and 6 months following injection of BoNT-A. The primary outcome measure was the Assisting Hand Assessment. Secondary outcomes included: the Quality of Upper Extremity Skills Test; Pediatric Evaluation of Disability Inventory; Canadian Occupational Performance Measure; Goal Attainment Scaling; Pediatric Motor Activity Log; modified Ashworth Scale and; the modified Tardieu Scale., Discussion: The aim of this paper is to describe the methodology of a randomised controlled trial comparing the effects of modified constraint-induced movement therapy (a uni-manual therapy) versus bimanual occupational therapy (a bimanual therapy) on improving bimanual upper limb performance of children with hemiplegic cerebral palsy following upper limb injection of BoNT-A. The paper outlines the background to the study, the study hypotheses, outcome measures and trial methodology. It also provides a comprehensive description of the interventions provided., Trial Registration: ACTRN12605000002684.

Objectives: The blind and visually disabled people form a predominant group in the disabled society and hence, need greater attention. Most of the rehabilitation therapists, especially occupational therapists, do not focus on this group. Thus, the aim of the study is to shed light on the issue of negligent attitude of rehabilitation therapists, especially occupational therapists, toward blind and visually-impaired people. Methods:To perform this study, a systematic, evidence-based process (Duffy 2005) was used. Data for the study was gathered from the following sources: Electronic databases: Medline PubMed, CINAHL, OVID Medline, CINAHL Plus with Full Text, Cochrane Databases of Systematic Reviews, ProQuest, UpToDate, Web of Science, OT Search, OTDirect, PEDro, SID, Magiran, IRAN MEDEX, MEDLIB, and IRANDOC. Results: From accessible databases, 112 articles related to blind and people with low vision in Iran were found; of these, only 17 articles have been included in this study. Discussion: Proper assessment of the visually disabled is required to implement the appropriate intervention technique. Occupational therapists need to pay special attention to the visually disabled people.

Person-centered approaches to measurement are needed to more fully reach the goals of person-centered practice. Keyform maps, derived from Rasch analysis and principles of person-centered measurement, are thought to be an important tool for translating person-centered measurement into clinical practice. The purpose of this study was to understand the impact of keyform map use in a variety of learning activities embedded across multiple courses in an entry-level occupational therapy curriculum. This paper includes a description of 3 keyform map learning activities and corresponding results. The effects of keyform maps as a signature instructional strategy within entry-level occupational therapy education and implications for future studies are also discussed.

The purpose of this study was to investigate student satisfaction and perceived clinical reasoning and learning using a computer-based simulation platform that incorporates case-based learning principles. The simulation was used to replace a previously scheduled face-to-face clinical rotation which was cancelled due to COVID-19. A descriptive design was used to implement the Satisfaction with Simulation Experience Scale (SSES) with students (n = 27) following each a low fidelity (paper cases) and high fidelity (Simucase™) simulation. A comparison of the SSES data following paper cases and simulation scenarios indicated statistically significant increases in "Debrief and Reflection" (p = 0.008) and "Clinical Reasoning" (p = 0.043), suggesting that students develop in-depth reflection, reasoning, and clinical abilities as they progress through their simulated experience.

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Background Executive skills refer to a set of cognitive skills that allow individuals to engage in goal directed behavior. They encompass planning, initiation, inhibition, monitoring and flexibility in approach to tasks, and are necessary for functional competence. Executive skills are vulnerable to disruption with damage to the brain, as occurs with dementia. Methods Participants were recruited from a tertiary memory assessment and support Service. The Assessment of Motor & Process Skills (AMPS), a standardised observational assessment of occupational performance (1Fischer, 2003) was administered by trained Occupational Therapists. In addition, the EXIT-25, a pen & paper based assessment of executive skills (2Royall et al, 1992) was administered. Process scores from the AMPS, and overall score from the EXIT 25 were utilised for correlation analysis. Results 22 participants, 12 male and 10 females, age range 60-91 (mean 75.5 years), was analysed using Spearman's Rho correlation (-.2). Results did not identify a strong correlation Conclusion Dementia is commonly regarded as a disorder of memory. However, diagnosis is dependent on functional decline related to cognitive decline. The AMPS provides a formal assessment of functional skills, in terms of motor & process skills with cut off scores regarding safe independent living. The results of this study indicate that the AMPS is not associated with executive scores on formal cognitive assessments, highlighting the value of an extensive multi-component MDT approach (also incorporating history taking, imaging, bio marker testing etc.) in assessing and diagnosing a dementia. [ABSTRACT FROM AUTHOR]

Faced with broad scale cancellation of allied health student placements due to COVID-19, placement coordinators at The University of Melbourne Department of Rural Health established remote, online work-integrated learning placements across a range of settings, including a primary school, specialist school, kindergarten association and a homelessness sector organization. To ensure safe and high-quality placements, the evidence for telepractice and placement innovation was reviewed and integrated with existing knowledge of developing quality service-learning placements and COVID-safe guidelines from professional associations. This paper describes how placements were established, how student learning needs were aligned with host site objectives, and critically analyses the benefits and challenges of the online placement format. Partnerships, communication, and planning with all stakeholders were critical in placement redesign. The outcome is that students have enhanced their clinical and professional skills and provided community services to clients that would otherwise not have been provided during a pandemic.

Interdisciplinary is a huge innovation in education. It sets a wide perspective of knowledge boundaries with different background of expertise in order to achieve better outcome and social impact. Innovation in the other way closely related to creative mind as being portrayed as design thinking. A cross-field research has being conducted between occupational therapist (expert-user) and designer due to innovation activities occurs in the rehabilitation setting. Increasing creation on assistive technology (AT) for patients grows in numbers but unfortunately issues of low rate of usage being highlighted. What went wrong to those creation? The purpose of this paper is to investigate the effective design practice that suits to the need of interdisciplinary for design intervention in rehabilitation setting. In design education, several approaches are being applied by the designers to help the non-designer to innovate products in their field such as co-creation. Hence, a total of selected studies from design and innovation journal between year 2010 until 2018 being reviewed using Mendeley to analyse the difference design activities involved. Upon findings, attributes for interdisciplinary for design education for expert-user are including types of user, experience and technology factors. Recommendation for further research in design method for interdisciplinary collaboration for expert-user is perceived to bring better creation by future Design Innovation Catalyst (DIC) where they can adopt design intervention in their field for effective problem solving; either in design or non-design activities. The importance of these findings for design interdisciplinary are discussed.

A quiz concerning the treatment of symptomatic joint hypermobility in childhood is presented.

Background: Children with Down syndrome (DS) typically have motor and language needs. Improving function is a shared goal for the rehabilitation therapy team, however physical therapy, occupational therapy, and speech-language pathology professionals treat patients differently. This difference in care may mask developmental cascades whereby changes in one domain (e.g., motor) can have seemingly unexpected effects on another domain (e.g., language). Objective: This scoping review identified papers where motor and language data have been reported together in children with DS and reinterpreted findings from a developmental cascades lens. Design: Online databases were used to identify 413 papers published before October 2021 from which 33 papers were retained that reported both motor (gross and/or fine) and language (expressive and/or receptive) data in individuals with DS with a chronological age of 0-18 years. Results: The majority of papers (79%) that reported motor and language data in children with DS did not examine their link, while 12% analyzed motor-language links, but using a cross-sectional or retrospective design. Only three papers (9%) utilized a longitudinal design to examine predictive links. Conclusion: Motor functioning and language functioning have often been reported together, but not analyzed together, in studies of children with DS. The few studies that did analyze motor-language links largely replicated findings from other developmental populations where motor gains were positively linked to language gains. Analyzing links between domains when such data is available is needed to fully characterize developmental cascades in DS and may have broad clinical implications. [ABSTRACT FROM AUTHOR]

There is growing pressure in higher education to develop graduates with the capabilities to work effectively in collaborative, interdisciplinary teams to solve the key issues facing humankind. For many years, health has been pioneering interprofessional education as the means to deliver professionals with capacity to work together to deliver high quality, cost-effective, client-centered care. This paper reports on an explorative case study where interviews were undertaken with ten students from different professions who had experienced interprofessional education at three different community sites. The learning was informed by an adapted version of contact hypothesis for use in interprofessional education combined with adult learning principles. Four interrelated metathemes were identified: space and time, informality and independence, which resulted in a more holistic approach to practice. Results suggest that the contact hypothesis, with consideration of contact variables, has the potential to improve the quality of interdisciplinary group interaction.

This paper reviews the accreditation requirements for six Allied Health (AH) degree programs in Australia to understand the range of accreditation requirements and approaches, with a particular focus on requirements around clinical education in AH education. Strengths of current approaches and further requirements are identified. Of particular interest are those areas where accreditation could better support educational goals and processes, including the preparation of work ready graduates and the encouragement of the use of currently underutilized opportunities for preparing the AH workforce for future healthcare needs. The findings suggest that the accreditation criteria perform well for the development of students' conceptual and procedural knowledge. However, there are several opportunities for improvement where accreditation could better support preparation of graduates to meet current and future needs of healthcare. These opportunities include increased emphasis on biopsychosocial perspectives of health as healthcare models shift from hospital to community-based settings, increased emphasis on development of interprofessional skills, encouragement of diverse supervision models, explicitness about intentions and interpretations of accreditation requirements, and increased employer representation on accreditation panels. Constraints on universities' uses of new educational approaches imposed by or arising from non-explicit accreditation requirements are outlined. Arising from this analysis, a summary of considerations for AH accreditation bodies is provided.

Universities, health services and health students have a vested interest in the development of work-ready graduates to improve employment prospects, standards of practice and healthcare outcomes. Work integrated learning supports the transition of theoretical knowledge into professional practice, thus preparing students for their work following graduation. The positive impact of practice experiences on work-readiness and employability is largely assumed. This paper describes the impact of participation in a rural Australian service-learning program on student and academic perceptions of work-readiness and future employability. Qualitative data was gathered from allied health students who participated in inter-professional focus groups and allied health academics who participated in individual interviews. The findings indicate that students were challenged in transitioning from being observational or highly directed learners, described as [being in the] 'shadows' or 'shadowing', to semi-autonomous healthcare providers. Participants reported enhanced perceptions of future employability through 'real work' experiences and identified broader program implications for universities and students. Based on participant experiences, service-learning, a relatively new educational pedagogy in rural health education in Australia, may provide universities, health services, and students with an alternative to acute hospital placements in the development of work-ready attributes for new graduate allied health practitioners.

Assessment of practical clinical skills is essential in the health fields. Objective Structured Clinical Exams (OSCEs), where examiners assess students performing clinical procedures on simulated patients (actors), are central to the evaluation of practical skills. However, traditional OSCEs require considerable time-investment to administer, and providing timely, individualised student feedback is difficult. To address these issues, an electronic OSCE (eOSCE) was developed utilising the iPad and specialised software. The eOSCE was trialled in four courses within two entry-level rehabilitative pre-professional programs at two universities, physiotherapy and occupational therapy. Evaluation consisted of student surveys (n = 206), eight student focus groups (n = 25), examiner surveys (n = 25) and interviews with course coordinators (n = 3). This paper describes the administration of the eOSCE and reports on its evaluation from the academic's perspective. A majority of examiners (68%) preferred the eOSCE over traditional paper-based OSCEs, primarily because of the consistency and promptness of student feedback. The advantages academics cited were equitable student feedback and post-examination administrative time-savings. Disadvantages of the eOSCE were the pre-examination preparation required and challenges for examiners not comfortable using technology. Overall, the key benefits of the eOSCE were the automated, immediate individualised student feedback and a time saving in OSCE administration.

Multilingual speakers' languaging practices are undervalued and problematised in formal teaching and learning spaces in higher education. The environment has legitimised monolingualism as the only acceptable practice, hence students often lack the confidence to recruit their full linguistic repertoires. In the third and fourth years of their Occupational Therapy studies, many African students faced challenges due to socio-historic-political factors that put them at risk of failure. These challenges were addressed in academic support tutorial spaces using pedagogical translanguaging. The aim of the paper is to demonstrate the use of translanguaging as a socially just strategy, its affordances, and its challenges. This paper utilises data from a case study within a larger project aiming to describe the use of translanguaging in multilingual teaching and learning settings at a historically White university in South Africa. The case study comprised of eight African students. Linguistic ethnography and Moment analysis were employed. Pedagogical translanguaging and humour were used to create a space conducive to collaborative learning and co-construction of knowledge that granted epistemic access to occupational therapy discourse. Respect and dignity were fundamental in fostering cohesion, improving confidence, enacting speaking rights, and creating a sense of belonging among students who often felt alienated. [ABSTRACT FROM AUTHOR]

Social impairments experienced by children diagnosed with autism spectrum disorder (ASD) can limit participation in meaningful occupations. Incorporating typically developing siblings of children with ASD in occupational therapy-based community settings is an emerging practice approach that aims to support children with ASD during social challenges to enhance their participation in daily activities. The inclusion of siblings in occupational therapy practice presents a unique opportunity to address social skill development while facilitating positive sibling relationships. In this Opinions in the Profession paper, the influential role siblings play as social models for their siblings with ASD will be examined. The purpose of this paper is to describe sibling-mediated interventions and the distinct role of occupational therapists in facilitating positive sibling interactions and relationships through a coaching approach to promote the achievement of positive social and emotional outcomes. [ABSTRACT FROM AUTHOR]

Karen Sames was born and raised in Milwaukee, WI. From an early age, she was surrounded by art. An experience with occupational therapy during the third grade jumpstarted her journey connecting art to occupation. Karen believes that art is a necessary part of life and credits much of her own personal success with art to her friends and family for their inspiration and to the instructors at the Eagan Art House in Minnesota. Her piece "Cherry Blossoms," a pastel on paper, is based on a photograph taken by her son, who is currently living in Japan, and graces the cover of the Spring 2024 edition of The Open Journal of Occupational Therapy (OJOT). [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of occupational therapy (OT) on the self‐management of function, pain, fatigue, and lived experience for people living with rheumatoid arthritis (RA). Methods: Five databases and gray literature were searched up to June 30, 2022. Three reviewers screened titles and abstracts, with two independently extracting and assessing full texts using the Cochrane risk of bias (quantitative) and Critical Appraisal Skills Programme (qualitative) tools to assess study quality. Studies were categorized into four intervention types. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (quantitative) and GRADE‐ Confidence in Evidence from Reviews of Qualitative research (qualitative) were used to assess the quality of evidence for each intervention type. Results: Of 39 eligible papers, 29 were quantitative (n = 2,029), 4 qualitative (n = 50), and 6 mixed methods (n = 896). Good evidence supports patient education and behavior change programs for improving pain and function, particularly group sessions of joint protection education, but these do not translate to long‐term improvements for RA (>24 months). Comprehensive OT had mixed evidence (limited to home OT and an arthritis gloves program), whereas limited evidence was available for qualitative insights, splints and assistive devices, and self‐management for fatigue. Conclusion: Although patient education is promising for self‐managing RA, no strong evidence was found to support OT programs for self‐managing fatigue or patient experience and long‐term effectiveness. More research is required on lived experience, and the long‐term efficacy of self‐management approaches incorporating OT, particularly timing programs to meet the individual's conditional needs (i.e., early or established RA) to build on the few studies to date. [ABSTRACT FROM AUTHOR]

Parenting with a physical disability often brings with it a range of challenges. Occupational therapists are well positioned to support parents to address these challenges, yet occupational therapy research and practice around parenting is relatively scarce. This paper addresses the questions: (1) How should occupational therapists support parenting occupations for people with physical disability? (2) How do parents with physical disability experience occupational therapy? An anonymous survey of 62 parents, primarily mothers, with physical disability about their experiences with parenting challenges and occupational therapy was analysed using both quantitative and qualitative techniques. Parents experienced challenges in engaging in a range of parenting tasks with children over a range of age groups. Parents reported that support was often needed and indicated that occupational therapy could assist them directly with specific parenting goals as well as the more usual biomechanical goals that influence parenting. Yet less than half of participants who received occupational therapy services reported that parenting tasks were addressed, and only one-fifth reported that their goals had been fully met. The data also indicated that the knowledge, skills, and attitudes of occupational therapists with regard to working with parents with disability can be improved. Findings suggest a need to better incorporate parenting occupations in standard occupational therapy training to increase occupational therapists' comfort and competence in working with clients on parenting issues., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Anne Honey et al.)

Research has shown that children with learning disabilities exhibit considerable challenges with visual motor integration. While there are specialized Occupational Therapy interventions aimed at visual motor integration, computer games and virtual toys have now become increasingly popular, forming an integral part of children's learning and play. Technological advancements, especially in the field of Virtual Environment and Haptics, provide the opportunity to incorporate force feedback and multiple sensory modalities (visual, audio, tactical and propioceptive) into interactive games. This paper presents a preliminary qualitative evaluation of three iterations of haptic games designed to improve visual-motor integration in children with a spectrum of learning disabilities. Data was collected from ten children to evaluate - 1) the usability of the games, in terms of children's engagement, sustained interest and level of fun in playing the games, and 2) the compatibility of the system's hardware with Occupational Therapy standards. The results indicate that children enjoyed playing most games, demonstrated sustained interest and were not resistant to interacting with the technology. This result is promising and lends credence to the feasibility of implementing training interventions using Haptics. Lessons learned and recommendations for future design have been discussed both from the standpoint of interaction design and Occupational Therapy. The paper demonstrates the value of the multidisciplinary approach of combining both usability and occupation therapy evaluation methods to improve the software and hardware design of the haptic device. (Contains 4 figures and 1 table.)

The purpose of this paper is to present a preliminary, qualitative review of a therapeutic programme for preschool children and their parents in severely under-resourced contexts to aid the development of the underlying skills required to be ready for formal school. A team of two pairs, each comprising an occupational therapist and a community worker, responded to teachers' requests to assist struggling children in their classes. This led to the development of a programme focusing on Grade R classes, by firstly helping teachers to develop their capability and confidence in assessing and assisting children to develop the abilities underlying vital school-readiness skills during whole-class, therapeutic group sessions. Secondly, parent group sessions were added to empower parents to understand and support their children's development needs at home and so to complement the work done by teachers in the classroom. This second aspect, of working with the parents, developed owing to observations of the children's irregular school attendance, scant parent-school contact, and teachers' reports indicating that parents were not aware of, nor equipped to deal with, the challenges faced by their children. Implications for practice, for planning and for further research are discussed.

The introduction of problem-based learning (PBL) as an innovative strategy is often challenging to both teaching staff and students. This is particularly the case when it is only used on one module within a programme. This case study reports on an evaluation of the experiences of students and staff in the first cohort introduced to problem-based learning in one module of an accelerated taught Masters level programme in occupational therapy. Most students responded positively to the module with an acknowledged development in personal and professional skills, team working skills, knowledge base, independent learning skills and successful completion of the module. For a minority of students, however, this was not the case. This paper identifies strategies for effective introduction of a problem-based learning approach to a single module and considers how the potential negative impact on some learners might be minimised.

Collaborative consultation has been widely adopted in school-based occupational therapy practice; however, limited research has examined how collaboration between educators and occupational therapists contributes to students' outcomes. The purpose of this study was to describe the nature of collaborative working in two cases of school-based occupational therapy service delivery. This paper reports a cross-case analysis, comparing findings about the nature of a joint effort in each case study to identify workplace practices that facilitated educator-occupational therapist collaboration. Ethnographic case study methods (Stake, 1995; Wolcott, 2008) and socio-cultural activity theory (SCAT; Engestrom, 2001) were used to examine multiple perspectives concerning school-based occupational therapy collaborative consultation for two students with developmental disability in one region of Ontario, Canada. Cross-case analysis (Stake, 2006) facilitated examination of the similarities and differences in teamwork. Specific ways that educator-occupational therapist collaboration can be facilitated were identified in three areas: (a) focus for educational programming; (b) communication practices; and (c) leadership practices of educators. SCAT provided a robust framework for describing the depth, quality, and context of interactions from multiple stakeholder perspectives. As such, this research contributes to the development of theoretical and empirical perspectives on the processes of collaborative working and the relationship of these processes to outcomes. (Contains 3 figures and 3 tables.)

Often, research projects are presented as final products with the methodologies cleanly outlined and little attention paid to the decision-making processes that led to the chosen approach. Limited attention paid to these decision-making processes perpetuates a sense of mystery about qualitative approaches, particularly for new researchers who will likely encounter dilemmas and uncertainties in their research. This paper presents a series of questions that assisted one Ph.D. student in making key methodological choices during her research journey. In this study, a collective case study design informed by constructivist grounded theory data analysis methods was used to develop a framework of community development from an occupational therapy perspective. Ten methodological questions are proposed regarding research question development, research paradigm, design and analysis, and trustworthiness. Drawing on examples from this research project, these questions are used to explicate the decisions made "behind the scenes," with the intention of providing both theoretical and practical guidance to others embarking on similar research journeys. (Contains 5 tables.)

Affective learning is a key dimension of health professional education and involves teaching topics such as empathy or grief that impact student attitudes and beliefs to prepare them to be novice practitioners. The move in higher education toward online and "blended" learning (a mix of online and traditional, classroom based learning) disrupts traditional approaches to teaching professional affect, which is heavily reliant on instructor modeling. This paper documents insight into the redesign process of a course, "Professional Identity: Behaviors and Attitudes," from a traditional to a blended learning format, with a focus on affective learning. This study employed a survey approach to compare classroom and online student perceptions of learning across the seven affective topics of the course. The study also examined the contribution of various technology-enhanced learning activities to the students' perceptions of learning. Twenty-five classroom students and 64 blended learning students indicated that while both formats increased students' perceived understanding of topics related to affective learning, the blended learning group perceived a significantly greater understanding in four affective topic areas. Furthermore, blended learning students cited reading, online discussions, and unstructured out-of-classroom discussions as contributing to their learning significantly more than the classroom group.