A systematic review of the effectiveness of flipped classrooms in medical education

LecturePlus: a learner-centered teaching method to promote deep learning

A new teaching format, the LecturePlus, was formulated as a lecture followed by small-group learning activities. This study assessed the effectiveness of LecturePlus in medical education. An interventional study was conducted among final-year medical students, with 74 students in the experimental group and 96 students in the control group. Each LecturePlus lasted ∼1 h and was conducted with 12-18 students. A LecturePlus session comprised of a lecture followed by small-group problem-solving exercises. The exercises were clinical cases with open-ended short-answer questions. Students were divided into groups of three (triads) for these exercises. A faculty tutor assisted the small groups as needed. Closure was achieved through a discussion moderated by the tutor. Learning outcomes were assessed via the National Board of Medical Examiners (NBME) subject scores and compared with those of the preceding academic year. An additional multiple-choice question (MCQ) test was administered before and after the clerkship. The MCQ test showed improvement in knowledge application (P < 0.001, partial eta squared = 0.42). There was a statistically significant improvement in adjusted NBME scores among female students (74.8 vs. 71.8; P = 0.017) but not among male students. An anonymous written questionnaire survey showed high ratings for LecturePlus (95% selecting yes or partly yes to overall satisfaction). LecturePlus is an instructional strategy that integrates a lecture with learning activities. It can be scaled to large class sizes facilitated by one teacher. By combining didactic teaching with problem-solving, this new instructional strategy may foster application of knowledge.NEW & NOTEWORTHY We developed a new structured teaching format, the LecturePlus, to promote deep learning. A LecturePlus session consists of a brief lecture, followed by small-group problem-solving exercises, ending with a closing discussion moderated by the teacher. During the small-group exercises, students were divided into groups of three (triads) and given case-based problems. One faculty tutor supervised the entire session. LecturePlus resulted in improved learning outcomes and was rated highly by medical students.

Using cognitive load theory to evaluate and improve preparatory materials and study time for the flipped classroom

BACKGROUND

Preclinical medical education is content-dense and time-constrained. Flipped classroom approaches promote durable learning, but challenges with unsatisfactory student preparation and high workload remain. Cognitive load theory defines instructional design as "efficient" if learners can master the presented concepts without cognitive overload. We created a PReparatory Evaluation Process (PREP) to systematically assess and measure improvement in the cognitive-load efficiency of preparatory materials and impact on study time (time-efficiency).

METHODS

We conducted this study in a flipped, multidisciplinary course for ~ 170 first year students at Harvard Medical School using a naturalistic post-test design. For each flipped session (n = 97), we assessed cognitive load and preparatory study time by administering a 3-item PREP survey embedded within a short subject-matter quiz students completed before class. Over three years (2017-2019), we evaluated cognitive load- and time- based efficiency to guide iterative revisions of the materials by content experts. The ability of PREP to detect changes to the instructional design (sensitivity) was validated through a manual audit of the materials.

RESULTS

The average survey response rate was ≥ 94%. Content expertise was not required to interpret PREP data. Initially students did not necessarily allocate the most study time to the most difficult content. Over time, the iterative changes in instructional design increased the cognitive load- and time-based efficiency of preparatory materials with large effect sizes (p < .01). Furthermore, this increased the overall alignment of cognitive load with study time: students allocated more time to difficult content away from more familiar, less difficult content without increasing workload overall.

CONCLUSIONS

Cognitive load and time constraints are important parameters to consider when designing curricula. The PREP process is learner-centered, grounded in educational theory, and works independently of content knowledge. It can provide rich and actionable insights into instructional design of flipped classes not captured by traditional satisfaction-based evaluations.

Academic half days, noon conferences and classroom-based education in postgraduate medical education: a scoping review

BACKGROUND

Classroom-based education (CBE) is ubiquitous in postgraduate medical education (PGME), but to date no studies have synthesized the literature on the topic. We conducted a scoping review focusing on academic half days and noon conferences.

METHODS

We searched 4 databases (MEDLINE [OVID], Embase [OVID], ERIC [EBSCO] and Web of Science) from inception to December 2021, performed reference and citation harvesting, and applied predetermined inclusion and exclusion criteria to our screening. We used 2 frameworks for the analysis: "experiences, trajectories and reifications" and "description, justification and clarification."

RESULTS

We included 90 studies, of which 55 focused on resident experiences, 29 on trajectories and 6 on reification. We classified 44 studies as "description," 38 as "justification" and 8 as "clarification." In the description studies, 12 compared academic half days with noon conferences, 23 described specific teaching topics, and 9 focused on resources needed for CBE. Justification studies examined the effects of CBE on outcomes, such as examination scores (17) and use of teaching strategies in team-based learning, principles of adult learning and e-learning (15). Of the 8 clarification studies, topics included the role of CBE in PGME, stakeholder perspectives and transfer of knowledge between classroom and workplace.

INTERPRETATION

Much of the existing literature is either a description of various aspects of CBE or justification of particular teaching strategies. Few studies exist on how and why CBE works; future studies should aim to clarify how CBE facilitates resident learning within the sociocultural framework of PGME.

Comparison of the effectiveness of exclusively facilitated clinical teaching as an alternative to traditional practice-based primary care placements

INTRODUCTION

COVID-19 presented major challenges to undergraduate GP placement capacity and there was an increased reliance on clinical training using facilitated simulation. The authors present a novel comparison of the effectiveness and cost-effectiveness of delivering a one-week primary care course using entirely GP-facilitated clinical teaching outside the GP setting against traditional practice-based GP clinical education.

METHODS

A one-week GP placement was redeveloped from a traditional teaching model (TT-M) to an exclusively facilitated teaching model (FT-M) delivered outside the GP practice setting, using principles of blended learning, flipped classroom methods, e-learning and simulation. Both teaching models, delivered in different locations during 2022 to pre-clinical students, were evaluated using student feedback surveys for attainment of learning outcomes and course satisfaction.

RESULTS

The students reported their consultation skills and clinical knowledge (amalgamated mean score 4.36 for FT-M versus 4.63 for TT-M; P = 0.05), as well as preparation for the clinical phases (mean scores 4.35 for FT-M versus 4.41 for TT-M; P = 0.68), were well developed and similar for both courses. Students reported similar enjoyment across both teaching models (FT-M mean score 4.31 versus 4.41 for TT-M; P = 0.49). The costs for delivering teaching per 4-h session for 100 students were £1,379 and £5,551 for FT-M and TT-M, respectively.

CONCLUSION

Delivery of a one-week primary care attachment to third year medical students using an FT-M was similarly effective and more cost effective than delivering it by a TT-M. FT-M potentially offers an important adjunct to clinical learning and resilience to capacity challenges for GP placements.

Implementing case-based collaborative learning curriculum via webinar in internal medicine residency training: A single-center experience

This study aimed to investigate the effects of the Case-based collaborative learning (CBCL) curriculum in webinar format on internal medicine residents' knowledge covering cardiologic topics and their attitudes toward the CBCL teaching module. CBCL is a novel small-group approach, that incorporates elements of problem-based learning and case-based learning, and it has shown to improve medical students' knowledge mastery. However, few studies have explored its applicability for internal medicine residents, especially in the webinar format. This prospective cohort study included internal medicine residents in a residency program in Beijing, China. Eight CBCL sessions in webinar format covering cardiologic topics were delivered to them from February to April 2020. Pre-session reading materials included textbook and guidelines published by the academic societies. Multiple-choice questions were delivered to assess participants' knowledge before and after the sessions. Changes in participants' knowledge were determined using the paired t test to compare mean values. In addition, surveys based on 5-point Likert scale scores assessed satisfaction at the end of the second and eighth sessions. The Wilcoxon signed-rank test was used to identify any potential satisfaction improvement. In total, 9 internal medicine residents participated in the study, of whom 33.3% were male, and the overall rate of participation in CBCL sessions in webinar format was 94.4%. The mean scores of 50 multiple-choice questions were 68.0 ± 12.3 and 75.1 ± 9.9 in the pre- and post-curriculum assessments (P = .029). In the first survey performed at the second week, 5 (55.6%) residents chose "like" or "extremely like" in overall satisfaction, "neutral" by 3 (33.3%) residents and "dislike" by 1 (11.1%) resident. In the second survey, only 1 (11.1%) resident selected a neutral reply in satisfactory assessment, and the other 8 (88.9%) residents selected either "like" or "extremely like" choices. Compared with the results of the first survey, the overall satisfaction rate significantly improved (P = .031). Implementing the CBCL sessions in webinar format for cardiology residents was resulted in the improved knowledge mastery and a high acceptance rate.

Examining the effects of student-centered flipped classroom in physiology education

BACKGROUND

The flipped classroom approach has gained increasing popularity in medical education. Physiology is a basic medical course that studies the phenomena and laws of human life activities, and is a crucial link course connecting preclinical courses and clinical courses. However, there is a paucity of data showing the effectiveness of the flipped classroom model for the entirety of physiology course in medical undergraduate students.

METHOD

131 sophomore students with clinical medicine major at Harbin Medical University were recruited and they were randomly allocated into two groups: the control group which was subjected to traditional lecture teaching (n = 69), and the experimental group which was subjected to flipped classroom teaching (n = 62). To assess the effect of flipped teaching, the usual performance and final exam scores were used to evaluate the physiology learning effectiveness of students. The correlation between the usual performance and final exam scores by Pearson method was also conducted in the two teaching groups. After course completion, an anonymous questionnaire survey was conducted among the subjects of flipped classroom group to assess students' opinion regarding the flipped classroom teaching.

RESULTS

Our results showed that the usual performance and final exam scores of students in the flipped classroom were both significantly higher than that in the traditional teaching class (P < 0.05). Moreover, our results also showed that the usual performance of students was significantly correlated with the final exam scores in the flipped classroom (r = 0.3945, P < 0.01), but not in the traditional teaching group (r = 0.1522, P = 0.2119). The results of questionnaire survey showed that 77.58% of the students believed flipped classroom teaching improved their knowledge acquisition. 70%~86% of students perceived that flipped classroom enhanced their learning abilities, including self-study ability, collaborative learning and problem-solving skills, and clinical thinking ability. In addition, about 60% of students acknowledged the teaching design and teaching environment, more students' engagement and presentation of group learning in the flipped classroom.

CONCLUSION

The flipped classroom teaching significantly improved students' learning effectiveness in physiology course, as indicated by final exam score and usual performance. It also promoted higher-order ability-set acquisition and allowed a rationalized formative evaluation system.

Using a Flipped Classroom to Compare 2 Ultrasonography Operating Methods to Improve Practice in Ultrasound Detection Acupuncture

Objective

Ultrasound (US) detection acupuncture (UDA) is an innovative acupuncture technique that uses ultrasonography (USG) to detect the depth of the lung before performing acupuncture on the points around the chest to avoid puncturing the lungs. For acupuncturists to use UDA appropriately, it is crucial to have a good operating method to identify the pleura with USG. This study compared 2 US operating methods through active learning in a "flipped classroom" setting for acupuncture students.

Materials and Methods

Students and interns were recruited to complete the UDA flipped classroom course and evaluate the operations of 2 US methods on either of 2 simulation models: (1) a single B-mode or (2) a combined M-mode + B-mode. Participants were interviewed and satisfaction surveys were administered to obtain feedback.

Results

A total of 37 participants completed the course and evaluations. The combined mode had better measurement accuracy, acupuncture safety, and operating time (P < 0.05), and no pneumothoraxes occurred. Among both participant groups, the combined mode allowed the student group to learn quickly and the intern group to become more proficient. Both interviews and satisfaction surveys yielded positive feedback.

Conclusions

Using a combined mode for UDA can improve its performance greatly. The combined mode is definitely helpful for learning and promotion of UDA.

Evidence-based teaching in contact lenses education: Teaching and learning strategies

INTRODUCTION

Contact lens (CL) practice is an ever-changing field with clinical knowledge, techniques and equipment continuously evolving. These new developments are backed with clinical trials and research to ensure that practitioners feel confident that there is an evidence base to support these advances. Evidence-based practice is now a crucial part of CL practice, and its importance also filters down to CL education. For example, lectures are one of the most popular tools for an educator but, is standing at the front of a lecture theatre full of students a more effective way of teaching than providing the same material for students to read by themselves? What evidence exists specific to CL education?

METHOD

An expert panel of educators completed a comprehensive literature review of current evidence of teaching methods in CL training, or if not available then what can be learnt from other health care professional training that could be potentially applicable to CL education.

RESULTS

Due to the amount of evidence available in the overall subject area relating to healthcare education, the initial plan of compiling evidence into one narrative review paper was discarded in favour of producing two linked papers. Here, the first paper details definitions of terminology, and also teaching methods. The second paper focuses on assessment and specific clinical training required to attain CL practice competency. In this first paper, no direct evidence of the spreading and benefit of new education strategies evidence such as flipped classrooms, spaced learning, test-enhanced learning, group work, CBL, PBL, TBL, and reflective practice in CL education was found. The only technique that was widely used in the CL field was case reports and the group discussion of them. Nevertheless, the authors found a consensus of opinion from other disciplines that are transferable to CL teaching and could help students meet the intended learning outcomes.

CONCLUSION

There is a small amount of evidence supporting CL education, but most of this seems to be related to the practical element of the training. However, there is a lot of evidence in the field of healthcare education from related disciplines which provides additional but important learning tools that may be effectively implemented in CL education.

Online Interactive Flipped Classroom Teaching in Pediatrics for Medical Undergraduates

OBJECTIVES

To introduce online flipped classroom teaching for medical undergraduates in Pediatrics and to assess students' engagement and satisfaction with the students and faculty with the flipped classroom teaching method.

METHODS

An interventional education study was conducted on online flipped classrooms for final-year medical undergraduates. The core team of faculty members was identified, students and faculty were sensitized, and pre-reading material and feedback forms were validated. Students were engaged using the Socrative app, and feedback from students and faculty was collected using Google Forms.

RESULTS

One hundred sixty students and six faculty members participated in the study. During the scheduled class, 91.9% of students were engaged. The majority of the students strongly agreed that the flipped classroom was interesting (87.2%) and interactive (87%) and developed an interest in the subject of Pediatrics (86%). Faculty were also motivated to adopt this method.

CONCLUSION

The present study revealed that introducing flipped classroom strategy in an online model improved students' engagement and increased their interest in the subject.

A national qualitative investigation of the impact of service change on doctors' training during Covid-19

BACKGROUND

The Covid-19 crisis sparked service reconfigurations in healthcare systems worldwide. With postgraduate medical education sitting within these systems, service reconfigurations substantially impact trainees and their training environment. This study aims to provide an in-depth qualitative understanding of the impact of service reconfiguration on doctors' training during the pandemic, identifying opportunities for the future as well as factors that pose risks to education and training and how these might be mitigated.

METHODS

Qualitative parallel multi-centre case studies examined three Trusts/Health Boards in two countries in the United Kingdom. Data were collected from online focus groups and interviews with trainees and supervisors using semi-structured interview guides (September to December 2020). A socio-cultural model of workplace learning, the expansive-restrictive continuum, informed data gathering, analysis of focus groups and coding.

RESULTS

Sixty-six doctors participated, representing 25 specialties/subspecialties. Thirty-four participants were male, 26 were supervisors, 17 were specialty trainees and 23 were foundation doctors. Four themes described the impact of pandemic-related service reconfigurations on training: (1) Development of skills and job design, (2) Supervision and assessments, (3) Teamwork and communication, and (4) Workload and wellbeing. Service changes were found to both facilitate and hinder education and training, varying across sites, specialties, and trainees' grades. Trainees' jobs were redesigned extensively, and many trainees were redeployed to specialties requiring extra workforce during the pandemic.

CONCLUSIONS

The rapid and unplanned service reconfigurations during the pandemic caused unique challenges and opportunities to doctors' training. This impaired trainees' development in their specialty of interest, but also presented new opportunities such as cross-boundary working and networking.

Flipped classroom applied to Neurosurgery in undergraduate medical education

PURPOSE

To compare the academic achievement obtained in Neurosurgery in a class of undergraduate students according to the pedagogical methodology employed: flipped classroom (FC) versus traditional lecture. Students' satisfaction with the FC model is also analyzed.

METHODS

A quasi-experimental study was designed. The traditional lecture was the pedagogical method employed in teaching units (TUs) 1, 2, and 3 (61, 60, and 66 enrolled students, respectively), whereas TU 4 (69 enrolled students) used the FC methodology.

RESULTS

The dropout rate was lower, whereas the academic achievement and the rate of correct answers were higher in TU 4 compared to the rest of the TUs, but these results were not statistically significant. However, the mean score obtained in Neurosurgery was significantly higher in TU 4 compared to the rest of the TUs (p = 0.042). Active learning activities based on clinical cases were positively emphasized. The main weakness was with the time consumed for video-recorded lecture viewing.

CONCLUSIONS

The FC approach showed better academic results than traditional lectures when comparing students in the same Medical School during the same academic year undergoing the same exam. The students rated the FC approach positively, considering it stimulating and useful for learning.

Flipping the classroom in neurological bedside teaching: a prospective controlled study

BACKGROUND

Bedside teaching is essential to foster core clinical competences in medical education, especially in Neurology. However, bedside skills are declining and new concepts to enhance the effectiveness of bedside teaching are needed, also in view of limited in-person teaching possibilities in the ongoing pandemic situation. If theoretical knowledge is taught prior to in-person sessions this might allow to better focus on practical application aspects during bedside teaching. We thus aimed to answer the question to what extent such an approach can enhance the effectiveness of neurological bedside teaching.

METHODS

In this prospective controlled study, neurological bedside courses following a traditional and a flipped classroom (FC) approach were compared with regards to their effects on theoretical knowledge and practical skills of medical students. Evaluations were obtained from 161 students and their lecturers participating in a neurological bedside teaching course at a German university hospital between October 2020 and July 2021. Students were randomly assigned to course dates. However, the 74 students assigned to course dates from May to July 2021 completed a mandatory online preparation course prior to the bedside teaching. These students served as the interventional group (IG) and the remaining 87 students formed the control group (CG). Ratings of knowledge and skills provided by the students and their lecturers on numerical rating scales served as primary outcome measures. Moreover, the time needed to recapitulate theoretical contents during the in-person teaching session was assessed as a secondary outcome measure. Group comparisons were performed using t-statistics.

RESULTS

Theoretical knowledge upon entering the course was rated significantly higher in the IG by the students (p < 0.001) and lecturers (p = 0.003). Lecturers also rated the practical skills of students in the IG significantly higher (p < 0.001). Furthermore, significantly less time was needed to recapitulate theoretical contents during the in-person session in the IG (p = 0.03).

CONCLUSIONS

Using a FC approach enhances the effectiveness of in-person neurological bedside teaching. Thus, these concepts are particularly valuable in the ongoing pandemic situation. Moreover, they might allow to reuse e-learning contents developed during the pandemic and to develop future bedside teaching concepts.

Radiography education in 2022 and beyond - Writing the history of the present: A narrative review

OBJECTIVES

The COVID-19 pandemic had a major effect on teaching and learning. This study aimed to describe a range of teaching, learning, and assessment strategies related to radiography education which have become more common due to the pandemic through a narrative literature review.

KEY FINDINGS

Educational change in radiography was accelerated by the disruption caused by the pandemic. Changes included the site and mode of teaching and conducting of assessment. While some of the digital transformation trends were introduced before the pandemic, others were further amplified during this period of time. Alternative solutions such as virtual reality technology, gamification, and technology-enhanced learning were especially salient and have the potential to mitigate challenges brought about by the pandemic. The use of technology in the clinical setting, in assessment, and to facilitate feedback, are important tools for improving learners' clinical skills performance. Collectively, these digital technologies can maximise learning and support mastery of knowledge, skills and attitudes.

CONCLUSION

The pandemic has cast a new light on existing methodologies and pedagogies in education. This review suggests that digital technology is shaping teaching and learning within radiography education and also that educators cannot ignore this digital shift. With the digital trajectory, it would be highly useful to transform approaches to education within radiography to support learning as radiography education moves towards the new normal era.

IMPLICATIONS FOR PRACTICE

Digital technology in education can help improve the learning experience for learners but educators need to be equipped with the technological skills and be adaptable to these changes. Continual sharing of experiences and knowledge among radiography educators is essential. Safety nets need to be in place to ensure digital inclusiveness and that no learner gets left behind due to the digital divide in education.

Student engagement in flipped classroom in nursing education: An integrative review

AIM

To summarize the effect of the flipped classroom method (FCM) on student engagement in nursing education and provide the implications for future practice.

BACKGROUND

Technological advancement of learning approaches including flipped classroom has become increasingly popular in nursing education. However, no integrative review has been published that specially explore the behaviour engagement, cognitive engagement and emotional engagement of flipped classroom use in nursing education.

METHODS

Population, Intervention, Comparison, Outcomes and Study (PICOS) strategies were implemented to investigate the literature from published peer-reviewed papers from 2013 to 2021 in CINAHL, MEDLINE and Web of Science.

RESULTS

The initial search identified 280 potentially relevant articles. After comprehensively reviewing the initial catchment using several analytical phases, 16 articles were considered for the final review. Most of articles targeted on undergraduate nursing students and were conducted in the USA and Australia. The review primarily identified positive learning outcomes among nursing students in term of student engagement. However, a few studies reported contrasting findings, possibly due to students are still dependent on traditional lecture-based classroom.

CONCLUSION

This review suggests that use of the FCM in nursing education could promote students' behavioral engagement and cognitive engagement but yield a mixed outcome in emotional engagement. This review contributed to our understanding of the effect of the flipped classroom method on student engagement in nursing education, the strategies for promoting student engagement in future flipped classroom practice and recommendation for future research on flipped classroom.

Student Pharmacists' Perspectives Regarding a Virtually Delivered Research Proposal Course in the Doctor of Pharmacy Curriculum

This study aimed to assess third-year student pharmacists' perspectives regarding a virtually delivered research proposal course. A 23-item questionnaire was distributed to third-year student pharmacists enrolled in a research proposal course over three weeks in April 2021. The questionnaire contained 15 Likert-scale items, seven descriptive items, and a free-text item for additional comments about the course. Items were summarized using descriptive statistics. Fifty-four student pharmacists (response rate = 40.9%) participated in the survey. The student pharmacists surveyed generally had a positive perception of the virtually delivered research proposal course with median scores ≥ 4 (indicating agreement) for the majority (13/15) of survey items. Students did not agree that there was no difference in their motivation to succeed in the virtual course versus an in-person course and did not agree that they were more likely to pursue a career that involves undertaking a research project. This study found that student pharmacists generally had a positive perception of a virtually delivered research proposal course. These findings offer some support for the provision of an online, virtually delivered research proposal course for student pharmacists. Further research with a larger sample of students from multiple pharmacy schools is needed to improve the generalizability of the results.

Attendance Improves Student Electrocardiography Interpretation Skills Using the Flipped Classroom Format

The implementation of classroom capture and casting technologies has changed how content can be accessed. Students can access live, streaming, and/or recorded formats of material. Broadening this accessibility has, in turn, introduced flexibility for both the learner and the instructor. This flexibility has impacted the necessity of attendance to access classroom-delivered content. There are many reports that investigate the changing attendance climate as well as the potential impact of attendance on student outcomes. Here we investigated the impact of attending classroom activities on student performance with two common content delivery methods in an undergraduate, pre-clinical cardiology course. Electrocardiography (ECG) interpretation was taught using a flipped classroom format which allowed for the practice of interpretive skills with faculty guidance. Other components of the course related to the diagnosis, treatment, and management of cardiovascular disease were delivered using a lecture-based format. The results demonstrate that attendees outperform their classmates in the ability to interpret ECGs and related content. However, the attending student does not appear to have a performance advantage when content is delivered by lecture. The results provide evidence for students to prioritize their time when making decisions about attendance, based on teaching modality, when given a choice. Further, the information can guide curricular change and help colleges and programs identify curricular activities that have a clear attendance benefit for students.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01689-5.

Semi-flipped classroom-based learning interventions in a traditional curriculum of oral medicine: students' perceptions and teaching achievements

BACKGROUND

In recent years, flipped classes have emerged and become popular in college medical education. However, due to the huge medical learning system and the limited pre-class study time of students, it is difficult to implement in all courses. And then we adopted the semi-flipped classes (SFCs) to evaluate its teaching effect. This study analysed three educational methods that can be used in oral medicine courses: online education, offline education, and semi-flipped classes.

METHODS

We used two surveys to evaluate the three educational methods. In the first survey 46 teachers and 238 undergraduates shared their experience of the live-streaming and traditional offline courses offered in the different oral medicine curricula; we used anonymous questionnaires to evaluate their class experience. In the second survey 94 students shared their experience of the semi-flipped and traditional classrooms. Students who attended the SFCs in the experimental group learned about the oral mucosa disease by themselves using an online video course and then participated in offline interaction with teachers. The evaluation of the above educational methods was conducted using the anonymous questionnaires and final exam assessment.

RESULTS

According to the first survey, teachers and students both agreed that the overall teaching experience and learning effectiveness in offline education are superior to those in online education. According to the second survey, students who participated in the SFCs performed better in the final exam than those who participated in the simple offline classes. Additionally, the survey showed that the new teaching method helped students gain more knowledge and positively influenced their clinical practice.

CONCLUSIONS

Compared with the online and offline educational methods, the SFC showed better results in both the questionnaire and final exam assessment. Hence, the effectiveness of medical education can be improved by adopting a teaching mode that combines online and offline teaching methods. Scientific and logical SFCs designs, along with their effective implementation, would eventually make SFCs an important tool for medical education.

Online flipped learning methods for teaching hospitality skills and management practices in an epidemic situation: A study on learning attitude and effectiveness

Starting in 2019, the ongoing COVID-19 pandemic has lasted 3 years and will likely continue to affect the lives of people all over the world. According to a United Nations Educational, Scientific and Cultural Organization (UNESCO) survey, more than 91% of students from all over the world have been affected by the spread of COVID-19. The application of technological networks can help solve problems related to being unable to attend school in person, as online teaching can effectively help reduce learning loss in the short term. In Taiwan, the higher education system has been using online learning, but now faces a new and huge crisis, as some courses do not readily translate to this setting. In professional courses run by hospitality departments, it is essentially impossible to accurately convey the practical skills required, for example, aspects of color, aroma, and taste through online teaching. Moreover, the learning level of each student varies greatly. During the online teaching process, instructors teach professional skills and movements through a single teaching video, which may not meet the needs of all students. In response, this study explores using the flipped teaching method, to not only enable students to master and control their learning and effectively adjust their self- adaptive learning progress but also to help teachers solve problems and impart professional skills using a two-way, interactive, online teaching method. This approach, flipping a class in an online learning environment, could effectively make up for the one-way teaching sometimes created by video content, and address the problem of gaps in learning professional practical skills. It can also induce students with poor learning attitudes to actively participate in learning. This study involved 55 bachelor students from a university of science and technology in Taiwan. The research results are as follows: (1) Students who participated in the flipped teaching mode, which involved two-way interaction showed better professional understanding of the course and improved willingness to learn, thereby improving the learning effect. (2) Awareness of these poor practical catering professional skills in students, assisted in laying the professional foundation for students to gradually improve their learning attitude and their advanced skills. This indicates that students with poor academic performance in an online environment might benefit from two-way interactive teaching. Teachers should clarify detailed descriptions of professional practical actions that confuse students. (3) In flipped learning, the grouping of "game/toy-based e-learning" can not only improve the performance of students who actively study to achieve good grades but also help and motivate other students to learn together. These results indicate that in flipped classrooms that use an online learning environment, the active learning and learning attitudes of students were positive and that their interest in learning and learning efficiency was also significantly improved. At the same time, this approach stimulated the innovation, creativity, and creative development of students in using professional technology in the hospitality industry. It transformed the passive learning situation of online one-way teaching into an active two-way teaching environment.

Be in the Digital Room Where it Happens, Part II: Social Media for Neurology Educators

Social media has changed the way we communicate and interact. Unsurprisingly, it has also changed how we teach and learn. Younger generations of learners have transitioned from traditional educational sources to digital ones. Medical educators need to adapt to trends in medical education and develop fluency in the digital methods used by medical learners today. This is part two of a two-part series on social media and digital education in neurology. This article provides an overview of how social media can be used as a teaching tool in medical education and provides an overview in which it is grounded. We offer practical strategies on how social media can promote lifelong learning, educator development, educator support, and foster educator identity with accompanying neurology-specific examples. We also review considerations for incorporating social media into teaching and learning practices and future directions for integrating these tools in neurology education.

Inverted classes as a successful tool to overcome teaching and learning challenges imposed by COVID-19 lockdown to food microbiology laboratory classes

This study evaluated if the online inverted classes (IC) model maintained high students’ learning engagement and performance on the laboratory component of Food Microbiology during an academic year dominated by COVID-19-lockdown, compared to pre-pandemic years. Porto University students from 2 courses (n = 36-Pharmaceutical Sciences; n = 59-Nutrition Sciences) were engaged. A high rate of students answered they prefer the IC rather than lecture-only style delivery mode and were involved in the IC learning process (prepared classes asynchronously; participated in case-studies resolution during synchronous classes). Very good laboratory final performances were maintained as in pre-pandemic years. Variable perceptions about work volume and adaptation to face-to-face laboratory classes were observed among both groups, potentially related to different course organization and defined learning outcomes/competences.

A qualitative study to explore the acceptability and feasibility of implementing person-focused evidence-based pain education concepts in pre-registration physiotherapy training

Objectives

The purpose of this study was to engage with physiotherapy clinicians, academics, physiotherapy students and patients to explore the acceptability, feasibility, and practical considerations of implementing person-focused evidence-based pain education concepts, identified from our previous research, in pre-registration physiotherapy training.

Design

This qualitative study took a person-focused approach to ground pain education in the perspectives and experiences of people who deliver and use it. Data was collected via focus groups and in-depth semi-structured interviews. Data was analysed using the seven stage Framework approach.

Setting

Focus groups and interviews were conducted either face to face, via video conferencing or via telephone. This depended on geographical location, participant preference, and towards the end of data collection the limitations on in-person contact due to the Covid-19 pandemic.

Participants

UK based physiotherapy clinicians, physiotherapy students, academics and patients living with pain were purposively sampled and invited to take part.

Results

Five focus groups and six semi-structured interviews were conducted with twenty-nine participants. Four key dimensions evolved from the dataset that encapsulate concepts underpinning the acceptability and feasibility of implementing pain education in pre-registration physiotherapy training. These are (1) make pain education authentic to reflect diverse, real patient scenarios, (2) demonstrate the value that pain education adds, (3) be creative by engaging students with content that requires active participation, (4) openly discuss the challenges and embrace scope of practice.

Conclusions

These key dimensions shift the focus of pain education towards practically engaging content that reflects people experiencing pain from diverse sociocultural backgrounds. This study highlights the need for creativity in curriculum design and the importance of preparing graduates for the challenges that they will face in clinical practice.

The Effect of a Flipped Classroom Learning Model Versus Traditional Lecture Model on Resident's Knowledge Acquisition for Atraumatic Back Pain in the Emergency Department

Objective

The effectiveness of lecture-based (LB) formats for residency education has recently been challenged as the gold standard. Studies suggest a flipped classroom (FC) lecture improves resident satisfaction, but evidence that showing improved knowledge acquisition is lacking. To determine whether the flipped classroom model improves knowledge acquisition compared to traditional LB model.

Methods

Emergency medicine resident physicians at 2 academic programs were included in December 2019; at Sinai-Grace Hospital, a traditional lecture was the teaching method and at Detroit Receiving Hospital, FC was utilized. Residents completed prelecture and postlecture content tests. The primary outcome was change in test results (pretest to post-test). A noninferiority design comparing the changes between intervention and control groups was utilized (1-sided t-test, noninferiority margin of -0.5; 1-sided alpha = 0.05).

Results

Results were available for 31 residents (17 controls and 14 interventions) out of 83 enrolled. There were 14 postgraduate year 1 (PGY-1), 9 PGY-2, and 8 PGY-3 residents. The mean difference in score was +0.71 (SD 1.38) and +0.77 (SD 1.48) for the FC and LB groups, respectively. This resulted in a mean difference between groups of -0.05 (lower bound of the upper 95% confidence interval -0.93 and therefore crossing the noninferiority margin of -0.05; P = .20).

Conclusions

This study of resident education at 2 training programs was unable to demonstrate noninferiority of an FC format compared to standard lecture. Surprisingly, there was little improvement in test results after both teaching formats. Larger studies are needed to power results.

The impact of the transition from flipped classroom to online lectures on learning outcomes and student satisfaction in a rehabilitation medicine clerkship during the COVID-19 pandemic

BACKGROUND

The flipped classroom (FC) is a well-known active learning module that activates the prior knowledge of students and promotes their cognitive skills during in-class activities. However, most on-site teaching during the COVID-19 pandemic had to be conducted online. The FC in our rehabilitation medicine clerkship curriculum was also shifted to online asynchronous lectures (OLs), without real-time interactions. There is no previous comparison of effectiveness between these two methods. Therefore, this study aimed to compare learning outcomes and student satisfaction in both FC and OL models.

METHODS

The study design was a historically controlled study. A physical modality was chosen for the content. The FC group (n = 233), in the academic years 2018 and 2019, was assigned to perform a pre-class activity consisting of reading study materials. Thereafter, the in-class activity comprised a small-group case-based discussion. The OL group (n = 240) in the academic years 2020 and 2021 followed an online model during the COVID-19 lockdown. They were also asked to read the online materials and then watch a self-paced recorded lecture video on Learning Management Systems. The learning outcomes, including their multiple-choice questions (MCQs) scores, final exam scores, grade points, and letter grades, were evaluated. Their overall course satisfaction ratings were also collected.

RESULTS

The OL group had an overall higher MCQ score for the physical modality portion than the FC group (p = 0.047). The median (lower quartile, upper quartile) of the total 50-MCQ scores were 34 (31, 37) in the OL group and 33 (29, 36) in the FC group (p = 0.007). The median final exam scores of the OL and FC groups were 69.5 and 68.3, respectively (p = 0.026). The median grade points and the letter grades were not significantly different between the groups. The proportions of satisfaction were significantly higher in the FC group than in the OL group.

CONCLUSIONS

The OL group revealed significantly higher learning outcomes than the FC group. However, the FC group showed more satisfaction with interactivity than the OL group. The authors are of the view that a combination of both FC and OL methods will likely result in better outcomes.

Dependence of learning outcomes in flipped and lecture classrooms on review questions: A randomized controlled trial and observational study

PURPOSE

The effects of class structure (i.e., lecture vs. flipped) and repeated review on: 1) exam scores and 2) student perceptions of learning were compared in a prospective randomized controlled trial (Study 1) and a retrospective cohort study (Study 2).

METHODS

In Study 1, 42 second year students in a Doctor of Physical Therapy program were randomized to either a lecture or flipped section of a neurobiology class. Both sections incorporated repeated review. In Study 2, exam scores were retrospectively compared between two cohorts: a lecture cohort without repeated review (n = 42) and a flipped cohort with repeated review (n = 46). In both studies, outcomes of interest were exam scores and student surveys.

RESULTS

In Study 1, students in the lecture and flipped sections had similar exam averages (lecture = 76.7 ± 17%, flipped = 77.5 ± 17%, p = 0.73). Repeated review significantly improved exam scores by 12.0 percentage points (95% CI: 8.0 to 16.0 percentage points) in the lecture section and 10.8 percentage points (95% CI: 6.9 to 14.8 percentage points) in the flipped section. The flipped section reported higher levels of satisfaction and perceived learning. In Study 2, the flipped cohort had significantly higher exam scores than the lecture cohort (lecture = 70.2 ± 6.9%, flipped = 83.4 ± 7.7%, p < 0.0001). Student satisfaction and perceived learning were similar in both cohorts.

CONCLUSION

Exam scores improve with review questions and quizzes provided in a class, both in a lecture or flipped classroom.

CRISP method with flipped classroom approach in ECG teaching of arrhythmia for trainee nurses: a randomized controlled study

BACKGROUND

This study aimed to explored the effects of the Cardiac Rhythm Identification for Simple People (CRISP) method with flipped classroom approach for arrhythmia interpretation in electrocardiogram (ECG) by trainee nurses.

METHODS

A total of 120 trainee nurses were enrolled and randomly divided into the experimental group and the control group using lecture-based learning method. We observed the effects of the two methods in ECG interpretation training and investigated the students' attitudes toward the teaching practices.

RESULTS

After training, the ECG test scores in the experimental group were significantly higher than that of the control group. Six months later, the ECG test scores of the experimental group was still higher. Self-learning enthusiasm, understanding of teaching content, satisfaction of teaching mode, satisfaction of teaching effectiveness, and interest in learning ECG were significantly higher in the experimental group.

CONCLUSION

CRISP method with flipped classroom approach is a new and effective mode worth trying in ECG teaching for trainee nurses.

Videos of demonstration versus text and image-based material for pre-skill conceptualisation in flipped newborn resuscitation training for medical students: a pilot study

BACKGROUND

The flipped skills lab is a student-centred approach which incorporates pre-class preparation (pre-skill conceptualization) followed by repeated, hands-on practice for practical skills training. Objective measures of skills acquisition in the flipped literature are few and conflicting. The importance of pre-skill conceptualization in flipped skills training suggests that pedagogically informed pre-skill conceptualization can enhance outcomes.

METHODS

A mixed quasi-experimental study was conducted on 41 final year medical students who followed a flipped newborn resuscitation skills lab. Pre-class preparatory material covered conceptual and procedural knowledge. Students in the traditional group (n = 19) and those in the interventionalmental group (n = 22) received identical reading material covering conceptual knowledge. Procedural knowledge was shared with the interventional group as demonstration videos, while the traditional group received a PowerPoint presentation with text and images covering the same material. Knowledge acquisition was assessed by 20 single best answer questions before and after hands-on practice in the skills lab and skill performance was tested post-intervention with a simulated scenario. Students' perceptions were collected by survey. Quantitative data was analysed using Wilcoxon Signed Ranks test and Mann-Whitney U test as appropriate. Qualitative data was analysed by thematic analysis.

RESULTS

Overall student rating of the intervention was positive with ratings of 4.54 and 4.46 out of 5 by the traditional group and the experimental group respectively. Post-intervention skill performance in the experimental group was significantly better (p < .05) in the interventional group (M = 87.86%, SD = 5.89) than in the traditional group (M = 83.44, SD = 5.30) with a medium effect size (r = .40). While both groups showed significant knowledge gains, only students in the experimental group showed a statistically significant gain in procedural knowledge (p < .05) following the flipped skills lab. Finally, while both groups self-reported feeling more knowledgeable and confident following the intervention, the level of confidence was superior in the experimental group.

CONCLUSIONS

Flipping the skills lab with pre-skill conceptualisation combining text-based conceptual knowledge and video-based procedural knowledge followed by simulation-based hands-on practice improves procedural knowledge and skills acquisition in newborn resuscitation training for medical students. This study shows that in addition to temporal benefits, pedagogically informed pre-skill conceptualization can confer procedure-specific cognitive and emotional benefits supporting skills acquisition.

Maintaining informatics training learning outcomes with a COVID-19 era shift to a fully online flipped course

The emergence of the coronavirus disease 2019 pandemic forced us to adapt our recently developed informatics training serving a variety of students as well as faculty and staff. The successful flipped classroom course series (a hybrid-format with both asynchronous online learning and in-person synchronous components) was shifted to a fully online format with the synchronous portion now held via web-based video conference. We repeated our participant survey at the end of each of the 3 one-credit courses to compare student satisfaction and learning outcomes achievement to the original offering. The responses were overall very positive again and while there were no differences in satisfaction levels for 2 of the courses, overall satisfaction was higher for the new, fully online Python Programming course. Likewise, students reported similar achievement of the learning outcomes across all courses with 1 of the 12 objectives receiving higher competency agreement in the new, fully online version. Overall, the fully online version of the course series was equally successful, if not more so, than the original version with a physical classroom session each week. Given that participants also had strong agreement with a new question that they would prefer online class meetings instead of in a classroom, even if there wasn’t a global pandemic (citing a variety of logistical reasons such as “convenience of screen sharing,” parking issues, and job-related time constraints), the fully online version of the informatics training will be retained.

Just-in-Time Teaching (JiTT) Screencasts: a Randomized Controlled Trial of Asynchronous Learning on an Inpatient Hematology-Oncology Teaching Service

BACKGROUND

The efficacy of just-in-time teaching (JiTT) screencasts for graduate medical education on an inpatient adult hematology-oncology service (HOS) setting is not known. Our preceding pilot data identified six high-yield topics for this setting. The study objective was to evaluate screencast educational efficacy.

METHODS

Internal medicine residents scheduled to start a rotation on the primary HOS of an academic medical center were eligible for this parallel, unblinded, randomized controlled trial with concealed allocation. Participants underwent block randomization to the usual educational curriculum either with or without access to a series of novel screencasts; all participants received an anonymous online end-of-rotation survey and a $20 gift certificate upon completion. The primary outcome was the change in attitude among learners, measured as their self-reported confidence for managing the clinical topics.

RESULTS

From 12/9/2019 through 6/15/2020, accrual was completed with 67 of 78 eligible residents (86%) enrolled and randomized. Analysis was by intention-to-treat and participant response rate was 91%. Sixty-four percent of residents in the treatment arm rated their clinical management comfort level as "comfortable" or "very comfortable" versus 21% of residents in the usual education arm (p = 0.001), estimated difference = 43% (95% CI: 21-66%), using a prespecified cumulative cutoff score. Treatment arm participants reported that the screencasts improved medical oncology knowledge base (100%), would improve their care for cancer patients (92%), and had an enjoyable format (96%).

CONCLUSION

Residents on a busy inpatient HOS found that a JiTT screencast increased clinical comfort level in the management of HOS-specific patient problems.

Effect of gamified flipped classroom on improving nursing students’ skills competency and learning motivation: a randomized controlled trial

Background

Flipped learning excessively boosts the conceptual understanding of students through the reversed arrangement of pre-learning and in classroom learning events and challenges students to independently achieve learning objectives. Using a gamification method in flipped classrooms can help students stay motivated and achieve their goals. 

Methods

This study adopted a randomized controlled study design with a pre-test and post-test and involved 128 nursing students at Mansoura University. This study randomly divided the students into the study and control groups. Data were collected at three time points using six tools. In the intervention group, Moodle was gamified for 6 weeks. 

Results

A significant difference in the students’ self-confidence (p = 0.021), skills knowledge (p < 0.001), intensity of preparation (p < 0.001), and motivation (p < 0.001) was observed between the two groups; however, no difference in the students’ skills performance (p = 0.163) was observed between the two groups after using gamified flipped classrooms.

Conclusions

Compared with the traditional flipped classrooms, gamified flipped classrooms improved nursing students’ motivation, intensity of preparation, skills knowledge, and self-confidence during laboratory clinical practice. Thus, gamification is a learning approach that can be implemented in conjunction with the flipped classroom model to motivate students to participate in the learning process.

Trial registration.

Prospectively registered with ClinicalTrials.gov on 26/04/2021; registration number NCT04859192.

Comparison of knowledge acquisition and retention following traditional didactic vs. flipped classroom education utilizing a standardized national curriculum: a randomized controlled trial

OBJECTIVE

Measure the effectiveness of and preference for a standardized, national curriculum utilizing flipped classrooms (FC) in neonatal-perinatal medicine (NPM) fellowships.

STUDY DESIGN

Multicentered equivalence, cluster randomized controlled trial of NPM fellowship programs randomized to receive standardized physiology education as in-class lectures (traditional didactic, TD arm) or as pre-class online videos followed by in-class discussions (FC arm). Four multiple-choice question quizzes and three surveys were administered to measure knowledge acquisition, retention, and educational preferences.

RESULTS

530 fellows from 61 NPM fellowships participated. Quiz performance was comparable between groups at all time points (p = NS, TD vs FC at 4 time points). Post intervention, more fellows in both groups preferred group discussions (pre/post FC 42% vs. 58%, P = 0.002; pre/post TD 43% vs. 60%, P = < 0.001). FC fellows were more likely to rate classroom effectiveness positively (FC/TD, 70% vs. 36%, P < 0.001).

CONCLUSIONS

FCs promote knowledge acquisition and retention equivalent to TD and FC modalities are preferred by fellows.

A comparative analysis of the impact of online, blended, and face-to-face learning on medical students' clinical competency in the affective, cognitive, and psychomotor domains

BACKGROUND

The Coronavirus Disease-2019 (COVID-19) pandemic in South Africa compelled medical schools to switch to a purely online curriculum. The innovative changes transformed the standard clinical skills curriculum to increase learning transfer to bridge the theory-practice gap. The efficacy of this intervention remains unknown. This study aims to measure medical students' clinical competency in the affective, cognitive, and psychomotor domains by assessing clinical skills knowledge retention and transfer from the online platform compared to face-to-face and blended learning.

METHODS

A non-random cross-sectional quasi-experimental study assessed third-year medical students' knowledge retention and learning transfer in three domains of clinical skills competence. Data were obtained using a score sheet during a directly observed formative and a trial online summative assessment. One hundred and one third-year medical students volunteered for the formative onsite assessment that tested the psychomotor domain. Two hundred and thirty-nine students were evaluated on the affective and cognitive domains in the summative online trial mini-objective structured clinical examination (tm-OSCE). The OSCE scores were analysed using descriptive statistics. The significance of the findings was evaluated by comparing OSCE scores with the pre-pandemic 2019 third-year medical students.

RESULTS

Statistically significant differences were found between the two cohorts of medical students from both years (p < 0.05). The 2021 blended group's (n = 101) medians were 90%, 95%CI [86, 92], 82%, 95%CI [80, 85], and 87%, 95% CI [84, 90] for the psychomotor, affective, and cognitive skills, respectively. The e-learning group's affective and cognitive skills medians were 78%, 95%CI [73, 79] and 76%, 95%CI [71, 78], respectively. The 2019 face-to-face cohort (n = 249) achieved medians of 70%, 95% CI [69, 72] and 84%, 95%CI [82, 86] for the affective and psychomotor skills, respectively.

CONCLUSION

Medical students demonstrated near and far transfer bridging the theory-practice gap in three clinical skills domains. The blended group performed significantly better than the e-learning and face-to-face groups. Medical schools and educators play a vital role in overcoming learning challenges and achieving higher transfer levels by adopting multiple student-centered teaching delivery approaches and arranging immediate application opportunities. This study offers medical educators suggestions that encourage the transfer of online learning to face-to-face practice, decentralising medical education with a revised blended learning strategy.

Design principles for fully online flipped learning in health professions education: a systematic review of research during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, some instructors transitioned their courses into a fully online environment by adopting flipped learning. In this context, this review examined the challenges to fully online flipped learning and identified useful course-design elements for practicing this instructional approach in health professions education.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for selecting relevant articles. Thirty-three empirical studies (with 32 unique interventions) published between 2020 and 2021 (i.e., the first 2 years of the pandemic) were selected for analysis.

RESULTS

When the instructors in the reviewed studies designed and implemented their online flipped courses, numerous challenges emerged, which could be broadly categorized into student-related challenges (e.g., unfamiliarity with online flipped learning; N = 5), faculty challenges (e.g., increased workload; N = 8), and operational challenges (e.g., students' technical problems; N = 9). Nevertheless, we identified various useful elements for online flipped learning practice and organized them based on the following components of the Revised Community of Inquiry (RCoI) framework: cognitive presence (e.g., application of knowledge/skills; N = 12), social presence (e.g., peer interaction; N = 11), teaching presence (e.g., instructors' real-time demonstration/facilitation; N = 17), and learner presence (e.g., care and emotional support; N = 4).

CONCLUSIONS

Based on the findings from the review and the RCoI framework, we developed nine principles for the effective practice of online flipped learning. These principles appear crucial for sustaining quality health professions education in a fully online flipped learning environment.

Impact of a Hybrid-Virtual Teaching Model on the Physical Examination Skills of Fourth-Year Medical Students

ABSTRACT

A required fourth-year advanced core neurology-physical medicine and rehabilitation clerkship was adapted to hybrid format (2-wk remote; 2-wk in-person) during the COVID-19 pandemic. With teaching of the neurological physical examination being shifted to the remote component, we sought to determine whether this negatively affected student performance on an Objective Structured Clinical Examination, particularly the physical examination component. Mean pandemic-era total Objective Structured Clinical Examination scores ( n = 79, 85.1 ± 7.3) were similar to prepandemic era ( n = 137, 83.5 ± 6.0, P = 0.082). Pandemic-era physical examination scores were slightly higher than prepandemic (86.9 ± 6.5 vs. 84.9 ± 6.6). Despite conversion of the clerkship to a hybrid curriculum, the performance of the students on the Objective Structured Clinical Examination and the physical examination were unchanged. Reasons for this lack of change may include the constructiveness and integration of the case-based virtual demonstrations combined with in-person learning or the flexibility of the virtual course to allow students more time to prepare for the Objective Structured Clinical Examination and the physical examination. Our findings demonstrate that a hybrid-virtual model can be used to teach foundational skills such as the basics of the physical examination, while allowing faculty to address higher-order skills such as integration of clinical data with medical knowledge.

State-of-the-art literature review methodology: A six-step approach for knowledge synthesis

INTRODUCTION

Researchers and practitioners rely on literature reviews to synthesize large bodies of knowledge. Many types of literature reviews have been developed, each targeting a specific purpose. However, these syntheses are hampered if the review type's paradigmatic roots, methods, and markers of rigor are only vaguely understood. One literature review type whose methodology has yet to be elucidated is the state-of-the-art (SotA) review. If medical educators are to harness SotA reviews to generate knowledge syntheses, we must understand and articulate the paradigmatic roots of, and methods for, conducting SotA reviews.

METHODS

We reviewed 940 articles published between 2014-2021 labeled as SotA reviews. We (a) identified all SotA methods-related resources, (b) examined the foundational principles and techniques underpinning the reviews, and (c) combined our findings to inductively analyze and articulate the philosophical foundations, process steps, and markers of rigor.

RESULTS

In the 940 articles reviewed, nearly all manuscripts (98%) lacked citations for how to conduct a SotA review. The term "state of the art" was used in 4 different ways. Analysis revealed that SotA articles are grounded in relativism and subjectivism.

DISCUSSION

This article provides a 6-step approach for conducting SotA reviews. SotA reviews offer an interpretive synthesis that describes: This is where we are now. This is how we got here. This is where we could be going. This chronologically rooted narrative synthesis provides a methodology for reviewing large bodies of literature to explore why and how our current knowledge has developed and to offer new research directions.

Near-Peer Teaching in Conjunction with Flipped Classroom to Teach First-Year Medical Students Basic Surgical Skills

BACKGROUND

There is increasing evidence that students are completing medical school with insufficient surgical education. Near-peer tutoring and flipped classroom formatting may be used to enhance learning while simultaneously relieving faculty burden of teaching. Here, we qualitatively evaluate a 3-month course that integrates the use of near-peer teaching and flipped classroom formatting, with the goal of increasing first-year medical students' self-perceived confidence in performing basic sutures and knot-ties as well as interest in surgery.

METHODS

Twenty-one first-year medical students participated in a suturing and knot-tying course led by senior medical students. The course consisted of 2-h sessions held every 2 weeks for a total of five sessions. Students were sent publicly available videos prior to each session by which to learn the upcoming techniques and received live feedback from instructors during sessions. Questionnaires were completed pre-course and post-course.

RESULTS

Compared to pre-course ratings, post-course ratings of self-perceived confidence to perform various knot-ties and sutures all increased significantly (p < 0.05). All students stated that the course strengthened their desire to pursue a career in surgery. Student feedback of the course was overall positive.

CONCLUSIONS

Near-peer teaching can be used in conjunction with flipped classroom to increase first-year medical students' self-perceived confidence in surgical suturing and knot-tying as well as interest in surgery. This curriculum may serve as an outline for student-led courses at other institutions.

Development of a Scientific Writing Course to Increase Fellow Scholarship

Physicians in training are often taught how to conduct original research but may lack the skills necessary to write their results in a paper for the peer-reviewed medical literature. To help our critical care fellows increase their publication rates, we implemented an 8-hour scientific writing course that provides a structured approach to writing an academic research paper. We have demonstrated an increase in publication rate during fellowship from an average of 0.7 manuscripts per fellow just before course inception to 3.7 manuscripts per fellow in the current graduating class. We highlight strategies for developing a writing course aligned with adult learning theory within three key areas: planning, pedagogy, and implementation. Planning strategies center around creating a case for change, including multiple stakeholders with diverse backgrounds, including the research mentor, and ensuring accountability among stakeholders. Pedagogical strategies focus on harnessing the power of experiential learning, considering a flipped classroom approach, and peer teaching to leverage social and cognitive congruence. Implementation strategies include breaking down the writing process into manageable tasks, organizing the writing process according to learner needs, using peer review processes to drive learning, and celebrating the accomplishments of learners within the course. These strategies represent broad initiatives that can be tailored to local training needs and instituted across a wide variety of teaching platforms.

[Teaching otorhinolaryngology in times of COVID-19: to what extent can digital formats replace face-to-face teaching?]

OBJECTIVE

Due to the coronavirus disease 19 (COVID-19) pandemic, postgraduate training in otorhinolaryngology in 2020 was transferred completely from face-to-face to digital teaching. This paper assesses whether this change was possible without a reduction in the quality of teaching and learning.

METHODS

Results of final written examinations were compared for the years 2016-2020, and the results of the teaching evaluation by the students for 2017-2020. The evaluation by students in 2020 included additional questions related to the switch from face-to-face to digital teaching. Additionally, the lecturers and teachers were asked for their assessments.

RESULTS

Results of the final written examination did not show any significant differences between 2016-2019 and 2020. Students were highly satisfied with the digital format, but values did not reach the level of former years with face-to-face-teaching. Especially the interaction with patients and the teaching of manual skills were rated lower in the digital format. Lecturers emphasized the additional workload for preparation of digital teaching.

CONCLUSION

The results of written examinations showed no difference between digital and face-to-face teaching. Online communication and interaction were reduced and regarded as cumbersome by students and faculty. Digital solutions providing more interaction and active participation are required. The digital format is more appropriate for teaching basic knowledge than for teaching practical skills.

Implementing blended learning for clinician teachers: a qualitative study identifying their needs and the impact on faculty development initiatives

BACKGROUND

Learning Technologies has been a fast-growing field in Health Professions Education (HPE). Approaches to teaching, learning and assessment have been increasingly influenced by learning technologies which requires HPE teachers to adapt their teaching practices and, with that, identify areas for professional development.  The implementation of blended learning in HPE, has shown improvements in student performance. However, it seems as if there are challenges with the implementation of a blended learning approach and that there might be some needs that clinical teachers have that are not being addressed in order to implement blended learning successfully.  Methods: We used a qualitative exploratory design to identify clinician teachers' needs. Semi-structured, individual interviews were conducted with a total of eight (n=8) module co-ordinators in the third year of the MBChB programme, Stellenbosch University, Faculty of Medicine and Health Sciences.  Results: Results indicated the need for continuous technical and pedagogical support which refers to a longitudinal faculty development approach. Additionally, faculty development should include the support in structuring and rethinking the blended curriculum, as well as assisting in the clinicians' development in their role and identity as a clinical teacher.   Conclusions: These results reveal the importance of faculty development as a targeted longitudinal approach.

Evaluation of a Novel Cardiology Undergraduate Medical Education Curriculum

Introduction

Cardiology is a complex discipline that requires mastery of key principles and the ability to apply them in varied clinical scenarios, which may be challenging to teach in the traditional lecture-based format. The purpose of this educational intervention was to evaluate the effect of a flipped classroom model on knowledge base and attitudes towards high-yield cardiology concepts in third and fourth-year medical students at our institution.

Methods

An invitation to this optional course was sent to third and fourth-year medical students at the Icahn School of Medicine at Mount Sinai. Interested students were sent a document providing optional pre-course self-directed educational materials designed to take one hour to review. The materials included videos, graphics, and short sections of articles related to heart failure (HF), acute coronary syndrome (ACS), and tachyarrhythmias (TA). Students were then scheduled for a thirty-minute small-group session with a clinician, during which they reviewed the diagnosis and management of HF, ACS, and TA on an online video conference platform. Anonymous pre- and post-course assessments to measure knowledge and confidence were collected.

Results

Twenty-one students completed the pre-course assessment, and 19 students completed the post-course assessment. Seventy-nine percent of the students reported completion of at least half of the self-directed pre-work. The average score on the knowledge assessment rose from 42% to 71% after the course (p<0.001). After the course, 18 (95%) felt comfortable contributing to the management of a case of HF, 16 (84%) a case of ACS, and 13 (68%) a case of TA.

Conclusion

Knowledge assessment scores and learner self-confidence with the management of HF, ACS, and TA rose significantly after undergraduate medical education students completed this flipped classroom training. This exploratory study showed that the flipped classroom model with small group sessions can be a well-received model for medical student cardiology education among a self-motivated group of learners, though further analysis with a larger learner cohort is needed.

Teaching poster design to enhance research presentation quality at academic conferences: a guide for educators

Poster sessions are one of the most common platforms for presenting research at academic conferences, yet posters are often inefficient at transferring knowledge to their readers due to suboptimal design and content selection. Physician trainees may not receive education on constructing posters as a traditional part of their residency curriculum. The purpose of this work is to propose a curriculum that will provide residents foundational knowledge and skills needed for designing high-quality research posters. The curriculum uses the flipped classroom model, a pedagogical approach that reverses the traditional learning environment by delivering instructional content outside of the classroom and moves activities into the classroom. Preparatory work includes watching an educational video on 'how to create a better research poster in less time' and preparing a poster to be presented at an upcoming conference. An 1-hour workshop is conducted during protected resident didactic time. It incorporates a 10-min slide show presentation on poster design and 50 min of active learning. During the active learning component, learners are asked to 'think-pair-share' to construct a research poster rubric using the information they just learnt. The learners work as a group to evaluate sample research posters. The class is then broken down into small groups of 2-3 learners to spend time working on their own posters and provide peer feedback. Following the workshop, residents continue to develop their research posters for conference presentation. This curriculum has the potential to enhance the quality of resident research posters presented at academic conferences, advance research education and ultimately improve dissemination of research within academic communities. The lesson plan outlined in this work can be used as a guide for teaching poster design to physician trainees in a number of specialties and may encourage programmes to consider integrating poster design as a formal part of the residency curriculum.

One year of general practice during the COVID-19 pandemic - presentation and evaluation of digital medical education

BACKGROUND AND TEACHING SITUATION

The SARS-CoV-2 pandemic had a substantial didactic impact on medical teaching. In Erlangen, the lecture "General Practice" was offered asynchronously and digitally in an inverted-classroom concept. Contents were available via a learning platform. The lecture was presented using annotated videos, consolidation materials and control questions. A forum encouraged for discussions and feedback and collected in-depth aspects for a case-based video consultation. The aim of this work is to evaluate and critically examine the digital teaching concept during the SARS-CoV-2 pandemic.

METHODOLOGY

Two semester cohorts evaluated the lecture. Overall impression of the lecture, didactic elements, suitability and the desired future lecture format were surveyed quantitatively. Free text answers were evaluated by means of qualitative content synthesis.

RESULTS

In terms of overall impression, the students (N=199) rated the lecture on average as "very good" (M=1.41, SD=.57). Digital methods were perceived as suitable for supporting self-study, and digital usage was rated as unproblematically (M=1.18, SD=.50). Desired future teaching formats were blended learning concepts (79.4%). Organisation, structure and content presentation were highly appreciated. The time for completing the course was perceived critically. The students urged for more practical and consolidating lecture work.

DISCUSSION AND IMPLICATIONS

The results illustrate high acceptance of digital teaching and underline the demand for future blended learning concepts. It is particularly important to better consider the students' time investment and practical relevance of digital self-learning mechanisms.

From Flipped Classroom to Personalised Learning as an Innovative Teaching Methodology in the Area of Sports Management in Physical Activity and Sport Sciences

Application of new methodologies at Spanish universities is essential to improve the teaching–learning process, although their implementation for the initial training of students is not common. The aim of this study was to use the flipped classroom (FC) methodology in the sports management area of the bachelor’s degree in Physical Activity and Sport Sciences (DPASS). Students (n = 370) from private (n = 284) and public (n = 86) universities participated in different activities, ending with the completion of a survey in which the impact of an FC was analysed in three dimensions: (1) interaction, (2) learning, and (3) methodology and resources. The results show significant differences concerning ownership (private universities are more highly rated than public universities). In terms of gender (with no significant differences), the female students had a better perception of the FC. The most highly valued aspects in the dimensions were as follows: (1) they are more likely to collaborate with their classmates (3.95 + 1.05); (2) learning is more active and experiential (3.69 + 0.86); and (3) with an FC, they spent more time than in other subjects. The most used device was laptop (68.4%). This pioneering study is of relevance to faculty members in the field of sports as it enhances students’ engagement with their learning development.

Comparison between two asynchronous teaching methods in an undergraduate dental course: a pilot study

BACKGROUND

Properly designed and implemented eLearning can lead to improvement of dental teaching quality. Various strategies have been proposed to increase the effectiveness of eLearning in dental education, however, there is a lack of research to assess the effectiveness of these strategies.

OBJECTIVE

To investigate dental students' learning performance and perception of a virtual flipped learning format compared to a virtual traditional learning method.

METHODS

A crossover pilot study was conducted at the College of Dentistry, Princes Sattam Bin Abdulaziz University, Saudi Arabia. Computer-generated randomization, blinded from researchers who analyzed the results, was performed to allocate 32 participants (aged 23.27 ± 0.86 years) to one of two groups. Participants in the control group were taught through the virtual traditional learning method (VTL) using live video lectures. In contrast, participants in the intervention group were taught through the virtual flipped learning method (VFL) using recorded online lectures and post-lecture virtual discussions. Learning gain and preference were measured by pre- and post-test average score differences and a modified validated survey, respectively.

RESULTS

There was no significant difference in learning performance between VFL and VTL groups (P > 0.05). However, students preferred VFL over VTL and the differences were significant among all survey items, except for the opportunity to ask questions.

CONCLUSION

Health professions educators are encouraged to carefully design online curricula with efficient learning strategies that help students improve learning performance and foster self-directed learning skills while valuing active learning in an online environment.

TRIAL REGISTRATION

NCT04692142 , 31/12/2020.

Design and Validation of a Virtual Physical Education and Sport Science-Related Course: A Learner's Engagement Approach

Learners’ engagement is shown to be a major predictor of learning, performance, and course completion as well as course satisfaction. It is easier to engage learners in a face-to-face teaching and learning format since the teacher can observe and interpret the learner’s facial expression and body language. However, in a virtual setting with the students sitting behind cameras, it is difficult to ascertain engagement as the students might be absent-mindedly attending the class. Henceforth, with the rapid transition to online learning, designing course content that could actively engage the students towards achieving the said elements is, therefore, necessary. We applied a data-driven approach in designing a virtual physical education and sport science−related course via a learner engagement model. A fully online course catering to 132 students that runs for a total of 14 weeks was used as a case study to develop the course. The study was conducted during the 2020/2021 academic year, which was the period of the peak COVID-19 pandemic in Malaysia. The delivery of the course content was implemented in stages to achieve three essential educational outcomes namely, skill and knowledge acquisition, and personal development as well as course satisfaction. We hypothesised that the developed learners’ engagement approach will promote the students’ acquisition of skills and knowledge and foster the personal development of the students through fitness improvement. It is also hypothesised that the students will be satisfied with the course developed upon successful completion. A chi-square analysis projected a statistically significant difference in the skill and knowledge acquisition before and after the programme (p < 0.001). A Wilcoxon rank-sum test demonstrated personal improvement in the overall fitness of the student upon completing the prescribed activity of the course content. Moreover, a total of 96.2%, 95.5% and 93.2% of students expressed their satisfaction with the clarity of the learning objectives, good organisational and course content plan, and appropriate workload of the course designed, respectively. There is sufficient evidence to accept all hypotheses formulated, and hence, we postulated that, since students spend more time outside the classroom, out-of-class learners’ engagement activity should be considered when designing a virtual course to promote lifelong learning, experience, and higher-order thinking. The techniques presented herein could be useful to academics, professionals, and other relevant stakeholders in developing virtual course content within a specific domain of interest.