The Flipped Classroom - From Theory to Practice in Health Professional Education

Cultural adaptation and validation of instruments for measuring the flipped classroom experience

INTRODUCTION

In 2017, a revamped bachelor of pharmacy program was introduced at Monash University and incorporated a predominantly flipped classroom-based pedagogy. The attitudes and preferences of students towards this program had yet to be assessed using a reliable instrument. Since no instrument was readily available, the objective of this study was to identify, contextualize, and validate a suitable instrument.

METHODS

We conducted a literature search to identify and adapt a validated instrument. Cognitive interviews were conducted to examine students' understanding of scales and definitions of items. The instrument was then evaluated by education experts for further refinement. The reliability of the final instrument was assessed in a cohort of students, and unsuitable items were removed.

RESULTS

Students had issues understanding the scales and specific terms used in the original instrument, potentially due to differences in terminologies used in the university's context and variance in English proficiency levels and exposure. In the preference domain, wording of the instrument to present exclusively traditional classroom or exclusively flipped classroom statements greatly influenced its reliability. This could be due to exposure of students to a predominantly flipped classroom environment since inception. The final instrument optimized in this study had α = 0.85, 0.86, and 0.9 for the pre-activities, in-class lectures, and in-class workshops attitude domains, respectively, and α = 0.73 for the preference domain.

CONCLUSIONS

Our study highlights the necessity of contextualizing instruments to fit the local context in which they are administered and provides key recommendations when conducting such adaptations.

Flipped Classroom Experiences in Clinical Dentistry – A Strategic Mini-Review

Background:

Pedagogy in dental education has evolved over the decades. Today, many alternative modes of content delivery are being used as an adjunct to the traditional classroom. A flipped classroom is one among those that are being explored for teaching clinical dentistry.

Objective:

This mini-review is aimed at evaluating the available evidence in the efficacy of flipped classrooms and its related aspects in the learning curve of clinical dentistry.

Methods:

A thorough literature search on electronic databases for all the studies focusing on the following evidence-based question: “Is Flipped classroom in clinical dentistry a useful mode of pedagogy delivery? was performed. A combination of MeSH terms using Boolean operators “AND,” “OR:” FLIPPED [All Fields] AND (“dental health services” [MeSH Terms] AND “health” [All Fields] AND “services” [All Fields]) OR “dental” [All Fields]) AND (“learning” [MeSH Terms] OR “learning” [All Fields]). Specific terms such as “Perio” OR “Prostho” OR “Restorative” OR “Ortho” OR “Oral medicine” OR “Maxillofacial surgery” OR “Pediatric” OR “endo” was also used. Data from these articles addressing the aim of this study was extracted.

Results:

A total of 16 articles were considered for the review. The majority of the studies considered flipped classroom as a successful model of pedagogy. The most common mode of outside classroom activity was pre-recorded videos. In-classroom activities, a combination of seminars, interactive discussions, and quiz were explored. Time constraints, lack of faculty development programs are considered to be negative factors for the success of the flipped classroom.

Conclusion:

Within the limitation of the study, flipped classroom can be adapted as a method of pedagogy in clinical dentistry.

The catalyst for change in teaching and assessing virtual laboratory skills

INTRODUCTION

Historically, pharmacy skills laboratory courses have primarily been delivered utilizing in-person instruction; however, changes in methods of healthcare delivery serve as a catalyst to consider best practices for virtual learning in the skills laboratory setting.

PERSPECTIVE

Shifting to a virtual delivery method is valuable for future curriculum and course development. Three specific delivery methods including flipped classroom, virtual formative simulations, and telehealth objective structured clinical examinations, provide examples of the opportunities and challenges instructors may encounter when shifting delivery methods. Furthermore, the examples illuminate the need to deliberately incorporate virtual technology into pharmacy skills laboratory courses to ensure students are practice-ready for the changing methods of delivery in the healthcare environment.

IMPLICATIONS

Skills laboratory instructors and students must reimagine how patient care skills can be taught and assessed. It is imperative to reassess priorities and adapt skills-based courses to incorporate the virtual learning environment to prepare student pharmacists for future practice.

Flipped Classroom Versus Classroom Lecture: A Content Mapping Study in Undergraduate Nursing

BACKGROUND

Educators face the ongoing difficulty of managing finite class time and limited instructor-student interactions to balance discourse and active learning. Complicating this is the growing expectation to incorporate technology into nursing curriculum. This study explored the differences of the traditional classroom lecture (TL) with the flipped classroom (FC) format and the effects on higher-order thinking.

METHOD

A content analysis was performed on previous work. Concept maps were used to evaluate data from transcripts of undergraduate nursing students' case study discussions in either a TL or FC format.

RESULTS

FC groups had a more complex concept map morphology and identified more subcategories and links. They exhibited a greater number of higher-order thinking concepts compared with the TL groups. The emergence of discussion tangents across both the FC and the TL groups was unexpected.

CONCLUSION

The FC approach enhances student learning and aids in the development of higher-order thinking. [J Nurs Educ. 2021;60(11):629-632.].

Medical Education in Pathology: General Concepts and Strategies for Implementation

CONTEXT.—

Pathology education must evolve as medical knowledge expands and disruptive technologies emerge. The evolution in pathology teaching practices accelerated as traditional teaching modalities were suspended in March 2020 during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVES.—

To provide pathologists an overview of established teaching paradigms and practical examples of how these paradigms may be applied to pathology education, emphasizing differences in graduate and undergraduate medical education as well as the challenges and promises of remote learning, as revealed by the COVID-19 pandemic.

DATA SOURCES.—

Selected peer-reviewed publications representing the field of educational social science.

CONCLUSIONS.—

Evidence-based methods described in education and social sciences can be effectively deployed in pathology education and especially remote learning, as necessitated by the current COVID-19 pandemic. Understanding established principles, such as cognitive load, competency-based learning, peer-assisted learning, and flipped classrooms may prove useful in developing effective, learner-centric content for pathology education.

"Learning to Learn" in the Extended Inverted Classroom: An Evaluation of the Effects of Interactive teaching on Knowledge and Cognitive Regulation in Medical Students

INTRODUCTION

The evidence regarding the effects of the Inverted Classroom on students' metacognitive skills is limited. This study evaluates these effects on student perceptions about knowledge and cognitive regulation during a surgical course.

METHODS

We measured student perceptions before and after a conventional Inverted Classroom in surgery using the Metacognitive Awareness Inventory. We evaluated the mean differences between the scores of the two measurements using Student's t-test (p<0.05), and the size of the effect on knowledge and cognitive regulation using Cohen's d test (95%CI).

RESULTS

A total of 158 students (pre-intervention) and 155 students (post-intervention) were included in the analysis. Significant differences were found (p<0.05)in, as well as positive effects on, the students' abilities to know their own learning (declarative knowledge) (d=0.24; 95%CI, 0.02-0.47), to use learning strategies (procedural knowledge) (d=0.19; 95%CI, -0.02 to 0.41) and to understand when and why to use these strategies (conditional knowledge) (d=0.20; 95%CI, -0.01 to 0.42), in addition to the abilities to plan (d=0.31; 95%CI, 0.09-0.53) and to evaluate their learning (d=0.31; 95%CI, 0.08-0.53).

CONCLUSIONS

The Inverted Classroom has positive effects on metacognitive skills according to students' perceptions. Further studies are required that compare these effects with other methodologies for teaching in the classroom and the workplace.

Development of Culinary and Self-Care Programs in Diverse Settings: Theoretical Considerations and Available Evidence

Culinary-based self-care programs are innovative and increasingly utilized models for catalyzing behavior change and improving health and well-being. The content, duration, and delivery of existing programs vary considerably. Between January and August 2019, we developed a teaching kitchen and self-care curriculum, which was administered as part of a year-long worksite well-being program to employees at an academic healthcare system. The curriculum domains included culinary skills, nutrition, physical activity, yoga, stress management, mindful eating, and ethnobotany. An informal systematic literature search was performed to assemble and evaluate key principles and practices related to self-care domains, learning methodologies, and programmatic design considerations. Here, we provide a qualitative summary of the evidence-informed development of the curriculum intervention.

Flipped learning: an alternative pedagogical approach in the untact age

Flipped learning, abbreviated as "FL" is a new pedagogical approach that reverses the order of a typical lecture. It was developed to compensate for the shortcomings of a typical teaching method. Students learn by watching video clips before class and continue to learn through peer discussion in the classroom. The educational benefits of FL like student's positive attitude were revealed in the previous studies. FL can be a valuable alternative to the existing classes in the untact age of coronavirus disease 2019.

Value, Strengths, and Challenges of e-Learning Modules Paired with the Flipped Classroom for Graduate Medical Education: A Survey from the National Neonatology Curriculum

OBJECTIVE

This study aimed to determine the value, strengths, and challenges of implementing an e-learning based flipped classroom (FC) educational modality as part of the standardized physiology National Neonatology Curriculum (NNC), created for neonatal-perinatal medicine (NPM) fellow learners and faculty educators.

STUDY DESIGN

This is a cross-sectional study of NPM fellows and faculty educators who utilized at least one of the e-learning based NNC FC respiratory physiology programs between May and September 2018. Participants were surveyed anonymously regarding their experiences participating in the NNC, including measures of preparation time. A combination of descriptive statistics and proportion comparisons were used for data analysis.

RESULTS

Among 172 respondents, the majority of fellow and faculty respondents reported positive attitudes toward the educational content and case discussions, and the majority supported national standardization of NPM physiology education (92%). Fellows reported greater preclass preparation for their FC compared with previous didactic lectures (30-60 vs. 0-15 minutes, p < 0.01). Faculty facilitators reported less preparation time before facilitating a FC compared with the time required for creating a new didactic lecture (median: 60 vs. 240 minutes, p < 0.01). Both fellows and faculty respondents preferred the FC approach to traditional didactics, with fellows showing a greater degree of preference than faculty (68 vs. 52%, respectively, p = 0.04).

CONCLUSION

Fellows and faculty educators supported the FC learning, reporting peer-to-peer learning, and the establishment of a learning community which promotes adult learning and critical thinking skills. A national physiology curriculum creates equitable and engaging educational experiences for all NPM fellows while reducing individual program burden of content creation. Our findings further supported the development of an NNC using a flipped classroom modality.

Integration of a new classification scheme for periodontal and peri-implant diseases through blended learning

PURPOSE

In recent years, dental education has experienced a general shift toward an increased technology presence in education delivery and learning. This research examines the student-perceived efficacy of a blended learning approach (mixture of online content and face-to-face instruction) in a predoctoral periodontics curriculum to teach a new periodontal classification scheme to dental students in clinical training.

METHODS

Participants were recruited from third- and fourth-year predoctoral periodontal classes at the University of Washington School of Dentistry. Students were administered a live lecture introducing the new classification system and given access to an online module with built in case quizzes and interactive activities. Upon completing the module, students were given a post-module survey to assess learning preferences, utilization of various learning methods, and student-perceived efficacy of blended learning.

RESULTS

In a study group of 69 predoctoral dental students, the online module was the most preferred (52.2% ranked first) and utilized learning method for students (p < 0.001). Over 80% of students agreed or strongly agreed that they enjoyed using it and found it more effective than traditional lecture alone. Traditional lecture was preferred by 31.9% of students, and no students ranked the assigned reading as their first choice of learning method (p < 0.001).

CONCLUSIONS

Our findings demonstrate higher student preference, utilization, and self-perceived efficacy of blended learning as compared to traditional assigned readings and lectures - supporting blended learning as a promising educational approach for predoctoral dental education.

Application of the Inverted Classroom Model for Teaching Pathophysiology to Chinese Undergraduate Medical Students: Usability Study

BACKGROUND

The inverted classroom model differs from the traditional teaching model as it reverses the pattern of knowledge transfer and internalization. In recent years, this new teaching model has received much attention in undergraduate medical education. Pathophysiology is a course in the undergraduate Chinese medical curriculum that is critical in bridging basic medical science and clinical medicine.

OBJECTIVE

The purpose of this study was to investigate the application of inverted classroom in delivering the course on pathophysiology to Chinese undergraduate medical students.

METHODS

In the spring semester of 2018, inverted classroom teaching was implemented for second-year clinical medicine students at the College of Medicine at Nanchang University. The topics of hypoxia and respiratory failure were selected for the inverted classroom study. The effect of the inverted classroom on teaching pathophysiology was evaluated using classroom performance metrics, a final examination, and questionnaires.

RESULTS

This study found that students in the inverted classroom group achieved higher scores in their in-course assessments (82.35 [SD 11.45] vs 81.33 [SD 9.51], respectively) and in their final exams (73.41 [SD 10.37] vs 71.13 [SD 11.22], respectively) than those in the traditional lecture-based group, but the scores were not significantly different (P=.13, unpaired two-tailed t test). There was also no significant difference in the distribution of the score segments in the class quiz (P=.09, chi-square test) and in the final exams (P=.25, chi-square test) between the 2 groups. Further, most of the students reported that the inverted classroom increased their learning motivation, made them more confident, and helped them understand the content on pathophysiology better. The students in the inverted classroom also improved in their problem-solving skills and teamwork abilities. However, some students from the inverted classroom group also reported that the self-learning and preparatory work before class increased their learning burden.

CONCLUSIONS

This study shows the feasibility and promise of inverted classroom for teaching pathophysiology to undergraduate Chinese medical students. The inverted classroom improves students' learning interests and attitudes toward learning. However, further studies are required to assess the benefits of broader acceptance and implementation of the inverted classroom among Chinese undergraduate medical students.

Enhancing generic capabilities and metacognitive awareness of first-year nursing students using active learning strategy

Background

Developing students’ generic capabilities is a major goal of university education as it can help to equip students with life-long learning skills and promote holistic personal development. However, traditional didactic teaching has not been very successful in achieving this aim. Kember and Leung’s Teaching and Learning Model suggests an interactive learning environment has a strong impact on developing students’ generic capabilities. Metacognitive awareness is also known to be related to generic capability development. This study aimed to assess changes on the development of generic capabilities and metacognitive awareness after the introduction of active learning strategy among nursing students.

Methods

This study adopted a quasi-experimental single group, matched pre- and posttest design. It was conducted in a school of nursing at a university in Hong Kong. Active learning approaches included the flipped classroom (an emphasis on pre-reading) and enhanced lectures (the breaking down of a long lecture into several mini-lectures and supplemented by interactive learning activities) were introduced in a foundational nursing course. The Capabilities Subscale of the Student Engagement Questionnaire and the Metacognitive Awareness Inventory were administered to two hundred students at the start (T0) and at the end of the course (T1). A paired t-test was performed to examine the changes in general capabilities and metacognitive awareness between T0 and T1.

Results

A total of 139 paired pre- and post-study responses (69.5 %) were received. Significant improvements were observed in the critical thinking (p < 0.001), creative thinking (p = 0.03), problem-solving (p < 0.001) and communication skills (p = 0.04) with the implementation of active learning. Significant changes were also observed in knowledge of cognition (p < 0.001) and regulation of cognition (p < 0.001) in the metacognitive awareness scales.

Conclusions

Active learning is a novel and effective teaching approach that can be applied in the nursing education field. It has great potential to enhance students’ development of generic capabilities and metacognitive awareness.

Flipped classroom combined with case-based learning is an effective teaching modality in nephrology clerkship

BACKGROUND

The flipped classroom (FC) is recognized as an effective teaching approaches by emphasizing on the development of high-order abilities; however, the implementation of FC has not been well explored in nephrology education. The present study aims to investigate the efficacy of FC in teaching nephrology via comparing with the traditional lecture-based teaching (LBT).

METHODS

Sixty-two medical clerkship students at Zhejiang University School of Medicine were equally allocated into either LBT or FC group demographically matched. The glomerular diseases module was chosen for the teaching content. Students from the FC group were required to study the pre-class materials in annotated PPT format in advance. In the class, case-based learning (CBL) was employed, students encountered the related clinical cases and participated in the face-to -face discussion. Students from the LBT group attended a didactic lecture during the class. Quiz and questionnaires were performed to assess the efficacy of FC versus LBT.

RESULTS

Participants from the FC group performed better in the quiz than those from the LBT group with higher total scores (78.06 ± 2.515 vs. 65.16 ± 3.209, mean ± SEM), particularly the scores of the case analysis-related questions (35.81 ± 1.657 vs. 27.42 ± 1.910, mean ± SEM). In the survey, more students considered FC beneficial to comprehension, critical thinking, patient management and team work as compared with LBT. Meanwhile, more participants agreed increased in-class pressure in FC than in LBT.

CONCLUSIONS

This study shows the positive impact of FC combined with CBL approach on nephrology education and provides an alternative pre-class and in-class format for the FC implementation.

Enhancing Student Knowledge of Diabetes through Virtual Choose Your Own Adventure Patient Case Format

Educational strategies to teach pharmacy students about diabetes are necessary to prepare future pharmacists to manage complex patients. The Choose Your Own Adventure (CYOA) patient case format is an innovative activity that presents a patient case in an engaging way. The objectives of this study were (1) to describe the development of the innovative teaching activity and (2) to assess its effect on student knowledge and confidence in outpatient management of diabetes. The CYOA patient case activity was designed by transforming a traditional paper patient case involving outpatient diabetes management into an interactive format utilizing an online platform. The activity was conducted with 186 second-year pharmacy students in a skills-based course. This activity was administered virtually through a combination of small group work and large group discussion. After completion of the activity, students completed an online self-assessment questionnaire. Of 178 completed questionnaires, there was a statistically significant difference in students’ self-ratings after versus before the activity for all survey items (p < 0.001). The CYOA activity improved self-reported knowledge of outpatient diabetes management and increased self-reported confidence in clinical decision-making skills. This format shows promise as an educational tool that may be adapted for other disease states to enhance clinical decision-making skills.

The Role of Electronic Learning in Orthopaedic Graduate Medical Training: A Consensus From Leaders in Orthopaedic Training Programs

The US orthopaedic graduate medical education system is based on long established methods in education, but academic leaders at orthopaedic institutions now have the ability to use electronic learning innovations. Hospital for Special Surgery gathered graduate medical education leaders from orthopaedic training programs around the country and an electronic learning expert to review current orthopaedic residency and fellowship program practices. This group came to consensus with the following points: (1) current training methods do not take full advantage of available technology/innovations, (2) trainees inappropriately use electronic resources in the absence of or in an underdeveloped formal electronic training program, (3) trainees learn at different rates and in different ways requiring individualized plans for optimal content engagement, and (4) formal electronic learning programs better use time dedicated to educating trainees than informal programs. Orthopaedic graduate medical training programs that adopt these points can establish an electronic learning program to complement their traditional education program by (1) guaranteeing online content is standardized and approved, (2) reducing time spent covering standard lecture material and increasing time spent reviewing cases, and (3) engaging students of all learning backgrounds with content in both asynchronous and synchronous formats.

Current Practices in Pediatric Emergency Medicine Fellowship Trauma Training

OBJECTIVE

The management of injured children is a required element of pediatric emergency medicine (PEM) fellowship training. Given the relatively infrequent exposure of trainees to major trauma, it is important to understand how programs train fellows and assess their competency in pediatric trauma.

METHODS

An online survey was sent to 84 PEM fellowship program directors (PDs). Program directors were asked to describe their program's characteristics, the degree of fellow independence, educational techniques used to train fellows in trauma, and their expectation of fellows' competency in 14 core trauma-related skills upon graduation. Program directors were classified as having high expectations if they anticipated that graduating fellows could perform 12 trauma skills or more independently.

RESULTS

Fifty-nine programs (70%) responded. Although most programs (55, 93%) identified as pediatric trauma centers, fellows at the majority of programs (41, 69%) spent some or all of their trauma experience at an outside hospital. Only a minority of programs (17, 29%) allowed fellows to lead pediatric trauma resuscitations as independent attendings without precepting. Programs used over a dozen different educational methods to varying degrees. Less than half of programs (28, 47%) used a formal trauma curriculum. Whereas 33 PDs (56%) had high expectations, only 9 (15%) expected fellows to be able to perform all 14 skills.

CONCLUSIONS

There is considerable variability in how PEM fellows are trained to care for injured children. Most PDs do not realistically expect fellows to be able to perform all recommended trauma skills after graduation. Our findings highlight the need for further research and efforts to standardize the training of PEM fellows in pediatric trauma.

Exploring the pedagogical design features of the flipped classroom in undergraduate nursing education: a systematic review

Background

In recent years, technological advancement has enabled the use of blended learning approaches, including flipped classrooms. Flipped classrooms promote higher-order knowledge application – a key component of nursing education. This systematic review aims to evaluate the empirical evidence and refereed literature pertaining to the development, application and effectiveness of flipped classrooms in reference to undergraduate nursing education.

Methods

A PRISMA systematic review protocol was implemented to investigate the literature pertaining to the development, implementation and effectiveness of flipped classroom pedagogy in undergraduate nursing education. Seven databases (Scopus, PsycINFO, CINAHL, ERIC, MEDLINE, Cochrane, Web of Science) were utilised to survey the salient literature. Articles were appraised with respect to their level of evidence, the origin of study, study design, the aims/s of the study, and the key outcomes of the study. A qualitative synthesis was then conducted to summarise the study findings.

Results

The initial search identified 1263 potentially relevant articles. After comprehensively reviewing the initial catchment using several analytical phases, 27 articles were considered for the final review, most of which were conducted in the USA and South Korea. A range of research designs were applied to measure or discuss the outcomes and design features of the flipped classroom pedagogy when applied to undergraduate nursing education. The review indicated that a common operational flipped classroom model involves three key components, namely pre-classroom activities, in-classroom activities and post-classroom activities, guided by two instructional system design principles. The review predominantly identified positive learning outcomes among undergraduate nursing students, after experiencing the flipped classroom, in terms of skills, knowledge and attitudes. However, a few studies reported contrasting findings, possibly due to the incompatibility of the flipped classroom pedagogy with the traditional learning culture.

Conclusions

Current evidence in this systematic review suggests that incorporating the flipped classroom pedagogy could yield positive educational outcomes in undergraduate nursing education. There are promising pedagogical models available for adapting or developing the flipped classroom pedagogy in undergraduate nursing education.

Structured work-based learning in undergraduate clinical radiology immersion experience

BACKGROUND

Practical courses in undergraduate medical training often lack a didactic concept. Active participation and learning success largely depend on chance. This study was initiated to evaluate a novel concept of structured work-based learning (WBL) in the course of students' half-day radiology immersion experience (IE).

METHODS

This prospective, single-centre cohort study included 228 third-year students of the 2019 summer semester who underwent the obligatory radiology IE at a university hospital. The course was based on a novel structured WBL concept that applied established didactic concepts including blended learning, the FAIR principles of feedback, activity, individualization, and relevance, and Peyton's four-step approach. Outcomes of equal weight were student and supervisor satisfaction with the clinical radiology IE assessed by paper-based- and online survey, respectively. Secondary outcome was achievement of intended learning outcomes assessed by means of mini clinical evaluation exercises and personal interviews.

RESULTS

Satisfaction with structured WBL was high in 99.0% of students. Students' expectations were exceeded, and they felt taken seriously at the professional level. Dissatisfaction was reasoned with quality of learning videos (0.6%), little support by supervisors (0.5%), or inadequate feedback (0.6%). Supervising resident physicians rated achievement of intended learning outcomes regarding cognitive and psychomotor competences as excellent for all students. Personal interviews revealed achievement of affective competence in some students. Twelve of 16 (75.0%) supervising physicians were satisfied with focussing on intended learning outcomes and student preparation for IE. Two of 15 (13.3%) supervisors were unsatisfied with time spent, and 4 of 16 (25%) with the approach of assessment.

CONCLUSIONS

This study demonstrated that both students and supervisors were satisfied with the novel concept of structured WBL within the scope of clinical radiology IE. Achievement of intended learning outcomes was promising.

An Innovative Application of Online Learning for Hospice Education in Medicine Trainees

Objective: To improve residents' knowledge, self-perceived skills, and attitudes about hospice. Methods: An online case-based curriculum in a flipped classroom design was provided to postgraduate year-one (PGY-1) residents. Residents completed a pre- and postassessment. Postgraduate year-two (PGY-2) residents served as a historical control. Results: Fifty-one PGY-1 residents received the curriculum. Postcurriculum knowledge scores increased significantly and were not statistically different from PGY-2 controls (n = 55). Postcurriculum confidence scores increased significantly and were statistically different from controls in subdomains of talking about hospice, facilitating the clinic to hospice transition, and seeking help with hospice dilemmas. Satisfaction with training in hospice was significantly higher after receiving the curriculum. Conclusion: A flipped classroom curriculum increased knowledge, confidence in skills, and satisfaction with residency training in hospice care. This design offers curriculum solutions that address competing demands in the new era of social distancing and remote learning.

Indonesian plastic surgeons' attitude during early period of the COVID-19 pandemic

Background

This study aims to report how the practice of plastic surgeons and their attitude was during the first measure period of coronavirus disease 2019 (COVID-19) pandemic.

Methods

A survey study was held among members of the Indonesian Association of Plastic Reconstructive and Aesthetic Surgeons during week 5 after the first report of COVID-19. A 10 multiple-choice questions (MCQs) and 1 essay covered key questions on the area of surgery and operating room, clinics, internal meeting, and consultation. The only open-ended question relates to the last MCQ addresses a future “flipped” medical practice.

Results

Response rate was 45.6% among 228 members, with 89.4% did no practice or limited their service to emergency and urgent cases only. Only 1.9% kept their official meeting as usual, while the majority modified it. The practice in the operating theatre and clinic were also altered to comply with the measures; with 21.2% from the total respondents only allowed patients with exposure to come for visit after taking 14 days of self-quarantine. Teleconsultation was practiced by 50% of the respondents, while 41.3% agreed and 10.6% disagreed upon the future “flipped” medical practice.

Conclusion

In general plastic surgeons have made supportive actions during the pandemic. Surgery was performed with all precautions at the utmost as a reflection of high alert of viral infection. Teleconsultation has been embraced via existing social media. Agreement upon the future “flipped” medical practice is reasonable. All in all, the actions were considered as most relevant.

Motivating Students to Engage in Preparation for Flipped Classrooms by Using Embedded Quizzes in Pre-class Videos

Background

The success of flipped classrooms is dependent upon students' preparation prior to class, the lack of which is the most common challenge associated with this teaching methodology. To mitigate this limitation, it is important to develop and assess methods of engaging learners during pre-class activities.

Objective

To determine if quiz delivery method (embedded throughout versus after pre-class videos) affects students' knowledge retention, grades, and video viewing behavior.

Methods

Participating students were randomized to take quizzes, either during pre-class videos via Panopto^™ (EQV) or after pre-class videos in the traditional manner via Moodle^™ (TMM). Outcomes assessed included students' knowledge retention, scores on pre- and post-class quizzes, and pre-class video viewing behavior (total views and minutes viewed per student) during a three-week period. Having experienced both quizzing modalities during the semester, the perceptions from students in the EQV group were surveyed.

Results

Baseline assessment results of both groups (n = 27 per group) were comparable with a median score of 33% (IQR: 17, 50) in both groups. Performance was also similar on knowledge retention [TMM: 67% (50, 83) vs. EQV: 83% (50, 83)], pre-class quiz scores [TMM: 90% (87, 97) vs. EQV: 93% (90, 95)], and post-class quiz scores [TMM: 93% (80, 100) vs. EQV: 87% (80, 100)], while students in the EQV group had more total views [10 (8, 12)] vs. [5 (2, 11)] and minutes viewed [71 (36, 108) vs. 35 (15, 81)]. Results from the perception survey administered to students in the EQV group (74.1% response rate) indicated a preference for embedded quizzes overall (58%) and for class preparation (75%) when compared with post-video quizzes.

Conclusion

Students' knowledge retention and performance were similar in both EQV and TMM groups, though students in the EQV group were more engaged with videos and most of them preferred this quiz delivery. Using embedded quizzes for formative rather than summative assessment might be an appropriate mechanism to encourage students' viewing of pre-class videos and their preparation for flipped classes.

A Curriculum Innovation on Writing Simulated Patient Cases for Communication Skills Education

INTRODUCTION

Facilitated communication practice with simulated patients (SPs) is a highly effective form of communication training. Unfortunately, little guidance exists on writing SP cases.

METHODS

We created a curriculum composed of a case-development workbook and case-writing session with input from national communication educators. In November 2017, we implemented the curriculum in a Teaching Communication Skills course for medical educators. Educators divided into four groups to write cases. Primary outcome was the number of criteria that cases fulfilled. Secondary outcomes were SP evaluation and educator-reported confidence and satisfaction.

RESULTS

Seventeen medical educators (including 15 fellows) completed the curriculum. Four new cases were analyzed against 24 criteria and compared to eight cases written by educators following a previous curriculum. An SP evaluated ease of portrayal for all 12 cases on a 5-point Likert scale (1 = poor, 5 = excellent). Educators completed precurriculum and postcurriculum surveys. Compared to the previous curriculum, cases based on the new curriculum incorporated 26% more case criteria (70% or 16.8 criteria/case vs. 96% or 23.0 criteria/case, p < .01). Ease-of-portrayal rating improved but did not differ statistically (mean: 2.8 vs. 4.5, p = .11). A moderate correlation was found between number of included case criteria and Likert-scale rating (r_s = .61, p = .03). Pre- and postcurriculum, educators reported significant increases in confidence (mean: 1.9 vs. 4.0, p < .01) and high curricular satisfaction (mean: 4.8).

DISCUSSION

A case-development workbook and case-writing session increased the quality of newly developed SP cases as assessed by prespecified case criteria.

Flipped classroom combined with human anatomy web-based learning system shows promising effects in anatomy education

Flipped classroom has received much attention in medical education. The aim of this study was to evaluate the efficacy of flipped classroom combing with human anatomy web-based learning system in anatomy education.A total of 89 freshmen in medical specialty were enrolled and randomly allocated into either the experimental group (receiving the flipped classroom with human anatomy web-based learning system, n = 45) or control group (receiving the traditional classroom teaching, n = 44). A pre-quiz and a post-quiz were conducted before and after the classes, respectively. The improvement in scores between groups was compared. A 5-point Likert scale questionnaire was used to evaluate perceptions and experience.The mean pre-quiz scores of the 2 groups were comparable (all P > .05). However, the mean post-quiz score in the experimental group was significantly higher than that in the control group (91.44 ± 6.25 vs 86.13 ± 11.67, P < .05). The results of questionnaires showed that 44 (97.8%) students agreed with flipped classroom combined with human anatomy web-based learning system, 43 (95.6%) students obtained improved study interest in anatomy learning, and 42 (93.3%) students felt that the interactive, applied in-class activities during the class greatly enhanced their learning.Flipped classroom combined with human anatomy web-based learning system can be used as an effective learning tool for anatomy education.

Interprofessional peer teaching: The value of a pharmacy student-led pharmacology course for physical therapy students

BACKGROUND

This report describes the creation, implementation, and evaluation of an interprofessional pharmacy student-led pharmacology course for physical therapy students. The course was designed using a flipped classroom model and a peer-assisted learning framework.

INTERPROFESSIONAL EDUCATION ACTIVITY

We describe the development, design, assessment, and evaluation of a pharmacy student-led pharmacology course for physical therapy students. This report focuses specifically on the interprofessional aspect of the course, which was measured using the student perceptions of physician-pharmacist interprofessional clinical education (SPICE) instrument.

DISCUSSION

The SPICE instrument was measured across two cohorts in 2015 and 2016. Each cohort consisted of approximately 50 physical therapy students. After implementation of the course, there were significant improvements across all three domains of the SPICE instrument: interprofessional teamwork, roles/responsibilities for collaborative practice, and patient outcomes from collaborative practice (P < .01). Qualitative feedback from the physical therapy students and pharmacy student teaching assistants was positive and emphasized the benefits of interprofessional peer teaching.

IMPLICATIONS

Overall, this interprofessional peer teaching model effectively improved interprofessional attitudes while accomplishing didactic needs. This innovative course may serve as a model for interprofessional education in different subject areas or across other health professions programs.

Evaluation of a Council Structure and Meeting Format for Pharmacy Student Government in the Co-Curriculum

Objective. To evaluate student perceptions of a transformed pharmacy student government structure and meeting format. Methods. The structure and general assembly meeting format of the University of North Carolina at Chapel Hill (UNC) Eshelman School of Pharmacy Student Senate (ie, student government) underwent a transformation from that of a forum to that of a council in an effort to address concerns regarding limited information exchange, minimal discussion, and unengaged meeting participants. To evaluate student perceptions of the new senate council format, members who attended at least one council meeting during the academic year were asked to complete a 12-item survey evaluating interorganizational relations, communication, collaboration, and efficiencies. Descriptive statistics were used to summarize students' agreement with 10 survey items. Thematic analysis was employed to identify common themes in students' responses to the two open-ended survey items. Results. The majority of students agreed or strongly agreed that the senate council facilitated interorganizational relations (86%), communication (93%), and collaboration (86%). Ninety-three percent of respondents agreed or strongly agreed that the senate council improved efficiencies, while 96% preferred the new senate council meeting format over the previous senate meeting format. Common qualitative themes included improved engagement during council meetings because of the "no laptop" policy and facilitation of open conversation by having a roundtable format and smaller number of members in attendance. Overall, 93% of students indicated they were satisfied or highly satisfied with the new meeting format. Conclusion. Student perceptions suggest that the new senate council structure and meeting format was effective at improving interorganizational relations, communication, collaboration, and efficiencies within student body government.

Learning outcomes of a flipped classroom teaching approach in an adult-health nursing course: a quasi-experimental study

BACKGROUND

New teaching strategies must be developed not only to enhance nurse's competence but also to allow nurses to respond to the complex health care needs of today's society. The purpose of this study was to explore the learning outcomes of a flipped classroom teaching approach in an adult-health nursing course for students in a two-year Bachelor of Science in Nursing program.

METHODS

The study had a quasi-experimental design. An 18-week flipped classroom teaching approach was applied in an adult-health nursing course. In total, 485 nursing students enrolled in the study, with 287 in the experimental group and 198 in the control group. The Self-Evaluated Core Competencies Scale, Metacognitive Inventory for Nursing Students, Self-Directed Learning Readiness Scale, and self-designed learning satisfaction questionnaire were used to evaluate the students' learning outcomes.

RESULTS

The experimental group showed a statistically significant increase in the overall scores for self-evaluated core competencies, the "self-modification" subscale of the Metacognitive Inventory for Nursing Students, and in overall self-directed learning readiness; further, they also showed high levels of course satisfaction.

CONCLUSIONS

A flipped classroom teaching approach had a positive impact on student's learning motivation and contributed to better learning outcomes in an adult-health nursing course. The flipped classroom combined with hybrid teaching methods is a suitable and effective learning strategy for a registered nurse (RN) to Bachelor of Science in Nursing (BSN) program to tackle today's complex revolution in nursing curricula, and may enhance nursing students' abilities to address numerous challenges.

Perception of nursing students about the implementation of GREENS© methodology in nursing studies

BACKGROUND

The Gymkhana Room for Education and Evaluation in Nursing Studies (GREENS©) is a pedagogical model that can be used as a learning and assessment method in nursing training workshops. This model combines the advantages of gamification, the flipped classroom and the use of low-fidelity clinical simulation, also including self-reflection and peer evaluation of the situations experienced.

OBJECTIVES

To evaluate the students' perception of the implementation of GREENS© as a learning and assessment tool in an academic course at the University of Almeria.

DESIGN

A cross-sectional descriptive study.

SETTINGS

Academic year 2018/2019, at the University of Almeria (UAL), Spain.

PARTICIPANTS

77 students enrolled in their 2nd year of the Nursing Degree who attended the "Health Promotion and Safety" class.

METHODS

After completing the GREENS© activity, the perception and anxiety of students were analyzed through an online ad hoc questionnaire composed of 17 questions. Data were collected in January 2019.

RESULTS

All of the questions scored above 4 out of a maximum of 5 on a Likert scale. For all the questions, >50% of the students were in total agreement with the questions answered, showing a high acceptance of the GREENS© methodology implementation. The students reported that their anxiety decreased significantly, with a score of 4.7 points on average (95% CI: 4.16 to 5.33, p < 0.001), after knowing that the assessment would be through a gamification tool, not an oral one. More than 60% of the students answered "agree" or "strongly agree" with the idea that GREENS© is useful for improving motivation, teamwork, learning, fun and knowledge assessment.

CONCLUSIONS

The use of GREENS© has generated a high satisfaction and motivation of the students in their learning process, and as an assessment tool, it created a lower degree of anxiety as compared to an oral examination.

Flipped classroom improves nursing students' theoretical learning in China: A meta-analysis

OBJECTIVE

At present, current didactic teaching delivery method help nursing students apply theory to clinical situations in an inefficient way. The flipped classroom (FC), a novel teaching mode emphasizing self-study and critical thinking, has generated interest in nursing education in China. However, there are a gap in the literature and no consistent outcomes of current studies which compared FC and lecture-based learning (LBL), and no systematic review has comprehensively compared theoretical scores as an affected outcome in FC versus LBL modes.

METHODS

In this review, we analyze flipped-learning nursing students' scores, and aim to assess the efficacy and provide a deeper understanding of the FC in nursing education. Following the inclusion criteria, articles were obtained by searching PubMed, Embase and Chinese data, including the China National Knowledge Infrastructure, Wanfang Data, and VIP database until 3 January 2020. Data were extracted from eligible articles and quality was assessed. A meta-analysis was then performed using a random effects model with a standardized mean value (SMD) and a 95% confidence interval (CI).32 studies were included after reviewing 2,439 citations. All studies were randomized controlled trials (RCTs). The FC theoretical knowledge scores in FC were significantly positively affected compared to those of the traditional classroom (SMD = 1.33, 95% CI: 1.02-1.64; P < 0.001). In addition, 23 studies reported skill scores, indicating significant difference between the FC mode and LBL mode (SMD = 1.58, 95%CI: 1.23-1.93; P < 0.001).

CONCLUSIONS

The results of this meta-analysis suggest that compared to the LBL teaching method, the FC mode dose significantly improve Chinese nursing students' theoretical scores. However, the problems of heterogeneity and publication bias in this study need to be remedied high-quality future studies.

Flipped Classroom Approach Used in the Training of Mass Casualty Triage for Medical Undergraduate Students

OBJECTIVE

The aim of this study was to explore the application of the flipped classroom approach in the training of Mass Casualty Triage (MCT) to medical undergraduate students.

METHODS

In this study, 103 fourth-year medical students were randomly divided into a Flipped Classroom (FC) group (n = 51) and a Traditional Lecture-based Classroom (TLC) group (n = 52). A post-class quiz, simulated field triage (SFT) and feedback questionnaires were performed to assess both groups of students for their learning of the course.

RESULTS

In the post-quiz, the median (IQR) scores achieved by students from the FC and TLC groups were 42(5) and 39(5.5), respectively. Significant differences were found between the two groups. In the SFT, overall triage accuracy was 67.06% for FC, and 64.23% for TLC students. Over-triage and under-triage errors occurred in 18.43% and 14.50% of the FC group, respectively. The TLC group had a similar pattern of 20.77% over-triage and 15.0% under-triage errors. No significant differences were found regarding overall triage accuracy or triage errors between the two groups.

CONCLUSIONS

The FC approach could enhance course grades reflected in the post-quiz and improve students' satisfaction with the class. However, there was no significant difference of competency between the two groups demonstrated in the SFT exercise.

Study Behaviors Associated with Student Pharmacists' Academic Success in an Active Classroom Pharmacy Curriculum

Objective. To identify the specific study behaviors that promoted student pharmacists' success in an active-learning pharmacy curriculum. Methods. The Washington State University College of Pharmacy and Pharmaceutical Sciences implemented an active-learning, flipped classroom model for instruction to equitably deliver course content to Doctor of Pharmacy students on both its main and extended campuses. Students' ability to adapt to the new model and its impact on their study behaviors were unknown. A qualitative descriptive design that included semi-structured interviews was applied to evaluate the study behaviors of high-performing students. The study sample included 13 third and fourth professional year pharmacy students in the top 20% of their respective classes. Results. Interview responses were unaffected by baseline demographics such as gender and year of graduation. Content analysis generated five primary themes related to the behavioral strategies used by high performers: preparing for class, preparing for testing, seeking help, knowing yourself, and building on strengths. These were mapped to the four tenants of Wenger's social learning theory in the representation of findings: learning as doing, learning as belonging, learning as becoming, and learning as experience. Conclusion. High-performing students demonstrated a refined ability to select and modify study behaviors that aided in their academic success, demonstrating a high degree of metacognition. The results of this research may assist pharmacy faculty members in identifying critical elements for success of students enrolled in pharmacy programs using an active learning model.

Standardized Patients or Conventional Lecture for Teaching Communication Skills to Undergraduate Medical Students: A Randomized Controlled Study

OBJECTIVE

The conduct of a medical interview is a challenging skill, even for the most qualified physicians. Since a training is needed to acquire the necessary skills to conduct an interview with a patient, we compared role-play with standardized patients (SP) training and a conventional lecture for the acquisition of communications skills in undergraduate medical students.

METHODS

An entire promotion of third year undergraduate medical students, who never received any lessons about communications skills, were randomized into 4 arms: 1) SP 2 months before the testing of medical communications skills (SP); 2) conventional lecture 2 months before the testing (CL); 3) two control groups (CG) without any intervention, tested either at the beginning of the study or two months later. Students were blindly assessed by trained physicians with a modified 17-items Calgary-Cambridge scale.

RESULTS

388 students (98.7%) participated. SP performed better than CL, with significant statistical differences regarding 5 skills: the use of open and closed questions, encouraging patient responses, inviting the patient to clarify the missing items, encouraging of the patient's emotions, and managing the time and the conduct of the interview. The SP group specifically improved communications skills between the SP training and testing sessions regarding 2 skills: the use of open and closed questions and encouraging patient responses. No improvements in communications skills were observed in CG between the two time points, ruling out a possible time effect.

CONCLUSION

Role-play with standardized patients appears more efficient than conventional lecture to acquire communication skills in undergraduate medical students.

Undergraduate Students Experience of Nutrition Education Using the Flipped Classroom Approach: A Descriptive Cohort Study

OBJECTIVE

To explore undergraduate students self-reported learning experience in a foundation nutrition education course/unit delivered using a flipped classroom approach (FCA), which requires students to complete independent learning before and after interactive in-class learning experiences.

METHODS

A descriptive cohort study design used selected items from a self-report flipped classroom student engagement questionnaire to assess Australian undergraduate student (n = 105) engagement in the course/unit and compared with nonflipped courses, preference for FCA, academic achievement, learning behaviors for 3 FCA learning phases, and more or less engaging aspects of the course/unit.

RESULTS

Most (66.5%) students were engaged or very engaged, with half (55%) more engaged in this course/unit compared with other nonflipped courses/units with a preference for the FCA (53%). Almost half of the students agreed the FCA improved their academic performance (grade) (45%) and other academic skills (ie, teamwork) (48.5%). Most student comments related to the value of participate phase activities.

CONCLUSIONS AND IMPLICATIONS

The FCA engaged most students in learning and is an emerging learning and teaching approach appropriate for undergraduate nutrition dietetic education.

Stimulating Intrinsic Motivation in Millennial Students: A New Generation, a New Approach

There has been a fundamental change in health care pedagogy to address the demands and challenges posed by the present generation of millennial students. There is also a growing recognition of the role of intrinsic motivation as a catalyst in a positive learning experience. The term intrinsic motivation refers to energizing behavior that comes from within an individual and develops due to an inherent interest in the activity at hand. However, stimulating intrinsic motivation in the present generation of millennial health care students is a daunting task, considering their diverse and disparate nature. In addition, the inherent generational differences between educators and students, and an increasing emphasis on technological tools have resulted in a dichotomy in the educational environment leading to the development of a greater incidence of burnouts among students. Hence, numerous innovative techniques have been introduced in health care education to enhance the levels of intrinsic motivation in these students. Unfortunately, most of these approaches have only been moderately successful due to their limited ability to address the unique educational expectations of millennial students. The cumulative evidence suggests that specific approaches to stimulate intrinsic motivation should aim at nurturing the learning efforts of students, bridging the generational barriers between educators and students, and ameliorating the stress associated with health care education. Hence, the specific aim of this narrative review is to suggest empirically proven curricular strategies and institutional reforms to enhance intrinsic motivation in health care students belonging to the Millennial Generation.

Educational Perspectives: Palliative Care Education in Neonatal-Perinatal Medicine Fellowship

The neonatal period from birth to less than or equal to 28 days is one of increased risk of death. Congenital anomalies and prematurity are 2 of the most common risk factors for death at this early age. Many of these neonates will die in an intensive care unit, some with full resuscitative efforts being undertaken despite the understanding that these actions are highly unlikely to yield an outcome different from death. Palliative care allows curative therapies to be provided alongside supportive techniques such as enhanced family communication, attention to spirituality and the psychosocial health of the family, management of symptoms other than those specific to the underlying disease process, and enhancing comfort. The American Academy of Pediatrics has set forth recommendations related to pediatric palliative care for the various pediatric subspecialties; however, much of the focus is on disease processes and curing or mitigating various illnesses. Given the high preponderance of death in the neonatal period, neonatal-perinatal medicine training programs should be tasked with generating formal palliative care training. Such training should be geared to providing better care for neonatal patients with a life-limiting or life-altering illness, and better equipping future neonatologists with the tools needed to provide truly comprehensive care for their sickest patients at risk for death and disability. This article serves to review the concept of palliative care in neonates, discuss the paucity of formal education in palliative care, explore the general trend in palliative care education, review various ways in which palliative care education can be formalized, and define metrics of a successful educational program.

Flipped classroom versus a didactic method with active learning in a modified team-based learning self-care pharmacotherapy course

BACKGROUND AND PURPOSE

To examine the educational outcomes comparing flipped classroom method versus a didactic method with active learning in two semesters of a modified team-based learning (TBL) self-care pharmacotherapy course and explore student-identified preferences for teaching modality.

EDUCATIONAL ACTIVITY AND SETTING

Grade performance on readiness assurance processes, both individual (iRAP) and team (tRAP), and exam questions were compared in two semester-long course offerings. Additionally, students were surveyed pre- and post-course.

FINDINGS

The mean iRAP scores were 81.9% for the didactic method and 80.7% for the flipped method (p = .092). The mean tRAP scores were 93.6% for both didactic and flipped methods (p = .979). Mean exam performance for content taught using didactic and flipped methods were 83.3% and 83.5%, respectively (p = .730). Pre-course respondents indicated the following preferences: didactic (27.7%), flipped (9%), combination (58.2%), no preference (5.1%). Post-course, 46.8% preferred didactic, 5.7% preferred flipped, and 47.5% preferred a combination. Respondents perceived the didactic method helped develop deeper understanding, stimulated greater interest, and improved retention; however, they felt the flipped method improved critical thinking and application.

SUMMARY

There were no statistically significant differences in student outcomes comparing teaching methods while student preference for the flipped classroom decreased.

Fill the gap between traditional and new era: The medical educational reform in Taiwan

The 7-year medical education program in Taiwan has been established since 1949. More than 60 years later, many medical professionals have observed and voiced its deficiencies following the outbreak of severe acute respiratory syndrome. The deficiencies are three-fold: (1) specialties are excessively institutionalized, (2) students engage in passive learning and memorization, and (3) passing one written national examination serves as the means of granting permanent physician qualification. The situation has aroused concerns and discussions among medical professionals and educators for a new medical education program. Authorized by the Conference of Deans of Medical Schools in Taiwan, Prof. Chyi-Her Lin assembled a team for planning medical curricular reform. Subsequently, Prof. Shan-Chwen Chang organized a task force team which has been monitoring the new 6-year program since 2013. The aims of medical reform by Prof. Lin are (1) to eliminate the specialty training part, (2) to use innovative teaching methods to motivate students to learn proactively, and (3) to implement competency-based medical education. Now, the first class of physicians will enter the workplace in 2019, subject to various clinical challenges.

A novel online platform promotes asynchronous class preparation and thought transparency

BACKGROUND AND PURPOSE

Engaging all learners with self-directed class preparation materials can be challenging. The purpose of this study is to assess student perceptions of a novel app and web-based program, Practice Improvement using Virtual Online Training (PIVOT) as a preparatory tool in a pharmacy therapeutics course.

EDUCATIONAL ACTIVITY AND SETTING

PIVOT was designed to encourage self-directed information gathering, group collaboration, and problem-solving prior to classes. Students accessed PIVOT to obtain patient information and provide responses to questions. A semi-structured large group case discussion, facilitated by the instructor, followed the preparatory assignment. All students were invited to participate in pre-/post-activity online surveys to evaluate their experiences.

FINDINGS

One hundred and ten students (92.4%) completed both surveys. Students identified viewing/comparing answers with classmates (73%), enforcing preparation (51%), and asynchronous preparation (51%) as useful aspects of PIVOT. Working with a group (42%) and organizing patient information (32%) were selected as negative aspects of PIVOT. More than half of students preferred not to use PIVOT for class preparation, but 41% of students would like to see PIVOT integrated in their therapeutics courses.

SUMMARY

Integrating PIVOT into a pharmacy therapeutics course resulted in mixed student perceptions. Several helpful aspects of this platform were identified and a majority suggested drawbacks that are also common features of actual pharmacy practice. Implementing PIVOT in a different learning context may improve student perceptions.

Effects of a Flipped Classroom Curriculum on Inpatient Cardiology Resident Education

BACKGROUND

The flipped classroom is designed to reinvigorate education and utilizes "at-home" time to learn concepts and "in-class" time for clinical application. While some studies have shown positive effects of the flipped classroom in undergraduate medical education, there is a paucity of data on its use in graduate medical education.

OBJECTIVE

We hypothesized that a flipped classroom curriculum of Medical Knowledge Self-Assessment Program (MKSAP) content with group case discussions could improve resident knowledge and preparedness in cardiology.

METHODS

Ninety-eight internal medicine residents who rotated on the inpatient cardiology service from March to October 2017 were quasi-randomized into control and intervention groups, with the intervention group assigned MKSAP readings and cases to review on their own, accompanied by weekly case discussion. Pre-post surveys evaluated for change in knowledge and preparedness, quantity of teaching received, and use of MKSAP.

RESULTS

A total of 93 of 98 residents (95%) participated in the curriculum. There were 37 of 51 residents (73%) in the control group and 37 of 47 residents (79%) in the intervention group who responded to pre-post assessments. In paired analysis, knowledge score did not improve significantly between the groups, nor did self-reported preparedness, number of teaching sessions per week, or reported MKSAP use. However, all participants had positive perceptions of the curriculum, and the majority felt it should be continued.

CONCLUSIONS

This flipped classroom curriculum did not affect knowledge, preparedness, or number of teaching sessions for internal medicine residents on a cardiology rotation when compared to usual teaching, although residents experiencing the new model expressed high satisfaction.

Needs Assessment Lessons Learned in Qatar: A Flipped Classroom Approach

This article was migrated. The article was marked as recommended. Continuing professional development (CPD) activities are expected to be purposeful and effective; the essential first step is a curriculum based on actual training needs. The Qatar Council for Healthcare Practitioners (QCHP) provides the oversight for accredited CPD programs for all groups of healthcare practitioners in Qatar this includes physicians, pharmacists, nurses and allied health professionals. In December 2017 several professionals created a local, collaborative and supportive network to share their expertise and to collaborate on accredited professional development initiatives. Network members included accredited CPD providers from two hospitals, Sidra Medicine and Aspetar, and from the College of the North Atlantic Qatar (CNA-Q). The implementation of a needs analysis is key to continuous service improvements. Network members conducted an audit of 43 educational programs in 2018 and found that this step is frequently missed or misinterpreted by curriculum planners. A workshop on needs assessments was seen as the most germane intervention to upskill program planners. An evidence-based approach was suggested in the development of a needs assessment teaching module. A review of the literature influenced the curriculum design as did a re-examination of adult learning principles and validated new methods to teaching in the health professions. The flipped classroom was identified as the most appropriate approach regarding design and content delivery. It requires skilled facilitators and content matter experts that are familiar with diverse teaching formats to ensure that learning outcomes are integrated across the formats. It has been documented that 'flipping' the classroom from a teacher-centered to a learner-centered approach encourages participants' higher order learning and fosters engagement, exploration, evaluation and reflection.

Pre-Class Learning Methods for Flipped Classrooms

Objective. To review the types of pre-class learning modalities used in flipped classrooms (FC) and team-based learning (TBL) and determine best practices. Findings. Forty-eight articles were included. Reading materials or video lectures were used most often as the primary modality to deliver the pre-class learning. Students favored assignments that have clear objectives, provide guidance, are guided, and are brief. Summary. This study describes how pharmacy schools and colleges are implementing FC into their curricula and the types of pre-class learning that are being developed and assigned with the implementation. More research should be done in comparing the impact of different types of pre-class material on learning outcomes, such as knowledge retention. This is especially important in FC settings because the in-class learning and higher order activities are built upon having a good foundational knowledge, which comes from the pre-class learning.

Using the Flipped Classroom With Simulation-Based Medical Education to Engage Millennial Osteopathic Medical Students

With advances in technology and the advent of social media and social networking sites, the way medical education is taught to millennials must evolve. The “flipped classroom,” which occurs when students are exposed to learning materials before their assigned face-to-face class or didactic session, can help engage all learning styles. A flipped classroom paired with simulation-based medical education (SBME) engages millennial learners to acquire the large amount of information required in osteopathic medical school. Using this paired approach in osteopathic medical education can help students meet the requirements outlined by the Accreditation Council for Graduate Medical Education (ACGME). With the single accreditation system for graduate medical education, finalizing in 2020, this article proposes mandating a flipped classroom with SBME to better prepare osteopathic medical students for their training in ACGME-accredited programs.

A Meta-Analysis of Outcomes Comparing Flipped Classroom and Lecture

Objective. To examine the evidence of the effectiveness of flipped classroom compared to traditional lecture. Methods. Experimental and observational studies were included and obtained through searches of PubMed, Education Resources Information Center (ERIC), and Google Scholar. Publications from January 1, 2000 through July 1, 2017 were included. Studies were eligible for this research if: (a) the study compared student outcomes using flipped classroom versus lecture and (b) at least one outcome measure was final examination score or final course score. This analysis used a random effects model with weighted mean difference (WMD) as the outcome. Results. Six studies were included in the qualitative synthesis and five were included in the quantitative synthesis. To date, there has only been one prospective randomized comparison of flipped classroom to lecture in student pharmacist education. When comparing final examination scores, there was no significant difference between flipped classroom and lecture based instruction. Only two studies examined the effect of flipped classroom compared to lecture on final course score. This analysis also found no significant difference. Conclusion. Despite a lack of prospective randomized studies, findings from this meta-analysis suggest that flipped classroom may be associated with minimal gains in student knowledge compared to lecture. These findings are important because previous research has estimated that the flipped classroom requires more time to develop and implement. Future studies using prospective randomized designs need to be conducted before widespread adoption.

Diversity and Inclusion in the Academic Medicine Workforce: Encouraging Medical Students and Residents to Consider Academic Careers

Introduction

The expansion of medical schools and increased faculty attrition call for heightened efforts to encourage medical students and residents to consider academic careers. As diversity serves as a driver of institutional excellence, special attention to the ongoing underrepresentation of certain groups in academia, such as racial and ethnic minorities, women, and lesbian, gay, bisexual, and transgender individuals, is warranted.

Methods

We developed a 90-minute workshop to raise medical student and resident awareness of academic medicine careers, and the benefits and challenges of having a diverse faculty. The workshop consists of a didactic PowerPoint presentation and a reflection exercise, shared in small- and large-group format, discussing facilitators and barriers to pursuing academia. The workshop was implemented at nine regional conferences.

Results

There were 165 diverse participants. In comparing pre- and postworkshop responses of learners using the sample t test, there was a statistically significant increase in confidence to succeed in academic medicine given learners' gender (2.69 vs. 3.34, p < .001), race and ethnicity (2.53 vs. 3.24, p < .001), or sexual orientation (3.04 vs. 3.42, p < .001). Approximately 95% of learners felt that each of the workshop's learning objectives had been achieved. Participants considered the workshop to be enlightening, motivational, realistic, and validating.

Discussion

This workshop was effective in providing an interactive format for medical students and residents to gain awareness of the state, benefits, and challenges of diversity and inclusion in academic medicine, and can affect their perception of being a future faculty member.

Influence of Reading Material Characteristics on Study Time for Pre-Class Quizzes in a Flipped Classroom

Objective. To examine how instructor-developed reading material relates to pre-class time spent preparing for the readiness assurance process (RAP) in a team-based learning (TBL) course. Methods. Students within pharmacokinetics and physiology were asked to self-report the amount of time spent studying for the RAP. Correlation analysis and multilevel linear regression techniques were used to identify factors within the pre-class reading material that contribute to self-reported study time. Results. On average students spent 3.2 hours preparing for a section of material in the TBL format. The ratio of predicted reading time, based on reading speed and word count, and self-reported study time was greater than 1:3. Self-reported study time was positively correlated with word count, number of tables and figures, and overall page length. For predictors of self-reported study time, topic difficulty and number of figures were negative predictors whereas word count and number of self-assessments were positive predictors. Conclusion. Factors related to reading material are moderate predictors of self-reported student study time for an accountability assessment. A more significant finding is student self-reported study time is much greater than the time predicted by simple word count.