Flipped classroom improves student learning in health professions education: a meta-analysis

Quantitative Analysis of the Acceptance and Learning Success Instead of Flipped Classroom Teaching in a Caries Diagnosis Course for Undergraduate Students

This pilot study aimed to investigate the effectiveness of a flipped classroom for undergraduate students in dentistry. The main objective was to compare the knowledge level of students before and after lectures and practice. All second-year dental students (n = 44) at Witten/Herdecke University participated in this pilot study. They took four knowledge assessments, i.e., T0: the baseline, T2a: after the online lecture (two weeks after T0), T2b: immediately after the face-to-face session, and T3: after the practical session (three weeks after T2). The students’ satisfaction and self-assessment of their abilities were determined immediately after the practical session in an anonymous online questionnaire using LimeSurvey. To assess the level of knowledge, we used the Friedman and Wilcoxon-signed-rank tests with the Bonferroni correction to analyze the correct answer by comparing the results from different sessions. The students’ satisfaction and self-assessment of their abilities were determined descriptively, presenting the mean and standard deviation. A significance level of $p$  ≤ 0.05 was applied. Data from thirty-nine students regarding the level of knowledge were analyzed. There were statistically significant differences in the level of knowledge of the students at different times ( $p$  = 0.001). A total of 19.5% of students reported a problem with the flipped classroom method, and 80.5% reported no problem with this educational method. Ninety-four percent of students would like further flipped classrooms in dental education. Within the limitations of this pilot study, the results suggest that dental students benefit from the flipped classroom method and that this mode of education can be effective in introducing caries diagnosis education for undergraduate students.

Envisioning nutrition teaching as a three-course meal: a blended approach to knowledge, application and assessment

Medical students receive inadequate training in nutrition counselling, but the best way to teach this topic is unknown. To address this research gap, we developed a longitudinal blended programme - combining physical classroom experiences with online education - to teach nutrition counselling in a primary care clinical course. The learning experience comprised a pre-class online module to convey knowledge; a formative, ungraded standardised patient exercise on dietary modification to practise skills; and a written exam on nutrition knowledge and an Objective Structured Clinical Exam assessing nutrition counselling skills. We likened this three-part curriculum to a complete meal, with its self-paced online 'appetiser', in-class 'entrée' of clinical practice with patients, and 'dessert' of an assessment. We ascertained feasibility, discovered positive student reactions, and, via exam performance analysis, noted achievement of the learning objectives. This three-course meal model can be applied to any learning experience that teaches and assesses skills.

Gender and Sexual Diverse Health Education: A Needs Assessment Among Internal Medicine Residents

Purpose: The purpose of this study was to assess perception of competency and comfort level of internal medicine (IM) residents in caring for gender and sexual diverse (GSD) patients, and to identify residents' preferred educational modalities and perceived facilitators and barriers to GSD curriculum implementation. Methods: A survey was distributed among IM residents during a mandatory didactic session between November 9 and December 18, 2020. Categorical variables were analyzed using Fisher's exact test. Open-ended questions were analyzed using content and theme analysis. Results: Of 138 residents, 89 (64%) completed the survey. Residents had varying levels of comfort and perceived competence. Small group (n = 61, 69%) and case-based learning (n = 58, 66%) formats were preferred. Content and theme analysis resulted in four major themes on facilitators and three major themes on barriers to GSD curricular implementation. Conclusion: This study provides unique insight to facilitate implementation of a learner-centered and developmentally appropriate curricular approach to GSD health education.

Opportunity Amid Crisis in Medical Education: Teaching During the Pandemic of COVID-19

Purpose

The pandemic of COVID-19 had reinforced adaptations in medical education. It was challenging, especially for developing countries where resources were scarce. This study examined the implementation of teaching and learning adaptation during the pandemic in a low-resource country as perceived by teachers. We also present the opportunities that arise from the adaptation process.

Participants and Methods

The participants of this study (n=24) were teachers in an undergraduate medical program. This study employed a qualitative approach using focus group discussions (FGDs) to collect the teachers' perceptions. Thematic analysis was performed to analyse the data.

Results

Teachers' perceptions were categorized into 19 subthemes and were accentuated into four general themes; learning facilitation, assessment during the pandemic, learning resources, and competence achievement. We discovered both challenges as well as opportunities in each theme due to the shifting of learning from offline to online learning. Flexibility and innovation were regarded as the most important opportunities and were perceived to hold potential for medical education in the future. Knowledge acquisition was most benefited from this adaptation. Facilitating skill acquisition and burnout were the major challenges.

Conclusion

Despite the challenges, including burnout, skills acquisition, and risk in academic integrity, innovations in medical education were strengthened during the pandemic of COVID-19. They also provided a positive influence regarding achievement in the cognitive aspect. Faculty development programs need to be encouraged to improve teachers' capacity in the future.

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.

Perception of health-related quality of life, sleep quality and sleepiness index in an educational environment at a dental school in Southeast Brazil

INTRODUCTION

University entrance is often associated with changes in quality of life, individuals' cognitive and physical behavior. The present study aimed to evaluate health-related quality of life (HRQoL), sleep quality and sleepiness index in dentistry students at a university in Southeast Brazil, in different semesters of their course.

MATERIALS AND METHODS

Samples were obtained from 55 students from the dentistry course at the Federal University of Alfenas (UNIFAL-MG). For collecting information, validated SF-36 questionnaires (Medical Outcomes Study 36-item Short-Form Health Survey), namely, Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), were used as instruments in an educational environment. The relationship between the association of demographic factors and academic performance with SF-36, PSQI and ESS was assessed with an alpha of 0.05.

RESULTS

The worst HRQoL parameters reported by the participants were observed in the domains of body pain, vitality, general health perception, and limitations due to emotional and social aspects when associated with the investigated variables. Regarding the relative sleep quality index, differences in the PSQI domains were observed when related to demographic factors and academic performance. There was no significant difference in the sleepiness index of these students according to the mean values of the ESS domains.

CONCLUSION

The SF-36, PSQI and ESS questionnaires indicated that it is a reliable instrument for measuring the impact of quality of life on dentistry students. In addition, dentistry students of UNIFAL-MG had poor indicators of quality of life associated with health and an inadequate index of quality of sleep.

Transforming postgraduate GP teaching through collaborative course design and peer-facilitated small-group, reflective learning

Shropshire Vocational Training Scheme's (VTS) traditional structure of peer-delivered teaching had received poor feedback from trainees. There is good evidence in the literature for stakeholder engagement in training design and participation in small group learning and case discussion as a bedrock of GP learning in the VTS. We introduced three new initiatives to improve half-day release (HDR): 1. collaborative course design; 2. reflective, case-based learning with flipped learning resources; and 3. peer-facilitated, small groups. The aim was to marry trainees' desire for clinical context with the need to comprehensively cover the professional knowledge, skills and attitudes of the 'Being a GP' Royal College of General Practitioner's curriculum.The new collaborative model has improved feedback, facilitated high-level small group reflection and resulted in a smooth transition to virtual HDR during Covid-19. We now have a cohort of highly motivated facilitators, with the opportunity to develop leadership skills, and a bank of complex clinical cases developed to facilitate useful, trainee-led, case-based discussion.Our model is deliverable in other VTS areas and could enhance trainee experience of HDR. Future challenges will be maintaining facilitator training, quality control for cases and discussion and how to ensure our near-peer facilitators successfully become future leaders in primary care.

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.

Implementing competency-based medical education in post-graduate ophthalmology training: Understanding key concepts and methodologies and overcoming challenges

The National Medical Council (NMC) has mandated that all post-graduate training shall be competency-based, following the principles of Competency. Based Medical Education (CBME). This aims to serve the dual purpose of standardizing ophthalmology post-graduate training and to overcome the shortcomings of the traditional curriculum by employing innovative and interactive teaching-learning and assessment techniques to produce competent ophthalmologists well equipped with clinical, surgical, and professional skills relevant to current times. CBME marks a paradigm shift from traditional curriculum methodologies and involves the introduction of several new concepts. This article aims to highlight the key principles of CBME and the various teaching-learning and assessment technique methodologies which can be employed for post-graduate training. It also highlights the various challenges that are likely to be faced in its implementation and measures to overcome them.

Using Medicare Annual Wellness Visits and telehealth to enhance ambulatory geriatrics education among medical students

The Medicare Annual Wellness visit (AWV) was mandated as a fully covered benefit for older adults to enhance preventive care and improve healthcare outcomes. Although the benefit of conducting AWV is proven, its adoption in primary care is far from universal. The COVID-19 pandemic affected medical education and clinical care in unprecedented ways. Telehealth became a prominent way of delivering healthcare. Older adults, being significantly affected by the pandemic-related mortality and morbidity, were less likely to engage in preventive care with their healthcare providers. Amidst this considerable shift, we conceptualized a clinical experience for third-year medical students during their Ambulatory Care - Geriatrics clerkship that involved a telehealth interaction with an older adult to review AWV components, followed by an in-person office visit with the geriatrician preceptor. Post-session survey data highlighted the beneficial effect on student learning about older adult health maintenance, immunizations and geriatric syndrome assessment. It also facilitated self-directed learning and increased student-patient rapport. Preceptors appreciated the additional elements of care identified by the telehealth call that would otherwise not have been addressed in a time-limited office visit. This hybrid clinical experience reduced crowding in ambulatory clinical space during the COVID-19 pandemic, yet enhanced learning for students in geriatrics preventive care.

Improving Multi-site Interaction Through Remote Learning Technology: Report from a Training Program to Increase Underrepresented Undergraduate and Medical Students in Health Disparities Research

Since 2018, we have evaluated the effectiveness of various teaching technologies for training young investigators on translational research in cancer health disparities. The Southeast Partnership for Improving Research and Training in Cancer Health Disparities (SPIRIT-CHD) unites Moffitt Cancer Center and the Louisiana State University Health Sciences Center. One of the main components of the SPIRIT-CHD is the Cancer Research Education Program (CREP) for training undergraduate and medical students from underrepresented backgrounds. The CREP utilizes a web-based didactic curriculum to engage students at both institutions in biobanking, precision medicine, and cancer health disparities topics. We report experiences from our cross-institutional cancer education program, specifically evaluating the cohorts' satisfaction and learning gains using various communication technologies and instructional approaches. Trainees completed a survey with questions evaluating the curriculum and technology. Trainees reported satisfaction with the flipped classroom model (FCM) content and overall program (mean score = 3.2, SD = 0.79), and would recommend the program to peers. Yet, despite improved program delivery, trainees felt interaction between the two sites (mean score = 1.5, SD = 0.85) and engagement with faculty (mean score = 2.80, SD = 1.14) could be improved. The technology with the highest reported use was e-mail, with a mean score of 4.6 (SD = 0.52). LinkedIn and Twitter had the lowest frequency of use with mean scores at 1.90 (SD = 0.99) and 1.30 (SD = 1.34). Our study highlights the successes and challenges of remote learning using technology to increase interaction and engagement among trainees and faculty in a multi-site cancer research training program.

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.

Gelingende Ethik-Lehre in der Medizin. Erkenntnisse aus der Lehrforschung

Die Frage nach den Faktoren, die eine wirksame Ethik-Lehre in der Medizin ausmachen, blieb bislang weitgehend unbeantwortet. Vor allem im deutschsprachigen Raum wird hier zu wenig Forschung betrieben. Aufgrund fehlender wissenschaftlich aussagekräftiger Evaluationsstudien lässt sich somit mitunter nur vermuten, wie wirksam bestimmte Lehrformate und -methoden in der Ethik-Lehre tatsächlich sind. Die Auswahl von Lehrformaten und -methoden, die Ethik-Dozierende für das Erreichen eines festgelegten Lernziels einsetzen, wird häufig nicht nach evidenzbasierten Kriterien, sondern auf der Grundlage von guten oder schlechten Lehrerfahrungen sowie von unmittelbarem Feedback der Studierenden getroffen. Im vorliegenden Beitrag werden nach einem kurzen Überblick über Evaluationsverfahren ethischer Kompetenzen Erkenntnisse aus ausgewählten internationalen Wirksamkeitsstudien vorgestellt und auf ihre Relevanz für den Medizinethik-Unterricht diskutiert. Wenngleich die Erkenntnisse aus diesen Evaluations- und Meta-Studien aus anderen, angrenzenden Bereichen wie der Forschungsethik und anderen Lehrkontexten kommen, so können sie doch als Diskussionsanstoß dienen und dazu beitragen, Eckpunkte für die Gestaltung wirksamer Ethik-Lehre in der Medizin im deutschsprachigen Raum zu definieren.

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.

The Influence of COVID-19 on Medical Student Resource Preferences

Introduction

Over the past decade, pre-clerkship medical education has shifted from solely relying on didactic lectures to implementing more group learning and clinical experience to promote individualized, self-directed, and patient-centered education. COVID-19 required medical schools to examine their curricula and determine which portions were adaptable to virtual learning. This study compared first-year medical students’ (MS1) perceptions of an online curriculum, focusing on the students’ preferred resources before and after the transition to virtual courses.

Materials and methods

At one community-based allopathic medical school, a decision was made to move the entire pre-clerkship curriculum to a virtual format in the setting of the pandemic. An end-of-course survey evaluation was distributed via email to 64 first-year medical students at a community-based allopathic medical school. The participants were asked numerous questions about their overall perceptions of each course, including questions about the usefulness of lectures, small group activities, course administration, and faculty communication. Quantitative and qualitative data were collected during the standard program evaluation process for the two courses, and a third survey that focused on learning resources asked questions regarding virtual learning.

Results

Of the students, 29.7% reported being disappointed with the virtual curriculum, while the other 70.3% reported an unchanged or improved overall medical education. Regarding resource preferences, 56.5% of the students viewed most (76%-100%) course lectures, while 35.5% of the students viewed less than half of the course lectures. In contrast, 75.8% of the students said the majority (>50%) of their learning comes from outside resources. Furthermore, 31% reported that they are satisfied with the resources provided by the school, while 42% reported that they would like the school to provide additional resources. With that being said, 61% reported using more outside resources with the onset of a virtual curriculum, while 34% reported no change in outside resource use. Only 2% reported using fewer outside resources.

Conclusion

This study found that pre-clerkship medical students preferred some aspects of the in-person setting, such as social interaction and clinical exposure that is lacking in the virtual setting. However, students preferred many aspects of the virtual setting, such as having more independent study time and a more efficient learning process. Overall, before and after the transition, students were less satisfied with traditional curricular resources and more likely to choose external, board-specific resources with hopes of building strong residency applications, and these preferences were heightened in the online format.

Ters Yüz Sınıf Modelinin Hemşirelik Öğrencilerinin Yaşamsal Belirti Becerileri Üzerindeki Öğrenme Etkileri: Yarı Deneysel Bir Çalışma

Amaç: Bu çalışmanın amacı, ters yüz sınıf sınıf öğrenme modeli ile verilen eğitimin hemşirelik psikomotor, bilişsel ve becerilerine etkisini değerlendirmektir.Yöntem: Çalışmada yarı deneysel deney (n=40) ve kontrol gruplu (n=40), ön son test ölçümleri olan bir bir tasarım kullanıldı. Deney grubu yaşamsal bulgular modülünde teorik ve pratik öğretimde ters yüz eğitim modeli ile eğitim alırken, kontrol grubunda sadece geleneksel öğretim modeli ile eğitim aldılar. Öğrenci performanslarını değerlendirmek için bir bilgi testi ve beceri kontrol listesi kullanıldı.Bulgular: Post-test bilgi sınavı ve beceri sınavlarında en yüksek puanları ters yüz sınıf eğitimi alan öğrenciler aldı (sırasıyla X̄ =62.15±16.55; X̄ =45.25±14.77). Ayrıca gruplar arası psikomotor beceri sınavı post-test toplam puanları incelendiğinde, deney grubunun kontrol grubuna göre daha yüksek puanlar aldığı bulundu (sırasıyla X̄=38.92±0.85, X̄=30.79±1.41).Sonuç: Ters yüz sınıf modelinin hemşirelik eğitiminde kullanılmasının hem teorik bilgileri hem de psikomotor beceri kazanımını olumlu yönde etkilediği bulundu.

Point-of-care ultrasound training for residents in anaesthesia and critical care: results of a national survey comparing residents and training program directors' perspectives

BACKGROUND

Point-of-care ultrasound (POCUS) has become an essential tool for anaesthesia and critical care physicians and dedicated training is mandatory. This survey describes the current state of Italian residency training programs through the comparison of residents' and directors' perspective.

METHODS

Observational prospective cross-sectional study: 12-question national e-survey sent to Italian directors of anaesthesia and critical care residency programs (N = 40) and residents (N = 3000). Questions focused on POCUS teaching (vascular access, transthoracic echocardiography, focused assessment for trauma, transcranial Doppler, regional anaesthesia, lung and diaphragm ultrasound), organization (dedicated hours, teaching tools, mentors), perceived adequacy/importance of the training and limiting factors.

RESULTS

Five hundred seventy-one residents and 22 directors completed the survey. Bedside teaching (59.4-93.2%) and classroom lessons (29.7-54.4%) were the most frequent teaching tools. Directors reported higher participation in research projects (p < 0.05 for all techniques but focused assessment for trauma) and simulation (p < 0.05 for all techniques but transthoracic echocardiography). Use of online teaching was limited (< 10%); however, 87.4% of residents used additional web-based tools. Consultants were the most frequent mentors, with different perspectives between residents (72.0%) and directors (95.5%; p = 0.013). Residents reported self-training more frequently (48.5 vs. 9.1%; p < 0.001). Evaluation was mainly performed at the bedside; a certification was not available in most cases (< 10%). Most residents perceived POCUS techniques as extremely important. Residents underestimated the relevance given by directors to ultrasound skills in their evaluation and the minimal number of exams required to achieve basic competency. Overall, the training was considered adequate for vascular access only (62.2%). Directors mainly agreed on the need of ultrasound teaching improvement in all fields. Main limitations were the absence of a standardized curriculum for residents and limited mentors' time/expertise for directors.

CONCLUSION

POCUS education is present in Italian anaesthesia and critical care residency programs, although with potential for improvement. Significant discrepancies between residents' and directors' perspectives were identified.

Flipped Classroom (FCR) as an Effective Teaching-Learning Module for a Large Classroom: A Mixed-Method Approach

Flipped classroom (FCR) is one of the emerging active teaching-learning methods in the medical profession. Its potential for achieving learning objectives, especially in the scenario of a large classroom, especially in medical schools, has not been convincingly demonstrated. This study was designed to establish FCR model conduction and its overall utility as a teaching-learning methodology for undergraduate medical students in large classroom settings using a mixed-method approach using quantitative (assessment scores) and qualitative criteria (subjective feedback from students and teachers).

FCR was conducted for a batch of 170 first-year medical students for a hematology topic. Pre- and post-assessments (based on all the cognitive learning domains) were done to quantify the objective improvement after exposure to the FCR. In addition, subjective feedback from both students and teachers was taken on a validated feedback survey to decipher the qualitative benefits of the FCR.

Comparing pre- and post-assessment scores, there was a significant improvement after the FCR session, especially in the low performers. There was optimistic feedback from students and teachers regarding the utility of FCR as a teaching-learning module.

FCR as a teaching-learning module was feasible and effective, and the users seemed primarily satisfied. Although there is a higher workload for students and teachers, still FCR is an effective teaching-learning module for a large classroom.

Basic Life Support Knowledge among Junior Medical and Dental Students, Communication Channels, and the COVID-19 Pandemic

Background and objective: The prognosis of cardiac arrest victims strongly depends on the prompt provision of Basic Life Support (BLS) maneuvers. Medical students should therefore be proficient in this area, but many lack essential BLS knowledge. The goal of this prospective, closed web-based study was to determine whether a short intervention designed to motivate first-year medical students to follow a blended BLS course could lead to a significant improvement in BLS knowledge in the following year. Materials and Methods: A fully automated web-based questionnaire was administered to second-year medical students one year after they had been given the opportunity of following a blended BLS course (e-learning and practice session). The primary outcome was the difference, on a 6-question score assessing essential BLS knowledge, between these students and those from the 2020 promotion since the latter had not been offered the optional BLS course. Results: The score was similar between the two study periods (3.3 ± 0.8 in 2022 vs. 3.0 ± 1.0 in 2020, p = 0.114), but no firm conclusion could be drawn since participation was much lower than expected (17.9% in 2022 vs. 43.7% in 2020, p < 0.001). Therefore, a second questionnaire was created and administered to understand the reasons underlying this low participation. Conclusions: There was a lack of improvement in BLS knowledge in second-year medical students after the introduction of an optional introductory BLS course in the first-year curriculum, but the limited participation rate precludes drawing definitive conclusions. Ineffective communication appears to be the cause of this low participation rate, but a lack of motivation in the aftermath of the COVID-19 pandemic cannot be ruled out. Corrective actions should be considered to enhance communication, restore motivation, and ultimately improve BLS knowledge among medical and dental students.

New concepts in neurology education: successful implementation of flipped classroom lectures

In order to inspire and attract young people to Neurology, we must offer high-quality and attractive teaching! To improve neurological education at our Medical School (Technical University of Munich), we converted the main lecture into an e-learning concept using a flipped classroom model. Students had to prepare with a video and a text as well as answering multiple choice questions before each lecture. As a further incentive, students with ≥ 80% right answers in multiple choice questions received a bonus for the final exam. During the lectures, predominantely patient cases were discussed to apply, improve and enhance the previously acquired knowledge. The realignment of the main lecture in Neurology into a flipped classroom model was very successful and was further optimized in the following semesters based on the evaluations obtained for the new concept. Moreover, this enabled us to quickly switch to remote teaching during the COVID-19 pandemic, while still offering lectures of high quality. In addition, this new teaching concept attracts students for Neurology. Furthermore, the exemplary conversion of the Neurology main lecture to a flipped classroom concept also serves as best practice and motivation to adapt other courses in our faculty and far beyond.

"Flipped" clinical rotations: A novel approach

Background

Near the beginning of the COVID‐19 pandemic in the United States, medical students were pulled out of all in‐person patient care activities. This resulted in massive disruption to the required clinical rotations (clerkships), necessitating creative curricular solutions to ensure continued education for medical students.

Approach

In response to the lockout, our school adopted a “flipped” clinical rotations model that assigned students to remote learning activities prior to in‐person patient care activities. This approach allowed students to continue their clinical education virtually with a focus on knowledge for practice while awaiting return to the shortened in‐person portions of their rotation. In planning the modified clinical curriculum, educational leaders adhered to several guiding principles including ensuring flexible remote curricular components that would engage students in active learning, designating that no rotation would be completely virtual, and completing virtual educational activities and standardised exams before students returned to in‐person experiences.

Evaluation

End of rotation evaluations and standardised exam scores were analysed to determine the effectiveness of this model. Despite the disruption associated with the pandemic and the rapid implementation of the “flipped” rotations, students continued to rate the overall experiences as highly as traditional clinical rotations. Students also performed similarly on standardised exams when compared to cohorts from other classes at the same experience level.

Implications

While borne out of necessity during a pandemic, the lessons learned from our implementation of a “flipped” rotations model can be applied to address problems of capacity and clinical preparedness in the clinical setting.

A Prospective Comparative Analysis Regarding the Assessment of Oral Mucosal Disease Using a Validated Questionnaire to Improve the Teaching of Dental Students

Structured examination and treatment are essential in medicine. For dental students, a structured approach to the assessment of oral mucosal lesions is missing thus far. To validate an approach, a structured questionnaire was compared with the habitually used free description of oral lesions (white lesions, ulcers, hyperplasia). Thirty-three dental students were divided into two groups (Group 1 (n = 17) used the free description; Group 2 (n = 16) used a guided questionnaire) to characterize mucosal lesions in patients and make a tentative diagnosis. Although no difference was found between the groups regarding the suspected diagnosis or the histopathological findings, there was a significant advantage of the structured questionnaire in all aspects of the description compared to the free description (p = 0.000018). Thus, a structured description is an important aspect in the evaluation of oral mucosal changes, and a guided questionnaire should be implemented in the study of dentistry.

Opportunities and Challenges in Medical Education During the COVID-19 Pandemic

The abrupt onset of the pandemic in early 2020 presented a clear challenge to medical and resident education across the nation. Numerous changes were made to allow educational efforts to continue, including the use of virtual formats. The benefits and challenges to virtual learning, as well as the difficulty in transitioning certain skills, such as thorough physical examination and procedural skills, are discussed. Future opportunities exist for hybrid virtual learning and conferences and the development of formal telehealth curricula. The effect of these changes on professional identity formation must be intentionally addressed and role model and mentor relationships fostered both virtually and in person. Given the availability of both vaccines and personal protective equipment, appropriately protected students and trainees should be afforded every opportunity to pursue hands-on medical learning in preparation for their future careers. [Pediatr Ann. 2022;51(8):e319-e323.].

Effective and Time-Efficient Implementation of a Flipped-Classroom in Preclinical Medical Education

The flipped classroom (FC) model of instruction has inherent barriers to implementation in medical education due to amount of content taught versus time allotted, the widespread adoption of interdisciplinary course structure causing a plethora of instructors responsible for content delivery, and trends to reduce the number of weeks to teach preclinical foundational science. Here we report on a FC model executed in an interdisciplinary endocrinology block in a time-saving manner, while preserving student preferences and satisfaction and improving written assessment performance. In this study, traditional lectures were 100% replaced with pre-session assignments (custom video modules) resulting in less time (- 9 h) spent on first pass learning. In-person, active-learning, case-based sessions were created (+ 8 h) to complete the FC model and achieve higher level understanding. Written assessment performance in the endocrinology block was compared between two cohorts: the FC model and traditional lecture model. The FC model cohort outperformed the traditional lecture cohort on written, multiple-choice assessments (both in-house and NBME assessments). Furthermore, a measured (survey data) student preference for the FC model was observed.

Texas professionals are employing a one health approach to protect the United States against biosecurity threats

Texas is a geographically large state with large human and livestock populations, many farms, a long coastal region, and extreme fluctuations in weather. During the last 15 years, the state of Texas has frequently suffered disasters or catastrophes causing extensive morbidity and economic loss. These disasters often have complicated consequences requiring multi-faceted responses. Recently, an interdisciplinary network of professionals from multiple academic institutions has emerged to collaborate in protecting Texas and the USA using a One Health approach. These experts are training the next generation of scientists in biopreparedness; increasing understanding of pathogens that cause repetitive harm; developing new therapeutics and vaccines against them; and developing novel surveillance approaches so that emerging pathogens will be detected early and thwarted before they can cause disastrous human and economic losses. These academic One Health partnerships strengthen our ability to protect human and animal health against future catastrophes that may impact the diverse ecoregions of Texas and the world.

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Texas has suffered from numerous disasters or catastrophes, often more than other US states.

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These disasters have caused tremendous morbidity, mortality, and economic loss.

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Texas professionals are partnering in One Health ways to mitigate such catastrophes.

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These numerous collaborations are important to Texas, the USA, and abroad.

Quality Assurance of Undergraduate Medical Education in Israel by Continuous Monitoring and Prioritization of the Accreditation Standards

External accreditation reviews of undergraduate medical curricula play an important role in their quality assurance. However, these reviews occur only at 4-10-year intervals and are not optimal for the immediate identification of problems related to teaching. Therefore, the Standards of Medical Education in Israel require medical schools to engage in continuous, ongoing monitoring of their teaching programs for compliance with accreditation standards. In this paper, we propose the following: (1) this monitoring be assigned to independent medical education units (MEUs), rather than to an infrastructure of the dean's office, and such MEUs to be part of the school governance and draw their authority from university institutions; and (2) the differences in the importance of the accreditation standards be addressed by discerning between the "most important" standards that have been shown to improve student well-being and/or patient health outcomes; "important" standards associated with student learning and/or performance; "possibly important" standards with face validity or conflicting evidence for validity; and "least important" standards that may lead to undesirable consequences. According to this proposal, MEUs will evolve into entities dedicated to ongoing monitoring of the education program for compliance with accreditation standards, with an authority to implement interventions. Hopefully, this will provide MEUs and faculty with the common purpose of meeting accreditation requirements, and an agreed-upon prioritization of accreditation standards will improve their communication and recommendations to faculty.

Faculty perspectives of small group teaching experience in medical school in Tamil Nadu

BACKGROUND

The small group teaching (SGT) is gaining popularity in medical education since it improves the student's thinking capacity and aids knowledge retention. Several studies have been conducted to analyze students' attitudes regarding SGT. Faculty, on the other hand, have mixed perception about SGT methodology. Therefore, the main objective of this study was to explore medical faculties' perceptions of SGT effectiveness in the medical curriculum.

MATERIALS AND METHODS

A cross-sectional, descriptive survey was conducted among 50 medical college teachers. We have developed set of 12 questionnaires to assess the perception of teachers on SGT methods. Content validation of the survey questionnaire was done by Lawshe method, and Cronbach's alpha was calculated for estimating the internal consistency. Teacher's perception responses were presented as proportion and percentage. We performed principal component analysis, structural equation modelling, Chi-squared test (χ²/df), goodness-of-fit index (GFI), adjusted GFI, comparative fit index, and root mean square error of approximation.

RESULTS

The validation resulted in the 12 items model indicated superior goodness of fit for sample data. All the extracted factors had good internal consistency of >0.9. Majority of the teachers strongly agreed that the SGT method enhances the student intrinsic motivation (n = 42, 84%), self-confidence (n = 40, 80%) self-directed learning (n = 35, 70%), and student teacher interaction (n = 38, 76%).

CONCLUSION

Teaching faculties' perception reflected that SGT is an effective method to impart knowledge to the students and also helps in improving their understanding of their subject. It helps in developing intrinsic motivation to do self-learning in the students. It also helps in developing good peer interaction and improves the communication skills.

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.

Global Evidence on Flipped Learning in Higher Education

The teaching dynamic has positioned flipped learning as a pedagogical model, a methodology that helps teachers prioritize active learning during class time by assigning students reading materials and presentations to view at home or outside of class. The objective was to determine the original stages, expansion and current situation of the flipped learning methodology. A bibliometric analysis of 654 documents was carried out. The results reveal that scientific productivity follows an increasing linear trend, with the main categories being Social Sciences and Computer Science. The lines of research developed in this period related to learning, online learning, teaching, distance education, higher education and educational innovation were identified. It was found that the research topic has a growing and dynamic interest in scientific activity at the international level. The analysis documented a rapidly growing knowledge base, primarily written by scholars located in developed societies. This study supposes an analysis of the scientific production and of the actors who stimulate the investigation, as well as the identification of the lines of investigation.

Online medical history taking course: Opportunities and limitations in comparison to traditional bedside teaching

Objective

Obtaining a systematic medical history (MH) from a patient is a core competency in medical education and plays a vital role in the diagnosis of diseases. At the Faculty of Medicine at LMU Munich, students have their first course in MH taking during their second year. Due to the COVID-19 pandemic, the traditional bedside MH taking course had to be transformed into an online course (OC). Our objectives were to implement an online MH taking course, to evaluate its feasibility and to compare the evaluation results to a historic cohort that had undertaken the traditional bedside teaching course (BTC).

Methods

874 second-year students participated in the OC (BTC=827). After teaching the theoretical background via asynchronous online lectures, students participated in a practical exercise with fellow students using the video communication platform Zoom where they were able to practice taking a MH on the basis of fictitious, text-based patient cases. Students were then asked to evaluate the course through a standardized online survey with 31 questions on teaching quality and self-perceived learning success, which had also been used in previous years. The survey results were compared to the results of the historic cohort using the Mann-Whitney U test.

Results

A total of n=162 students (18.5%) evaluated the OC. In the historic cohort, n=252 (30.5%) completed the survey. 85.3% of the OC respondents thought that the atmosphere during the practical exercise was productive and 83.0% greatly appreciated the flexibility in terms of time management. Moreover, they appreciated the online resources as well as having the opportunity to undertake a MH taking course during the COVID-19 pandemic. 27.7% of the respondents thought that traditional BTCs should be supplemented through more online activities in the future. With respect to the ability of independently taking a MH upon completion of the course, the OC was rated significantly lower relative to the BTC (mean OC=2.4, SD=±1.1 vs. mean BTC=1.9, SD=±1.1 (1=strongly agree; 5=strongly disagree); p<0.0001).

Conclusion

OCs are a feasible format and seem to convey the theory and practical implementation in a peer-exercise format of MH taking to medical students. The theoretical background can be acquired with great flexibility. Nevertheless, the students' self-appraisal suggested that the traditional teaching format was more effective at teaching MH taking skills. Thus, we propose a blended learning concept, combining elements of both formats. In this context, we suggest prospective, randomized trials to evaluate blended learning approaches.

Designing a Plastic and Reconstructive Surgery Virtual Curriculum (PRSVC): Assessment of Medical Student Knowledge, Surgical Skill, and Community Building

BACKGROUND

The COVID-19 pandemic displaced medical students from their rotations and into virtual classrooms. We aimed to develop a virtual curriculum with the goals for students to gain knowledge in plastic surgery, to acquire technical skills, and to be able to promote community.

METHODS

We developed a four-week educational curriculum of topics in plastic surgery using the American Society of Plastic Surgeons Resident Education Curriculum and an online plastic surgery curriculum. Virtual flipped classroom case discussions and weekly surgical skills workshops were offered. Pre- and post-course surveys were administered, and results analyzed using IBM SPSS Statistics version 25.0.

RESULTS

303 medical students and recent graduates enrolled in the course in June 2020. 182 students completed the pre-course survey (60% response rate), and of those, 50.0% (n=91) completed the post-course survey for paired comparison. Students reported significant improvement in confidence discussing the relevant anatomy, work-up and surgical approaches to clinical cases, as well as confidence in knowledge of all topic areas (p<0.001). Confidence in suturing and knot-tying techniques significantly improved among workshop participants (p<0.001). Students applying to residency programs this cycle felt significantly more prepared for sub-internships (p<0.001) and significantly more connected to the community of applicants (p<0.001).

CONCLUSIONS

The Plastic and Reconstructive Surgery Virtual Curriculum (PRSVC) improved knowledge, surgical skills, and community in the field among medical student participants. This course may serve to provide a framework for structured virtual learning activities for students interested in plastic surgery and may have significant long-lasting utility for students interested in the field.

Teaching and learning lifestyle medicine during COVID-19: how has living during a pandemic influenced students' understanding and attitudes to self-care and population health? A qualitative analysis

BACKGROUND

In 2019 a new Lifestyle Medicine (LM) module was introduced to the undergraduate medical curriculum at Imperial College London. Lifestyle Medicine is an emergent discipline which aims to tackle the increasing burden of non-communicable disease. Previous work has suggested that students value clinical teaching over traditional Public Health topics. Taking a constructivist view of learning, this paper assesses changes in medical students' attitudes towards Public Health and LM in response to living through a pandemic. We then make suggestions as to how this lived experience might be useful in teaching LM, and discuss the interaction between teaching, behaviour, and experience with consideration of self-determination theories in learning.

METHODS

First-year medical students were surveyed at the end of their first year of teaching and asked if living during the COVID-19 pandemic had changed the value they place on LM and if so, how. Thematic analysis was conducted on responses representing 71% (n = 216) of the year group.

RESULTS

Four themes were defined in the data: acknowledging importance; impact on behaviour; health inequalities and the wider determinants; and promoting Public Health and prevention. These themes highlight the distinct levels through which the pandemic has had an impact: from personal behaviour to population health.

CONCLUSIONS

This is the first study to look at the impact of living through a pandemic on attitudes to LM. Our results suggest that the pandemic has led to increased reflection on health behaviours. The lived-experience of COVID-19 may facilitate a better understanding of health inequalities and their impact, alongside the opportunities presented by effective LM interventions.

Nursing Students’ Perceived Learning Outcomes, Motivation to Learn and Grade Achieved in a Digital Blended Learning Course: A Norwegian Cross-Sectional Study

The COVID-19 pandemic forced educational institutions to move online, and it is important to understand how students perceive learning in a digital learning environment. We aimed to investigate students’ perceived learning outcomes in a digital learning environment and associations between perceived learning outcomes and grades achieved. An anonymous electronic survey was used (n = 230, response rate 34%). A significant linear relationship between overall perceived learning outcome and grade achieved was found (B 0.644, 95% CI 0.52 to 0.77). Of the different learning activities, attending digital seminars were positively associated with grades (B 0.163, 95% CI 0.002 to 0.32). In particular, participating in voluntary colloquium group (B 0.144, 95% CI 0.03 to 0.26) and motivation to learn (B 0.265, 95% CI 0.13 to 0.41) predicted the students’ grades. Intrinsic motivation was positively associated with grades (B 0.285, 95% CI 0.12 to 0.45), and extrinsic motivation was negatively associated with grades (B-0.213, 95% CI-0.35 to -0.07). Nursing students’ perceived learning outcomes and grades were positively associated. Of the different learning activities, attending digital seminars predicted higher grades. Additionally, attending colloquium groups and being motivated to learn predicted higher grades, while high extrinsic motivation was associated with lower grades.

Evaluation of a prerequisite course of histology implementation for Chinese students of eight-year medical programme: a mixed quantitative survey

BACKGROUND

Due to insufficient basic medical knowledge and inappropriate learning strategies, students of 8-year medical programme encountered many obstacles in the initial stage of basic medicine learning. This study was to determine whether a prerequisite course can improve basic medicine learning performance and adjust learning strategies to adapt to basic medicine learning.

METHODS

A prerequisite course of histology was constructed by a two-round modified Delphi study. Seventy-four students of 8-year medical programme were subjected to two groups: the prerequisite course group (PC group) and non-prerequisite course group (NPC group). The PC group take part in the prerequisite course by student-centred blended learning approach but NPC group not. The PC and NPC group underwent requisite histology teaching activities after prerequisite course. Examination of the prerequisite course and requisite histology course were carried out. Effect of the prerequisite course was evaluated by an empirical method using a questionnaire-based approach.

RESULTS

The results of examinations showed students' scores of the PC group were significantly higher than those of students of NPC group in both prerequisite course and requisite histology examinations (P < 0.05). The results of questionnaires showed that students were satisfied with the prerequisite course, which was beneficial for uptake in medical knowledge, cultivation of clinical thinking and scientific research ability and adaptation in learning strategies (P < 0.01). Furthermore, our prerequisite course is conducive to subsequent courses learning, especially for pathology (P < 0.01).

CONCLUSION

Our prerequisite course could effectively supplement knowledge of basic medicine, improve clinical thinking and scientific research ability and adapt their learning strategies. These findings suggest that the prerequisite course is useful and should be introduced in medical curriculum reform at the early stages of basic medical training.

Reimagining Undergraduate Medical Education in a Post-COVID-19 Landscape

Online education due to the COVID-19 pandemic caused many medical schools to increasingly employ asynchronous and virtual learning that favored student independence and flexibility. At the same time, the COVID-19 pandemic highlighted existing shortcomings of the healthcare field in providing for marginalized and underserved communities. This perspective piece details the authors' opinions as medical students and medical educators on how to leverage the aspects of pandemic medical education to train physicians who can better address these needs.

Evaluating the impact of a flipped classroom model based on cognitive science of learning strategies in a pharmacotherapy course

INTRODUCTION

The purpose of this study was to determine the impact of a flipped classroom method based on cognitive science of learning strategies on student performance and experience in a third-year pharmacotherapy course.

METHODS

The cognitive science of learning flipped classroom (CSL-FC) strategies in this study included pre-class learning (Preview), in-class application to cases (Retrieval), after-class learning (Spaced Retrieval), and post-module reflection (Deliberate Reflection) in a required pharmacotherapy course. During fall 2017, one instructor piloted the CSL-FC method. During fall 2018, this method expanded to four instructors. All other instructors used traditional lecture-based methods. The same multiple-choice exam questions were used both years. The average exam question scores between teaching methods were compared by independent t-test. Student focus groups were conducted after the 2017 semester. In 2018, students were surveyed using a 5-point Likert rating (1 = strongly agree, 5 = strongly disagree) to evaluate their experience.

RESULTS

The 2017 and 2018 classes included 132 and 137 students, respectively. During the two years, exam question scores were significantly better with CSL-FC (n = 136 questions) compared to traditional (n = 110 questions) (88.8% vs 84.9%, respectively; P = .02). The focus group analysis revealed three main themes including a "love-hate relationship," "time," and "it works." Student agreement to the survey question "the cognitive science of learning flipped classroom helped me learn" was 2.18 (SD 1.12).

CONCLUSIONS

Implementing a flipped classroom approach based on cognitive science of learning strategies positively impacted student performance and experience in a pharmacotherapy course.

Breaking barriers: The landscape of human and veterinary medical anatomy education and the potential for collaboration

Despite human (HUM) and veterinary (VET) medical institutions sharing the goal of educating future clinicians, there is little collaboration between them regarding curricular and pedagogical practices during the preclinical/basic science training years. This may be, at least in part, due to a lack of understanding of each type of curriculum. This study presents data about curricula, student populations, pedagogical methodologies applied, and anatomy educators' training at both HUM and VET institutions. Preclinical curricula, admissions criteria, and student demographics were analyzed for 21 institutions in the United States having both HUM and VET schools. This dataset was augmented by a questionnaire sent to anatomists internationally, detailing anatomy curricula, pedagogies applied, and anatomy educators' training. Many curricular similarities between both training programs were identified, including anatomy education experiences. However, VET programs were found to include more preclinical coursework than HUM programs. Students who matriculate to VET or HUM schools have similar academic records, including prerequisite coursework and grade point average. Median HUM class size was significantly larger, and the percentage of women enrolled in VET institutions was significantly higher. Training of anatomy educators was identical with one exception: VET educators are far more likely to hold a clinical degree. This study elucidates the substantial similarities between VET and HUM programs, particularly in anatomy education, underscoring the potential for collaboration between both types of programs in areas such as interprofessional education, bioethics, zoonotic disease management, and postgraduate training.

The flipped classroom is effective for medical students to improve deep tendon reflex examination skills: A mixed-method study

Deep tendon reflexes (DTR) are a prerequisite skill in clinical clerkships. However, many medical students are not confident in their technique and need to be effectively trained. We evaluated the effectiveness of a flipped classroom for teaching DTR skills. We recruited 83 fifth-year medical students who participated in a clinical clerkship at the Department of General Medicine, Chiba University Hospital, from November 2018 to July 2019. They were allocated to the flipped classroom technique (intervention group, n = 39) or the traditional technique instruction group (control group, n = 44). Before procedural teaching, while the intervention group learned about DTR by e-learning, the control group did so face-to-face. A 5-point Likert scale was used to evaluate self-confidence in DTR examination before and after the procedural teaching (1 = no confidence, 5 = confidence). We evaluated the mastery of techniques after procedural teaching using the Direct Observation of Procedural Skills (DOPS). Unpaired t-test was used to analyze the difference between the two groups on the 5-point Likert scale and DOPS. We assessed self-confidence in DTR examination before and after procedural teaching using a free description questionnaire in the two groups. Additionally, in the intervention group, focus group interviews (FGI) (7 groups, n = 39) were conducted to assess the effectiveness of the flipped classroom after procedural teaching. Pre-test self-confidence in the DTR examination was significantly higher in the intervention group than in the control group (2.8 vs. 2.3, P = 0.005). Post-test self-confidence in the DTR examination was not significantly different between the two groups (3.9 vs. 4.1, P = 0.31), and so was mastery (4.3 vs. 4.1, P = 0.68). The questionnaires before the procedural teaching revealed themes common to the two groups, including “lack of knowledge” and “lack of self-confidence.” Themes about prior learning, including “acquisition of knowledge” and “promoting understanding,” were specific in the intervention group. The FGI revealed themes including “application of knowledge,” “improvement in DTR technique,” and “increased self-confidence.” Based on these results, teaching DTR skills to medical students in flipped classrooms improves readiness for learning and increases self-confidence in performing the procedure at a point before procedural teaching.

The Significance of Digital Marketing in Shaping Ecotourism Behaviour through Destination Image

Ecotourism is the most encompassing alternative approach, and it is usually regarded as a panacea capable of combining economic development, environmental protection, and community well-being. Pakistan’s ecotourism industry is relatively new and has significant growth potential, with approximately 6 million domestic and international tourists visiting various northern destinations in 2018. However, as the number of tourists grows, so do the difficulties or obstacles associated with visitor/tourist behaviour, such as pollution, forest cutting, wildlife turmoil, filthy waste/garbage, and forest fire. These potential hazards have become natural environment-harming concerns that occur daily. Prior studies and government policies have emphasised the increasing knowledge and responsibility of ecotourism behaviour among tourists to address the issues. Digital marketing is known as a flashy way to connect with tourists by providing them with diverse tour information and destination images; however, reviews show that a smaller number of previous research in the tourism industry has been involved with digital marketing strategies. They use a quantitative design and Structural Equation Model testing. The guaranteed validity and reliability is an adaptive questionnaire created and tested in pilot research. For data gathering, a multistage sampling method is utilised. This research included 384 tourist respondents from three regions that used digital marketing for their travelling. It was chosen using a random and purposeful sampling process. The study found that destination image is positively connected to ecotourism. The current study employs the Theory of Planned Behaviour (TPB) as a theoretical contribution. The study’s findings suggest that visitors, the government, the tourism industry, and the community may use digital marketing strategies to encourage ecotourism behaviour.

Detecting latent topics and trends in blended learning using LDA topic modeling

With the rapid application of blended learning around the world, a large amount of literature has been accumulated. The analysis of the main research topics and development trends based on a large amount of literature is of great significance. To address this issue, this paper collected abstracts from 3772 eligible papers published between 2003 and 2021 from the Web of Science core collection. Through LDA topic modeling, abstract text content was analyzed, then 7 well-defined research topics were obtained. According to the topic development trends analysis results, the emphasis of topic research shifted from the initial courses about health, medicine, nursing, chemistry and mathematics to learning key elements such as learning outcomes, teacher factors, and presences. Among 7 research topics, the popularity of presences increased significantly, while formative assessment was a rare topic requiring careful intervention. The other five topics had no significant increase or decrease trends, but still accounted for a considerable proportion. Through word cloud analysis technology, the keyword characteristics of each stage and research focus changes of research were obtained. This study provides useful insights and implications for blended learning related research.

A hierarchy of needs for remote undergraduate medical education: lessons from the medical student experience

PURPOSE

The disruption of undergraduate medical education (UME) by the COVID-19 pandemic has sparked rapid, real-time adjustments by medical educators and students. While much is known about online teaching in general, little guidance is available to medical educators on how to adapt courses not originally designed for the online environment. To guide our faculty in this transition we conducted a needs assessment of students enrolled in virtual courses across all 4 years of UME training.

METHODS

Using a mixed-methods approach, we conducted a single-institution virtual learning needs assessment in May and June of 2020. We developed and disseminated a survey to assess student experiences with virtual learning. We conducted quantitative and qualitative analysis of responses (n = 255 or 39%) to identify emergent themes.

RESULTS

We identified six interdependent themes that need to be met for medical students to fully reach their learning potential: access to stable internet and quiet study spaces, flexible course design with asynchronous, self-paced components, clear expectations for engagement with content and each other, a sense of connectedness with faculty and peers, synchronous classes that maximize interactivity, and assessments that foster a sense of learning over performance. Interpersonal relationships with faculty and peers affected students' sense of learning more than any other factor.

CONCLUSIONS

Based on our findings we propose a hierarchy of needs for virtual learning that provides guidance on adapting existing medical school courses to the remote setting and overcoming common challenges. We highlight opportunities for how virtual elements may enrich in-person courses going forward, including in the clinical setting. Although the solutions required to meet the threshold of need at each level may differ based on the context, attending to these same fundamental needs can be extrapolated and applied to learners across a range of environments beyond the virtual.

Social Accountability and Regional Health Priorities in Medical Education

Social accountability in medical education refers to the commitment of medical schools to address priority health concerns of the community. Over a 2-year period, 200 Family Medicine clerkship students ranked the topics most emphasized in the first 2 years of medical school. These rankings did not align with the community health priorities of the region in which the medical school is located. While the basic science and introductory clinical material covered early in medical school is necessary, our data suggest that emphasizing the implications of this foundational curricula for addressing the regions' health priorities is worthy of greater consideration.

Students' perception on flipped classroom in contrast to live demonstration for teaching orthodontic wire-bending skills: A focus group study

OBJECTIVE

This study aimed to explore students' perceptions of flipped classroom (FC) compared to live demonstration (LD) in transferring skills of fabricating orthodontic wire components for orthodontic removable appliances.

METHODS

Forty third-year undergraduate dental students were randomly assigned to two groups: FC (n = 20) and LD (n = 20). Students in group FC attended FC, while students in group LD attended LD. Both groups underwent a series of standardized teaching sessions to acquire skills in fabricating six types of orthodontic wire components. Eight students (four high achievers and four low achievers) from each group were randomly selected to attend separate focus group discussion (FGD) sessions. Students' perceptions on the strengths, weaknesses, and suggestions for improvement on each teaching method were explored. Audio and video recordings of FGD were transcribed and thematically analyzed using NVivo version 12 software.

RESULTS

Promoting personalized learning, improvement in teaching efficacy, inaccuracy of three-dimensional demonstration from online video, and lack of standardization among instructors and video demonstration were among the themes identified. Similarly, lack of standardization among instructors was one of the themes identified for LD, in addition to other themes such as enabling immediate clarification and vantage point affected by seating arrangement and class size.

CONCLUSIONS

In conclusion, FC outperformed LD in fostering personalized learning and improving the efficacy of physical class time. LD was more advantageous than FC in allowing immediate question and answer. However, seating arrangement and class size affected LD in contrast to FC.

"Involve Me and I Learn": Active Learning in a Hybrid Medical Biochemistry First Year Course on an American-Style MD Program in the UAE

Perceived as a subject with abstract jargon, requiring extensive memorization of complex metabolic pathways, chemical structures, and names, students lose sight of the significance of biochemistry on their MD journey (Afshar M, Han Z. Teaching and learning medical biochemistry: Perspectives from a student and an educator. Med Sci Educ. 2014;24:339-41.). A disconnect between what is taught in the classroom and its application to clinical settings arises through over emphasis on the need to pass board exams, documented to be a poor measure of core competencies. Employing active learning strategies with meaningful activities with clinical applications, centered around the curriculum, cognitively engages students and is a deviation from the didactic way in which biochemistry is traditionally taught.

A Phenomenological Study of Educators' Experience After a Year of the COVID-19 Pandemic

This phenomenological study investigated educators' lived experiences of teaching online in higher institutions in Malaysia. Data, which was generated through semi-structured interviews with 20 lecturers from three universities in the country, was analysed based on the thematic analysis approach guided by the Technological, Pedagogical, and Content Knowledge (TPACK)-self-efficacy framework. The findings revealed that after a year of teaching online, the potential of technology has been acknowledged by the educators after some trials and constraints were addressed. The domains related to Technology Content Knowledge (TCK), Technology Pedagogical Knowledge (TPK), and TPACK were evident in the findings. However, Pedagogical Content Knowledge (PCK) was not given emphasis, hence this manuscript argues that educators need to be constantly reminded of the significance of PCK. The findings discussed in this manuscript can be a helpful guide for educators when there is a need for them to teach online.