Flipped Classroom: A Concept for Engaging Medical Students in Learning

Flipped online teaching of histology and embryology with design thinking: design, practice and reflection

BACKGROUND

Flexible hybrid teaching has become the new normal of basic medical education in the postepidemic era. Identifying ways to improve the quality of curriculum teaching and achieve high-level talent training is a complex problem that urgently needs to be solved. Over the course of the past several semesters, the research team has integrated design thinking (DT) into undergraduate teaching to identify, redesign and solve complex problems in achieving curriculum teaching and professional talent training objectives.

METHODS

This study is an observational research. A total of 156 undergraduate stomatology students from Jining Medical University in 2021 were selected to participate in two rounds of online flipped teaching using the design thinking EDIPT (empathy, definition, idea, prototype, and test) method. This approach was applied specifically to the chapters on the respiratory system and female reproductive system. Data collection included student questionnaires, teacher-student interviews, and exam scores. GraphPad Prism software was used for data analysis, and the statistical method was conducted by multiple or unpaired t test.

RESULTS

According to the questionnaire results, the flipped classroom teaching design developed using design thinking methods received strong support from the majority of students, with nearly 80% of students providing feedback that they developed multiple abilities during the study process. The interview results indicated that teachers generally believed that using design thinking methods to understand students' real needs, define teaching problems, and devise instructional design solutions, along with testing and promptly adjusting the effectiveness through teaching practices, played a highly positive role in improving teaching and student learning outcomes. A comparison of exam scores showed a significant improvement in the exam scores of the class of 2021 stomatology students in the flipped teaching chapters compared to the class of 2020 stomatology students, and this difference was statistically significant. However, due to the limitation of the experimental chapter scope, there was no significant difference in the overall course grades.

CONCLUSION

The study explores the application of design thinking in histology and embryology teaching, revealing its positive impact on innovative teaching strategies and students' learning experience in medical education. Online flipped teaching, developed through design thinking, proves to be an effective and flexible method that enhances student engagement and fosters autonomous learning abilities.

Novel teaching-learning and assessment tools to complement competency-based medical education in postgraduate training

Medical and educational techniques and approaches have evolved globally over the past few decades. The modern approach is more learner-centred, with a focus on the acquisition of skills. The recently implemented competency-based medical education (CBME) for the National Medical Commission (NMC) undergraduate course curriculum is also competency-based rather than an outcome-based traditional curriculum. It is vital to embrace innovative teaching-learning and educational strategies to achieve the aspiration of CBME. This article provides a list of some of the newer tools and their perceived advantages and challenges and serves as a guide for using these methods effectively to meet the objectives of CBME as proposed by the NMC. Virtual teaching, learning from digital resources, objective-structured practical and clinical examination, flipped classroom, case-based learning, serious gaming, simulation-based learning and learning from role-plays and portfolios emerged as novel instructional strategies.

Flipped classroom for undergraduate medical students in India: are we ready for it?

The teaching-learning environment has undergone a paradigm shift with the recent implementation of a Competency-Based Medical Curriculum in India. Despite this, the concept of flipped classrooms for medical students is still in its infancy in our country. We conducted an experimental randomized crossover study to find if a flipped teaching model improves learning for first-year medical undergraduate students. Students' perceptions of this novel method were also obtained and analyzed. In the first period (first part of the study), one group of students underwent the flipped model teaching (flipped teaching group), and the second group (traditional teaching group) was taught by the conventional method. A crossover was done with a second topic in the second period. A written test was conducted at the end of each period. Student feedback was also obtained. There was no statistically significant difference in students' performance on comparing traditional and flipped teaching methods. Reasons for this could be the level of the learner, prior exposure to active learning strategies, learner readiness/motivation for active learning, and timing of the study. Out of the participants, 80% of students preferred the flipped model classroom teaching, especially the interactive discussion, and expressed their desire for more frequent similar learning activities. We conclude that there was no difference in marks obtained by students in the two groups, yet they preferred the flipped classroom method, which indicates that it is feasible to adopt this method in the Indian medical undergraduate classroom.NEW & NOTEWORTHY We conducted a study to find if flipped teaching model improves the learning of medical undergraduate students and assess students' perceptions. There was no difference in marks obtained by students taught with either flipped or traditional methods. The reasons for this could be differences in the level of learner, prior exposure, or learner readiness for active learning. Since students prefer the flipped method of classroom teaching, it is feasible to adopt it in the Indian classroom.

Teaching clinical anatomy to medical students by flipped classroom

Background We aimed to introduce the flipped classroom approach for teaching clinical anatomy and to assess its perception and feasibility among medical undergraduate students. Methods Our study included 151 MBBS students of the first professional. We took written informed consent after the study was approved by the Ethics Committee. Selected topics of clinical anatomy were taught using the flipped classroom (FCR) method. It involved pre-class, in-class and post-class activities. In pre-class activity, pre-reading material was given to the students 1 week before the class. An assignment was given 2 days before the class in the form of solving multiple- choice questions, drawing well-labelled diagrams, etc. In- class activity included a pre-test followed by a discussion of the topic in the form of problem-based questions in the class on the principle of Think-Pair-Share. Post-class activity included summarization of the topic by students in the form of a group activity followed by a feedback session. Feedback was collected using a pre-validated feedback questionnaire on Google forms. Data collected were analysed using SPSS 21.0 and Microsoft office 2010. The response to close-ended questions was expressed as percentage. Open-ended questions were analysed by grouping of qualitative responses. Results We found FCR to be a feasible, interesting and necessary pedagogical tool for medical education. Most students (95%) agreed that FCR is a useful technique for better understanding of clinical anatomy. They learnt better from FCR than other teaching methods and their in-depth understanding of the topic improved with FCR. Conclusion FCR is an established teaching-learning tool but it needs to be implemented in undergraduate teaching of clinical anatomy for better understanding of the topics. Didactic lectures do not touch upon clinical correlations in a case-based manner, which can be easily discussed in FCR.

Online Interactive Flipped Classroom Teaching in Pediatrics for Medical Undergraduates

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

A Literature Review of Barriers and Opportunities Presented by Digitally Enhanced Practical Skill Teaching and Learning in Health Science Education

INTRODUCTION

An evidence gap exists identifying the challenges and opportunities presented by digitally enhanced practical skill teaching and learning in health science education. A literature review was carried out to address this gap and to provide recommendations for overcoming identified challenges.

METHOD

A systematic search strategy was carried out using PRISMA guidelines. The research databases PubMed, ERIC, Medline and CINHL, were searched using MeSH terms. Barriers and opportunities were identified through deductive thematic analysis of the included articles.

RESULTS

Of the 602 articles identified through the database screening, 29 were included in the current review. Potential challenges posed by technologically supported practical skill teaching identified were i) Inaccessibility and Inequity of Online Learning (ii) Digital illiteracy Among Staff (iii) Technological Challenges (iv) Lack of Engagement with Preparatory Material Hinders Practical Learning (v) Lack of Staff-Student Interaction (vi) Negative Attitudes Towards Online Learning and (vii) Skill Suitability. The opportunities presented by digital technologies identified were (i) Facilitates Higher Order Learning (ii) Ability to Practice in a Safe Environment (iii) Efficacious Use of Class Time (iv) Access to Education (v) Learning Brought to Life (vi) Diverse Range of Learning Materials (vii) Promotes Autonomous Learning.

DISCUSSION

This literature review demonstrates the acceptability and usability of digitally enhanced practical teaching in health science education among students and educators.

CONCLUSION

To consolidate the positive disturbances in higher education from the Covid-19 pandemic, potential barriers to online delivery and student engagement must be acknowledged and addressed by relevant stakeholders. Recommendations detailed as part of this paper suggest means of overcoming barriers and leveraging opportunities.

An evidence-based roadmap to integrate planetary health education into the medical curriculum

The urgency for action on climate change is regarded as the defining issue of our time. Planetary health education prepares future healthcare professionals to promote the health of the planet, including sustainable healthcare. This has potential benefits for the healthcare system, patients, community, and the environment. However, many educators are not confident in explaining and inspiring students and many deans and educational staff report challenges when integrating planetary health into education. The roadmap presented in this paper uses evidence from medical education literature to support medical schools with implementing this type of education. The roadmap can be used as a guide for educators, university leadership, and policy-makers in the design of planetary health education.

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.

Acquisition of Higher-Order Cognitive Skills (HOCS) Using the Flipped Classroom Model: A Quasi-Experimental Study

Introduction

Flipped classroom refers to a teaching model where the lecture and homework elements of the class are reversed. Students develop knowledge and understanding during the pre-class session, and use the in-class time for active learning such as small group discussions, wherein they are expected to develop the skills of problem-solving (application) and critical thinking (analysis). An educational psychologist, Benjamin Bloom, proposed Bloom’s Taxonomy for the cognitive domain. According to this taxonomy, knowledge, and understanding have been considered to be lower-order cognitive skills (LOCS), while application (problem-solving), analysis (critical thinking), synthesis, and evaluation have been considered higher-order cognitive skills (HOCS). Only one study has reported that flipped classroom approach helps in the acquisition of HOCS such as application, analysis, synthesis, and evaluation. The present study aims to compare the flipped classroom model with the traditional lecture model and focuses particularly on the acquisition of HOCS such as application and analysis, by assessing the students using multiple-choice questions based on clinical vignettes.

Methods

The study was conducted in the Department of Physiology at Government Medical College, Bhavnagar. A total of 102 students in two groups, Group A (n=52) and Group B (n=50), participated in all the phases of the study. In the flipped classroom group, students watched the pre-recorded videos and studied standard textbooks, followed by a group discussion in the class. The traditional Lecture group attended the didactic lecture only. Topic I was taught to Group A using the flipped classroom model and to Group B using the traditional didactic lecture approach. Topic II was taught to Group B by using the flipped classroom method and to Group A using the traditional didactic lecture.

Both groups of students were assessed after a gap of one week with multiple-choice questions based on clinical vignettes for checking the HOCS. These questions were designed based on Blooming Biology Tool (BBT).

The feedback collected responses regarding the learning experience, perceived value of the flipped classroom, the course materials, the teaching process, and the evaluation system.

Results

The students, who participated in the flipped classrooms, performed statistically better than those in the traditional lecture model (5.36 ± 1.69 vs. 4.94 ± 1.34) (p<0.05). The students strongly agreed that the flipped classroom method was an enjoyable way of learning: it enhanced their problem solving and analytical ability as well as developed their ability to work as team members and plan their own work. Students in both the flipped classrooms gave a similar perception indicated by the small effect size (r <0.3).

Conclusion

The pre-class time of the flipped classroom model helps students remember the facts and understand the concepts (both lower-order cognitive skills), and uses the valuable in-class time to master the application of the concepts and critically analyze them (application and analysis being higher-order cognitive skills).

Flipped Classroom versus Traditional Didactic Classroom in Medical Teaching: A Comparative Study

Background

The effective and efficient delivery of healthcare services that the National Medical Commission (NMC), India desires from Indian Medical Graduate (IMG) can only be fulfilled if the learner’s participation is extensive. Flipped classroom (FC) may promote enhanced as well as meaningful learning and critical thinking in students. By implementing this method trend can be changed from a teacher-centered approach to a student-centered approach, thus teaching-learning becomes more effective and interesting. It promotes learning and thinking helping the students in diagnosis and formulating appropriate management of patients during the clinical years of medical teaching of MBBS (Bachelor of Medicine and Bachelor of Surgery) and thereafter.

Aim

To compare FC and traditional didactic classroom (TDC) teaching for first-year MBBS students.

Objectives

-To evaluate FC method teaching for first-year MBBS students.

-To compare effectiveness of FC and TDC teaching for first-year MBBS students.

-To evaluate perception of students toward FC teaching method.

Methodology

The study was conducted after getting approval from the Institutional Ethics Committee. Total of 100 students volunteered to participate in the study after providing informed consent. Two groups based on pseudo randomization were created and subjected to the FC method and TDC method in module A and crossover of groups was done in module B. Both groups were subjected to post-test after intervention in modules. Feedback was obtained from students on their perception toward the FC method.

Results

There was a statistically significant difference (p<0.05) in post-test scores of both FC groups in both modules (FC Method: 14.77 ± 2.16 and 11.26 ± 1.76 vs TDC Method: 12.16 ± 2.05 and 10.03 ± 2.57). Overall positive feedback was received for FC method of teaching compared to TDC method.

Conclusions

Considering responses and results of the assessment, it can be concluded that the FC approach is beneficial for students. It enhances the learning of students. Perception of students toward medical teaching can be greatly improved. It helps students achieve better results in their learning. With larger sample size studies, this result of FC method being a better learning tool will gather more strength.

Analysis of Feasibility and Acceptability of an E-Learning Module in Anatomy

Recent advance in medical education is in correlation with the advances in information technology and thus computer-based learning is being increasingly employed. The objective of the present study was to design and evaluate an e-learning module in anatomy and assess the perceptions of students and faculty about this e-learning module. The participating students were randomized into three groups by block stratified randomization and Google groups were created for each of the three groups. The e-learning module was implemented in three sessions by rotating the three groups. Validated questionnaires were sent to faculty and participating students via Google forms to obtain feedback. The results of ANOVA showed that there was a significant difference among the groups in terms of marks obtained with conventional (F = 2.403, P = 0.103), online (F = 6.050, P = 0.005), and blended (F = 5.801, P = 0.006). Post hoc comparisons using the Tukey HSD test, about the gain of knowledge, indicated that the results were insignificant when comparing the conventional group with the online group, but were significant when comparing the blended group with the conventional and online group. The qualitative data regarding the perception of students toward e-learning were analyzed using thematic analysis. The introduction of an interactive e-learning module in anatomy was effective and well received by the students and faculty. The study showed that blended learning has a positive impact on the students' learning by improving cognitive gain and receptive perception for e-learning.

Enhancing the effectiveness of flipped classroom in health science education: a state-of-the-art review

BACKGROUND

In a flipped classroom, students acquire knowledge before class and deepen and apply this knowledge during class. This way, lower-order learning goals are achieved before class and higher-order skills are reached during class. This study aims to provide an overview of the factors that contribute to the effectiveness of the flipped classroom and how these factors can be stimulated. The effectiveness of the flipped classroom is conceptualized in this study as test scores, the achievement of higher learning goals, and student perceptions.

METHODS

A state-of-the-art review was conducted. The databases MEDLINE, PsycINFO, PubMed, Web of Science, and Scopus were consulted. The timeframe is 2016 till 2020. The studies were qualitatively analyzed according to the grounded theory method.

RESULTS

After screening the studies based on the inclusion-and exclusion criteria, 88 studies were included in this review. The qualitative analysis of these studies revealed six main factors that affect the effectiveness of the flipped classroom: student characteristics, teacher characteristics, implementation, task characteristics, out-of-class activities, and in-class activities. Mediating factors are, amongst other factors, the learner's level of self-regulated learning, teacher's role and motivation, assessment approach, and guidance during self-study by means of prompts or feedback. These factors can be positively stimulated by structuring the learning process and focusing the teacher training on competencies and learning-and teaching approaches that are essential for the flipped classroom.

CONCLUSION

This paper provides insight into the factors that contribute to the effectiveness of the flipped classroom and how these factors could be stimulated. In order to stimulate the effectiveness of the flipped classroom, the positively and negatively affecting factors and mediating factors should be taken into account in the design of the flipped classroom. The interventions mentioned in this paper could also be used to enhance the effectiveness.

Prioritising teaching modalities by extending TOPSIS to single-valued neutrosophic environment

An effective teaching modality not only improves the efficiency of the teaching process but also promotes active learning. Teaching modalities are continuously evolving due to advancement in technology. There is a range of contradictory reports available in the extant literature regarding the effectiveness of different teaching modalities. This work assesses and prioritises four teaching modalities namely face-to-face teaching, pure online teaching, blended teaching and flipped classroom teaching. Assessment is made based on 8 criteria identified from the literature in consultation with the experts. Analysis revealed that the flipped classroom and blended teaching approaches are the most effective teaching modalities. Examination of the literature indicates that to date no study evaluated all the four aforementioned teaching modalities in a single study. The study is the first attempt to assesses 4 teaching modalities based on 8 eight common criteria by extending TOPSIS to a single-valued neutrosophic environment. Current work provides valuable insights to various stakeholders including academicians, policymakers and practitioners, who are interested in giving a rich learning experience to learners.

Greek gods and the double-edged sword of liver regeneration

In the current issue of the Biomedical Journal we gain an insight into the regeneration of liver tissue and how an over-the-counter supplement, stem cells and two plant extracts counteract liver damage. Furthermore the advances against hepatitis C virus are presented, the role of long non-coding RNA elucidated as well as the potential of an adhesion G protein-coupled receptor. In another contribution, the definition and evolutionary impact of copy number variants is clarified. Also, the polymorphism of a scaffolding caspase is investigated. We furthermore learn about the relation between SARS-CoV2 mutants in dependence of geography and explore the challenges of telemedicine in a complex healthcare field. A novel approach to engineering artificial grafts is presented, the challenges of total knee arthroplasty discussed as well as a possible mean of sinus floor elevation for dental implants. At last the concept of flipped classroom is scrutinized in terms of usefulness for a hospital in Taiwan.

Using a Mock Rounds Model and Neurology Patients to Teach Neurological Exam Skills in a Medical Neurobiology Course

First-year medical student groups rotated through classrooms, each containing a Neurology patient and physician, as a "Neuro Day" event to make direct clinical connections with the basic sciences. Inspired by post-graduate Clerkships, this event provided timely first-hand experiences focusing on pathological neurologic exam findings. Qualitative and quantitative data were collected from end-of-course surveys. The results show how the event served to reinvigorate enthusiasm for learning Clinical Neurobiology outside the traditional lecture environment and could empower patients as educators within a teaching community.

Evaluation of students' performance and engagement using post-laboratory integrated assessments within a pharmacy course in the United Kingdom: a pilot cohort cross-over study

INTRODUCTION

This pilot study investigated the impact of practice integrated, post-laboratory assessment on the scientific education and attitudes of first-year pharmacy students. Median assessment performance, achievement of full marks, and engagement in laboratory classes were evaluated.

METHODS

The pilot randomised cross-over study was conducted at the University of Central Lancashire. Students were randomly assigned to two groups, and after undertaking four identical pharmaceutics laboratory classes, answered two science-based questions that were either integrated with practice using a contextualizing scenario or had no integration. Student performance and engagement were subsequently analysed.

RESULTS

Thirty students completed the study. Students performed better in the integrated assessment (median 3.5; interquartile range [IQR] 2.00-4.00) compared to the non-integrated assessment (median 2; IQR 1.75-3.00) (P < .001). Twenty-five students (83%) achieved full marks with the integrated assessment (P = .006). Correlation (R²) for the integrated assessment was 0.90 and for the non-integrated assessment was 0.12. Engagement was positive in both groups but significantly improved in the domains of "instructor contribution" and "value of activity" (P = .01) when receiving the integrated assessment.

CONCLUSIONS

Integrated and contextualized assessment of science teaching as a lone intervention increased pharmacy students' performance and engagement in laboratory classes without requiring any change to the teaching session itself.

Interactive Large Group Lecture Demonstrations: Dramatization of Medical Neurobiology Concepts to Improve Student Perception of Understanding Fluid Mechanisms of the Central Nervous System

With the advent of recorded lectures, face-to-face teaching in medical school large classroom settings is increasingly under pressure to incorporate engaging activities that encourage attendance and can translate to greater attainment and long-term retention for learners, especially of "Generation Z" learning styles. This places a greater onus on lecturers to convey key concepts in a manner that holds value beyond their recorded substitute. The present article details several on-stage Medical Gross Anatomy and Neurobiology demonstrations that involve the teaching of an intuitive understanding of brain fluidic mechanics, such as hematoma formation and the protective functions of an intact cerebral spinal fluid system (addressing concussion and lumbar punctures). These demonstrations can be presented relatively quickly on stage and are suitable for engaging large classroom sizes (n > 100), which can be used in conjunction with traditional lecture formats. Ideally, these in-class demonstrations, together with the continued contributions of other quantitatively assessed demonstrations from other institutions, will help to maintain a growing body of large class face-to-face teaching approaches and strategies to help influence decisions regarding what basic medical knowledge may best be taught in class live versus by recorded substitute or other non-traditional lecture methods.

Medical Education During the COVID-19 Pandemic: A Single Institution Experience

Social distancing to curb the COVID-19 pandemic has caused suspension of classroom teaching in all educational institutions. We implemented a novel online classroom platform at our institute to continue medical education. The program attracted encouraging feedback from the students. It may serve as a model for uninterrupted teaching and training during times of crisis.

Effect of flipped teaching on student performance and perceptions in an Introductory Physiology course

Flipped teaching (FT) has caught educators' attention due to its success in engaging students through pre- and in-class activities. To learn if FT improved student performance, scores from the quizzes and exams of a fully flipped classroom with retrieval exercises were compared with those of five semesters of traditional lecture-based [unflipped (UF)] teaching in an undergraduate sophomore-level physiology course. Student attitude surveys were also evaluated. Student performance on both the quizzes and exams was significantly higher in the FT class in general compared with that of the UF teaching. Interestingly, however, when the individual exam scores were compared between the two styles, the scores for students in the FT were significantly higher for exams 2 and 3, yet lower for exam 1. The shift in performance from exam 1 to exams 2 and 3 is likely explained by the need for time to adjust to the new teaching style. Students reported an overall positive perception of FT in their course evaluations at the end of the semester. In conclusion, FT improved student performance compared with that of lecture-based traditional teaching practice, but required some time to adjust in the beginning of the semester.