Flipping the Classroom in Health Care Higher Education: A Systematic Review

Effectiveness of the flipped classroom method using clinical scenarios and Educational Technology versus Subject-Based Lectures in a gastrointestinal physiology course for medical students

BACKGROUND

Medical education is evolving towards more practical, active, effective, and student-centered approaches that address the limitations of traditional lecture methods. Recently, the flipped classroom method has been considered to support these reforms. However, research on the use of flipped classroom methods in medical education, particularly related to clinical scenarios and educational technology, is still in its early stages. This study aims to evaluate the effectiveness of the flipped classroom method using clinical scenarios and educational technology versus subject-based lectures in the course of gastrointestinal physiology for medical students.

METHODS

A total of 60 medical students participated in this study. The control group (n = 30) received traditional subject-based lectures and participated in question-and-answer sessions. The intervention group (n = 30) received non-attendance educational content and participated in small group discussions based on clinical scenarios. Course satisfaction was measured using an 18-item questionnaire, and learning outcomes were assessed with a 20-question multiple-choice test, corresponding to levels 1 and 2 of Kirkpatrick's model. Data were analyzed using descriptive and analytical statistical tests with SPSS software version 24.

RESULTS

The findings indicated that the post-test scores in the intervention group were significantly higher compared to the control group. However, according to the student satisfaction questionnaire, satisfaction was significantly lower in the intervention group compared to the control group.

CONCLUSION

This study demonstrated that the flipped classroom method, compared to traditional lectures, improved the learning and performance of medical students at Hamadan University of Medical Sciences in the course of gastrointestinal physiology.

The Power of Metaphor: Learning Space and Faculty Development

Background

Education in the health sciences is transitioning to a student-centered approach that has impacted all components of educational institutions: classroom design, faculty training, selection of learners and faculty.

Activity

Using metaphor analyses, this study investigates the effects on instructor beliefs and values about teaching by having a series of professional development workshops in either a traditional lecture hall or in a collaborative/engaged learning-designed classroom. At the conclusion of the series, both sets of participants were invited to make a free-hand drawing of their "conception" of teaching and label the drawing that represents the conception. Drawings and metaphors were analyzed by non-study raters, and all metaphors were categorized into one of three domains: teacher-centered, learner-centered, learner-driven.

Results

Faculty who completed the series inside a collaborative learning classroom perceived their roles primarily in the learner-centered domains 37 (59.67%), whereas those that completed it in the lecture hall perceived their roles as primarily teacher-centered 62 (84.93%).

Discussion

The authors discuss the implications for faculty development during this transition.

Blended learning in nursing pharmacology: elevating cognitive skills, engagement and academic outcomes

Pharmacological education is crucial for healthcare professionals to safely manage medications and reduce errors. Traditional lecture-based learning (LBL) often struggles to address this complexity, whereas newer methods, such as flipped classrooms and problem-based learning, yield mixed results, particularly in pre-clinical contexts, owing to students' limited experience. Our nursing pharmacology course under LBL recorded a high failure rate of 37.8% and marginal passing scores across five cohorts (n = 849 students). An analysis using Bloom's taxonomy revealed significant gaps in higher-order cognitive skills. As a remedy, the course was transformed into a novel blended learning format that integrated question-based learning (QBL) to enhance critical thinking across all cognitive levels. This model blends asynchronous and synchronous learning, is tailored to individual needs in large classes, and fosters continuous, student-centric learning. The redesign markedly decreased the failure rate by approximately 2.8-fold and increased the average grade by 11.8 points among 426 students. It notably improved the pass rates in advanced cognitive categories, such as "Evaluate" and "Create" by 19.0% and 24.2%, respectively. Additionally, the blended course showed increased student engagement, reflecting a dynamic and effective learning environment that significantly elevated participation and academic outcomes at all cognitive levels. This study demonstrated the profound impact of blended learning in pharmacology. By integrating QBL with various teaching methods, it surpasses traditional lecture-based limitations, enhancing engagement and understanding of complex topics by nursing students. Notable improvements in foundational and advanced learning suggest its broader application in health professionals' education, effectively equipping students for clinical pharmacology challenges.

Development of a flipped learning course to deliver and scale molecular variant evaluation education: A quality improvement initiative

Over the past several decades, molecular genetic testing volumes have grown and testing has expanded from single-gene assays to multigene panels, exome sequencing, and genome sequencing. The number of molecular genetic variants that require manual interpretation has grown simultaneously, resulting in an increased demand for education on molecular variant evaluation (MVE). To meet this growing need, a team of genetic counselors and educational experts undertook a quality improvement (QI) initiative with the objectives of assessing, standardizing, and scaling access to MVE education, without increasing instructor time to deliver the education. Using the Six Sigma define-measure-analyze-improve-control (DMAIC) framework, a flipped learning course with a series of standardized online modules was developed to deliver MVE education in an enduring and accessible format for a diverse group of learners. Outcome measures included the number of online modules developed, the number of individual learners and unique learner groups accessing MVE education, and direct instruction time required to deliver MVE education. Countermeasures to ensure maintenance of educational quality included post-course learner satisfaction scores and performance on competency assessments. Both the total number of learners and the number of unique learner groups accessing MVE education increased, while instructor time required to deliver content per learner decreased. Learner satisfaction scores remained constant and performance on competency assessments improved. The QI initiative successfully scaled MVE education to a diverse group of learners without decreasing learner outcomes or satisfaction. The flipped learning format provides a scalable and flexible educational model for instructors and learners in a rapidly changing environment that often includes remote work and education.

Emergency medicine education via the micro-course and flipped classroom-reform of medical education during the COVID-19 pandemic

The "micro-course" and "flipped classroom" are emerging tools for medical education but little is known about their utility for emergency medicine teaching. The suitability of the micro-course combined with flipped classroom is investigated for delivery of an emergency medicine course in West Anhui Health Vocational College. Students from Class A and Class B of the Clinical Department of West Anhui Health Vocational College, Grade 2000, were assigned to experimental (micro-course plus flipped classroom, n = 102) and control (traditional, didactic teaching, n = 104) groups, respectively. The effectiveness of teaching was assessed by theoretical tests and questionnaires at the end of the course. Theory test results were significantly better for the experimental group than for controls (t = 3.122, P < .01). General satisfaction of students who had participated in the micro-course plus flipped classroom exceeded that of those who had received traditional teaching. Enthusiasm, efficiency, and learning facility was self-reported to be enhanced by students in the experimental group relative to controls. Use of the micro-course combined with flipped classroom successfully increased the outcome of emergency medicine teaching and may be considered as an approach to reform emergency medicine teaching in medical colleges and universities.

Flipped Classroom Case Learning vs Traditional Lecture-Based Learning in Medical School Ophthalmology Education: A Randomized Trial

PURPOSE

To address the problem of teaching noncore specialties, for which there is often limited teaching time and low student engagement, a flipped classroom case learning (FCCL) module was designed and implemented in a compulsory 5-day ophthalmology rotation for undergraduate medical students. The module consisted of a flipped classroom, online gamified clinical cases, and case-based learning.

METHOD

Final-year medical students in a 5-day ophthalmology rotation were randomized to the FCCL or a traditional lecture-based (TLB) module. The outcomes of subjective assessments (student-rated anonymous Likert scale questionnaire, scale 1 to 5, and course and teaching evaluation, scale 1 to 6) and objective assessments (end-of-rotation and post-MBChB multiple-choice questions, scale 0 to 60) were compared between the 2 groups.

RESULTS

Between May 2021 and June 2022, 216 students (108 in each group) completed the study. Compared with the TLB students, the students in the FCCL group rated various aspects of the course statistically significantly higher, including feeling more enthusiastic and engaged by the course and more encouraged to ask questions and participate in discussions (all P < .001). They also gave higher ratings for the instructional methods, course assignments, course outcomes, and course workload ( P < .001). They gave higher course and teaching evaluation scores to the tutors (5.7 ± 0.6 vs 5.0 ± 1.0, P < .001). The FCCL group scored higher than the TLB group on the end-of-rotation multiple-choice questions (53.6 ± 3.1 vs 51.8 ± 2.8, P < .001). When 32 FCCL students and 36 TLB students were reassessed approximately 20 weeks after the rotation, the FCCL group scored higher (40.3 ± 9.1) than the TLB group (34.3 ± 10.9, P = .018).

CONCLUSIONS

Applying the FCCL module in ophthalmology teaching enhanced medical students' satisfaction, examination performance, and knowledge retention. A similar model may be suitable for other specialties.

Team-based learning complemented by interactive response system: Application of a strategy on the course of human growth and development for nursing students

OBJECTIVE

Lecture-based learning (LBL) strategy cannot stimulate learners' ability to think and learn independently. Recently team-based learning (TBL), a learner-centered strategy, gained popularity in health education. An interactive response system (IRS) assists educators in providing instant feedback on classroom activities. This study was to evaluate the TBL strategy supplemented by IRS (TBL/IRS) on the learning effects of the core course, the human growth and development (HGD), in nursing education.

MATERIALS AND METHODS

A quasi-experimental study design with two-group, pretests and posttests was employed with year-one students enrolled in two HGD classes in the nursing department of a university in central Taiwan. Both HGD classes employed the LBL method at the beginning of a semester. TBL/IRS strategy was introduced to the experimental class 6 weeks later. Three scales were used to measure self-directed learning, classroom engagement, and team learning. Individual and group readiness assurance tests (IRATs and GRATs) were administered. Final exams were also compared between the groups. For thematic analysis, learners' experience with TBL/IRS was collected from learner reports and a semi-structured questionnaire designed for the study.

RESULTS

A total of 105 learners-48 in TBL/IRS and 55 in LBL-were recruited. Self-directed learning, classroom engagement and team learning were improved significantly in TBL/IRS whereas only self-directed learning was improved in LBL. In the TBL/IRS group, GRAT scores were significantly higher than IRAT. However, the difference in final exams between the groups was non-significant. Four themes emerged from learners' experiences with TBL/IRS: stimulate self-learning; a diverse and flexible learning method; promote high-level thinking and deepen learning results; and, cultivate teamwork and application.

CONCLUSIONS

This study confirmed that TBL/IRS was effective in enhancing learners' abilities to integrate concepts and skills, thereby cultivating competence in problem-solving and teamwork. The TBL/IRS strategy was cost-effective in promoting active learning of HGD in nursing students.

Flipped Classroom to Facilitate Deeper Learning in Veterinary Undergraduate Students: An Educational Change Pilot Study Limited to the Imaging Module Bones

In a flipped classroom, learners study at home and do the 'homework' in class. This approach respects the limitations of memory and allows more interaction between learners. The overall vision is self-paced activities for learners with decreased boredom and greater task value, which should facilitate deeper learning. To implement a flipped classroom, a bumpy incremental change process characterized by periods of relative stillness punctuated by the acceleration of pace was planned. All veterinary undergraduate students used an existing eLearning platform to access relevant text and selected image examples before class. Only for the randomly selected students in the flipped classroom (FC) was this content amended with purposeful audio content and concrete tasks. Further, FC learners discussed their opinions in an online class forum. To measure the educational change, a pre- and post-class formative test and a standardized questionnaire for students in the FC versus in the traditional classroom (TC) were performed. To assess engagement, students were invited to measure all learning activities, categorized into attendance, or self-study. The educational change project resulted in more commitment and less resistance from teachers. The FC consisted of 20 students, while the TC had 40. The mean pre-class scores difference between FC students and TC students was +1.7/20 points, and the mean post-class scores difference was +3/20 points. The chance of answering item 10 of the formative test (describe site of the fracture) correctly was about seven times higher for FC compared to TC learners (OR = 6.96; p = 0.002). The questionnaire revealed more satisfaction and greater task value in the FC compared to TC (p = 0.048). FC students invested 21 h into the course on average, while TC students invested 16 h. The results of this pilot agree with previous reports: A transparent process was helpful to initiate mainly positive interactions between teachers and students. Higher scores, higher chance to give the correct answer, greater task value, and more positive emotions are observed in the FC compared to the TC. Higher measures of learning time are not expected to affect exam results but indicate more engagement.

Tutorials in anatomy education of medical students during the COVID-19 pandemic - An evaluation of its effectiveness

Anatomy has traditionally been taught through prosected specimens and the use of models and other techniques. During the COVID-19 period, this was replaced by tutorials, where students came to college to continue taking practical sessions. The study comprised four components. The first component consisted of demographic data. The second component consisted of questions concerning students' satisfaction with the tutorials. The third component included questions for Year 2 medical students only because they had tried both the new and old systems. The fourth component included the results for the Year 2 medical students. The study included 102 medical students. The number of tutorials each week and the duration of each tutorial were considered successful, since 47 (46.1%) and 44 (43.1%) students approved, respectively. The students were comfortable with understanding the information from PowerPoint presentations; 41 (40.2%) agreed with this statement. Moreover, 44 students (43.1%) agreed about the ability to recall material after the tutorial and the interaction it allowed them with the doctors. Overall, all the questions proved that the tutorials were of great value to the students during the COVID-19 period. Although COVID-19 limited anatomy teaching, tutorials were seen as a light at the end of the tunnel pending the end of the COVID-19 period.

Development and evaluation of an efficient training program to facilitate the adoption of a novel neurorehabilitation device

Many rehabilitation devices are not adopted by therapists in practice. One major barrier is therapists' limited time and resources to get training. The objective of this study was to develop/evaluate an efficient training program for a novel rehabilitation device. The program was developed based on structured interviews with seven therapists for training preference and composed of asynchronous and in-person trainings following efficient teaching methods. The training program was evaluated for six occupational therapy doctoral students and six licensed therapists in neurorehabilitation practice. Training effectiveness was evaluated in a simulated treatment session in which 3 trainees shifted their roles among therapist applying the device, client, and peer assessor. In results, 11 of the 12 trainees passed the assessment of using the device in simulated treatment sessions. One trainee did not pass because s/he did not plug in the device to charge at the end. The in-person training fit within 1-h lunch break. All trainees perceived that they could effectively use the device in their practice and both asynchronous and in-person training easily fit into their schedule. This project serves as an example for development of an efficient and effective training program for a novel rehabilitation device to facilitate clinical adoption.

Digital learning designs in occupational therapy education: a scoping review

BACKGROUND

Digital learning is a rapidly advancing method for teaching and learning in professional health education. Although various digital learning designs have been tried in OT education, studies on digital learning designs are still limited.

METHODS

We conducted a scoping study that aimed to identify the digital learning designs used in occupational therapy (OT) education and review the effectiveness, learner perceptions, clinical skills integrated, and technology-based learning strategies used to facilitate learning. Four databases were searched using subheadings and terms relating to digital learning, occupational therapy, and education. The included studies were mapped according to the types of digital learning design, subjects, key clinical skills, and outcomes.

RESULTS

Twenty-two studies were included in this review, most of which were qualitative, observational, or mixed studies of the two designs. The digital learning designs identified in OT education were flipped, blended, hybrid, and distance learning, including e-learning and massive open online courses (MOOC). Among the components of clinical skills, professional reasoning and procedural knowledge were the most integrated into digital learning, and covered various OT subjects. Digital learning designs were reported to be equivalent to or more effective than the traditional face-to-face (F2F) class in learning outcomes of knowledge and skill acquisition, enhancing learning participation, reflection, and collaboration between learners. Various technologies have been used to promote synchronous or asynchronous active learning, providing learning strategies such as thinking, reflection, discussion, peer learning-group activity, and gamifying online learning.

CONCLUSIONS

In OT digital learning, appropriate learning subjects, the arrangement of clinical skill components that can be well integrated into digital learning, and the selection of appropriate technologies for effective learning are important. The results should be confirmed within an experimental study design.

Preparing for Next Generation NCLEX ® Through Team-Based Learning: Student Perspectives

ABSTRACT

The Next Generation NCLEX ® requires higher levels of understanding for new registered nurses to practice safely. Team-based learning (TBL) offers a rigorous but pragmatic approach to achieve that aim. TBL employs collaborative strategies for structured problem-solving, a key focus of contemporary nurse educators. In this prospective study, a faculty team at a second-degree, accelerated baccalaureate nursing program within the southeast United States evaluated student perspectives of TBL. Overall findings revealed positive student experiences ( n = 30, with three students on an alternate plan of study) in all aspects of the method.

Acceptance of a flipped classroom to improve university students' learning: An empirical study on the TAM model and the unified theory of acceptance and use of technology (UTAUT)

Higher education has given the flipped classroom a lot of attention as a result of its pedagogical success. As a result of the adoption of social media, smartphones, and computers in the classroom, new strategies for providing online courses, such as flipped classrooms, have evolved. To further understand the effects of such technology integration in teaching, the study looked at the responses of 213 undergraduate students at King Faisal University. For a semester, participants took their regular classes in a flipped classroom. The participants answered a survey made expressly for this study to find out if they would still be willing to use flipped classes following this experience. A structural equation modeling approach was used to analyze the research paradigm, which is based on the technological adoption model. The findings demonstrated that each variable category had a favorable influence on perceived usefulness and perceived ease of use. Perceived utility and ease of use serve as mediating elements in the relationship between independent variables and attitudes toward adopting flipped classrooms. Additionally, the findings indicated that ATFC and BIFC have a positive influence on the acceptance of flipped classrooms. In terms of education and learning, the utilization of classroom instruction is positively impacted by both ATFC and BIFC. These findings show that attitudes toward blended learning and intentions to use flipped classrooms have the biggest impacts on the adoption of the concept in Saudi Arabia higher education.

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

Background

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

Methods

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

Results

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

Conclusions

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

Trial registration.

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

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

OBJECTIVE

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

STUDY DESIGN

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

RESULTS

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

CONCLUSIONS

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

Multidisciplinary Student Groups Support Digital Education as a Public Health Precautional Action to Prevent Spread of COVID-19 Infection: A Mixed Methods Study

Background

Health personnel had greater odds of contracting COVID-19 during its first wave in Norway, compared with all working-age individuals. Students in health care, but also in social care and teacher education programs may be exposed to the risk of being infected themselves and to infect others through their mandatory practical training. Online education may reduce their risk of becoming patients and spreaders both in their private lives and during their mandatory training.

Aim

To explore the extent to which unvaccinated professional students fear transmission of SARS-CoV-2 from fellow students and from public transportation during the third wave.

Materials and Methods

In this cross-sectional study, 3148 students in health care, social care, and teacher education programs and 32 supervisors completed online questionnaires consisting of open and closed questions (mixed methods) after participating in digital interprofessional learning (IPL) small-group seminars (49.6% and 65% response rates, respectively). On a 6-point Likert scale (0–5), all means concerning fear were around 3, with overlapping confidence intervals. Fear of infecting high-risk individuals seemed higher than fear of contracting the virus themselves. High levels of loyalty to and trust in state and health authorities were expressed. Medical-related terminology was frequently used, such as the one-meter distance rule, infection tracking, national guidelines, and hand sanitizer, which implies high levels of health literacy. They expressed strong support for online course delivery (mean 4.5) ahead of practical training as a precautionary public health action.

Conclusion

These students did not have high levels of fear of contracting the virus from other students or public transport. They expressed a higher fear of infecting others than being infected themselves. The major implication for the public and the educational system is that students, even in a country with low death rates, support digital education as a public health precautional action to prevent the spread of infection.

Study on the Reporting Quality of Randomized Controlled Trials of Flipped Classroom in Medical Education

BACKGROUND

With the deepening of medical education reform, the flipped classroom has become a commonly used teaching method. Many randomized controlled trials (RCTs) have shown that flipped classroom combined with problem-based learning (PBL) improves many students' abilities. It remains unclear whether the design and reports of these RCTs comply with specifications. The aim of this study was to provide a systematic assessment of the quality of RCTs investigating the effectiveness of flipped classroom teaching in medical education.

METHOD

Two investigators searched PUBMED and EMBASE and analyzed 15 filtered RCTs addressing flipped classroom in medical education, published between January 1, 2016 and December 31, 2021. The overall reporting quality was assessed using the overall quality score (OQS) according to the 2010 CONSORT statement.

RESULTS

The search revealed 15 RCTs closely related to flipped classrooms. After analysis, it appeared that least half of them made no mention of half of the OQS items in the CONSORT 2010 statement. Since the flipped classroom is an emerging teaching method, all the retrieved articles were published after 2016. Furthermore, a number of issues that we considered very important were not adequately addressed in the RCT reports.

DISCUSSION

Although the CONSORT 2010 statement was issued 12 years ago, the quality and content of many RCTs are not satisfactory. Our findings suggest that authors need to make more effort to meet the CONSORT statement requirements. This article is protected by copyright. All rights reserved.

Creating IoT-Enriched Learner-Centered Environments in Sports Science Higher Education during the Pandemic

In the pandemic context, creating IoT-enriched learner-centered environments was not only a tendency but a requirement for sustainable teaching and learning in universities with sports science programs for theoretical classes and practical activities. Our study aims to assess both the extent to which the sports science academic environment has been prepared for online teaching and the key features of dedicated e-learning teaching and training in sports science to provide the highest-quality educational services in pandemic conditions. An online survey was administered to academic staff in the field of sports science from two Romanian universities. The results of the study reveal that online teaching has been associated with major changes in terms of methods and methodology, but also with a new dynamic of external and internal factors regarding teachers and their relationship with students. At the same time, it depends on a solid specific infrastructure and IoT facilities (MOOCs, VR/AR, mobile devices). As a mirror of the student-centered approach, universities in the field of sports science have experienced the same concerns about the outcomes of the educational process. In this regard, universities can become sustainable if they positively integrate e-learning into their teaching system and consolidate their quality standards from an e-learning perspective.

SAGES Reimagining Education & Learning (REAL) project

BACKGROUND

The COVID-19 pandemic has presented multiple challenges for health systems throughout the world. The clinical priorities of redirecting personnel and resources to provide the necessary beds, care, and staff to handle the initial waves of infected individuals, and the drive to develop an effective vaccine, were the most visible and rightly took precedent. However, the spread of the COVID-19 virus also led to less apparent but equally challenging impediments for healthcare professionals. Continuing professional development (CPD) for physicians and surgeons practically ceased as national societies postponed or canceled annual meetings and activities. The traditional in-person conferences were no longer viable options during a pandemic in which social distancing and minimization of contacts was the emerging norm. Like other organizations, The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) had to first postpone and then cancel altogether the in-person 2020 Annual Meeting due to the contingencies brought about by the COVID-19 pandemic. As a result, the traditional hands-on (HO) courses that typically occur as part of the Annual Meeting, could not take place. SAGES had already begun to re-structure these courses in an effort to increase their effectiveness (Dort, Trickey, Paige, Schwarz, Dunkin in Surg Endosc 33(9):3062-3068, 2019; Dort et al. in Surg Endosc 32(11):4491-4497, 2018; Dort, Trickey, Schwarz, Paige in Surg Endosc 33(9):3062-3068, 2019). The cancelations brought about by COVID-19 provided an opportunity to refine and to innovate further.

METHODS

In this manner, the Re-imaging Education & Learning (REAL) project crystallized, an innovative effort to leverage the latest educational concepts as well as communication and simulation-based technologies to enhance procedural adoption by converting HO courses to a virtual format.

RESULTS AND CONCLUSION

This manuscript describes the key components of REAL, reviewing the restructuring of the HO courses before and after the spread of COVID-19, describing the educational framework underlying it, discussing currently available technologies and materials, and evaluating the advantages of such a format.

Flipping the classroom: An innovative approach to graduate nursing education

Nurse educators must be prepared to adopt innovative, evidence-based teaching approaches that, like the flipped learning method, improve student learning outcomes and better prepare the nursing workforce of the future. The purpose of this paper is to provide a comprehensive plan and resources for faculty to transition a graduate nursing course from traditional lecture-based teaching to flipped learning. The flipped learning approach was fully implemented with 24 graduate nursing students in a primary care family nurse practitioner course. The process of transitioning from traditional lecture-based teaching to flipped learning is presented, including a detailed explanation of how flipped learning class sessions were facilitated. Nurse practitioner students who participated in the flipped learning course found that this method fostered engagement with the course content and improved students' confidence in their ability to apply knowledge and skills in clinical practice. The flipped learning method has the potential to increase active learning and student engagement, integration of classroom and clinical knowledge, and application of knowledge from the classroom to nursing practice.

Flipped classrooms in higher education during the COVID-19 pandemic: findings and future research recommendations

Flipped classroom (FC) approaches have gotten substantial attention in the last decade because they have a potential to stimulate student engagement as well as active and collaborative learning. The FC is generally defined as a strategy that flips the traditional education setting, i.e., the information transmission component of a traditional face-to-face lecture is moved out of class time. The FC relies on technology and is therefore suitable for online or blended learning, which were predominant forms of learning during the COVID-19 pandemic (March 2020-July 2021). In this paper we present a systematic literature review (SLR) of studies that covered online FC approaches in higher education during the pandemic. We analyzed 205 publications in total and 18 in detail. Our research questions were related to the main findings about the success of implementation of online FC and recommendations for future research. The findings indicated that those who had used FC approaches in face-to-face or blended learning environments more successfully continued to use them in online environments than those who had not used it before. The SLR opened possible questions for future research, such as the effectiveness of the FC for different courses and contexts, the cognitive and emotional aspects of student engagement, and students' data protection. It pointed to the need to examine different aspects of online delivery of the FC more comprehensively, and with more research rigor.

A Gap Between Children's Rights and Curricular Content in Health, Social Care, and Teacher Education Programs: An Exploratory Cross-Sectional Study

INTRODUCTION

Exposure to child maltreatment is a social and public health challenge that will require interprofessional collaboration to overcome. Evidence indicates that professional students in health, social care, and teacher education programs receive inadequate training in recognizing and responding to child maltreatment. The aims are to 1) assess the extent to which these students found that their uniprofessional education and a large-scale interprofessional learning (IPL) course had taught them about children in general, children's rights, and vulnerable/at-risk children; and 2) explore differences in student responses according to age and educational background.

METHODS

A cross-sectional study. Students (n=2811) completed questionnaires prior to or after IPL courses held in 2019 and 2020 (hybrid case-based, small-group, on-campus courses targeting children, young people, and their families as end users).

FINDINGS

The majority (>90%) agreed that it was important to learn about child-related topics. Only 4.3% disagreed that it was important to learn about vulnerable/at-risk children. Health and social care students enhanced their insight into all the child-related topics (p<0.001) after the IPL course. Teacher education and child welfare students reported decreased insight into children in general (p<0.001 in 2019 and p=0.008 in 2020) but increased insight into vulnerable/at-risk children in 2020 (p=0.001). According to stratified analyses, there was a significantly increased insight into all child-related topics among physiotherapy and Mensendieck physiotherapy students (p<0.001), decreased insight into children in general among teacher education students (p<0.02), and increased insight into vulnerable/at-risk children among teacher education students (p ≤ 0.001) in both 2019 and 2020. Age was of minor importance. The response rates ranged from 16.0% to 36.0%.

CONCLUSION

After the IPL course, the health and social care students significantly enhanced their insight into child-related topics, whereas the students in teacher education and child welfare gained increased insight into vulnerable/at-risk children.

Children as Next of Kin in Higher Education: An Exploratory Cross-Sectional Study Among Health, Social Care, and Teacher Education Programs

INTRODUCTION

Children who are "next of kin" (ie, sick/dying/addicted/imprisoned close relatives) are at increased risk for health consequences. Health professionals in Norway are required by law to help such children, and professional educations should focus on this issue.

AIM

To assess the extent to which students attending health, social care, and teacher education felt their uni-professional education and a mandatory interprofessional learning (IPL) course had taught them about children as next of kin. To explore variations in student responses according to age and educational background.

METHODS

This was a cross-sectional study. Students (n = 2811) completed questionnaires relating to IPL courses delivered in 2019 and 2020 (hybrid case-based learning). Students discussed issues relating to interprofessional collaboration targeting children, young people and their families in small IPL groups.

FINDINGS

The response rates ranged from 25.8% to 36.0%. All but 5.2% of the students agreed that it was important to learn about children as next of kin. Although 61.9% reported that their education had not taught about such children, 73.8% had gained increased insight from the IPL course (difference 35.7% 95% CI (29.0; 42.0), p < 0.001). The teacher and child welfare students had gained greater insight than the health and social care students. Significant pre- to post-course increases were found among the physiotherapy (p < 0.001), Mensendieck physiotherapy (p < 0.001), teacher education (p < 0.001), early childhood education (p < 0.001), and teacher education in art and design (p = 0.042) students.

CONCLUSION

Nearly 2/3 reported that they had not been taught about children as next of kin at their own educations, but more than 2/3 had gained greater insight from the IPL course. The health and social care students reported the least gain. Although the law has existed for a decade, the topic of children as next of kin is still omitted from most educational programs.

Useful Teaching Strategies in STEMM (Science, Technology, Engineering, Mathematics, and Medicine) Education during the COVID-19 Pandemic

The impacts of the COVID-19 pandemic throughout the world continue. These impacts influence many aspects of life, work, healthcare, and education in the U.S., which are drastically affected by the COVID-19 pandemic. Thus, a considerable challenge to tertiary-level education has been how to adapt our teaching styles and modalities to keep all stakeholders (students, faculty, teaching assistants, and staff) safe in lectures and labs. This viewpoint presents 15 teaching lessons and tips for undergraduate and graduate STEMM (Science, Technology, Engineering, Mathematics, and Medicine) education for face-to-face, hybrid, and distance learning. The goal was to describe teaching strategies that could be adaptable to most STEMM courses, independent of the classroom size, which is valuable for those educational settings capable of migrating from a classroom to either a hybrid or strictly online teaching environment. Although some of these teaching tips were straightforward, we believe collectively that they (1) provide safety and stability to the students and the instructors; (2) help to improve communications between faculty and students that the pandemic had strained; (3) strengthen student attention; (4) facilitate the transition from the classroom to online teaching; (5) enable the use of new technologies; and (6) offer teaching practices we imagined for educational scenarios post-SARS-CoV-2. Finally, we hope these teaching strategies offer valuable insight as we continue to navigate STEMM education during the ongoing COVID-19 pandemic.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Using the Four Pillars of FLIP to Implement Flipped Learning in an Undergraduate Nursing Research and Evidence-Based Practice Course

ABSTRACT

Nurse faculty teaching undergraduate nursing research and evidence-based practice are challenged to find creative and engaging instructional strategies that have positive learning outcomes. Utilizing the Flipped Learning Network's Four Pillars of FLIP, an undergraduate nursing research and evidence-based practice course for an accelerated nursing program was transformed from a traditional classroom to a flipped learning model. This article describes active learning strategies used, along with lessons learned for future implementation.

Student's experiences with online teaching following COVID-19 lockdown: A mixed methods explorative study

Background

The COVID-19 pandemic lead to a sudden shift to online teaching and restricted campus access.

Aim

To assess how university students experienced the sudden shift to online teaching after closure of campus due to the COVID-19 pandemic.

Material and methods

Students in Public Health Nutrition answered questionnaires two and 12 weeks (N = 79: response rate 20.3% and 26.6%, respectively) after the lockdown in Norway on 12 March 2020 and participated in digital focus group interviews in May 2020 (mixed methods study).

Findings and discussion

Two weeks into the lockdown, 75% of students reported that their life had become more difficult and 50% felt that learning outcomes would be harder to achieve due to the sudden shift to online education. Twelve weeks into the lockdown, the corresponding numbers were 57% and 71%, respectively. The most pressing concerns among students were a lack of social interaction, housing situations that were unfit for home office purposes, including insufficient data bandwidth, and an overall sense of reduced motivation and effort. The students collaborated well in digital groups but wanted smaller groups with students they knew rather than being randomly assigned to groups. Most students agreed that pre-recorded and streamed lectures, frequent virtual meetings and student response systems could improve learning outcomes in future digital courses. The preference for written home exams over online versions of previous on-campus exams was likely influenced by student’s familiarity with the former. The dropout rate remained unchanged compared to previous years.

Conclusion

The sudden shift to digital teaching was challenging for students, but it appears that they adapted quickly to the new situation. Although the concerns described by students in this study may only be representative for the period right after campus lockdown, the study provide the student perspective on a unique period of time in higher education.

Core Competencies for Interprofessional Collaborative Practice Among Teacher Education, Health and Social Care Students in a Large Scaled Blended Learning Course

Introduction

Society’s demands for better coordination of services for children are increasing. Interprofessional learning (IPL) has been suggested to achieve the triple aim of better services, better outcomes and reduced costs. The aims were to assess 1) to what extent students taking teacher education, health and social care programmes agreed that blended learning was a suitable approach in a mandatory IPL course, 2) to what extent they had learnt about the WHO’s core IPL competencies (roles and responsibilities, values and ethics, interprofessional communication, and teams and teamwork), and 3) the students’ ranking of the learning outcomes from different components of the IPL course.

Methods

This was a quantitative cross-sectional study. Students completed an online course evaluation after a two-day combination of online and face-to-face IPL small-group training.

Findings

The response rate was 25.8% (n=363). Among the students, 60.6% strongly agreed that blended learning was suitable, while 8.9% strongly disagreed. Among the respondents, 46.8%, 50.2%, 56.8% and 62.3% gained increased insight into roles and responsibilities, values and ethics, interprofessional communication, and teams and teamwork, respectively. In ascending order, students were most satisfied with the learning outcomes from the supervision (16.0%), the syllabus (28.6%), the submission assignment (42.4%), the digital learning content of Canvas (43.8%), the combination of everything (43.8%), and the IPL group discussions (78.6%). In stratified analyses, ‘teacher education and child welfare students’ were significantly more likely to gain better insight into the WHO competencies than “health and social care students”, and they were also more overall satisfied.

Conclusion

Students agreed that blended learning was a suitable approach, although the learning outcomes from the face-to-face discussions were markedly higher than from other course components. While the majority had learnt something about the WHO competencies, the teacher and child welfare students achieved the best learning outcomes, including new knowledge about the WHO competencies.

Active Learning: Basic Science Workshops, Clinical Science Cases, and Medical Role-Playing in an Undergraduate Biology Course

Effective undergraduate courses increasingly blend elements of active learning with a more traditional lecture format. Designing and implementing active learning sessions that engage, educate, and are challenging and workable in a group setting are essential for student learners. In addition, active learning sessions take concepts of fundamental knowledge and apply them to a more relevant and real-world environment. Thus, effective active learning lesson plans enable students to thrive in their educational experience, and this potentially enhances material retention. Presented here are examples of the critical components of active learning engagement in an undergraduate biology course. First, basic science workshops let students apply basic scientific principles to biomedical science scenarios. Second, clinical science case studies help students understand the interplay between basic and clinical sciences in a patient-based medical case format. Finally, medical role-playing allows student teams to understand the complexity of medical care, moving from the patient’s presenting symptoms to formulating a diagnosis and treatment plan. These exercises strengthen several aspects of active learning, especially those related to student-team-based collaboration, conversation, coordination, and compilation.

Flipping to Motivate: Perceptions Among Prelicensure Nursing Students

BACKGROUND

Research suggests flipped learning may improve student motivation to learn.

PURPOSE

This study examined motivation and learning strategies among prelicensure BSN students in a course taught using the flipped learning model. The hypothesis was that flipped learning may improve motivation and learning strategies of students.

METHODS

A descriptive, comparative design examined motivation and learning strategies used by students in a flipped learning course. The Motivated Strategies for Learning Questionnaire and a demographic survey were administered to 25 BSN students at a Midwestern university.

RESULTS

Substantial decreases were found from pretest to posttest mean scores for the task value, control of learning beliefs, and help seeking subscales.

CONCLUSION

The results did not support the hypothesis that flipped learning would improve motivation and learning strategies. Further research in larger diverse samples of students in a flipped learning course is recommended.

Comparing the Effects of Regular Lecture and Branching Path Simulation on Nursing Students' Academic Performance Evaluation

BACKGROUND

Nursing education in Jordan is predominantly centered on regular lectures (RLs) that fail to empower students to self-assess their academic performance. Branching path simulation (BPS) is an innovative teaching method that consistently guides the student through a logically defensible analytical thought process to make correct decisions.

PURPOSE

The aim was to determine the effect of BPS on students' academic performance.

METHOD

An experimental design with control group design was used.

RESULTS

Students trained by BPS had significant improvement in their academic performance as measured by the mean scores of the Advanced Adult Health Nursing examination compared with RL students.

CONCLUSION

BPS is an innovative teaching method that requires more attention to be incorporated into the nursing curricula. Given the current learning barriers associated with the high student-educator ratio in Middle Eastern countries, with BPS nursing students have a unique opportunity to self-assess their learning needs.

Active learning pedagogy transformation: A whole-of-school approach to person-centred teaching and nursing graduates

In contemporary higher education contexts, active learning pedagogy pervades in discourses around designing quality student experiences. Transposing student bodies from passive to active participants in learning experiences is widely considered best practice in curriculum and pedagogical design. While literature on active learning is vast and recommendations on how to transform into an active learning approach abounds, such advice is often prescribed to individual teachers or courses. What remains unknown in this transformational space is how leadership for person-centred teaching can guide a whole school to shift philosophical presuppositions and take-up active learning as the guiding pedagogy. This paper describes the challenges, processes and steps for how one school, the School of Nursing at an Australian University, invoked transformational change through a philosophical and practice-based shift across all learning spaces (online/ face-to-face/ blended, undergraduate and postgraduate domains). This paper offers recommendations for other schools interested in establishing a whole-of-school commitment to an active learning pedagogy transformation underpinned by person-centred teaching.

Implementation of flipped classroom combined with case- and team-based learning in residency training

The core problem of Chinese resident doctor training is that medical educators present content in an attractive teaching mode to make students more motivated to learn and improve their clinical thinking ability, humanistic care, and practical ability. The traditional classroom mode of teaching cannot meet the needs of modern medical education. The purpose of this study is to explore the benefits and challenges of the flipped classroom (FC) combined with case- and team-based learning (FC-CTBL) for residency training. In this study, 60 junior surgical residents of Xiangya Medical College were enrolled. "Diabetic foot" was selected as the content of this study. Residents were divided into an FC-CTBL group and an FC group. FC-CTBL and FC were compared on the basis of residents' feedback questionnaires, residents' learning burden, test scores from a pre-quiz, and objective structured clinical examinations (OSCE). Residents were more satisfied with the FC-CTBL model compared with FC. In the FC-CTBL group, more participants said that the course improved their teamwork skills, analytical skills and their confidence in tackling unfamiliar problems. Residents in the FC-CTBL group also spent significantly less time preparing for class and performed better in the OSCE than those in the FC group. FC-CTBL stimulates residents' learning motivation, decreases their workload, improves their performance in the OSCE and may help to enhance clinical thinking and teamwork skills. The FC-CTBL approach is a good option for residency training.

Learning Preferences and Engagement Level of Generation Z Nursing Students

BACKGROUND

Minimal information exists about the educational environment that will foster learning and engage Generation Z students.

PURPOSE

The purposes of this study were to identify the teaching methods that Generation Z nursing students preferred and felt were the most engaging and effective for learning and to determine their engagement level in the classroom setting.

METHODS

This study employed a descriptive, cross-sectional design.

RESULTS

Lecture with audience response clickers was the most preferred/most engaging and effective method for helping Generation Z nursing students learn, whereas assigned reading was the least preferred method. Students preferred a traditional classroom model instead of a flipped classroom. Acquiring skills was the dimension of engagement rated the highest by this group of students.

CONCLUSIONS

Innovative lectures that incorporate applicable visual images and audience involvement combined with simulation, videos, and case studies may encompass a teaching formula that will engage and foster learning for Generation Z students.

The Smart Class Teaching Module for Rehabilitation Medicine English Education in China

Background

Learning medical English is particularly challenging for non-native English-speaking medical students. The Smart Class teaching module is a new online teaching module for rehabilitation-related medical English, the efficacy of which has yet to be established in the literature. Gender differences should also not be ignored in our study, taking into account the proven performance differences between males and females in language learning.

Material/Methods

First-year physiotherapy students in Grade 2018 and Grade 2019 at Guangzhou Medical University were recruited to participate in this study. Grade 2019, as the experimental group, completed the Smart Class teaching module, while Grade 2018, as the control group, completed the Traditional Class teaching module. The efficacy of both modules was assessed objectively using the students’ medical English exam scores and subjectively using the students’ responses to a questionnaire.

Results

In total, 242 questionnaires were distributed, and 210 valid questionnaires were returned, of which 119 were from the Smart Class teaching module group and 91 were from the Traditional Class teaching module group. There was no statistically significant difference between the medical English exam scores of the 2 groups (P=0.324). However, the subjective assessment revealed that the students experienced a significantly greater burden from the workload in the Smart Class teaching module group (P<0.001).

Conclusions

We found both the Smart Class teaching module and the Traditional Class teaching module achieved similar teaching outcomes. Therefore, the former represents a viable alternative teaching option for situations where traditional class teaching is not possible.

Digital learning designs in physiotherapy education: a systematic review and meta-analysis

BACKGROUND

Digital learning designs have the potential to support teaching and learning within higher education. However, the research on digital learning designs within physiotherapy education is limited. This study aims to identify and investigate the effectiveness of digital learning designs in physiotherapy education.

METHODS

The study was designed as a systematic review and meta-analysis of randomized and non-randomized trials. A search of eight databases on digital learning designs and technology was conducted. Study selection, methodology and quality assessment were performed independently by three reviewers. The included studies were mapped according to the types of digital interventions and studies. For similar interventions, the learning effects were calculated using meta-analyses.

RESULTS

Altogether, 22 studies were included in the review (17 randomized controlled trials and five cohort studies). A blended learning design was used in 21 studies, a flipped classroom model in five and a distance learning design in one. Altogether, 10 of the 22 articles were included in meta-analyses, which showed statistically significant effects for flipped classrooms on knowledge acquisition (standardized mean difference [SMD]: 0.41; 95% confidence interval [CI]: 0.20, 0.62), for interactive websites or applications (apps) on practical skills (SMD: 1.07; 95% CI: 0.71,1.43) and for students self-produced videos on a practical skill in a cervical spine scenario (SMD: 0.49; 95% CI: 0.06, 0.93). Overall, the effects indicated that blended learning designs are equally as or more effective than traditional classroom teaching to achieve learning outcomes. Distance learning showed no significant differences compared to traditional classroom teaching.

CONCLUSIONS

The current findings from physiotherapy education indicate that digital learning designs in the form of blended learning and distance learning were equally or more effective compared to traditional teaching. The meta-analyses revealed significant effects on student learning in favour of the interventions using flipped classrooms, interactive websites/apps and students self-produced videos. However, these results must be confirmed in larger controlled trials. Further, research should investigate how digital learning designs can facilitate students' learning of practical skills and behaviour, learning retention and approaches to studying as well as references for teaching and learning in digital learning environments.

Consideraciones acerca del aula invertida AI (FLIPPED CLASSROOM)

La necesidad de mejorar las competencias de los futuros profesionales en salud ha conducido a repensar la manera como se imparten los conocimientos a los estudiantes y de cómo ellos podrían aprender de manera significativa. Actualmente, el aula invertida (AI) o flipped classroom (FC) se convierte en una estrategia de enseñanza alternativa en el campo de la educación en salud. Incentiva el aprendizaje del estudiante al promover la autonomía en el abordaje de los conocimientos antes de cada clase, favorece la motivación, el aprendizaje activo, colaborativo y significativo durante las sesiones presenciales, de tal manera que permite desarrollar el pensamiento crítico para una formación profesional idónea. Al realizar una revisión de la literatura se evidenció un amplio uso del AI en educación en salud con resultados positivos frente a la educación tradicional. Además, las tecnologías juegan un papel importante para presentar contenidos y ejecutar actividades fuera y dentro del aula. Se presentan algunas evidencias de la efectividad del AI en educación médica, cómo podría implementarse en nuestras aulas y la diversidad de recursos disponibles para usar en los diferentes escenarios que plantea esta estrategia.

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

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

Active Learning: Subtypes, Intra-Exam Comparison, and Student Survey in an Undergraduate Biology Course

Active learning improves undergraduate STEM course comprehension; however, student comprehension using different active learning methods and student perception of active learning have not been fully explored. We analyze ten semesters (six years) of an undergraduate biology course (honors and non-honors sections) to understand student comprehension and student satisfaction using a variety of active learning methods. First, we describe and introduce active learning subtypes. Second, we explore the efficacy of active learning subtypes. Third, we compare student comprehension between course material taught with active learning or lecturing within a course. Finally, we determine student satisfaction with active learning using a survey. We divide active learning into five subtypes based on established learning taxonomies and student engagement. We explore subtype comprehension efficacy (median % correct) compared to lecture learning (median 92% correct): Recognition (100%), Reflective (100%), Exchanging (94.1%), Constructive (93.8%), and Analytical (93.3%). A bivariate random intercept model adjusted by honors shows improved exam performance in subsequent exams and better course material comprehension when taught using active learning compared to lecture learning (2.2% versus 1.2%). The student survey reveals a positive trend over six years of teaching in the Perceived Individual Utility component of active learning (tau = 0.21, p = 0.014), but not for the other components (General Theoretical Utility, and Team Situation). We apply our findings to the COVID-19 pandemic and suggest active learning adaptations for newly modified online courses. Overall, our results suggest active learning subtypes may be useful for differentiating student comprehension, provide additional evidence that active learning is more beneficial to student comprehension, and show that student perceptions of active learning are positively changing.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS AND IMPLICATIONS

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

Evidence-Based Interventions for Retention of Nursing Students: A Review of the Literature

BACKGROUND

There is a need to better understand effective student retention strategies in nursing.

PURPOSE

This review of course and program interventions reported in the nursing literature is intended to highlight interventions, supported by evidence, to graduate more enrolled students and recommend areas of retention efforts that need further research.

METHODS

The PRISMA search strategy was used to identify and narrow the number of relevant studies. A scoring instrument to evaluate rigor, reliability, and validity of interventions was adapted from a valid and reliable tool used to evaluate studies using a health care education intervention.

RESULTS

Evidence-based interventions that improved retention included retention program/specialist, robust orientation, mentoring and tutoring, stipends, and remediation.

CONCLUSION

Nurse educators are independently striving to improve retention rates of nursing students. Implementing evidence-based interventions will advance this effort.

Education Research: Flipped classroom in neurology: Principles, practices, and perspectives

How to most effectively deliver a large amount of information in an engaging environment that encourages critical thinking is a question that has long plagued educators. With ever-increasing demands on both resident and faculty time, from shrinking duty hours to increased patient complexity, combined with the exponential growth of medical knowledge and unequal access to the spectrum of neurologic subspecialties around the country, this question has become especially pertinent to neurology residency training. A team of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review the current evidence regarding the implementation of the flipped classroom format. This educational model has only recently been applied to health care education along the training continuum, and a small collection of articles has, so far, used disparate methods of curricular implementation and assessment. While the feedback from learners is generally positive, a number of obstacles to implementation exist, most notably learner time commitments. These are presented with discussion of potential solutions along with suggestions for future studies.

The Effectiveness of Flipped Classroom in Health Professions Education in China: A Systematic Review

BACKGROUND

Flipped classroom has received much attention during the last few years in China, but inconsistent conclusions are made about the effectiveness this approach in health professions education. This review examined the findings of controlled studies published in Chinese in order to summarize the effects of the flipped classroom methodology. These studies focused specifically on undergraduate level of health professions students.

METHODS

A literature search was conducted using China National Knowledge Infrastructure (CNKI) and Wanfang Data Knowledge Service Platform in June 2019. No date restrictions were used. Peer-reviewed papers were reviewed and experimental studies were included if the study compared student outcomes using flipped classroom method versus traditional lectures. The revised version of the Kirkpatrick's model was applied to evaluate the effectiveness of the flipped classroom approach.

RESULTS

In total, 934 articles were obtained. Among them, 235 articles were full text reviewed and 59 met the inclusion criteria. Most of the student agreed that flipped classroom strategy was very helpful improving their self-learning ability, problem solving ability, teamwork, and communication skills, but reported increased workload and less-efficiency compared with traditional lectures. However, the majority of studies (n = 52) showed positive findings of the flipped classroom on changes in knowledge and skills, and 3 in negative. Among these 59 studies, there was little evidence of changes in behavior, organizational practice and patient outcome.

CONCLUSIONS

Better design with reduced content should be considered for instructors to promote learning effectiveness. Long-term effects of flipped classroom should be considered in future studies.

A multiyear comparison of flipped- vs. lecture-based teaching on student success in a pharmaceutical science class

BACKGROUND AND PURPOSE

To gauge the potential effect of mode of content delivery on overall student success in a pharmaceutical sciences course in a doctor of pharmacy program.

EDUCATIONAL ACTIVITY AND SETTING

Principles of Drug Action I (PDAI) is a first-year pharmaceutical science course typically taught by multiple faculty, and each utilizes their own approach to deliver course content. Over a seven year period, the course naturally separated into blocks. Block-1 was taught using a traditional lecture-based approach while Block-2 varied between either a lecture-based or a flipped-classroom format. Student success was evaluated by exam at the end of each block.

FINDINGS

For the four years in which Block-2 was taught by lecture, the number of exam failures was similar to Block-1. For each of the three years Block-2 was taught via the flipped-classroom format, the number of exam failures was approximately half that of Block-1. While grades for the lecture-based Block-1 trended downward over the seven-year evaluation period, average exam grades overall were similar between Block-1 and Block-2 each year regardless of teaching modality.

SUMMARY

Retrospective analysis of this novel blocked approach within PDAI provided a means of internally evaluating the potential effect of teaching format on overall student performance. The results described here support previous studies that indicate that the flipped-classroom approach can reduce course failures. These findings also show that flipped-classroom teaching may have a greater impact on improving learning in lower-performing students.

Effectiveness of flipped classroom combined with team-, case-, lecture- and evidence-based learning on ophthalmology teaching for eight-year program students

BACKGROUND

This study aimed to investigate the benefits and challenges of the flipped classroom combined with team-, case-, lecture- and evidence-based learning (FC-TCLEBL) for ophthalmology teaching for eight-year program students.

METHODS

FC-TCLEBL and the traditional lecture-based classroom (LBC) were compared based on student and teacher feedback questionnaires, student learning burden, and scores on standardized tests as well as their effects on the abilities of clinical thinking, scientific research, active-learning, practical application, humanistic care and communication with patients.

RESULTS

Both the students and teachers were more satisfied with the FC-TCLEBL model. More students in the FC-TCLEBL group agreed that the course helped them to develop skills in creative thinking, problem solving, and teamwork. Students in the FC-TCLEBL group spent significantly more time preparing for class than those in the LBC group, but the time spent on review was significantly lower in the FC-TCLEBL group. The students from the FC-TCLEBL group performed better in a post-test on diabetic retinopathy (DR) as compared to the LBC group.

CONCLUSIONS

FC-TCLEBL teaching model is effective and suitable for ophthalmology teaching.