The refinement of flipped teaching implementation to include retrieval practice

Systematic review of distributed practice and retrieval practice in health professions education

To determine the effect of distributed practice (spacing out of study over time) and retrieval practice (recalling information from memory) on academic grades in health professions education and to summarise a range of interventional variables that may affect study outcomes. A systematic search of seven databases in November 2022 which were screened according to predefined inclusion criteria. The Medical Education Research Study Quality Instrument (MERSQI) and Newcastle-Ottawa Scale-Education (NOS-E) were used to critically appraise eligible articles. A summary of interventional variables includes article content type, strategy type, assessment type and delay and statistical significance. Of 1818 records retrieved, 56 were eligible for inclusion and included a total of 63 experiments. Of these studies, 43 demonstrated significant benefits of distributed practice and/or retrieval practice over control and comparison groups. Included studies averaged 12.23 out of 18 on the MERSQI and averaged 4.55 out of 6 on the NOS-E. Study designs were heterogeneous with a variety of interventions, comparison groups and assessment types. Distributed practice and retrieval practice are effective at improving academic grades in health professions education. Future study quality can be improved by validating the assessment instruments, to demonstrate the reliability of outcome measures. Increasing the number of institutions included in future studies may improve the diversity of represented study participants and may enhance study quality. Future studies should consider measuring and reporting time on task which may clarify the effectiveness of distributed practice and retrieval practice. The stakes of the assessments, which may affect student motivation and therefore outcomes, should also be considered.

Providing the choice of in-person or videoconference attendance in a clinical physiology course may harm learning outcomes for the entire cohort

Clinical Physiology 1 and 2 are flipped classes in which students watch prerecorded videos before class. During the 3-h class, students take practice assessments, work in groups on critical thinking exercises, work through case studies, and engage in drawing exercises. Due to the COVID pandemic, these courses were transitioned from in-person classes to online classes. Despite the university's return-to-class policy, some students were reluctant to return to in-person classes; therefore during the 2021-2022 academic year, Clinical Physiology 1 and 2 were offered as flipped, hybrid courses. In a hybrid format, students either attended the synchronous class in person or online. Here we evaluate the learning outcomes and the perceptions of the learning experience for students who attended Clinical Physiology 1 and 2 either online (2020-2021) or in a hybrid format (2021-2022). In addition to exam scores, in-class surveys and end of course evaluations were compiled to describe the student experience in the flipped hybrid setting. Retrospective linear mixed-model regression analysis of exam scores revealed that a hybrid modality (2021-2022) was associated with lower exam scores when controlling for sex, graduate/undergraduate status, delivery method, and the order in which the courses were taken (F test: F = 8.65, df1 = 2, df2 = 179.28, P = 0.0003). In addition, being a Black Indigenous Person of Color (BIPOC) student is associated with a lower exam score, controlling for the same previous factors (F test: F = 4.23, df1 = 1, df2 = 130.28, P = 0.04), albeit with lower confidence; the BIPOC representation in this sample is small (BIPOC: n = 144; total: n = 504). There is no significant interaction between the hybrid modality and race, meaning that BIPOC and White students are both negatively affected in a hybrid flipped course. Instructors should consider carefully about offering hybrid courses and build in extra student support.NEW & NOTEWORTHY The transition from online to in-person teaching has been as challenging as the original transition to remote teaching with the onset of the pandemic. Since not all students were ready to return to the classroom, students could choose to take this course in person or online. This arrangement provided flexibility and opportunities for innovative class activities for students but introduced tradeoffs in lower test scores from the hybrid modality than fully online or fully in-person modalities.

Using the Teaching Career Enhancement Award from the American Physiological Society to train faculty to successfully implement flipped teaching

Flipped teaching (FT) is a student-centered instructional method that shifts lectures out of the classroom and uses a variety of activities to apply content during class time. FT has gained attention among educators as a student-centered instructional method. However, many faculty still lack the skills, knowledge, confidence, and expertise to implement FT in their classrooms. Therefore, course-specific training and focused mentorship are critical in successfully implementing FT. Four faculty members, from an adjunct professor to a full professor, from four diverse institutions around the country, were recruited and funded through the American Physiological Society's Teaching Career Enhancement Award to receive training in the implementation of FT in their courses. This study aimed to provide specific tools and strategies to engage students in deeper learning through activities in the participants' courses. A course was built using the Blackboard Learning Management System for the participants to receive relevant readings to be completed prior to the FT workshop. Upon completing this training, the participants examined the design and execution of FT in their classrooms and, subsequently, reflected on and refined their future course offerings. The facilitator mentored the participants throughout the process, including an on-site observation of a live FT session. Both qualitative and quantitative data were collected before and after their FT experiences. Based on the survey results, this study helped improve the FT knowledge and self-efficacy of all participants. In conclusion, the faculty utilized the training and mentoring to implement FT in their classrooms successfully and disseminate their experiences and findings.

Flipped teaching eased the transition from face-to-face teaching to online instruction during the COVID-19 pandemic

Due to the COVID-19 pandemic, Rice University canceled classes for the week of March 9-13, 2020 and shifted all instruction to online only following spring break. For the second half of the semester, animal physiology was taught exclusively over Zoom. Here we describe how a flipped teaching format that was used before the pandemic eased the transition from face-to-face teaching to online instruction. The preclass preparation resources and the active learning materials that were already in place for flipped teaching were helpful in the transition to solely online teaching. Therefore, the focus during the transition was to reconfigure active learning and examinations from the face-to-face format to the online platform. Instead of small group discussions in the classroom, teams interacted in Zoom Breakout Rooms. Rather than taking exams in-person during scheduled class time, students submitted exams online. Additionally, students prerecorded their project presentations instead of presenting them "live" during the last week of classes. Overall, students felt that the class smoothly transitioned to a remote only format. These and other changes to the instructional methods will be implemented during the Spring 2021 semester when the course is taught fully online.

Tunes in the Zoom Room: Remote Learning via Videoconference Discussions of Physiology Songs

As most instruction has been forced online, biology instructors have become acutely aware of the many advantages and limitations of online teaching. Here, we investigate one possible advantage of online education: the ease of allowing remote guest speakers to interact with students in real time. In particular, we piloted a model in which guest speakers could facilitate direct music-related interactions with students, possibly benefiting students' content knowledge and sense of community. In the context of an undergraduate animal physiology course, face-to-face lessons on arterial blood gases and the renal system were supplemented with videoconferences with a guest speaker who presented relevant content-rich songs and led class discussions of the lyrics. Survey and test data suggested that, after each of the lessons, the students (i) had increased confidence in their understanding of the material, (ii) performed better on objective test questions, and (iii) attributed their learning chiefly to the musical intervention. While our approach awaits further exploration and testing, this report provides preliminary evidence of its feasibility and offers practical suggestions for others who may wish to give it a try.

Using dramatizations to teach cell signaling enhances learning and improves students' confidence in the concept

Certain physiology concepts can be difficult for students to understand, and new strategies need to be implemented to teach these concepts. Cell signaling is a core concept in physiology and is presented to undergraduate students starting with their first-year Principles of Biology course. Flipped teaching (FT) combined with dramatizations were used to teach steroid hormone and protein hormone cell signaling in an Animal Physiology course. Student knowledge level improved, as demonstrated by posttest scores compared to pretest scores. Their confidence level in the material improved after the dramatization activities were completed. In conclusion, the combination of FT with dramatizations enhances student learning and confidence level.

Students from a large Australian university use Twitter to identify difficult course concepts to review during face-to-face lectorial sessions

Engaging undergraduate students in large classes is a constant challenge for many lecturers, as student participation and engagement can be limited. This is a concern since there is a positive correlation between increased engagement and student success. The lack of student feedback on content delivery prevents lecturers from identifying topics that would benefit students if reviewed. Implementing novel methods to engage the students in course content and create ways by which they can inform the lecturer of the difficult concepts is needed to increase student success. In the present study, we investigated the use of Twitter as a scalable approach to enhance engagement with course content and peer-to-peer interaction in a large course. In this pilot study, students were instructed to tweet the difficult concepts identified from content delivered by videos. A software program automatically collected and parsed the tweets to extract summary statistics on the most common difficult concepts, and the lecturer used the information to prepare face-to-face (F2F) lectorial sessions. The key findings of the study were 1) the uptake of Twitter (i.e., registration on the platform) was similar to the proportion of students who participated in F2F lectorials, 2) students reviewed content soon after delivery to tweet difficult concepts to lecturer, 3) Twitter increased engagement with lecturers, 4) the difficult concepts were similar to previous years, yet the automated gathering of Twitter data was more efficient and time saving for the lecturer, and 5) students found the lectorial review sessions very valuable.