The effect of flipped teaching combined with modified team-based learning on student performance in physiology

Using a flipped classroom in a veterinary systems physiology course increases student performance on basic knowledge and clinical applicability questions

Flipped classrooms are being utilized more frequently in biomedical education to provide more active learning opportunities to students although there are mixed results on the benefits of the flipped classroom in biomedical education. In this study, the effects of using a flipped classroom with case-based learning in the endocrine section of a first-year veterinary-integrated histology and physiology course were investigated. Results demonstrated that the flipped classroom improved performance on the endocrine section exam by 15.9% (Cohen's d = 1.08; P < 0.001) with improvements on both clinically applicable and basic knowledge questions. Student satisfaction with the flipped classroom was also investigated. Students reported high satisfaction with the in-class case-based learning opportunities but lower satisfaction with the asynchronous content delivery and the time required outside of class. Student perceptions of the flipped classroom were measured again after being exposed to the results of the flipped classroom on student learning. After seeing the results, students were significantly more likely to value the time spent in the flipped classroom and to desire more opportunities for flipped classrooms in the future.NEW & NOTEWORTHY A flipped classroom using case-based learning can significantly improve student performance in a veterinary physiology course with the largest gains going to lower performing students. Student perception of the flipped classroom can be improved by showing students data on the improvement in performance on examinations.

A partially flipped physiology classroom improves the deep learning approach of medical students

This study aimed to compare the impact of the partially flipped physiology classroom (PFC) and the traditional lecture-based classroom (TLC) on students' learning approaches. The study was conducted over 5 mo at Xiangya School of Medicine from February to July 2022 and comprised 71 students majoring in clinical medicine. The experimental group (n = 32) received PFC teaching, whereas the control group (n = 39) received TLC. The Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) was used to assess the impact of different teaching methods on students' learning approaches. After the PFC, students got significantly higher scores on deep learning approach (Z = -3.133, P < 0.05). Conversely, after the TLC students showed significantly higher scores on surface learning approach (Z = -2.259, P < 0.05). After the course, students in the PFC group scored significantly higher in deep learning strategy than those in the TLC group (Z = -2.196, P < 0.05). The PFC model had a positive impact on deep learning motive and strategy, leading to an improvement in the deep approach, which is beneficial for the long-term development of students. In contrast, the TLC model only improved the surface learning approach. The study implies that educators should consider implementing PFC to enhance students' learning approaches.NEW & NOTEWORTHY In this article, we compare the impact of the partially flipped classroom (PFC) and the traditional lecture classroom (TLC) in a physiology course on medical students' learning approaches. We found that the PFC benefited students by significantly enhancing their deep learning motive, strategy, and approach, which was good for them. However, the TLC model only improved the surface learning motive and approach.

Applying Iterative Student Feedback across Flipped Classroom and Flexible Teaching Approaches: Impact on Veterinary Students' Learning Experience

No single teaching strategy supports all learning styles in veterinary science students. To facilitate more convenient and flexible teaching, learning, and revision, an innovative online digital learning platform-VetCloud-was developed to provide access to modularized programme content across courses to promote active, integrated learning. This study aimed to understand student perceptions regarding the enhancement of the student learning experience in a foundational course in gastrointestinal anatomy and physiology at The University of Queensland across two learning cycles, via applying iterative student feedback in transitioning a flipped classroom approach using VetCloud for the delivery of lecture content in 2022 to a flexible learning approach in 2023. By 2023, the use of VetCloud in the flexible learning approach improved students' work/study/life balance, reduced their stress levels, and enabled a more efficient use of their time when studying, compared to the flipped classroom approach in 2022. Surveying student perceptions was integral to maximizing their learning experience. Data clearly demonstrates that students will mix-and-match how they interact with available options provided via flexible delivery on an individualized basis. This teaching method offers veterinary educators an innovative and efficient approach to veterinary student education in anatomy and physiology while enhancing student well-being.

Exploring the dynamics of situational interest in team-based learning in undergraduate medical education

BACKGROUND

Team-based learning (TBL) is a widely recognized instructional approach in medical education blending direct instruction with active-cooperative learning in small groups. While TBL is known to enhance knowledge acquisition, its impact on student motivation, particularly through situational interest, remains underexplored. This study aimed to investigate the development of situational interest across the distinct phases of TBL, focusing on how each phase (individual readiness assurance test; iRAT, team readiness assurance test; tRAT, and application exercise; AE) influences students' situational interest. The study sought to provide insights into the motivational dynamics underpinning TBL in a medical education setting.

METHODS

A total of 88 medical students participated in a TBL session on "Bleeding during Pregnancy." Situational interest was measured after each TBL phase. A one-way repeated-measures analysis of variance (ANOVA) was conducted to assess the fluctuation of situational interest throughout the session.

RESULTS

The analysis revealed significant variations in situational interest across different TBL stages. There was a significant increase in situational interest following the tRAT (p = .001). Post-tRAT, situational interest significantly decreased after the AE (p = .007), returning to levels observed at the session's start. Post hoc correlation analysis suggested a negative association between tRAT performance and situational interest, indicating heightened interest in response to awareness of knowledge gaps during the tRAT.

CONCLUSIONS

The findings of this study may challenge the traditional view of TBL, suggesting a more integrated and dynamic interplay between knowledge acquisition and application phases. The results highlight the importance of the AE phase in clinical education and suggest that situational interest is one key driver in the learning process within TBL. Future research should focus on replicating these findings and comparing situational interest development between pre-clinical and clinical student cohorts to further understand the effects of situational interest on TBL in medical education.

Interactive audio human organ model combined with team-based learning improves the motivation and performance of nursing students in learning anatomy and physiology

Among the basic medical sciences, anatomy and physiology (anatomy & physiology) is a fundamental subject for students majoring in nursing. Due to its diversity and difficulty, nursing students experience stress when studying it. Previous graduates generally presented lower achievements in anatomy & physiology than in other nursing-related subjects in the National Council Licensure Examination-Registered Nurse, indicating that anatomy & physiology education requires improvement. Accordingly, we examined the impact of innovative teaching on students' motivation and performance when learning anatomy & physiology through a quasi-experimental pre-/post-test design. For innovative teaching, we used the novel interactive audio human organ model, followed by team-based learning. The participants were 200 lower-grade students in the nursing department of a junior college in Taiwan, divided into two groups receiving innovative teaching (experimental group) or traditional teaching (control group). Questionnaire surveys were administered, and the collected data were statistically analyzed. The innovative teaching in anatomy & physiology improved learning motivation, especially in terms of affect, executive volition, and learning performance. The essential components of learning motivation, such as value, expectation, affect, and executive volition, were positively correlated with the reaction levels of learning performance. Regarding the improvement in academic performance, the experimental group performed significantly better than the control group. The use of innovative teaching in class enhances students' learning motivation and learning performance when studying anatomy & physiology. Interactive teaching aids enhance the enjoyment of learning anatomy & physiology while facilitating in-depth exploration of the human organs and systems.

A comparative study on the effectiveness of online and in-class team-based learning on student performance and perceptions in virtual simulation experiments

BACKGROUND

The swift transition to online teaching in medical education has presented the challenge of replicating in-class engagement and interaction essential for active learning. Despite online team-based learning (TBL) offering potential solutions through structured cooperative activities, its efficacy in virtual simulation experiment courses remains scantily researched. This study investigates the effectiveness of online TBL for teaching virtual patient experiments in a basic medical laboratory course and contrasts it with traditional offline teaching in terms of student performance and perceptions.

METHODS

A comparative analysis involved 179 Year 3 medical students using online TBL, face-to-face TBL (FTF-TBL), and the flipped classroom (FC) approach. The learning outcomes were assessed based on experiment reports, IRAT scores, TRAT scores, and final exam performance. Students' perceptions of both online and in-class TBL methodologies were also surveyed.

RESULTS

Both online and in-class TBL groups demonstrated comparable academic outcomes and surpassed the FC group in academic performance. Students displayed a marked preference for the TBL format (whether online or in-class), valuing its enhancement of learning interest and practical knowledge application. Nevertheless, refinements in discussion efficiency, platform convenience, and student-instructor interaction were indicated as potential areas of improvement in the online setting.

CONCLUSIONS

Online TBL, along with its in-class counterpart, showed superior academic performance and a more positive learning experience compared to the FC group. These findings underscore the potential of online TBL in adapting to modern pedagogical challenges and enriching medical education through virtual simulation experiments.

Factors associated with utilization of student-centered pedagogy by nurse educators

BACKGROUND

Despite suboptimal level of the utilization of student-centered pedagogy, multidimensional, modifiable factors associated with the utilization have been rarely examined among nurse educators.

PURPOSE

The aim of this study was to examine the utilization status of student-centered pedagogy and factors associated with the utilization by nurse educators.

METHODS

Data on student-centered pedagogy utilization, knowledge, beliefs in effectiveness, stress, coping, support, degree earned, teaching experiences, and other demographic characteristics were analyzed using multiple regression analyses.

RESULTS

The status of the student-centered pedagogy utilization was moderate, and knowledge was consistently associated with the utilization in the total sample (N = 108) and in both subgroups (≤50 vs. >50 years old). Beliefs in effectiveness were associated with the utilization only in the age > 50 years old group.

CONCLUSIONS

Nurse educators need to develop and deliver interventions to facilitate the utilization of student-centered pedagogy through increase in knowledge and beliefs in effectiveness of student-centered pedagogy.

A comparison between the impacts of lecturing and flipped classrooms in virtual learning on triage nurses' knowledge and professional capability: an experimental study

BACKGROUND

The quality of triage in emergency department depends on regular evaluation of triage nurses' professional capabilities and development of programs to improve them. Flipped classrooms are a new approach to learning which can be employed to improve professional capabilities. The present study aims to compare the impact of lecturing to flipped classrooms in virtual learning on the knowledge and professional capabilities of triage nurses in the emergency departments of the state hospitals of Yazd province in south-western Iran in 2022.

METHODS

The present study is an experimental work of research. Seventy-four triage nurses participated in the study. Seventy-four triage nurses were randomly allocated to the two groups, including flipped classrooms (group B) and lecturing (group A). The data collection instruments were an emergency department triage nurses' professional capability questionnaire and a triage knowledge questionnaire. The collected data were analyzed in SPSS v.22 using independent t-test, chi-squared test, and repeated measures analysis of variance. Level of significance was set at p ≥ 0.05.

RESULTS

The participants' mean age was 33.1 ± 4.3 years. As measured one month after the education, the triage knowledge mean score of the nurses who were educated using the flipped classroom method (9.29 ± 1.73) was higher than that of the nurses who were educated via lecturing (8.45 ± 1.788), and the difference was statistically significant (p = 0.001). Also, measured one month after the education, the professional capability mean score of the nurses who were educated using the flipped classroom method (140.27 ± 11.744) was higher than that of the nurses who were educated via lecturing (132.84 ± 10.817), and the difference was statistically significant (p = 0.006).

CONCLUSION

There was a significant difference between the pretest and posttest knowledge and professional capability mean scores of both groups immediately after the education. However, measured one month after the education, the mean and standard deviation of the knowledge and professional capability scores of the triage nurses who had been educated via flipped classrooms were higher than those of the nurses in the lecturing group. Thus, virtual learning using flipped classrooms is more effective than lecturing in improving triage nurses' knowledge and professional capability in the long run.

Application of Blended Learning to Veterinary Gross Anatomy Practical Sessions: Students' Perceptions of Their Learning Experience and Academic Outcomes

The use of blended learning strategies is increasingly common in health sciences, including veterinary medicine; however, there are very few descriptions of these methods being applied to practicals. We describe here the application of blended learning based on the implementation of flipped classrooms with collaborative learning and gamification to the 2020-2021 veterinary medicine gross anatomy practicals at CEU Cardenal Herrera University (Spain). Students prepared for the sessions by pre-viewing videos and taking a quiz before the start. The sessions were conducted in small groups where students learned through collaborative work and reviewed their learning with a card game. A small but significant increase was observed when comparing the scores of practical exams of the locomotor apparatus with those of 2018-2019 (6.79 ± 2.22 vs. 6.38 ± 2.24, p < 0.05), while the scores were similar (7.76 ± 1.99 vs. 7.64 ± 1.92) for the organ system exams. Students' responses in a satisfaction survey were mostly positive (>80%) regarding the motivating and learning-facilitating effect of this educational method. Our work shows that the application of blended learning in anatomy practicals based on a flipped classroom and with elements of gamification and collaborative work can be an effective way to improve the learning experience of students.

Impact of combination of short lecture and group discussion on the learning of physiology by nonmajor undergraduates

This study assessed the impact of an "active learning" strategy employed alone or in combination with traditional lectures on the learning of mammalian physiology by undergraduate students. The study investigated the impact of three teaching strategies, namely 1) traditional lecture, 2) group discussion alone, and 3) combination of lecture and group discussion. For all strategies, students were given homework in a textbook and they completed written assignments before each session. Every student led the discussion of at least one assigned theme during each group session. The students had no access to the textbook or notes during group discussions. Four examinations (3 in-semester and a final) assessed the students' knowledge of fundamental concepts of physiology of specific organ systems. Part of the final examination reassessed knowledge of previously tested topics. The results show that the teaching modality employed to introduce physiology topics influenced students' learning. The average marginal effect of the lecture + discussion modality (average improvement linked to lecture + discussion strategy) on students' performance was 6.45% [95% confidence interval (CI₉₅) (4.73, 8.16), P = 1.74 × 10^-13], and the average improvement associated with the discussion-only modality was 5.5% [CI₉₅ (3.84, 7.16), P = 7.84 × 10^-11]. On average, all class ranks performed better on materials covered under active learning settings than under lecture-only conditions. Moreover, students' performance under combined lecture and discussion conditions is predictive of their overall performance in the course. The results support the positive effect of student-centered learning and demonstrate the efficacy of a combination of lectures and group discussions on learning of physiology by nonmajor students.NEW & NOTEWORTHY The purpose of this study was to evaluate the effect of group discussion on the learning of mammalian physiology by nonmajor undergraduate students. Combining traditional lectures with group discussions increased the active participation of students in class and improved their learning of physiology, as measured by the results of in-semester and final examinations. The active learning technique benefited all class ranks on average.

Online flipped classroom with team-based learning promoted learning activity in a clinical laboratory immunology class: response to the COVID-19 pandemic

BACKGROUND

Given the rapid development of clinical immunology technologies, students majoring in laboratory medicine should master the technological principles and application of clinical laboratory immunology. However, many are required to take online courses due to COVID-19 restrictions, which highlights the need to revisit teaching strategies. Recently, various medical education courses (such as Biochemistry, Physiology, etc.) have implemented the flipped classroom (FC) and team-based learning (TBL) methods, resulting in more positive teaching evaluations. To promote the students' mastery of the difficult knowledge effectively during the online teaching work, we evaluated the performance of online FC-TBL in a clinical laboratory immunology course.

METHODS

Sixty-two third-year students from two classes majoring in Laboratory Medicine were recruited and divided into two groups, including one group with traditional lecture-based learning teaching strategy (LBL group) and the other group with LBL or online FC combined with TBL teaching strategy (FC-TBL group). We selected three chapters to conduct FC-TBL teaching in class. All participants took in-class quizzes and final examinations that targeted the same knowledge points. Finally, all participants completed anonymous questionnaires asking for their perceptions of the respective teaching models. In addition, we conducted a survey of teaching suggestions by a FC-TBL class of students majoring in Laboratory Medicine.

RESULTS

The FC-TBL group (vs LBL group) had significantly higher scores on the in-class quizzes and final examinations, and also reported high satisfaction with the FC-TBL model. These findings indicate that FC-TBL is suitable for clinical laboratory immunology, as the participants quickly gained essential knowledge. Specifically, FC-TBL helped to "increase learning motivation," "promote self-directed learning skills," "extend more related knowledge," "enhance problem-solving abilities," "enhance clinical reasoning abilities," and "enhance communication skills." For participants' suggestions, 48.38% (15/31) students held positive attitude to FC-TBL teaching strategy compared to 25.81% (8/31) students who considered FC-TBL teaching strategy still needs continuous improvement, and 25.81% (8/31) students reported that they believed FC-TBL teaching strategy was perfect and no further suggestions.

CONCLUSIONS

Online FC-TBL effectively enhanced learning activity among students of a clinical laboratory immunology course. This is particularly useful in the COVID-19 context.

Exploring physiology instructors' use of core concepts: pedagogical factors that influence choice of course topics

The physiology core concepts are designed to guide instructors in undergraduate physiology courses. However, although past work has characterized the alignment of physiology programs with the core concepts, it is unclear to what extent these core concepts have influenced instructors' pedagogical decisions or how represented these core concepts are across physiology courses. We surveyed undergraduate physiology instructors to determine their familiarity with the core concepts, the impact of the core concepts on their teaching, as well as the alignment of their courses with these core concepts. Instructors report predominantly relying on textbooks and past syllabi of their courses as resources that influence their instructional decisions on which topics to include in a course. However, many instructors report reorganizing their physiology courses in subsequent iterations or reducing the number of concepts covered to allow more time for critical thinking and active learning. In addition, we find that the majority of instructors indicate that they are not knowledgeable about the list of physiology core concepts and that the influence of these core concepts is limited even for those who report familiarity with the list of core concepts. Finally, we find that instructors report uneven coverage of physiology core concepts in their courses, with some core concepts ubiquitous while others are sparsely covered. We conclude by discussing implications of our work for the physiology education community and call for the continued development of resources to support new physiology instructors and the need to promote coverage of certain core concepts in physiology courses.NEW & NOTEWORTHY The physiology core concepts are a critical resource for undergraduate physiology instructors. Despite this, little past work has investigated the impact of these core concepts across institutions. We find that most instructors are unfamiliar with these core concepts and instead rely on other resources when developing and revamping their physiology courses. We also identify uneven coverage of the core concepts in the curriculum and offer implications for the physiology education community.

The contribution of the flipped learning environment to value perception and controllability of classroom activities as antecedents of learners’ anxiety: A control-value approach

Students enrolled in tertiary education encounter multiple challenges, which prevent them from being proficient. One of these challenges is anxiety which is a common achievement emotion that impacts many students. Anxiety may prevent learning and may be negatively related to learning due to the negative values of classroom activities and their low controllability. As a result, obtaining more research evidence on anxiety plays an important role in allowing learners to develop the skills they need in different types of technology-based environments such as Flipped Learning (FL). With the prevalence of Internet usage, FL is gaining increasing popularity among higher education individuals. The FL approach is an important model for modifying teaching, cultivating enthusiasm, and interaction, and developing educational presentations in student-focused learning circumstances. The potential affordances of the FL environment might place learners in more positive states of control and value appraisals than the environment of conventional classes, which can lead to the removal of negative emotions such as anxiety. Given the benefits of FL and the potential affordances of its environment, the purpose of this conceptual study is to argue how the inherent affordances of the FL environment can contribute to the controllability and positive values of classroom activities reducing learners’ anxiety in light of control-value theory.

Incorporating modified team-based learning into a flipped basic medical laboratory course: impact on student performance and perceptions

BACKGROUND

Basic medical laboratory courses (BMLCs) play an essential role in medical education and offer several benefits to students. Although various student-centered and active learning strategies have been increasingly incorporated into medical education, their applications in BMLCs are limited. This paper aimed to explore the educational effects of a flipped classroom (FC) combined with team-based learning (TBL) strategy in BMLCs at Zhejiang University School of Medicine.

METHODS

Four hundred eight 3rd-Year medical students were assigned to either the FC-TBL group (n = 235) or the FC group (n = 173) to complete three experiments on the respiration block of BMLCs. The two groups' immediate and long-term academic performance were compared, and the FC-TBL students' perceptions of different instructional strategies were surveyed.

RESULTS

Students in the FC-TBL group scored higher on the immediate post-tests after class and higher on the final exams in two of the three experiment sessions. They preferred FC-TBL to FC for its higher engagement, more feedback, and better learning environment. Students felt the FC with TBL blended instructional strategy stimulated their interest in learning and deep thinking.

CONCLUSIONS

Compared with the FC group, students in the FC-TBL group improved academic performance and had a more positive experience overall. Our findings support the feasibility and advantage of the flipped classroom with team-based learning as a blended learning strategy in the BMLC curriculum.

The Impact of Flipped Classroom: Evaluation of Cognitive Level and Attitude of Undergraduate Medical Students

BACKGROUND

Anatomy is a core component of the basic health sciences and a structural foundation for higher clinical courses. Mastering this foundational science is an essential competency for health care providers. Some medical schools still adopt the traditional teacher-centered methods for teaching anatomy with the disadvantages of lacking the students' opportunity to practice higher levels of thinking such as application, interpretation, or analysis during class. One of the promising teaching strategies that enhance student engagement is the flipped classroom (FC). The present study explored the students' achievement during the anatomy FC, compared with traditional classroom for the first time in Qassim College of Medicine.

METHODS

Online educational materials were uploaded on the Blackboard in the form of electronic textbooks, PowerPoint presentations, online websites, journal articles and multimedia in the pre-class phase of the FC. The in-class phase included open discussion and problem-solving activities were based upon the digitalized resources. Students' attendance was recorded during the in-class sessions. Comparison between the students' scores of the pre-and post-tests for both the FC and traditional classroom. A computed students' survey towards the FC was analysed.

RESULTS

The mean students' scores of the lower and higher-order thinking questions of the FC in the pre-tests were significantly increased in the pre-tests (4.40±1.18 and 1.39±0.53 respectively), compared with that of the traditional classroom (1.44±1.09 and 0.41±0.51 respectively) as well as in the post-tests (5.73±1.03 and 2.14±0.71), compared with that of the traditional classroom (5.07±1.2 and 1.66±0.93 respectively). The absence rate of the students during the FC was lower by 16.13%. Students' survey conveyed their satisfaction towards the FC. Cronbach's alpha test revealed high reliability of all students' survey items and their correlation coefficient was positive.

CONCLUSION

The current work concluded that the educational outcome gained from the technology-enhanced active learning (TEAL), through the implementation of the anatomy FC, enhanced the students' achievement and commitment and suggested the upgrading of the anatomy teaching methods and exploring the long-term effects of the FC.

The effectiveness of combining e-learning, peer teaching, and flipped classroom for delivering a physiology laboratory course to nursing students

The Internet and 5G era makes e-learning a vital part of modern education, and extensive evidence has shown that peer teaching and flipped classroom contribute to increased success in medical teaching. However, the applicability of these pedagogies in laboratory courses remains largely unexplored. This study aimed to evaluate the academic performance, proficiency in procedural skills, and perception of nursing students in physiology laboratory classes delivered with nontraditional classroom (NTC) pedagogies comprising the combination of e-learning, peer teaching, and flipped classroom. Each class was subdivided into two equal halves by successive student identification (ID) number and randomly assigned to the control or NTC group. Compared to the control class, NTC teaching significantly enhanced mean score of six preclass tests (67.77 ± 9.83 vs. 62.94 ± 9.70), with "B" graders increased obviously, suggesting that preclass e-learning was more effective than textbook-based preview, especially for general grasp of the topic. Similarly, average scores on postclass quizzes in the NTC group were improved (79.40 ± 9.12 vs. 74.43 ± 8.88). Lesser time cost and higher success rates were observed in trachea, artery, and heart catheterizations in the NTC group, although no disparities were found in ureteral intubation. The majority (∼74%) of students supported the reform and shared positive experiences with NTC methodology. They reported that virtual experiments and self-paced procedural skill videos affected pre- and in-class learning outcomes most, respectively. These findings indicated that NTC pedagogy was workable to improve students' subject scores and proficiency in complicated and direct-viewing procedural skills and was favorable to students.

Improvement in Student Performance and Perceptions through a Flipped Anatomy Classroom: Shifting from Passive Traditional to Active Blended Learning

One of the major challenges facing anatomy educators is delivering the anatomy materials in fewer hours with a reduction of anatomy courses in the integrated curricula. The flipped classroom modality may be an innovative solution. However, its effectiveness remains under debate due to a lack of outcome-based research and the mixed results of students' performance. The present study aimed to determine the outcome of the flipped classroom based upon the level of student cognition. The study investigated performance on 17 multiple-choice anatomy questions as a part of the final examination of the musculoskeletal system module. The results were compared between the first-year female students of Qassim Medical College, specifically the flipped classroom group (46 students) of the academic year (2018-2019) and the traditional group (49 students) of the academic year (2017-2018). The mean differences in the students' grades on the anatomy questions at the level of knowledge, application, and analysis using Cohen's d test were 0.43, 1.41, and 1.01, respectively. These results suggest the positive impact of flipping the students' classrooms on improving their levels of thinking according to Bloom's taxonomy. Perception surveys also revealed students' enthusiasm for the pre-class activities, leading to a better performance in the class with more engagement with their peers and teachers. The present study suggested that the flipped classroom modality can be performed to compensate for the reduction of anatomy educational hours. However, further studies are recommended to investigate the best practices of the flipped classroom that fit with the students' needs and workloads.

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.

Evaluating Usability in Blended Learning Programs Within Health Professions Education: a Scoping Review

Knowledge was mapped about how usability has been applied in the evaluation of blended learning programs within health professions education. Across 80 studies, usability was explicitly mentioned once but always indirectly evaluated. A conceptual framework was developed, providing a foundation for future instruments to evaluate usability in this context.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01295-x.

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.

Nursing students' perception of class immersion facilitators in psychiatric nursing: Team-based learning combined with flipped learning

BACKGROUND

Psychiatric nursing is a complex subject for nursing students due to abstract concepts and required pre-licensure competencies including collaboration and communication. A student-centred educational approach is needed to encourage engagement and immersion in class.

OBJECTIVES

This study aimed to use students' perspectives to explore factors facilitating class immersion in a psychiatric nursing subject using team-based learning combined with flipped learning.

DESIGN

This study used a qualitative approach.

SETTINGS

Team-based learning combined with flipped learning was applied in a 3-credit psychiatric nursing subject over a 15-week semester at a university in Daejeon, South Korea.

PARTICIPANTS

Participants included 12 senior nursing students who had completed a psychiatric nursing subject.

METHODS

Data were collected using individual interviews, and analysed by reflexive thematic analysis. Data analysis was based on constructivist learning theory.

RESULTS

The following four main themes emerged, teacher as a facilitator, inquiry-based learning, collaboration, and reflection. The teacher's role as a facilitator was to guide student's self-directed learning and immersion in enjoyable classes with a non-hierarchical environment. Realistic complex problems allowed students to prepare for future clinical practice and helped students with immersion. Students actively integrated different opinions through collaboration with team members and became immersed in class. Students were able to immerse more in class through critical thinking process and immediate feedback.

CONCLUSIONS

The findings suggest that team-based learning combined with flipped learning based on constructivist learning theory may be an effective instructional approach for increasing class immersion in a psychiatric nursing subject, thereby improving instructor's design for the subject.

The Physiological Court

Research has been important to prove that student achievement can improve when active methodologies are properly implemented, either in isolation or integrated with lectures. Here, active methodology was organized according to a student-centered collaborative design that involved group debate, described as a Physiological Court. The purpose of this work was to evaluate the performance and perception of medical students after integrating short lectures with collaborative work and debate. The activity was carried out with students (n = 50) from the 2nd year of medical school. The activity performed was related to the hypothalamus-pituitary-thyroid and hypothalamus-pituitary-adrenal axes. The students were instructed to prepare a study material on the proposed themes to be used on the day of the debate. At the activity day, the 2 students' groups (n = 25) were organized in the classroom so that they were face-to-face. Five days after, the students answered the cognitive monitoring test (CMT) which consists of 5 multiple choice questions (MCQ). Students also answered a question about their perception of the activities performed. Ninety-two percent of students showed a positive perception of the activities performed. After completion of the physiological court, 83 ± 4% of students achieved grades above 7.0 on CMT. The percentage of incorrect answers was 5 ± 1.3% in CMT. The association of 40-min lectures with active methodologies was positive for the perception and the performance of students in the second years of medical school related to the physiology of the endocrine systems.

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.

Evaluation of the effectiveness of student learning and teacher instruction on team-based learning during quality control of diagnostic imaging

Background: Team-Based Learning (TBL), which is a student-centered instructional approach, has been applied in various health-related courses, but research on the effectiveness of TBL in radiologic technology is limited. More research is needed to examine the effectiveness of TBL within the field of radiologic technology as well as to study teachers' reflective practices for instructional development in TBL.Objectives: This study examines the effectiveness of TBL on students' learning and course instructors' instructional development during quality control activities in diagnostic imaging.Design: This study employed an action research approach with mixed-methods. The study was categorized using four TBL modules as the topics: film/screen receptors and processors, radiography, mammography, and computed tomography. Quantitative data included pre-test scores on individual readiness assurance tests (IRAT-pre), group readiness assurance tests (GRAT), and post-test scores on individual readiness assurance tests (IRAT-post). Qualitative data included students' responses to open-ended questions about their experience with TBL and transcripts of instructors' interviews.Results: Forty junior college students participated in the study. A non-parametric test was conducted to compare the scores. The results showed that the GRAT score was significantly higher than the IRAT-pre-score, and the IRAT-post score was significantly higher than the IRAT-pre-score. The IRAT-post score was significantly higher than the GRAT score for the first and fourth modules, but IRAT-post score was significantly lower than the GRAT score on the second and third modules. Using direct content analysis, five themes were coded around instructional development, while 15 themes were coded to understand students' experiences with TBL.Conclusions: TBL can be an effective instructional approach to improve students' understanding of radiologic technology content. The results of this research can help instructors decide what action plan to implement to increase the effectiveness of TBL when further employing it for radiologic technology courses.

Student assessment of online tools to foster engagement during the COVID-19 quarantine

As a result of the installation of the COVID-19 (coronavirus disease 19) pandemic, online education has become an important teaching alternative, and new challenges about how to teach were found. Here we report our experience in offering an online course to review Human Physiology. We proposed synchronous and asynchronous activities using different online tools to address topics considered key to understanding the different systems of human physiology. The students considered important the use of this type of methodology, which uses different online tools to help understand the Human Physiology contents. The students highlighted the use of the Lt platform, Zoom, Mentimeter, and YouTube as the preferred online tools to use in physiology learning.

Implementation of structured team-based review enhances knowledge consolidation and academic performance of undergraduate medical students studying neuroscience

Team-based learning (TBL) provides a systematic approach to teaching and learning and promotes critical thinking and enhances medical educational activities and professional development. TBL-based didactic methodology has proven beneficial in enhancing learning and consolidating key educational concepts throughout educational curricula. Such areas of application include neuroscience, which is traditionally considered to be one of the most difficult disciplines to be taught in undergraduate medical courses to the point where the scientific literature reports "neurophobia" among undergraduate medical students. Herein, we report the design and application of a modified version of TBL, which we termed team-based review (TBR) throughout two cohorts of undergraduate medical students undertaking neuroscience. We show that our TBR methodology enhanced student understanding of neuroscience, increasing average marks and grades achieved in final exams, while also increasing the proportion of students obtaining higher grades. Application of TBR also improved marks obtained by students throughout continuous assessment (midterms, TBL, and problem-based learning grades). In surveys taken following final exams, students strongly felt that TBR enhanced their learning experience and aided knowledge acquisition, consolidation, and exam preparation. Collectively, we show that TBR-based methodology was effective in enhancing the student learning experience and performance in neuroscience and could potentially be successfully used to enhance performance and learning in other subjects in the undergraduate medical curriculum.

The refinement of flipped teaching implementation to include retrieval practice

There has been growing evidence that flipped teaching (FT) can increase student engagement. Traditional lecture-based teaching (TT) method was compared with FT and FT combined with retrieval practice (FTR) in a 400-level Exercise Physiology course over eight semesters. In the FT format, lecture content was assigned for students to prepare before class along with an online quiz. During class, the assigned content and quiz questions were reviewed, and a team-based learning (TBL) activity was conducted. Students found FT implementation three times a week (FT3) to be overwhelming, which led to reconfiguration of the FT design to minimize the quiz and TBL sessions to one per week. Subsequently, FT was combined with retrieval exercises (FTR), which involved recalling information, thus promoting retention. The students in the FTR format were given weekly quizzes in class, where no notes were allowed, which affected their quiz grade negatively compared with FT (P < 0.0001). Again, no resources were permitted during FTR's TBL sessions. When exam scores were compared with TT, student performance was significantly greater (P < 0.001) with the FT and FTR methods, suggesting these methods are superior to TT. While both male and female students benefited from FT and FTR methods compared with TT (P = 0.0008), male students benefited the most ((P = 0.0001). Similarly, when the exam scores were organized into upper and lower halves, both groups benefited from FT and FTR (P < 0.0001) approaches. In conclusion, both FT and FTR methods benefit students more compared with TT, and male students are impacted the most.

Student Perception of the Flipped Classroom in Nursing Education

As nurse educators consider new pedagogy for teaching nursing, the students' views and perceptions must be considered. Many studies and commentaries have been written to date on the flipped classroom in nursing education, but few have used research methods to tease out student views of this teaching approach. The purpose of this study was to investigate student perceptions of the flipped classroom using a phenomenological approach. Students who had experienced traditional lecture instruction and the flipped classroom in the same semester were asked about their perceptions and comparisons of the two instructional methods. Qualitative analysis of fifteen individual interviews and two focus groups revealed seven themes, each encompassing a rich data set to inform nurse educators about student perceptions of the flipped classroom. This research informs educators on the effects of launching innovative teaching and learning strategies while considering the audience within the classroom.

Is hybrid-PBL advancing teaching in biomedicine? A systematic review

BACKGROUND

The impact of instructional guidance on learning outcomes in higher biomedical education is subject of intense debate. There is the teacher-centered or traditional way of teaching (TT) and, on the other side, the notion that students learn best under minimal guidance such as problem-based learning (PBL). Although the benefits of PBL are well-known, there are aspects susceptible to improvement. Hence, a format merging TT and PBL (hybrid-PBL, h-PBL) may advance education in biomedical sciences.

METHODS

Studies that employed h-PBL in higher biomedical education compared to TT and/or pure PBL were systematically reviewed. Specifically, this review addressed the following question: does h-PBL in biomedical sciences result in superior marks and a better student's perception of the teaching and learning process?

RESULTS

We found that the use of h-PBL in higher biomedical sciences was superior compared to TT and pure-PBL. This was evidenced by the higher performance of the students in h-PBL as well as the level of student's satisfaction as compared to TT or pure PBL.

CONCLUSIONS

These findings encourage more research on investigating the pedagogical benefits of h-PBL. In addition, these data support an eclectic system in which the pedagogical tools from TT and PBL are used cooperatively in the best interest of the education and satisfaction of the students.

Pre-Class Learning Methods for Flipped Classrooms

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

Embracing the flipped classroom: the planning and execution of a faculty workshop

A great deal of interest has emerged recently in the flipped classroom (FC), a student-centered teaching approach. After attending a presentation by the first author on the FC, a faculty member of a medical school in Mexico arranged for a 3-day workshop for 13 faculty members. The goal of the workshop was to train faculty to use the FC strategy in their classrooms to increase student engagement in learning. The workshop was in the FC style, where the participants would assume the role of students. Pre- and posttraining surveys were administered to examine participants' current teaching practices and to evaluate their perceptions of the FC. The participants overwhelmingly reported the need to change their lecture-based teaching, as it was not engaging students. Their large class size, lack of technology, training, and uncertainty of the effectiveness of new teaching methods had hindered participants from changing their teaching technique. The on-site training not only allowed the entire department to work closely and discuss the new teaching approach, but also reinforced the idea of changing their teaching strategy and embracing FC teaching method. After the workshop, participants reported being determined to use the FC strategy in their classrooms and felt more prepared to do so. The post-survey results indicated that participants valued the FC training in the flipped style and wanted more of the hands-on activities. In conclusion, the 3-day faculty workshop on the FC was successful, since every participant was motivated to use this teaching method.