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

Inverted Classroom Teaching of Physiology in Basic Medical Education: Bibliometric Visual Analysis

Background

Over the last decade, there has been growing interest in inverted classroom teaching (ICT) and its various forms within the education sector. Physiology is a core course that bridges basic and clinical medicine, and ICT in physiology has been sporadically practiced to different extents globally. However, students' and teachers' responses and feedback to ICT in physiology are diverse, and the effectiveness of a modified ICT model integrated into regular teaching practice in physiology courses is difficult to assess objectively and quantitatively.

Objective

This study aimed to explore the current status and development direction of ICT in physiology in basic medical education using bibliometric visual analysis of the related literature.

Methods

A bibliometric analysis of the ICT-related literature in physiology published between 2000 and 2023 was performed using CiteSpace, a bibliometric visualization tool, based on the Web of Science database. Moreover, an in-depth review was performed to summarize the application of ICT in physiology courses worldwide, along with identification of research hot spots and development trends.

Results

A total of 42 studies were included for this bibliometric analysis, with the year 2013 marking the commencement of the field. University staff and doctors working at affiliated hospitals represent the core authors of this field, with several research teams forming cooperative relationships and developing research networks. The development of ICT in physiology could be divided into several stages: the introduction stage (2013-2014), extensive practice stage (2015-2019), and modification and growth stage (2020-2023). Gopalan C is the author with the highest citation count of 5 cited publications and has published 14 relevant papers since 2016, with a significant surge from 2019 to 2022. Author collaboration is generally limited in this field, and most academic work has been conducted in independent teams, with minimal cross-team communication. Authors from the United States published the highest number of papers related to ICT in physiology (18 in total, accounting for over 43% of the total papers), and their intermediary centrality was 0.24, indicating strong connections both within the country and internationally. Chinese authors ranked second, publishing 8 papers in the field, although their intermediary centrality was only 0.02, suggesting limited international influence and lower overall research quality. The topics of ICT in physiology research have been multifaceted, covering active learning, autonomous learning, student performance, teaching effect, blended teaching, and others.

Conclusions

This bibliometric analysis and literature review provides a comprehensive overview of the history, development process, and future direction of the field of ICT in physiology. These findings can help to strengthen academic exchange and cooperation internationally, while promoting the diversification and effectiveness of ICT in physiology through building academic communities to jointly train emerging medical talents.

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.

Knowledge acquisition efficacy of a remote flipped classroom on learning about removable partial dentures

PURPOSE

Coronavirus disease 2019 has forced the use of remote education worldwide. In 2020, the authors conducted a fully digitized, remote flipped (RF) classroom focusing on removable partial dentures. This study aimed to evaluate the learning outcomes of the RF classroom and compare these with those of the on-site classroom.

METHODS

The fourth-year dental students in 2017-2019 attended on-site flipped classroom (OF; n=70) or on-site lecture classroom (OL; n=67), and those in 2020 (n=58) attended the RF classroom. Lecture videos and text were provided online in the OF and RF groups, while only the text was given to the OL group. Individual and group tests were conducted to assess knowledge acquisition one week after all the classes ended. A one-way analysis of variance following Tukey's test was performed to compare individual/group test scores among the OF, OL, and RF groups. Multilevel linear regression analysis was performed to identify the factors associated with an increase in each test score.

RESULTS

The mean individual test scores in the RF and OF groups were significantly higher than in the OL group (P<0.01). The mean group test score in the RF group was significantly higher than in the OF and OL groups (P<0.001). The multilevel analysis identified remote and flipped classroom styles in the individual test, and the remote style in the group test, as significant effective factors in learning (P<0.05).

CONCLUSIONS

These results suggest that the RF classroom is more effective than the on-site lecture in knowledge acquisition in undergraduate prosthodontic education.

Improved Zoom engagement by adopting flipped class strategies to the curriculum of a Biology of Aging course during the Covid-19 pandemic

During the pandemic, a 4th year course: Biology of Aging was modified with extensive flipped classroom strategies to promote better student engagement. By utilizing the strength of the Zoom video conferencing platform students were able to have meaningful in-class experiences that promoted engagement and learning. This was further enhanced by shifting traditional lectures to a pre-recorded format to act as resources and promoting forum discussions outside of class times using the course management system (Brightspace). These changes influenced the satisfaction and benefited the student experience. Shifting to active student-centered learning and facilitation led to a dynamic well received teaching environment. The one trade off being that students needed to produce content every week, which was perceived as a heavy but manageable workload by many in the course. These changes can be used as a format for other online courses.

The effectiveness of the fully online flipped classroom for nursing undergraduates during the COVID-19: Historical control study

AIM

Evaluate the fully online flipped classroom's effects during the pandemic.

DESIGN

A comparative descriptive study with historical control design.

METHODS

In an internal medicine nursing course, the fully online flipped classroom instruction was used with 53 undergraduates in 2020. Their final examinations were compared with the 50 students taught with traditional offline methods in 2019. Online interactions and students' experiences were described. Pass rates in both classes were over 90% (Χ²  = 0.276, p = 0.60), but the median score in 2019 was higher than in 2020 (Z = -2.491, p = 0.01). There were 996 online interactions and 734 valid interactions in total. All 49 students believed the online flipped classroom schedule was reasonable and all but three said it was helpful. However, 19 students (39%) felt traditional teaching is more effective.

CONCLUSIONS

The fully online flipped classroom method was fairly effective during the pandemic. This model also did increase class participation and sufficient faculty-student interactions in remote education. However, fewer students earned outstanding scores, with possible reasons including the online flipped classroom, lack of clinical practice, stress from COVID-19 and the shortened exam time. Overall, the method is worth recommending under public health emergencies like COVID-19, and future research exploring potential concerns about scores is necessary.

Scenario-based learning: preliminary evaluation of the method in terms of students' academic achievement, in-class engagement, and learner/teacher satisfaction

We sought to evaluate the effectiveness of a newly developed scenario-based learning (SBL) module considering students' academic achievement, in-class engagement, and learner/teacher satisfaction. Third-year students in a 6-year medical education program, who had preexperience in problem-based learning, studied in small groups with facilitators throughout a week allocated for the SBL module. SBL processes, student/facilitator roles, and expectations were explained to students and facilitators in online training before implementation. Three online discussion sessions were scheduled, but the groups were allowed to organize extra online meetings. The students provided with learning objectives were asked to create a problem-based learning (PBL) scenario with a facilitator's guide including answers to scenario questions, evidence-based information, and tips for facilitators. Evaluated outcomes were learner/teacher satisfaction, students' academic achievement, and engagement. Satisfaction was determined using semistructured feedback forms. Generated scenarios were assessed using a checklist. A written exam was performed to assess students' knowledge and reasoning skills. Student engagement during the sessions was evaluated using forms completed by facilitators and students. SBL module outcomes were compared to students' grade point averages (GPAs) and former PBL outcomes. Mean scenario evaluation, student engagement, and satisfaction scores were around 90%. Mean scores for facilitator satisfaction and whole module success were around 80% and 77%, respectively. Academic achievement and student satisfaction were higher in SBL compared to GPA and previous PBL modules. Facilitator satisfaction and student engagement did not differ between SBL and PBL. Student satisfaction and academic achievement were higher in online SBL compared with PBL without any differences in in-class engagement and facilitator satisfaction.NEW & NOTEWORTHY A newly developed scenario-based learning (SBL) module was implemented assigning third-year medical students to create (highest cognitive level) a problem-based learning facilitator scenario studying in small groups with a facilitator. The 1-wk online SBL module was composed of three scheduled and an unlimited number of nonscheduled sessions. The students and facilitators positively received SBL with some recommendations for improvement. Preliminary evaluation suggests SBL can be implemented without compromising (maybe improving) students' academic achievement, satisfaction, and engagement levels.

The promotion of active aging through older adult education in the context of population aging

We have entered an era of population aging, and many public health problems associated with aging are becoming more serious. Older adults have earlier onset of chronic diseases and suffer more disability. Therefore, it is extremely important to promote active aging and enhance health literacy. These involves full consideration of the need for education and the provision of solutions to problems associated with aging. The development of OAE is an important measure for implementing the strategy of active aging, and curriculum construction is a fundamental component of achieving OAE. Various subjective and objective factors have limited the development of OAE. To overcome these difficulties and ensure both active and healthy aging, the requirements for active aging should be implemented, the limitations of current OAE should be addressed, system integration should be increased, and the curriculum system should be improved. These approaches will help to achieve the goal of active aging. This paper discusses OAE from the perspective of active aging, based on the promotion of health literacy and provides suggestions to protect physical and mental health among older adults, while promoting their social participation. The provision of various social guarantees for normal life in older adults is a new educational concept.

Strategies adopted by undergraduate teaching assistants in physiology and biophysics education during the COVID-19 pandemic

The COVID-19 pandemic affected almost all aspects of our lives, including the education sector and the way of teaching and learning. In March 2020, health authorities in Brazil imposed social isolation and the interruption of on-site activities in schools and universities. In this context, the Federal University of Minas Gerais (UFMG), one of the largest universities in Brazil and Latin America, developed an emergency remote learning (ERL) plan that allowed the return of classes in an online format and supported students to obtain access to equipment and internet network. Within this new perspective, the Undergraduate Teaching Assistant (UTA) program of the Department of Physiology and Biophysics (DFIB) explored strategies to minimize the impact of the absence of face-to-face classes. Using different available tools in online platforms and social media such as Microsoft Teams, YouTube animated video classes, and Instagram, the UTA program assisted >500 undergraduate students and strongly supported professors during ERL. In just over a year, our video classes on YouTube Channel reached ∼40,000 views. Most of the students reported that their questions were fully and quickly solved by the UTA program. Collectively, our results indicate that the strategies implemented by the UTA program helped the undergraduate students and professors to adapt to a remote learning format.

Hot topics and frontier evolution in college flipped classrooms based on mapping knowledge domains

With the outbreak of COVID-19 and the development of online teaching, the online flipping teaching mode has attracted increasing attention. Systematic analysis of the research status and development trend of the flipped classrooms is significant for guiding the improvement of the quality of online flipped teaching. This study used the metrology software CiteSpace to draw a scientific knowledge map of relevant research in the web of science database from 2013 to 2021. It performed visual analysis of research authors, research institutions and countries, keyword clustering, keywords co-occurrence, and keyword time zone distribution. The results showed that: (1) The flipped classrooms research has attracted increasing attention from the social and educational circles, however, the relationship between relevant research authors, institutions, and countries is not close enough, and there is little cooperation. We need to strengthen cooperation further and realize the sharing of high-quality resources; (2) Based on keyword co-occurrence cluster analysis, this study identified three hot topics, namely, preparation before class, classroom activities and consolidation after class; (3) According to the keyword time zone map, this study divided three frontier evolution trends: exploration period, adaptation period, and growth period; (4) Finally, with the spread of novel coronavirus, it is suggested to promote the online flipped classroom teaching mode, and put forward reasonable suggestions from the perspective of teachers, students and researchers, and look forward to the future digital development direction of the flipped classroom.

The COVID-19 pandemic and its impact on medical teaching in obstetrics and gynecology—A nationwide expert survey among teaching coordinators at German university hospitals

Purpose

The COVID-19 pandemic has imposed severe challenges on medical education at German university hospitals. In this first German nationwide expert survey, we addressed the responsible university teaching coordinators in obstetrics and gynecology departments and investigated their experiences during the pandemic as well as their opinions on future developments, especially with regard to the broader implementation of e-learning in the standard curriculum.

Methods

The questionnaire included 42 items and was disseminated among teaching coordinators at all 41 departments of obstetrics and gynecology at German university hospitals via an email that included a weblink to the online survey provider. Responses were collected between 19 April and 7 June 2021.

Results

In total, 30 responses were collected from 41 departments across Germany and their respective teaching coordinators in obstetrics and gynecology. The general opinion of the medical teaching provided during the pandemic was positive, whereas the teaching quality in practical skills was considered inferior and not equivalent to the standard face-to-face curriculum. Lectures and seminars had to be substituted by remote-learning alternatives, while clinical clerkships were reduced in length and provided less patient contact. Students in their final year experienced only a few differences in the clinical and teaching routine. Teaching coordinators in obstetrics and gynecology stated that they intend to incorporate more e-learning into the curriculum in the future.

Conclusion

The medical educators’ views presented here may help to complement the already-thoroughly investigated experiences of students under the restrictions of the COVID-19 pandemic. Medical educators in obstetrics and gynecology at German university hospitals have successfully established online and hybrid teaching alternatives to their standard face-to-face courses. Building on recent experiences, digitalization could help to improve future medical education.

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.

Effects of modified BOPPPS-based SPOC and Flipped class on 5th-year undergraduate oral histopathology learning in China during COVID-19

BACKGROUND

Colleges and universities in China have offered courses based on online teaching platforms as required by the Ministry of Education since the beginning of the COVID-19 pandemic. This emergency action was not an expedient measure, but a powerful impetus to improve extant education and implement teaching reform. Oral histopathology is a basic subject in oral medicine education, which combines theory with practice. The course aims to improve the ability of students to observe, think, analyze and identify oral diseases.

METHOD

We adjusted and modified the original Bridge-In, Outcomes, Pre-assessment, Participatory Learning, Post-assessment, and Summary (BOPPPS) teaching method to fit the characteristics and needs of oral histopathology. We then combined the characteristics of Small Private Online Courses (SPOCs) and a Flipped class to complete teaching material online, and assessed the effects of such teaching using a questionnaire and interviews. Fifty 5th-year undergraduates in stomatology at the School of Stomatology of Harbin Medical University of China participated in online classes. All were in the junior second half of the semester at the beginning of 2020. Teachers investigated from various medical colleges were responsible for delivering courses associated with stomatology or ophthalmology.

RESULT & CONCLUSION

The results showed that the modified BOPPPS combined with SPOC and the Flipped class improved teaching satisfaction. Modified BOPPPS combined with SPOC and the Flipped class is a useful complement to offline teaching on 5th-year undergraduate oral histopathology learning in China during COVID-19, and it can meet the multiple needs of students participating in the course.

Report on the online course "Basic Concepts in Neurophysiology": a course promoted during the COVID-19 pandemic quarantine

"Basic Concepts in Neurophysiology" was a 3-wk online course developed during six synchronous meetings combined with asynchronous activities. We proposed an active learning course that used free online platforms to teach physiology during a period in which undergraduates were not in classrooms or taking online classes due to the COVID-19 pandemic. Herein, we report the course organization and the students' involvement in, acceptance of, and evaluation of the course. To address the students' perceptions about these points, we sent a questionnaire to 49 participants who finished the course. We found that although most students (52.5%) had never taken a course with similar methods before, almost all of them (95%) liked the flipped class model. Additionally, a majority of the students (92.5%) said that the method increased their study frequency during the social distancing period, which is an important aspect to consider during this challenging time for both students and professors.