Implementation of flipped classroom combined with problem-based learning: an approach to promote learning about hyperthyroidism in the endocrinology internship

Neuroanatomy teaching in the flipped classroom: Attitudes and effect on medical students' performance

BACKGROUND

Neuroanatomy is essential to clinical neurosciences and is one of the most difficult components of the anatomy curriculum. Flipped classrooms are one of the pedagogical approaches that have been found to enhance students' abilities and encourage in-depth learning. The current study aims to assess the attitudes and effects of flipped classrooms on neuroanatomy teaching among medical students compared to traditional classrooms.

METHODS

A quasi-experimental study was carried out during the period January through June 2023. The effectiveness of teaching neuroanatomy in flipped classrooms versus traditional classrooms was assessed using formative assessment and a pre-designed structured questionnaire. The questionnaire was composed of four sections assessing different domains on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).

RESULTS

The total sample reached 214 students. Most students' attitude statements covering skills, knowledge and learning process, and length of time were significantly in favor of flipped teaching at the expense of traditional teaching. Then mean examination grades were significantly higher for pre-test flipped and post-test flipped in comparison to pre-test and post-test traditional examination.

CONCLUSIONS

Although the flipped classroom is an effective method of learning neuroanatomy as compared to traditional classes, it faces some challenges in its implementation. Such challenges need awareness and solutions from educational institutions.

Comparison of lecture-based learning with presentation-assimilation-discussion method in occupational bloodborne exposure education of nursing students, a randomised trial

BACKGROUND

Occupational Bloodborne Exposures (OBEs) are incidents where healthcare workers come into contact with blood or other potentially infectious materials, leading to risks of transmitting bloodborne pathogens. Nursing students, often in direct contact with patients, face heightened risks due to their duties.

METHODS

First, we conducted a cross-sectional survey using a OBEs questionnaire to explore the knowledge, attitudes, practices, and needs regarding OBEs among nursing students. Subsequently, we used a randomized controlled trial (RCT) to compare the impact of the Presentation-Assimilation-Discussion (PAD) method with the traditional lecture-based learning (LBL) method on OBEs education for nursing students. Pre-test, post-test, and retention test were used to observe the teaching effectiveness, and the students' feedback on the teaching method was also observed.

RESULTS

In the cross-sectional survey, we found that nursing students lacked sufficient knowledge and management skills regarding OBEs but recognized the importance of standard precautions and expressed a desire for systematic OBEs training during their education and internships. In the RCT, the total, theoretical, and practical scores of the PAD and LBL groups were comparable in the pre-test (56.70 ± 3.47 vs. 56.40 ± 3.95, 33.09 ± 3.39 vs. 33.33 ± 2.44, 23.61 ± 4.66 vs. 23.07 ± 4.84, p > 0.05). After training, the PAD model demonstrated an advantage over the LBL model in immediate total (84.25 ± 4.06 vs. 78.95 ± 4.23, p < 0.001), theoretical (54.32 ± 2.43 vs. 51.44 ± 2.58, p < 0.001), and practical scores (29.93 ± 3.90 vs. 27.51 ± 4.33, p < 0.01). It also showed superior retention of total (69.05 ± 3.87 vs. 65.77 ± 2.94, p < 0.001) and theoretical scores (39.05 ± 3.05 vs. 36.23 ± 3.18, p < 0.001). However, there was no significant difference in the retention of practical scores between the two groups (30.00 ± 4.76 vs. 29.53 ± 3.73, p > 0.05). The PAD group benefited more across various learning dimensions but reported a higher study load.

CONCLUSIONS

Our study reveals that the PAD model could be a valuable approach for teaching OBEs to nursing students.

Flipping Veterinary Biochemistry, Anatomy, and Physiology: Students' Engagement and Perception

Flipped classroom (FC) is a teaching method where traditional learning roles are inverted. Students are provided with material in advance and are expected to study the content prior to in-class sessions. These sessions are subsequently utilized to clarify doubts and examine in greater depth the previously acquired knowledge. Despite the widespread nature of its approach in health education, its application in basic veterinary subjects remains poorly described. This study explores the implementation of the FC approach in veterinary physiology, biochemistry, anatomy, and embryology. Pre-class material was mainly provided in video format, and class sessions facilitated quizzes and interactive activities aimed to reinforce understanding. The findings indicate a high level of student involvement and effective class preparation, as evidenced by over 84% of students participating in FC in-class sessions and generally achieving satisfactory scores on quizzes. A survey conducted at the end of the first semester shows that a high proportion of students positively valued pre-class material (>90%), quizzes (82%), and the FC approach (66%). However, by the end of the second semester, traditional lectures were preferred by more students than FC (45% and 25%, respectively), while 30% of the students mentioned having no preference between the two methods. Analysis of open-ended responses underscored positive facets of the FC approach, including self-organization, enhanced understanding, and availability of pre-class material. However, it also emphasized challenges associated with FC, such as the significant time and effort required. In conclusion, this study suggests that the FC approach can be well received in integrated basic veterinary subjects if it does not imply an excessive student workload, underscoring the potential benefits of a blended teaching approach that combines elements of both traditional and FC methods.

Effectiveness of Different Teaching Methods in Enhancing Dental Undergraduate Students' Knowledge and Restorative Cement Manipulation Skills

Background and objectives Developing manual skills is important in dental education. Clinical skills can be taught via clinical demonstrations, and knowledge can be delivered through lectures. Performing dental restorations is an essential skill for dentists, which requires a comprehensive knowledge of the manipulation of the restorative materials. The present study sought to compare the effectiveness of flipped learning (FL), smart class (SC), and traditional teaching (TT) methods in two arenas of learning: acquisition of theoretical knowledge and practical skill in manipulating dental restorative cement. Materials and methods All first-year undergraduate dental students (n = 60) were divided into three study groups and exposed to three teaching methods, namely TT, SC, and FL of three different dental restorative cements. Each teaching method was followed by an evaluation of the "knowledge assessment score," a live demonstration of the cement manipulation, and the participants' "skill assessment score." Descriptive statistics were expressed as mean and SD for continuous variables. A comparison of the knowledge assessment scores and skill assessment scores between the study groups was analyzed using a one-way ANOVA test. Intergroup comparison was done using Tukey's post hoc test. Results The FL group had a significantly higher "knowledge assessment score" (p = 0.001), while there was no significant difference between the SC and TT groups (p = 1.0). Both FL and SC groups had significantly higher "skill assessment scores" (p = 0.001), with no significant difference between them (p = 0.798). Conclusions Of the three teaching methods assessed, FL proved to be more effective in the knowledge acquired and clinical competence demonstrated when compared to the other two techniques in dental education.

Effectiveness of error-based active learning compared to conventional lecture-based method among undergraduate dental students: A randomized controlled trial

INTRODUCTION

Dental education assumes an indispensable role in adequately equipping students for a successful career in dentistry. Error-based active learning, an innovative approach in dental education, is a combination of mistake-driven learning (MDL) and case-based learning (CBL) to provide a transformative learning atmosphere for students. While active learning has gained popularity in dental education, the effectiveness of error-based active learning remains unexplored. This study aims to evaluate the effectiveness of error-based active learning among final-year dental undergraduate students in comparison with the conventional lecture-based approach.

MATERIALS AND METHODS

A parallel-arm single-blind randomized controlled trial was conducted in a dental institute in India from November 2022 to December 2022. A total of 74 students were randomly allocated to two groups: Group A (n = 37) received error-based active learning and group B (n = 37) received conventional lecture-based learning approach. Atraumatic restorative treatment (ART) was chosen as the topic for the study. The knowledge of students was assessed at three intervals: baseline, post-intervention, and 4 weeks after the intervention, using a self-designed and validated questionnaire with Cronbach's alpha of 0.87 and a content validity ratio of 0.84. A standard survey questionnaire was employed to evaluate students' perceptions of the teaching methods.

RESULTS

Error-based active learning group outperformed the lecture-based group significantly in the post-intervention test (20.92 ± 1.42 vs 16.97 ± 3.06), with better knowledge retention (18.30 ± 2.02 vs 14.05 ± 4.26) and positive feedback from the students.

CONCLUSIONS

The error-based active learning approach proved superior to the conventional lecture-based method in enhancing and retaining knowledge regarding ART.

Advancing arrhythmia education through the CDIO approach: a new paradigm in nursing student training

BACKGROUND

The accurate diagnosis and effective management of arrhythmias are crucial, with nurses playing a key role in the early detection and treatment, significantly impacting patient outcomes. Improving education on arrhythmias among nurses, especially in critical care and perioperative settings, can enhance patient safety and the quality of care.

METHODS

A total of 116 trainee nurses were randomly divided into two groups: one utilizing the conceive-design-implement-operate (CDIO) model and the other employing a traditional lecture-based learning (LBL) method, to undergo arrhythmia training. The studyassessed the effects of the two teaching methods and investigated the students' attitudes toward these educational practices, with all participants completing pre- and post-course tests.

RESULTS

The CDIO model significantly enhances nursing students' arrhythmia proficiency, yielding higher test scores and sustained improvement after 24-week compared to the traditional LBL method, alongside markedly better self-learning enthusiasm, understanding, satisfaction with the teaching approach and effectiveness, and interest in learning arrhythmia. The CDIO model in nursing arrhythmia courses boosts theoretical knowledge and application, showing potential in clinical skill enhancement.

CONCLUSIONS

Our study introduces the CDIO model in nursing arrhythmia courses, with improvement in knowledge and skills, and promise for broader application.

Nursing students'experience of flipped classroom combined with problem-based learning in a paediatric nursing course: a qualitative study

BACKGROUND

Problem-based learning (PBL) is a student-centred approach that triggers learning by presenting problems cenarios early in the learning process.Flipped classrooms have been used in various disciplines using various models.Pre-class e- learning in aflipped classrooms can enrich knowledge acquisition in PBL teaching. This study was conducted to explore nursing students'experience of flipped classroom combined with problem-based learning in a paediatric nursing course.

METHOD

This descriptive qualitative study was conducted between January and June 2022.Semi-structured interviews were conducted with nursing students who were participated in flipped classrooms combined with PBL teaching in a paediatric nursing course at Soochow university in China. Nursing students were selected using a purposive sampling method until no new data were generated (n = 16).

RESULTS

We identified ten sub-themes and four higher-order themes based on these sub-themes: (1)stimulating interest in learning and enhancing autonomous learning,(2)improving independent thinking and problem-solving skills,(3)cultivating team work spirit, and (4) gaining knowledge and improving skills.The findings of our research contribute to show the effectiveness of the flipped classroom combined with PBL in a paediatric nursing course.

CONCLUSION

The flipped classroom combined with PBL in a paediatric nursing course can enhances communication and cooperation abilities among nursing students, promoting common progress and the comprehensive development of nursing students.

The application of flipped classroom combined with team-based learning in the orthopedic clinical teaching

BACKGROUND

Medical education has evolved rapidly, with the development of flipped classrooms and team-based learning based on lecture-based learning, but the novel model of combining flipped classrooms with team-based learning has been poorly investigated in orthopedic education.

METHODS

A femoral neck fracture teaching mode was chosen to 109 clinical internship students to explore the effectiveness of flipped classroom combined with team-based learning in internship education. They were enrolled and randomly divided into either the flipped classroom combined with team-based learning group (FTG, n = 55) or the traditional lecture-based classroom group (n = 54). All students completed the learning according to the course flow and took before-class and after-class tests. The questionnaires were used to compare students perceptions and satisfaction with the different teaching methods and were utilized to assess the strengths and weaknesses of the 2 groups.

RESULTS

The post-class test scores of both groups significantly improved compared to pre-class test scores. Regarding the post-class test scores, FTG's was significantly higher than the traditional lecture-based classroom group's, mainly in clinical areas such as imaging analysis, fracture classification, treatment options, and management of postoperative complications, but there was no significant difference in the mastery of basic theoretical knowledge. The students were more satisfied with the FTG and believed that it improved their various competencies, but with significantly more time spent.

CONCLUSION

FTG is generally recognized as a promising option for training clinical interns and is worth spreading as it has outstanding merits in developing students clinical competence.

The effects of flipped classrooms to improve learning outcomes in undergraduate health professional education: A systematic review

Background

The 'flipped classroom' approach is an innovative approach in educational delivery systems. In a typical flipped class model, work that is typically done as homework in the didactic model is interactively undertaken in the class with the guidance of the teacher, whereas listening to a lecture or watching course-related videos is undertaken at home. The essence of a flipped classroom is that the activities carried out during traditional class time and self-study time are reversed or 'flipped'.

Objectives

The primary objectives of this review were to assess the effectiveness of the flipped classroom intervention for undergraduate health professional students on their academic performance, and their course satisfaction.

Search Methods

We identified relevant studies by searching MEDLINE (Ovid), APA PsycINFO, Education Resources Information Center (ERIC) as well as several more electronic databases, registries, search engines, websites, and online directories. The last search update was performed in April 2022.

Selection Criteria

Included studies had to meet the following criteria: Participants: Undergraduate health professional students, regardless of the type of healthcare streams (e.g., medicine, pharmacy), duration of the learning activity, or the country of study. Intervention: We included any educational intervention that included the flipped classroom as a teaching and learning tool in undergraduate programs, regardless of the type of healthcare streams (e.g., medicine, pharmacy). We also included studies that aimed to improve student learning and/or student satisfaction if they included the flipped classroom for undergraduate students. We excluded studies on standard lectures and subsequent tutorial formats. We also excluded studies on flipped classroom methods, which did not belong to the health professional education(HPE) sector (e.g., engineering, economics). Outcomes: The included studies used primary outcomes such as academic performance as judged by final examination grades/scores or other formal assessment methods at the immediate post-test, as well as student satisfaction with the method of learning. Study design: We included randomised controlled trials (RCTs), quasi-experimental studies (QES), and two-group comparison designs. Although we had planned to include cluster-level RCTs, natural experiments, and regression discontinuity designs, these were not available. We did not include qualitative research.

Data Collection and Analysis

Two members of the review team independently screened the search results to assess articles for their eligibility for inclusion. The screening involved an initial screening of the title and abstracts, and subsequently, the full text of selected articles. Discrepancies between the two investigators were settled through discussion or consultation with a third author. Two members of the review team then extracted the descriptions and data from the included studies.

Main Results

We found 5873 potentially relevant records, of which we screened 118 of them in full text, and included 45 studies (11 RCTs, 19 QES, and 15 two-group observational studies) that met the inclusion criteria. Some studies assessed more than one outcome. We included 44 studies on academic performance and eight studies on students' satisfaction outcomes in the meta-analysis. The main reasons for excluding studies were that they had not implemented a flipped class approach or the participants were not undergraduate students in health professional education. A total of 8426 undergraduate students were included in 45 studies that were identified for this analysis. The majority of the studies were conducted by students from medical schools (53.3%, 24/45), nursing schools (17.8%, 8/45), pharmacy schools (15.6%, 7/45). medical, nursing, and dentistry schools (2.2%, 1/45), and other health professional education programs (11.1%, 5/45). Among these 45 studies identified, 16 (35.6%) were conducted in the United States, six studies in China, four studies in Taiwan, three in India, two studies each in Australia and Canada, followed by nine single studies from Brazil, German, Iran, Norway, South Korea, Spain, the United Kingdom, Saudi Arabia, and Turkey. Based on overall average effect sizes, there was better academic performance in the flipped class method of learning compared to traditional class learning (standardised mean difference [SMD] = 0.57, 95% confidence interval [CI] = 0.25 to 0.90, τ 2: 1.16; I 2: 98%; p < 0.00001, 44 studies, n = 7813). In a sensitivity analysis that excluded eleven studies with imputed data from the original analysis of 44 studies, academic performance in the flipped class method of learning was better than traditional class learning (SMD = 0.54, 95% CI = 0.24 to 0.85, τ 2: 0.76; I 2: 97%; p < 0.00001, 33 studies, n = 5924); all being low certainty of evidence. Overall, student satisfaction with flipped class learning was positive compared to traditional class learning (SMD = 0.48, 95% CI = 0.15 to 0.82, τ 2: 0.19, I 2:89%, p < 0.00001, 8 studies n = 1696); all being low certainty of evidence.

Authors' Conclusions

In this review, we aimed to find evidence of the flipped classroom intervention's effectiveness for undergraduate health professional students. We found only a few RCTs, and the risk of bias in the included non-randomised studies was high. Overall, implementing flipped classes may improve academic performance, and may support student satisfaction in undergraduate health professional programs. However, the certainty of evidence was low for both academic performance and students' satisfaction with the flipped method of learning compared to the traditional class learning. Future well-designed sufficiently powered RCTs with low risk of bias that report according to the CONSORT guidelines are needed.

Hybridizing video-based learning with simulation for flipping the clinical skills learning at a university hospital in Pakistan

BACKGROUND

While learning and practicing on actual patients is a major mode of teaching clinical skills, concerns about patient safety, unavailability, and lack of standardization have led to the development of simulation for medical education. Simulation-based teaching is affected by challenges such as lack of protected time for faculty, inexperienced learners, and the number of students per group. These have led to the integration of various eLearning formats in the curriculum. The hybridized format changes the traditional clinical skills teaching into the flipped classroom. This study aims to measure the effectiveness of hybridizing video-based learning with simulation for flipping the clinical skills teaching of fourth-year medical students at the Department of Paediatrics and Child Health at Aga Khan University, Pakistan.

METHODS

The study employed a mixed-methods design. Fourth-year medical students of the batch 2020-21 (n = 100) consented to participate in the study. The quantitative component focuses on identifying the effect of the intervention on the perceived self-efficacy of medical students (batch 2020-21) relevant to the clinical skill. Along with this, the performance of the intervention batch of 2020-21 on the end of clerkship objective structured clinical exam (OSCE) was compared with the previous batch of 2019-20, taught using simulation alone. Focused group discussions (FGDs) were used to explore the experiences of medical students (batch 2020-21) about the intervention. Quantitative data underwent descriptive and inferential analysis using Stata v16 while qualitative data underwent content analysis using NVivo software.

RESULTS

Hybridization of video-based learning with simulation significantly improved self-efficacy scores for all examinations (cardiovascular, respiratory, neurological, and abdomen) with p-value < 0.05. OSCE scores of the intervention group were significantly higher on the neurological and abdominal stations as compared to the previous batch (p-value < 0.05). In addition, the overall structure of the intervention was appreciated by all the students, who stated it allowed reinforcement of basic concepts, retention, and further insight into clinical applications.

CONCLUSION

The hybridization of video-based learning with simulation facilitated in creation of better opportunities for medical students to revive their prior knowledge, apply core concepts for the problem and engage in clinical reasoning.

WeChat as a platform for blending problem/case-based learning and paper review methods in undergraduate paediatric orthopaedics internships: a feasibility and effectiveness study

BACKGROUND

Paediatric orthopaedics is a significant and difficult for undergraduate students to master. During the COVID-19 pandemic, we used the WeChat platform to combine the advantages offered by problem-based learning (PBL), case-based learning (CBL) and paper review teaching methods to establish a new blended online teaching model and demonstrated its feasibility and effectiveness.

OBJECTIVE

This study aims to demonstrate the feasibility and effectiveness of a new blended pedagogical method that uses the WeChat platform and combines PBL, CBL and paper review.

METHODS

We enrolled 22 students participating in the Department of Paediatric Orthopaedics. They participated in the WeChat blended pedagogy mode. Their departmental rotation examination scores were compared with those of 23 students who participated in the traditional teaching method. Moreover, an anonymous questionnaire was used to evaluate students' perceptions and experiences.

RESULTS

The total average scores of students who participated in the WeChat blended pedagogy mode and the traditional teaching method were 47.27 and 44.52, respectively. There were no statistically significant differences between the online teaching mode and the traditional teaching method in terms of possessing professional accomplishment, gaining knowledge and promoting interpersonal skills (P = 0.07, P = 0.12 and P = 0.65, respectively). In terms of independent clinical thinking, self-improving capability and improving clinical skills, the scores associated with the WeChat blended pedagogy mode were 8.00, 8.00 and 6.00, whereas those associated with the traditional teaching method were 6.70, 6.87 and 7.48. The overall satisfaction with the WeChat blended pedagogy mode reached 100%. A total of 64%, 86%, 68%, 64% and 59% of students chose very large or large in response to the items concerning professional accomplishment, knowledge absorption, independent clinical thinking skills, English reading and literature exploring capacity, as well as interpersonal skills, respectively. Fifteen participants claimed that the WeChat blended pedagogy mode was less helpful to them with regard to promoting the improvement of their clinical skills. Nine students claimed that the WeChat blended pedagogy mode was time-consuming.

CONCLUSIONS

Our study verified the feasibility and effectiveness of the WeChat blended pedagogy mode for undergraduate paediatric orthopaedics internships.

TRIAL REGISTRATION

Retrospectively registered.

Impact of flipped classroom model in increasing the achievement for medical students

BACKGROUND

Over the past few years, there has been a parallel development in the use of the internet and technology for teaching purposes. The Flipped classroom model (FCM) used by the instructor aims at spending more time interacting with students rather than lecturing them. There are very few studies about the effectiveness of FCM on student performance and perception as compared to the traditional lecture in colleges of medicine. This study evaluates the effectiveness of the FCM on the academic achievement of students in terms of increased performance and perception as compared to the traditional lecture the medical students in Al-Neelain University-Sudan.

METHOD

This case-control study compares using (FCM) in the medical students at Al-Neelain University and the traditional lecture and its effect on students' academic achievement. The students were randomly assigned into two groups (A & B), flipped classroom group A (30 students as a test), and traditional classroom group B (33students as control). Major outcome indexes were pretest and posttest results used for students' academic achievement performance assessment and a questionnaire used for student perception evaluation about the FCM. Finally, statistical analysis was performed using SPSS programs.

RESULTS

Although the pretest and posttest scores showed highly statistically differences within each group (A&B) with P<.000, when comparing the pretest and posttest scores of the studied groups showed that, there were no statistically significant differences between the pretest and posttest scores between them with P=0.912 and 0.100 respectively. However, more than 80% of participants were satisfied with using a flipped classroom. While more than 90% of students were more motivated to learn in flipped classrooms meeting learning targets when they used FCM.

CONCLUSION

There was a positive student perception towards using the FCM, despite no significant effect of FCM on medical students' academic achievement.

"LEARN", a novel teaching method for Chinese clinical clerkship: A cross-sectional study

Background

Despite the clerkship being crucial in the training of a future doctor, no widely accepted education model has been proposed. This study devised a new model for clinical clerkship rotations, titled "LEARN" for Lecture, English-video, Advisor, Real-case and Notion, and evaluated whether the LEARN model is appropriate for medical education in China.

Methods

A cross-sectional study was performed among 101 fourth-year students from the Xiangya School of Medicine during an Orthopaedic Surgery clerkship rotation in the Third Xiangya Hospital. They were divided into seven groups and took clerkship based on the LEARN model. A questionnaire was collected at the conclusion to measure learning outcomes.

Results

The LEARN model was highly accepted with the acceptance of five sessions being 95.92% (94/98), 93.88% (92/98), 96.98% (97/98), 100% (98/98) and 96.94% (95/98). The outcomes of two genders were comparable, whereas a difference was observed in the test score among groups (group 3 scored 93.93 ± 5.20, higher than others). Quantitative analysis showed that positive correlations existed in participation in the Notion (Notion means students' case discussion) section with leadership (r = 0.84, 95% CI: 0.72-0.94, p < 0.001), participation in the Real-case section with leadership (r = 0.66, 95% CI: 0.50-0.80, p < 0.001), participation in the Real-case section with mastery of inquiring skills (r = 0.57, 95% CI: 0.40-0.71, p < 0.001) and participation in the Notion section with mastery of physical examination skills (r = 0.56, 95% CI: 0.40-0.69, p < 0.001). Further qualitative analysis demonstrated that high-level participation in the English-video section indicated better outcomes in mastery of inquiring (p < 0.01), physical examination (p < 0.001), film reading (p < 0.01) and clinical reasoning (p < 0.01) skills.

Conclusion

Our results support the LEARN model is a promising method for medical clerkship in China. Further research involving more participants and more meticulous design is planned to test its efficacy. For refinement, educators may try to promote students' participation in the English-video session.

Application of SPARK teaching in acute abdomen radiography teaching for undergraduate medical students

BACKGROUND

Acute abdomen is a series of acute and severe abdominal diseases commonly encountered in clinic. It is important to strengthen the image teaching of acute abdomen for undergraduates.

AIM

This study aimed to explore the application effect of SPARK[sub-speciality (S), problem-based learning (P), assessment (A), report (R) and reading skill (K)] teaching mode in the experimental teaching of acute abdomen for undergraduate medical students.

METHODS

We selected a total of 58 third year medical students for observation. The students were divided into experimental group and control group. Among them, 29 students in the experimental group studied in SPARK teaching mode, 29 students in the control group studied in traditional teaching mode. The two groups of students were tested after the theory class, before and after the experimental class, and one week after the experimental class, to compare the application effects of the two teaching modes. After the test one week after the experimental class, the two groups of students jointly adopted SPARK mode to learn, and were tested again one month after the experimental class to compare whether the two groups of students achieved the same results. The total score of all tests was 150.

RESULTS

The average scores of the experimental group and the control group after theory class were (69.0 ± 26.4) and (72.1 ± 24.1) respectively, with no statistical difference (t = 0.468, P = 0.642). The average scores of the experimental group before, after and one week after the experimental class were higher than those of the control group. The experimental group was (84.5 ± 23.1), (109.7 ± 23.8), (105.5 ± 31.0) respectively, and the control group was (52.8 ± 15.1), (93.8 ± 17.0), (80.0 ± 22.8) respectively. The differences were statistically significant (t = -6.195, P = 0.00; t = -2.919, P = 0.05; t = -3.569, P = 0.01). The average scores of the experimental group and the control group after one month were (99.0 ± 31.0) and (95.5 ± 25.6) respectively, and there was no significant difference between the two groups (t = -0.462, P = 0.646).

CONCLUSIONS

The SPARK teaching mode was helpful for undergraduate medical students to consolidate image foundation, improve image reading skills.

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.

The effect of flipped classroom in multiple clinical skills training for clinical interns on Objective Structured Clinical Examinations (OSCE)

AIMS

The flipped classroom (FC) is a hybrid approach, combining online learning and face-to-face classroom activities. To comprehensively evaluate the role of the Flipped Classroom (FC) model in clinical skills teaching of medical interns and investigate the acceptance and recognition of FC and Objective Structured Clinical Examinations (OSCE).

METHODS

In the teaching of clinical skills, the students were further grouped into two groups- A and B (A = 37, B = 42), using a computer-based random digital method. group A adopted the traditional classroom (TC) model, and group B adopted the FC model. OSCE was used to assess the clinical skills of the two groups of interns. Two independent sample t-test was used to analyze the difference of participant's demographic data and OSCE scores between the two different teaching model. We sent FC questionnaires to group A and OSCE questionnaires to groups A and B.

RESULTS

The score of OSCE in group B was higher than that in group A (P = 0.024), especially in the heart physical examination (P < 0.050), lung physical examination (P < 0.050), and abdominal physical examination (P < 0.050). The result of the FC questionnaires showed that regarding online courses, most students in group B thought watching videos was a good way to prepare for class (97.6%), For offline courses, most medical interns said that it enhanced their learning ability (88.1%), and they could accept this form of teaching (85.7%). As for the form of OSCE questionnaires, most people in group A and B said that they knew more about this form of assessment (81.0%), that it truly reflected the clinical ability (82.3%).

CONCLUSIONS

FC model has shown good results in clinical skills training, while FC and OSCE can be further promoted in future teaching and assessment.

Application of problem-based learning combined with a virtual simulation training platform in clinical biochemistry teaching during the COVID-19 pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has had a great impact on the traditional teaching mode (Lecture-based Learning, LBL) and laboratory teaching. To address this challenge, the researchers conducted online Problem-based learning (PBL) teaching and virtual simulation laboratory teaching through DingTalk, and evaluated the effectiveness of this method in teaching clinical biochemistry.

METHODS

With the method of cluster sampling, the researchers randomly selected 60 students from two classes of the Class 2019 as the experimental group for this prospective experimental study. The theory class was taught online PBL through DingTalk, and experimental lectures were given by virtual simulation. After the experimental teaching, students were assessed for theory and operation. Self-administered questionnaires were administered through DingTalk. 65 students from our 2018 medical laboratory class were randomly selected as the control group, and offline LBL and traditional experimental teaching methods were used. Examination results were obtained through teaching portfolios.

RESULTS

The experimental group had significantly better examination scores in theoretical knowledge and experimental operational skills than the control group (87.45 ± 5.91 vs. 83.52 ± 9.94, P = 0.0095; 87.08 ± 12.42 vs. 80.18 ± 14.04, P = 0.0044). The results of the questionnaire survey revealed that the experimental group was more receptive to the DingTalk-PBL teaching method and virtual simulation laboratory teaching. Moreover, this hybrid teaching method was more effective in promoting basic knowledge understanding (95.0%, 57/60), facilitating the mastery of operational skills (93.3, 56/60), cultivating interest in learning (96.7%, 58/60), training clinical thinking (95.0%, 57/60), improving communication skills (95.0%, 57/60), and enhancing self-learning ability (91.7%, 55/60) and was more satisfying than traditional teaching method (all P < 0.05).

CONCLUSION

The DingTalk-based PBL method combined with virtual simulation experiments was an effective and acceptable teaching strategy during the pandemic compared with the traditional teaching method.

Flipped Classroom Formats in a Problem-Based Learning Course: Experiences of First-Year Bachelor European Public Health Students

Objectives: Students would like to see more creativity and flexibility in the performance of problem-based learning (PBL). Therefore, we applied flipped classroom formats in a course of the Bachelor European Public Health at Maastricht University to investigate the experiences of the students. The main objective was to stimulate interaction between students mutual, and between students and teachers.

Methods: 304 first-year students following the course on “Ageing in Europe” in three academic years, were asked to fill out questions focussing on prior knowledge, preparation work, and group session parameters, e.g., duration, content, extent of interaction and format group session.

Results: In-class activities, such as debate, making a mind map, giving a pitch, role-play e.g., were highly appreciated by students, especially the interactivity and discussions with the experts during these sessions. Students felt they applied knowledge.

Conclusion: Flipped classroom formats can be used to extend the Maastricht University PBL design and students do recommend this. It can be a relevant and challenging answer on the articulated request for more creativity and flexibility in the regular PBL format.

Effectiveness of a combined problem-based learning and flipped classroom teaching method in ophthalmic clinical skill training

BACKGROUND

Previous studies have primarily implemented problem-based learning (PBL) or flipped classroom (FC) teaching models in different majors; however, research on the combined PBL-FC teaching method in clinical medicine is scarce. Therefore, we investigated the combined PBL-FC teaching method in teaching ocular trauma on students' competencies.

METHOD

About 75 ophthalmology postgraduates were randomly divided into PBL-FC and traditional teaching groups. Students completed pre-and post-class theoretical examinations, skills evaluation, learning ability scales, and feedback questionnaires.

RESULTS

Both groups showed significantly higher theoretical scores and improved learning ability. Feedback questionnaire scores of the PBL-FC group's postgraduates without clinical experience were significantly higher than the traditional group's for some items; there was no difference between groups in postgraduates with clinical experience. PBL-FC group's pre-class preparation time was significantly longer than the traditional group's, but the post-class review time was significantly shorter. PBL-FC group's post-class theoretical performance was significantly higher than the traditional group's. There was no statistical difference between the groups regarding skill operation. Among postgraduates without clinical experience, the PBL-FC group's skill operation performance was significantly higher than the traditional group's; for postgraduates with clinical experience, the traditional group's skill operation performance was significantly higher than the PBL-FC group's.

CONCLUSIONS

PBL-FC teaching is better for students without clinical experience or knowledge of ophthalmic diseases. Meanwhile, traditional teaching is a good choice for students with clinical experience who need more relevant knowledge.

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.

The effect of online and in-person team-based learning (TBL) on undergraduate endocrinology teaching during COVID-19 pandemic

BACKGROUND

Team-based learning (TBL) combines active and collaborative learning, while incorporating aspects of the flipped classroom approach and problem-based learning. The COVID-19 pandemic presented certain challenges in the delivery of TBL in class. In this study, we investigated the impact of TBL on the academic performance of final year Biomedical Sciences' undergraduate students in the context of an "Endocrine Disorders" study block. We did so by comparing the classical in-person approach and online delivery due to the COVID-19 pandemic.

METHODS

A non-compulsory TBL session was introduced to the curriculum of this block, which followed the traditional 2-h lecture delivery. Comparative analysis was performed for the exam and coursework performance of students who attended the TBL sessions (online and in-person) and those that did not.

RESULTS

Both cohorts of students who attended either in-person (n = 66) or online TBL sessions (n = 109) performed significantly better in their exams (p < 0.05) and a related coursework (p < 0.001 and p < 0.05, respectively) when compared to those that did not attend. For both these cohorts the exam mark distribution was much narrower compared to those that did not attend the TBL sessions where the majority of fails and "no shows" were recorded.

CONCLUSIONS

Online and in-person TBL, can successfully supplement traditional lecture-based teaching and enhance the learning/performance, for complex medical subjects/topics. Our findings demonstrate that it is possible to deliver these sessions online with demonstrable benefit for students suggesting that there is greater flexibility in the use of TBL in higher education.

Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review

BACKGROUND

Problem-based learning (PBL) is a pedagogical approach that shifts the role of the teacher to the student (student-centered) and is based on self-directed learning. Although PBL has been adopted in undergraduate and postgraduate medical education, the effectiveness of the method is still under discussion. The author's purpose was to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs.

METHODS

The authors applied the Arksey and O'Malley framework to undertake a scoping review. The search was carried out in February 2021 in PubMed and Web of Science including all publications in English and Spanish with no limits on publication date, study design or country of origin.

RESULTS

The literature search identified one hundred and twenty-four publications eligible for this review. Despite the fact that this review included many studies, their design was heterogeneous and only a few provided a high scientific evidence methodology (randomized design and/or systematic reviews with meta-analysis). Furthermore, most were single-center experiences with small sample size and there were no large multi-center studies. PBL methodology obtained a high level of satisfaction, especially among students. It was more effective than other more traditional (or lecture-based methods) at improving social and communication skills, problem-solving and self-learning skills. Knowledge retention and academic performance weren't worse (and in many studies were better) than with traditional methods. PBL was not universally widespread, probably because requires greater human resources and continuous training for its implementation.

CONCLUSION

PBL is an effective and satisfactory methodology for medical education. It is likely that through PBL medical students will not only acquire knowledge but also other competencies that are needed in medical professionalism.

Effectiveness of applying clinical simulation scenarios and integrating information technology in medical-surgical nursing and critical nursing courses

BACKGROUND

To determine the impact of combining clinical simulation scenario training and Information Technology Integrated Instruction (ITII) on the teaching of nursing skills.

METHODS

120 4th-year students in a nursing program who were enrolled in medical and surgical nursing courses. 61 received innovative instruction (experimental group) and 59 received conventional instruction (control group). The ADDIE model, systematic method of course development that includes analysis, design, development, implementation, and evaluation,was used to build simulation teaching and clinical scenarios and to create and modify objective structure clinical examination (OSCE) scenario checklists for acute myocardial infarction (AMI) care, basic life support and operation of automated external defibrillator (BLS), and subdural hemorrhage (SDH) care. The modified OSCE checklists were assessed for reliability, consistency, and validity. The innovative training included flipped classrooms, clinical simulation scenarios, ITII and blended learning formats.

RESULTS

The reliability and validity of the OSCE checklists developed in this study were acceptable and comparable or higher than checklists in past studies and could be utilized as an OSCE performance tool. Students in innovative instruction obtained significantly better OSCE performance, lab scores and improvements from the previous year's grades. Significant differences were found in situational awareness (SA). No strong correlations were found between OSCE scores and clinical internship scores, and no significant differences were found between the groups in overall clinical internship performance.

CONCLUSIONS

Innovative instruction showed better performance than conventional methods in summative evaluation of knowledge components, OSCE formative evaluation and clinical nursing internship scores, as well as improved situational awareness in nursing students.

IUPS Physiology Education Workshop series in India: organizational mechanics, outcomes, and lessons

Active learning promotes the capacity of problem solving and decision making among learners. Teachers who apply instructional processes toward active participation of learners help their students develop higher order thinking skills. Due to the recent paradigm shift toward adopting competency-based curricula in the education of healthcare professionals in India, there is an emergent need for physiology instructors to be trained in active-learning methodologies and to acquire abilities to promote these curriculum changes. To address these issues, a series of International Union of Physiological Sciences (IUPS) workshops on physiology education techniques in four apex centers in India was organized in November 2018 and November 2019. The "hands-on" workshops presented the methodologies of case-based learning, problem-based learning, and flipped classroom; the participants were teachers of basic sciences and human and veterinary medicine. The workshop series facilitated capacity building and creation of a national network of physiology instructors interested in promoting active-learning techniques. The workshops were followed by a brainstorming meeting held to assess the outcomes. The aim of this report is to provide a model for implementing a coordinated series of workshops to support national curriculum change and to identify the organizational elements essential for conducting an effective Physiology Education workshop. The essential elements include a highly motivated core organizing team, constant dialogue between core organizing and local organizing committees, a sufficient time frame for planning and execution of the event, and opportunities to engage students at host institutions in workshop activities.

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.

The effectiveness of the combined problem-based learning (PBL) and case-based learning (CBL) teaching method in the clinical practical teaching of thyroid disease

Background

This study aimed to evaluate the effectiveness and efficiency of PBL–CBL combined teaching in thyroid surgery and make observations from the students’ perspectives, based on their satisfaction with the learning process.

Methods

We prospectively enrolled 354 fourth-year students majoring in clinical medicine, along with 232 residents, from September 2014 to June 2019. These participants were randomly allocated into either the combined PBL–CBL teaching group or the traditional lecture-based classroom group to attend a course about thyroid nodules. Both pre- and post-class quizzes were conducted. An anonymous questionnaire was also administered to both groups to evaluate the students’ perceptions and experiences. We compared the two teaching methods among all the students as well as with the fourth-year students and residents in subgroups.

Results

The traditional group’s pre-class quiz scores were significantly higher than the PBL–CBL group’s (as determined by a two-tailed t-test at a 95% confidence interval, T = 16.483, P < 0.001). After class, in the PBL–CBL group, the mean total quiz score and the basic knowledge and case analysis scores increased significantly (P < 0.001). The PBL–CBL group’s performance improvement was significantly higher than the traditional group’s (increasing from 52.76 to 70.51 vs. from 67.03 to 71.97). Furthermore, the scores for learning motivation, understanding, student–teacher interaction, the final examination, communication skills, clinical thinking skills, self-learning skills, teamwork skills, and knowledge absorption, as measured by the survey, were significantly higher in the PBL–CBL group than in the traditional group (P < 0.001). Meanwhile, the survey scores representing the amount of students’ free time the course consumed were significantly lower in the PBL–CBL group than in the traditional group (P < 0.001).

Conclusions

PBL combined with CBL may be an effective method for improving medical students’ and residents’ performance and enhancing their clinical skills.

Flipped classroom improves nursing students' theoretical learning in China: A meta-analysis

OBJECTIVE

At present, current didactic teaching delivery method help nursing students apply theory to clinical situations in an inefficient way. The flipped classroom (FC), a novel teaching mode emphasizing self-study and critical thinking, has generated interest in nursing education in China. However, there are a gap in the literature and no consistent outcomes of current studies which compared FC and lecture-based learning (LBL), and no systematic review has comprehensively compared theoretical scores as an affected outcome in FC versus LBL modes.

METHODS

In this review, we analyze flipped-learning nursing students' scores, and aim to assess the efficacy and provide a deeper understanding of the FC in nursing education. Following the inclusion criteria, articles were obtained by searching PubMed, Embase and Chinese data, including the China National Knowledge Infrastructure, Wanfang Data, and VIP database until 3 January 2020. Data were extracted from eligible articles and quality was assessed. A meta-analysis was then performed using a random effects model with a standardized mean value (SMD) and a 95% confidence interval (CI).32 studies were included after reviewing 2,439 citations. All studies were randomized controlled trials (RCTs). The FC theoretical knowledge scores in FC were significantly positively affected compared to those of the traditional classroom (SMD = 1.33, 95% CI: 1.02-1.64; P < 0.001). In addition, 23 studies reported skill scores, indicating significant difference between the FC mode and LBL mode (SMD = 1.58, 95%CI: 1.23-1.93; P < 0.001).

CONCLUSIONS

The results of this meta-analysis suggest that compared to the LBL teaching method, the FC mode dose significantly improve Chinese nursing students' theoretical scores. However, the problems of heterogeneity and publication bias in this study need to be remedied high-quality future studies.

Survey of Gross Anatomy Education in China: The Past and the Present

Medical education in mainland China has undergone massive expansion and reforms in the past decades. A nation-wide survey of the five-year clinical medicine programs aimed to examine the course hours, pedagogies, learning resources and teaching staff of anatomy both at present and over the past three decades (1990-1999, 2000-2009, and 2010-2018). The directors or senior teachers from 90 out of the 130 five-year clinical medicine programs were invited to fill out a factual questionnaire by email. Ultimately, sixty-five completed questionnaires were received from 65 different schools. It was found that the total number of gross anatomy course hours has decreased by 11% in the past 30 years and that systematic and regional anatomy have been increasingly taught separately among the surveyed medical schools. Problem-based learning has been adopted in thirty-five (54%) of the surveyed schools, and team-based learning is used in ten (15%) of the surveyed schools. The surveyed schools reported receiving more donated cadavers in recent years, with the average number increasing from 20.67 ± 20.29 in 2000-2009 to 36.10 ± 47.26 in 2010-2018. However, this has not resulted in a decrease in the number of students who needed to share one cadaver (11.85 ± 5.03 in 1990-1999 to 14.22 ± 5.0 in 2010-2018). A decreasing trend regarding the teacher-student ratio (1:25.5 in 2000-2009 to 1:33.2 in 2010-2018) was also reported. The survey demonstrated the historical changes in gross anatomy education in China over the past thirty years.

Mento's change model in teaching competency-based medical education

BACKGROUND

Resistance to change is customary and is expected in any organization. However, most of the downsides of change can be avoided if the organization/individual prepares for the change by acknowledging guided strategies. In healthcare, change is the state of nature, which has also translated to medical education (ME). ME in the current era has undergone a shift from a traditional content-based curriculum to a competency-based curriculum. Recently, however, the broader social-accountability movement has accelerated this rate of transformation. One of the key challenges to educators harbingering this transformation to competency-based medical education (CBME) is to redesign the processes of teaching.

AIM

Here we define a framework designed using Mento's model of change that will totally agree with introducing positive change in teaching in an institution undergoing transformation from a traditional content-based curriculum to a competency-based curriculum.

METHODOLOGY

Using Schein's "unfreezing" as a guide term we critically reflected on the popular change-management models, to home in on Kotter's model of change to transform organizations. However, Kotter's change-model draws from Situational and Contingency Leadership Theories, which may not agree with academic organizations involved in ME. As such organizations adhere to Transactional and Transformational Leadership archetypes, where Leadership is constructively executed by "The Leader Team", we decided to adopt Mento's change-model for our study. Mento's model not only draws from the precepts of Kotter's model, but also incorporates axioms of Jick's and GE's change-models.

RESULTS

Using Mento's model a framework was blueprinted to implement active learning (AL) strategies in CBME. Here we have elaborated on the framework using the exemplar of flipped teaching. The development of this framework required the design and execution of a faculty development program, and a step by step guidance plan to chaperon, instruct and implement change in teaching to harbinger CBME. Further, we have also reflected on the change process using Gravin's framework.

CONCLUSION

To our knowledge this is the first report of the use of Mento's model of change in medical education. Also, the blueprinted framework is supported by acknowledged leadership theories and can be translated to implement any curricular change in CBME.