Concept and benefits of the Inverted Classroom method for a competency-based biochemistry course in the pre-clinical stage of a human medicine course of studies

Comparison of the teaching clinical biochemistry in face-to-face and the flex-flipped classroom to medical and dental students: a quasi-experimental study from IRAN

INTRODUCTION

Biochemistry is one of the main courses of basic sciences in the medical curriculum, along with other difficult subjects that are difficult to learn. The emergence of new technologies has made it possible to test new methods such as e-Learning. In this study, we compared two methods of Flex-Flipped Classroom (FFC) and face-to-face.

METHOD

A quasi-experimental research was done which involved both medical and dental students studying the clinical biochemistry course in the joint semester in 2019. A total of 100 medical students were trained in biochemistry through face-to-face teaching, and 60 dental students were trained in the same course through the FFC model. Three researcher-made tools were used to compare the two groups to assess the student's satisfaction, scores, and self-evaluation. The content validity of the tools was checked using the opinions of 10 experts through the CVI index. The results were analyzed using one-sample t-tests, independent t-tests, and ANOVA.

RESULTS

Both groups scored significantly more than the cut-off-point (Mean > 3.5) in their average scores of the total and sub-components of the self-evaluation questionnaire (P < 0.05). Face-to-face teaching was viewed more favorably than the FFC teaching except for considering the flexibility (4.14 ± 1.55), but the difference was not significant (P > 0.05). The students' knowledge score in the FFC was slightly higher than that in the face-to-face method, but this difference was not significant(P = 0.758).

CONCLUSION

Both face-to-face and FFC methods were effective according to the students, but the level of satisfaction with the face-to-face method was higher. It seems that teacher-student interaction is an important factor in students' preferences. However, the students preferred the flexibility of multimedia. It seems necessary to use the advantages of each method in a model appropriate to the students' conditions and available facilities.

Medical students in their first consultation: A comparison between a simulated face-to-face and telehealth consultation to train medical consultation skills

Objective

A simulated conversation between a physician and a family member, i.e., a medical conversation, was changed from a conventional face-to-face conversation (SS 2019) to a telehealth conversation (SS 2020) due to the COVID-19 pandemic. The medical education conversation is part of the biochemistry seminar "From Genes to Proteins" which second semester human medicine students take. The objective of this study was to analyze to what extent the switch from face-to-face to telehealth conversations affected student satisfaction and motivation.

Methodology

In the seminar, students study biochemical as well as competency-oriented content, such as how to talk to family members. In the summer semester of 2019, students were trained how to talk to their patients' family members in a traditional conversation setting with the help of lay actors in a classroom format. In the summer semester of 2020, this conversation took place under comparable conditions, but in the form of an online telehealth conversation instead. Student satisfaction and motivation were surveyed by means of an evaluation questionnaire following the seminar in both semesters.

Results

Both conversation formats achieved a high level of satisfaction from students (school grade A-B). For some evaluation items, such as "realistic conversation simulation", the face-to-face conversation was perceived as more satisfying (Md=5.0, IQR=1.0) than the telehealth conversation (Md=5.0, IQR=2.0). In addition, the face-to-face conversation resulted in higher subjective motivation from students (Md=5.0, IQR=1.0) than that of the telehealth conversation (Md=4.0, IQR=2.0).

Conclusion

The high student satisfaction and acceptance of both didactic concepts leads to the conclusion that the simulated telehealth conversation is an adequate substitute for the simulation of a traditional face-to-face conversation with regard to the parameters that were studied.

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.

Randomised controlled monocentric trial to compare the impact of using professional actors or peers for communication training in a competency-based inverted biochemistry classroom in preclinical medical education

OBJECTIVE

In medical education, biochemistry topics are usually knowledge based, and students often are unaware of their clinical relevance. To improve students' awareness of the relevance, we integrated communication skills training into biochemistry education. No studies before have examined the difference between peer and standardised patient (SP) role plays where students explain the biochemical background of a disease in patient-centred language. Therefore, we evaluated whether students' self-perceived competency in Canadian Medical Education Directives for Specialists (CanMEDS) roles and their opinion of the quality of role play differ if the layperson is played by peers or SPs.

METHODS

We randomly assigned medical students in a preclinical semester to one of the two groups. The groups used predefined scripts to role play a physician-parent consultation with either a peer (peer group) or an SP (SP group) in the parent role. Students then assessed the activity's effects on their competency in CanMEDS roles and motivation and the relevance of the role play. To determine whether students achieved biochemistry learning goals, we evaluated results of a biochemistry exam.

RESULTS

Students' self-perceived competency improved in both groups. The SP group rated their competency in the roles 'Scholar' and 'Professional' significantly higher than the peer group did. The peer group rated their competency in the role of 'Medical Expert' significantly higher if they played the role of the parent rather than physician or observer. The SP group agreed more that they were motivated by the role play and wanted to receive more role play-based teaching. The SP group perceived the role play as being realistic and rated the feedback discussion as more beneficial. The examination results were the same in both groups.

CONCLUSION

We showed that role plays in a biochemistry seminar improve students' self-perceived competency. The use of SPs has some advantages, such as being more realistic.

Enhancing the effectiveness of flipped classroom in health science education: a state-of-the-art review

BACKGROUND

In a flipped classroom, students acquire knowledge before class and deepen and apply this knowledge during class. This way, lower-order learning goals are achieved before class and higher-order skills are reached during class. This study aims to provide an overview of the factors that contribute to the effectiveness of the flipped classroom and how these factors can be stimulated. The effectiveness of the flipped classroom is conceptualized in this study as test scores, the achievement of higher learning goals, and student perceptions.

METHODS

A state-of-the-art review was conducted. The databases MEDLINE, PsycINFO, PubMed, Web of Science, and Scopus were consulted. The timeframe is 2016 till 2020. The studies were qualitatively analyzed according to the grounded theory method.

RESULTS

After screening the studies based on the inclusion-and exclusion criteria, 88 studies were included in this review. The qualitative analysis of these studies revealed six main factors that affect the effectiveness of the flipped classroom: student characteristics, teacher characteristics, implementation, task characteristics, out-of-class activities, and in-class activities. Mediating factors are, amongst other factors, the learner's level of self-regulated learning, teacher's role and motivation, assessment approach, and guidance during self-study by means of prompts or feedback. These factors can be positively stimulated by structuring the learning process and focusing the teacher training on competencies and learning-and teaching approaches that are essential for the flipped classroom.

CONCLUSION

This paper provides insight into the factors that contribute to the effectiveness of the flipped classroom and how these factors could be stimulated. In order to stimulate the effectiveness of the flipped classroom, the positively and negatively affecting factors and mediating factors should be taken into account in the design of the flipped classroom. The interventions mentioned in this paper could also be used to enhance the effectiveness.

Towards the optimal use of video recordings to support the flipped classroom in medical school basic sciences education

The use of recorded video in medical education is increasing. Video material may be assigned before scheduled sessions to create a flipped classroom. Here, the instructor may lead a session that is organized for discussion, interpretation, and reflection of the previewed content. We established conditions that lead to increased student participation and engagement with prerecorded content for a medical genetics section in a first-year medical school basic sciences integrated course. Preliminary analysis of an asynchronous video-based pre-professional program directed the design of video material to support a first semester medical genetics course. We compared student participation in, and opinion of, a flipped-classroom session based on written vs. video presentation of material. Student opinion was surveyed with audience response devices (clickers). Shorter videos that were created specifically for the course were preferred by students compared to recordings of previously delivered lectures. Students preferred videos to assigned reading material and consistent scheduling throughout the teaching semester increased student participation. Presentation of medical school content with previously recorded video material can be a useful teaching tool if properly implemented.

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.

Rapid development of a digital module during the Covid 19 pandemic in undergraduate medical education of pediatrics by teachers and students

Objective: During the early Covid 19 pandemic, undergraduate medical teaching of pediatric medicine had to be switched to online teaching at the Hanover Medical School (MHH). The aim was to develop an online module together with students. Methodology: In a multi-stage process, a working group consisting of lecturers and students developed the concept and implemented it. Afterwards the online module was evaluated. Results: The conceptualization process and the implementation of the module together with students can be represented as a modified PDCA cycle (Plan-Do-Check-Act). We showed that including students in the development of an online module is helpful in times of limited resources e.g. such as personnel and time. Conclusion: The cooperation between students and lecturers is suitable for developing and implementing an online module in a short time. In the future, in addition to joint conceptualization phases, digital elements (e.g. preparatory webinars) for the module itself in attendance phases should be retained.

Development of an interactive e-learning software "Histologie für Mediziner" for medical histology courses and its overall impact on learning outcomes and motivation

Objective: To develop and evaluate an interactive histology learning software for medical students in the preclinical study phase. The educational design of the software was based on current learning theory models, such as the Cognitive load theory, Cognitive theory of multimedia learning, and the ARCS model, so that the acquired knowledge can be repeated using a diversified design. Moreover, the learning effects achieved by using the software shall be evaluated. Apart from the software's usability, the influence of the learning theory principles on the students' motivation shall be assessed. Methodology: The software was evaluated using an experimental wait list control group with a pre-/post-test design (n=213). Depending on the group they were assigned to, students learned the histology contents of chapter "Liver, gall bladder, pancreas" using the traditional program of the Goethe University (n=65), the new interactive software (n=56), or without any of the two software versions (n=92). The influence of the different learning aids on the acquisition of knowledge was assessed with three questionnaires comprising four different multiple choice questions each. For the evaluation of the usability and motivational factors, a second test was added to the questionnaire of both software versions. Results: The interactive software was rated significantly better with regard to usability and motivational aspects than the traditional learning program (F(7, 113)=12.48, p<.001, partial η²=.436). Moreover, use of the interactive software resulted in a significant increase of knowledge acquisition as compared to the group of students who had learned without any of the two software versions (0.77, p=.001). Conclusion: With regard to the histology contents, usability was comparable to the official learning program. Interactive elements and the educational design contributed to an increase of the factors that are essential for intrinsic motivation. Thus, our program can be valuable tool to supplement the curriculum as an additional service.

Longitudinal curriculum development: gradual optimization of a biochemistry seminar

Objective: The Master Plan for Medical Studies 2020 places additional emphasis on curricular development processes. In addition, institutes may recognize a need to optimize their courses, for example because of poor evaluations. Frequently, however, the resources required for comprehensive optimizations are not available. In the present study, we aimed to use the example of a biochemistry seminar that takes place in the preclinical part of the medical degree at Ulm University Medical School to show how a course can be successfully optimized in small steps and evaluation results can be used for quality assurance. Methods: Similar to a continuous improvement process (CIP), over the course of five years a biochemistry seminar was gradually optimized in three steps. This process used structural, methodological, and content components, such as vertical integration, the inverted classroom method, and competence orientation. For quality assurance, we analyzed the official, standardized evaluation sheets from a total of n=1248 students. We evaluated the optimization process on the basis of responses to evaluation statements that were arranged into categories such as "organization, structure, implementation" and "quality of teaching," free text information, and the results of a pilot study conducted in parallel. We then determined the usefulness of the students' evaluation results for evaluating the optimization process. Results: Each developmental step resulted in a significantly more positive overall evaluation of the seminar by the students. This result was independent of whether the development was on a structural or methodological/content-related level. In addition, the evaluations of the categories that were optimized were significantly better. For example, the vertical integration and introduction of the inverted classroom method were accompanied by a better evaluation of the "quality of teaching" and a change in the structure led to a higher score in the category "organization, structure, implementation." A comparison with the free text evaluation sheets and the results of the pilot study supports the results. Conclusion: Although optimization of a curriculum or course is a major task, it can also be successfully completed in small steps. With this approach, new learning goals, for example as required in the Master Plan for Medical Studies 2020, can be continuously integrated and student satisfaction with a course can be increased. Student evaluation results can represent a kind of quality assurance in this process and can provide important impulses for optimization.

Modified Conventional Teaching: An Assessment of Clinical Biochemistry Learning Process Among Medical Undergraduate Students Using the Traditional Teaching in Combination with Group Discussion

Background: Clinical biochemistry is a branch of organic chemistry which involves a detailed study on the normal functioning of living cells in relation to the disease. The subject is not only volatile but also complicated. Also, teaching biochemistry to medical undergraduates is really a challenging job. Routine didactic lectures alone may not be enough for students while learning clinical biochemistry.

Methods: This study included 90 first-year medical undergraduate students. They were grouped as three groups of 30 students each. The routine conventional classroom teaching method was followed by a group discussion session. The topics were informed in advance so that they were provided with adequate time to prepare and be mentally ready for the session. The group discussion was preceded by a set of 10 multiple-choice questions (MCQs), and a final assessment of five MCQs following the discussion.

Results: There was only minor difference in the marks obtained by various student groups after the group discussion with Group B students (5.5 ± 1.54; p < 0.001) performing better than the other two groups. Students also scored evenly in the final assessment using MCQs with Group A (2.7 ± 1.36; p < 0.001) performing better than the other two groups. Prior to the group discussion session, 33% of the students in all the groups scored more than 75% of marks. The overall performance of all the students after the final assessment using MCQs revealed that 60% of the students scored more than 75% marks.

Conclusion: The study results confirm the fact that the modified conventional teaching method appears to be better than traditional teaching. The student performances had significantly improved with such kind of education process. The results also highlight the importance of increased student efforts, probably including group discussions and revisions to improve understanding and subject retention.

Investigating the self-study phase of an inverted biochemistry classroom - collaborative dyadic learning makes the difference

BACKGROUND

The inverted classroom approach is characterized by a primary self-study phase for students followed by an on-site, face-to-face teaching phase that is used to deepen the prior acquired knowledge. Obviously, this teaching approach relies on the students preparing before the on-site phase, which in turn requires optimized preparatory material as well as defined working instructions. The major aim of this study, therefore, was to investigate the effect of different preparatory materials and working instructions for the self-study phase of an e-learning-based inverted classroom on the knowledge gained by medical students in biochemistry. Furthermore, we analyzed whether collaborative dyadic learning during the self-study phase is more effective than individual learning with respect to knowledge gain.

METHODS

The study was performed in a biochemistry seminar for second semester medical students at Ulm University in Germany. This seminar was held using an e-learning-based inverted classroom. A total of 196 students were divided into three homogeneous study groups that differed in terms of the working material and instructions provided for the self-study phase. Knowledge gain was measured by formative tests at the beginning of the on-site phases. Questionnaires were also handed out asking about motivation, interest and learning time in the self-study phases.

RESULTS

Students who were told to prepare in collaborating dyads during the self-study phase performed better in formative tests taken at the beginning of on-site phases than learners who were told to prepare individually. The study material that was provided was of minor importance for the differences in formative testing since almost all students prepared for the on-site phases. With the dyadic learning approach, both students benefited from this collaboration, characterized by a higher motivation and interest in the topic, as well as a longer time spent on task.

CONCLUSION

Our study provides strong evidence that the study material, but more importantly the instructions provided for the self-study phase, affect students` knowledge gain in an e-learning-based inverted classroom. The instructed collaboratively working group was the most successful.