Experiences of medical teachers in flipped learning for medical students: a phenomenological study

Effectiveness of the Flipped Classroom Teaching and Learning Method Among Underachievers in Physiology: Experience From a Tertiary Care Teaching Hospital

Introduction Traditional classroom teaching involves a process where knowledge is disseminated to students by the teachers through a one-way process. Such a learning environment makes students passive and muted, which can be improved by alternative teaching and learning (TL) methods like the flipped classroom (FC) technique. The FC approach involves a student-inclusive TL process. FC is a student-centered approach that benefits teachers and students by emphasizing the key information during the learning process. The present study aimed to understand the efficacy of the FC TL method and evaluate students' perception of FC among underachieving first-year medical students in learning physiology. Methods This prospective, descriptive, and cross-sectional study was conducted on 100 underachieving first-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students in the Department of Physiology at a tertiary care teaching hospital. All the participants were taught cardiovascular physiology through the FC method. The study subjects were asked to take a pretest including multiple choice questions a week before the study. The study period was four weeks, following which the students were asked to take a post-test. A questionnaire was used to understand the student's perception of FC. The responses to the questionnaire were graded based on the Likert scale.  Results The mean scores of the post-test (19.40±4.22) were significantly (p< 0.05) greater than those of the pre-test (12.43±4.26). Regarding the perception of FC, 68% (68/100) of students agreed that the objectives, methodology, and outcomes were well-defined. Around 39% (39/100) of students strongly agreed that the study material was adequate, relevant, and easy to learn. Nearly 58% (58/100) of the students agreed that the competencies are dealt with completely in every session. Roughly 16% (16/100) of students agreed that the classroom time is sufficiently utilized for peer-based learning. Many (61%, 61/100) students agreed that sufficient time was given for learning. About 34% (34/100) of the students strongly agreed that the assessment tools were relevant. About 56% (56/100) of students agreed and 21% (21/100) strongly agreed that the FC method helped them to improve their understanding of the subject. More than half (54%, 54/100) of the students agreed and 18% (18/100) strongly agreed that the FC promoted self-directed learning. Most students (71%, 71/100) believed FC to be an interesting and satisfactory learning experience. Conclusions The results indicate that most students believed FC was an effective and innovative TL technique. The FC method could help underachievers improve their cognitive skills and analytical thinking and enhance exam performance.

Flipped Classrooms in Medical Education: Improving Learning Outcomes and Engaging Students in Critical Thinking Skills

The flipped classroom (FC) model involves students independently acquiring knowledge before in-person class sessions, during which they engage in active discussions and problem-solving. Various methods to implement FC are quizzes, e-content, case-based learning, problem-based learning, and reading assignments. The advantages of the FC approach included improved student preparation, active participation, and the promotion of critical thinking skills. Some disadvantages identified are technical problems like internet connection, improper planning and preparation, which increases teacher workload, and lack of self-motivation. This review underscores the potential of the FC approach to improve medical education by promoting independent learning, active participation, and deeper understanding. Consideration of factors such as curriculum design, faculty development, technological infrastructure, and student readiness is vital for successfully implementing the FC model. Balancing self-directed study with meaningful face-to-face interactions remains crucial to harnessing the full benefits of this innovative approach. By leveraging technology and student-centered methods, medical educators can create an enriched learning experience that positively influences future healthcare professionals.

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.

A conceptual review of the effectiveness of flipped learning in vocational learners' cognitive skills and emotional states

An inverted method of teaching is an instructional model where traditional classroom activities take place before class while class time is devoted to discussion, problem-solving, and interaction among students. Flipped learning is a learner-centered and technology-driven approach that benefits from the inverted method of teaching. Recently, instructors have begun to employ innovative pedagogies like flipped learning approach, to change the conventional practices in vocational education as flipped learning gives them a chance for professional development. In order to find out the reasons of the improvement of vocational education through the use of flipped learning approach, this review examined the effect of the flipped learning approach on vocational learners' cognitive skills and emotional states in earlier studies. The earlier investigations showed the significant effect flipped learning approach on vocational learners' emotions, such as engagement, motivation, self-efficacy, and their cognitive skills, including critical thinking, problem-solving, learning skill, learning strategies, and communicative competence. However, this review implicated that flipped learning, as a type of blended learning, may be beneficial for learners, instructors, and students' parents to be aware of this valuable learner-centered approach in vocational education.

A Double-Flipped Virtual Classroom Format for Medical Students Learning Ophthalmology: An Approach to Clinical Rotations in the Context of COVID-19

Purpose The aim of this study was to assess efficacy of a virtual, double-flipped clinical rotation in ophthalmology for medical students during the coronavirus disease 2019 (COVID-19) pandemic.

Methods We instituted a virtual, reverse-classroom clinical elective for eight medical students interested in ophthalmology as a career. The course included required prework, interactive case-based discussions, and follow-up quizzes (first flip) entirely prepared and delivered by the students as teachers (second flip). After completion of the course, we surveyed students on five domains: (1) Autonomy and Leadership, (2) Self-Efficacy, (3) Impact on Career Selection, (4) Quality of Educational Experience, and (5) Clear Goals and Feedback using a Likert scale of 1–5 (5 being the most positive). We also asked open-ended questions regarding the overall experience, that is, strengths, weaknesses, and future recommendations for the course. Due to the small N and exploratory nature of the study, no formal statistical inference was performed.

Results Seven students responded to the survey. Aggregated mean survey scores for each domain are represented in parentheses. Responses were very positive in regard to “Autonomy and Leadership” (4.5), “Impact on Career Selection” (4.1), “Quality of Educational Experience” (5.0), and “Clear Goals and Feedback” (4.4). “Self-Efficacy,” which had an emphasis on ability to perform an eye exam and basic knowledge of ophthalmology, had a lower mean (3.4). The subjective responses were also very positive, but similarly alluded to the limitation of learning examination skills virtually.

Conclusions A medical school clinical elective can be successfully executed in a virtual format with an emphasis on student-directed learning. The novel “double-flipped” approach was highly rated by our small sample size. However, there remained a glaring limitation in the ability to transfer clinical skills in the virtual format. In the context of limited in-person contact due to the COVID-19 pandemic, we believe that the double-flipped, virtual format was a viable replacement for a traditional clinical rotation.

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.

Implementation of flipped classroom combined with case- and team-based learning in residency training

The core problem of Chinese resident doctor training is that medical educators present content in an attractive teaching mode to make students more motivated to learn and improve their clinical thinking ability, humanistic care, and practical ability. The traditional classroom mode of teaching cannot meet the needs of modern medical education. The purpose of this study is to explore the benefits and challenges of the flipped classroom (FC) combined with case- and team-based learning (FC-CTBL) for residency training. In this study, 60 junior surgical residents of Xiangya Medical College were enrolled. "Diabetic foot" was selected as the content of this study. Residents were divided into an FC-CTBL group and an FC group. FC-CTBL and FC were compared on the basis of residents' feedback questionnaires, residents' learning burden, test scores from a pre-quiz, and objective structured clinical examinations (OSCE). Residents were more satisfied with the FC-CTBL model compared with FC. In the FC-CTBL group, more participants said that the course improved their teamwork skills, analytical skills and their confidence in tackling unfamiliar problems. Residents in the FC-CTBL group also spent significantly less time preparing for class and performed better in the OSCE than those in the FC group. FC-CTBL stimulates residents' learning motivation, decreases their workload, improves their performance in the OSCE and may help to enhance clinical thinking and teamwork skills. The FC-CTBL approach is a good option for residency training.

Education Research: Flipped classroom in neurology: Principles, practices, and perspectives

How to most effectively deliver a large amount of information in an engaging environment that encourages critical thinking is a question that has long plagued educators. With ever-increasing demands on both resident and faculty time, from shrinking duty hours to increased patient complexity, combined with the exponential growth of medical knowledge and unequal access to the spectrum of neurologic subspecialties around the country, this question has become especially pertinent to neurology residency training. A team of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review the current evidence regarding the implementation of the flipped classroom format. This educational model has only recently been applied to health care education along the training continuum, and a small collection of articles has, so far, used disparate methods of curricular implementation and assessment. While the feedback from learners is generally positive, a number of obstacles to implementation exist, most notably learner time commitments. These are presented with discussion of potential solutions along with suggestions for future studies.

Effectiveness of flipped classroom combined with team-, case-, lecture- and evidence-based learning on ophthalmology teaching for eight-year program students

BACKGROUND

This study aimed to investigate the benefits and challenges of the flipped classroom combined with team-, case-, lecture- and evidence-based learning (FC-TCLEBL) for ophthalmology teaching for eight-year program students.

METHODS

FC-TCLEBL and the traditional lecture-based classroom (LBC) were compared based on student and teacher feedback questionnaires, student learning burden, and scores on standardized tests as well as their effects on the abilities of clinical thinking, scientific research, active-learning, practical application, humanistic care and communication with patients.

RESULTS

Both the students and teachers were more satisfied with the FC-TCLEBL model. More students in the FC-TCLEBL group agreed that the course helped them to develop skills in creative thinking, problem solving, and teamwork. Students in the FC-TCLEBL group spent significantly more time preparing for class than those in the LBC group, but the time spent on review was significantly lower in the FC-TCLEBL group. The students from the FC-TCLEBL group performed better in a post-test on diabetic retinopathy (DR) as compared to the LBC group.

CONCLUSIONS

FC-TCLEBL teaching model is effective and suitable for ophthalmology teaching.

Effects of digital flipped classroom teaching method integrated cooperative learning model on learning motivation and outcome

Purpose

This paper aims to study the effects of digital flipped classroom teaching method integrated cooperative learning model on learning motivation and outcome. From the perspective of promoting students’ learning engagement, this study puts forward suggestions for the effective implementation of flipped classroom teaching, so as to provide reference for the implementation of flipped classroom teaching practice in colleges and universities. Along with the time change and promotion of 12-year compulsory education, traditional didactic instruction can no longer satisfy all students. The reform wave in education is therefore emerged in past years, where the “flipped classroom” model strikes a chord and becomes a trend.

Design/methodology/approach

By applying nonequivalent pretest posttest control group design to the experimental research, 242 college students in Henan Province are selected as subjects of study. They are divided into four groups. The first group adopts the flip classroom teaching method. The second group adopts the cooperative teaching method. The third group adopts the flipping classroom teaching method integrated the cooperative teaching method. The fourth group (control group) adopts the traditional teaching method. The study lasted 15 weeks with sessions carried out 3 h a week.

Findings

The research results show significant effects of flipped classroom teaching method on learning motivation, flipped classroom teaching method on learning outcome, cooperative learning on learning motivation, cooperative learning on learning outcome, flipped classroom teaching method integrated cooperative learning on the promotion of learning motivation and flipped classroom teaching method integrated cooperative learning on the promotion of learning outcome.

Research limitations/implications

First, on the basis of consulting the links of many teaching strategies and summarizing the experience of flipped classroom practice in famous universities, a series of teaching strategies is put forward. However, the pertinence of different subjects may be different, which requires teachers to focus on the specific practice of reference. Second, due to the limitation of time, the author spent more time and energy on the proposal part of strategy, and the scientific nature of the strategy is not verified in practice, so it needs to spend time and practice in the later stage to improve this work.

Practical implications

This topic is the integrated design practice and research of flipped classroom in current teaching. The practical significance of the research is to find a solution to the problem of low learning efficiency of students in traditional classrooms, so as to update teachers’ teaching concepts, change teaching methods and promote teaching behaviors. In flipped classroom, there is a systematic integrated design process before, during and after class, which can effectively improve teachers’ teaching design ability, help students change their learning methods and truly improve students’ learning efficiency and effectiveness. The research on the implementation of flipped classroom can enrich the theory of flipped classroom, including the research on the orientation of learning theory and the reorientation of the role of teachers and students. This study can provide theoretical support for the strategies and environment for the cultivation of students’ independent learning ability. The results of this study can provide a reference for improving the scientificity and diversity of research methods.

Originality/value

Based on the integrated design of flipped classroom before, during and after class, this research systematically explores the role of flipped classroom in cultivating students’ autonomous learning ability in the teaching of information science and technology, and studies how to maximize the role of flipped classroom in teaching to promote and help students’ learning. In addition, a special iterative method is adopted. In each round of research, according to the opinions of students and peers, the inadequacies and improvements in the last round of research is found, certain links are increased or decreased, and finally the research goals are achieved.

The effectiveness of a flipped classroom on the development of Chinese nursing students' skill competence: A systematic review and meta-analysis

OBJECTIVES

Skill competence is essential for nursing students and flipped-classroom teaching has become increasingly popular in China's nursing education. However, no studies have yet specifically examined the effect of a flipped classroom versus a traditional classroom on their skill competence.

DESIGN

A systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

The China National Knowledge Infrastructure, Wanfang Data, VIP, Superstar, PubMed, and Web of Science databases were searched from their inception until 9 June 2018.

REVIEW METHODS

We screened the studies according to inclusion and exclusion criteria, extracted the data, and assessed the quality. Then, a meta-analysis was conducted.

RESULTS

Twenty-two studies were eligible after reviewing 484 citations. The flipped classroom increased the students' skills score compared with the traditional teaching method (standardised mean difference = 1.79, 95% confidence interval: 1.32-2.27, p = 0.000). Additionally, it improved the cooperative spirit and sense of teamwork (effect size = 1.60, 95% confidence interval: 1.15-2.06), practical ability (effect size = 1.47, 95% confidence interval: 0.93-2.01), enjoyment of the course (effect size = 1.39, 95% confidence interval: 0.81-1.97), expression and communication (effect size = 1.41, 95% confidence interval: 0.69-2.12), the curriculum's effects (effect size = 1.32, 95% confidence interval: 1.00-1.64), interest in participation (effect size = 1.58, 95% confidence interval: 1.28-1.87), ability to think and analyse problems (effect size = 1.62, 95% confidence interval: 1.24-2.00), and resolution and resilience (effect size = 1.62, 95% confidence interval: 1.29-1.94).

CONCLUSIONS

The results suggest that the flipped classroom is more effective for the nursing students' skill competence than traditional teaching in China. However, due to heterogeneity and bias risk, a large sample and high-quality studies are needed in future to confirm its effectiveness.