Pre-Class Learning Methods for Flipped Classrooms

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

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

Effectiveness evaluation of flipped classroom in emergency medicine online teaching for medical undergraduates

INTRODUCTION

Due to policy changes in the context of COVID-19 pandemic, online teaching has become the main form of class in many Chinese universities. Flipped classroom has been widely used in other disciplines, but there is a dearth of evidence available about the use in online teaching of emergency medicine. This study aimed to develop a flipped classroom for online emergency medicine teaching and evaluate its effectiveness by comparing it with traditional lecture-based online teaching.

METHODS

A total of 62 clinical medical undergraduates from Jinan University participated in this study from September to December in 2022. An online flipped classroom approach was developed (FC group, n = 31). Traditional lecture-based online teaching was applied as a contrast (LBT group, n = 31). The undergraduates completed examinations and questionnaires at the end of the course. A course experience questionnaire and course examination score were used to evaluate the effectiveness of the flipped classroom approach.

RESULTS

Regarding the five dimensions of the course experience questionnaire, the scores for good teaching (3.47 ± 0.50 vs. 2.34 ± 0.48, p < .001), appropriate assessment (3.31 ± 0.68 vs. 2.95 ± 0.71, p = .043) and generic skills (3.16 ± 0.60 vs. 2.72 ± 0.39, p < .001) were higher for the FC group than for the LBT group. There was no significant difference between the two groups in clear goals and standards, and appropriate workload. The undergraduates in the FC group showed significantly higher overall satisfaction than those in the LBT group (3.52 ± 0.1.03 vs. 2.87 ± 0.92, p = .012). The examination scores (77.936 ± 11.573 vs. 70.484 ± 7.434, p < .001), especially the scores for questions related to case analysis (33.032 ± 5.363 vs. 26.968 ± 7.657, p < .001), were significantly higher in the FC group than in the LBT group.

CONCLUSIONS

The flipped classroom for online teaching was efficient in improving undergraduates' emergency medical academic performance and promoting the development of clinical case analysis ability. These findings provide an alternative flipped classroom approach for online teaching of emergency medicine.

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.

Evaluation of ChatGPT's Real-Life Implementation in Undergraduate Dental Education: Mixed Methods Study

BACKGROUND

The recent artificial intelligence tool ChatGPT seems to offer a range of benefits in academic education while also raising concerns. Relevant literature encompasses issues of plagiarism and academic dishonesty, as well as pedagogy and educational affordances; yet, no real-life implementation of ChatGPT in the educational process has been reported to our knowledge so far.

OBJECTIVE

This mixed methods study aimed to evaluate the implementation of ChatGPT in the educational process, both quantitatively and qualitatively.

METHODS

In March 2023, a total of 77 second-year dental students of the European University Cyprus were divided into 2 groups and asked to compose a learning assignment on "Radiation Biology and Radiation Protection in the Dental Office," working collaboratively in small subgroups, as part of the educational semester program of the Dentomaxillofacial Radiology module. Careful planning ensured a seamless integration of ChatGPT, addressing potential challenges. One group searched the internet for scientific resources to perform the task and the other group used ChatGPT for this purpose. Both groups developed a PowerPoint (Microsoft Corp) presentation based on their research and presented it in class. The ChatGPT group students additionally registered all interactions with the language model during the prompting process and evaluated the final outcome; they also answered an open-ended evaluation questionnaire, including questions on their learning experience. Finally, all students undertook a knowledge examination on the topic, and the grades between the 2 groups were compared statistically, whereas the free-text comments of the questionnaires were thematically analyzed.

RESULTS

Out of the 77 students, 39 were assigned to the ChatGPT group and 38 to the literature research group. Seventy students undertook the multiple choice question knowledge examination, and examination grades ranged from 5 to 10 on the 0-10 grading scale. The Mann-Whitney U test showed that students of the ChatGPT group performed significantly better (P=.045) than students of the literature research group. The evaluation questionnaires revealed the benefits (human-like interface, immediate response, and wide knowledge base), the limitations (need for rephrasing the prompts to get a relevant answer, general content, false citations, and incapability to provide images or videos), and the prospects (in education, clinical practice, continuing education, and research) of ChatGPT.

CONCLUSIONS

Students using ChatGPT for their learning assignments performed significantly better in the knowledge examination than their fellow students who used the literature research methodology. Students adapted quickly to the technological environment of the language model, recognized its opportunities and limitations, and used it creatively and efficiently. Implications for practice: the study underscores the adaptability of students to technological innovations including ChatGPT and its potential to enhance educational outcomes. Educators should consider integrating ChatGPT into curriculum design; awareness programs are warranted to educate both students and educators about the limitations of ChatGPT, encouraging critical engagement and responsible use.

Application of Team-Based Flipped Classroom and Traditional Learning on the Antenatal Education Center Course

Background

The goal is to evaluate the effects of a flipped class strategy on knowledge, self-directed learning ability, learning satisfaction and pregnancy outcomes in primiparas undergoing antenatal education.

Methods

A random sampling method was adopted. A total of 600 primiparas who were diagnosed with early pregnancy in a first-class hospital in southeast China and received continuous prenatal health education from May to July 2020 were selected as the research subjects. In order to make the baseline of the two groups of primipara comparable, we divided the two groups in the antenatal education centre according to the odd-even number of the lesson card number. The odd-numbered group was the experimental group, who used the prenatal health education model based on blended learning; the even-numbered group was the control group, who used the traditional mode of prenatal health education. The two groups were compared on the following outcomes: knowledge, self-directed learning ability, learning satisfaction and pregnancy outcomes.

Results

Compared with traditional learning, the blended learning approach can effectively controlled the gestational weight gain (GWG), alleviated the anxiety and depression during pregnancy, improved the natural delivery rate of the primipara, shortened the delivery process and reduced the risk of gestational diabetes mellitus (GDM), the difference was statistically significant (all P<0.05).

Conclusion

Blended learning may be an effective strategy because of its validity and practicality in antenatal education.

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.

Quality of podcasts recorded by nursing lecturers as pre-class learning material for students: An observational study

AIM

To evaluate the quality of podcasts produced by lecturers as pre-class learning material; to verify lecturers' buy-in, after a specific workshop, regarding the practice of producing and using podcasts.

BACKGROUND

The teaching-learning process has undergone significant changes in recent years with the proposal of the flipped classroom strategy, which places the student at the center of the learning process and uses technology that requires adaptation of lecturers, both inside and outside the classroom. Pre-class learning material is one of the features of the flipped classroom model. It provides basic concepts for problem solving in small group discussion in classroom. Podcasts for this educational purpose are a recent technology and their innovative characteristics require deeper understanding in terms of their influence and usability.

DESIGN

Prospective, descriptive and quantitative study.

SETTING AND POPULATION

A workshop on the production of educational podcasts was offered to 23 lecturers on the Nursing course.

METHODS

Data were collected in the second semester of 2021 and the quality analysis was based on criteria available in the literature.

RESULTS

Eighteen professors (78 %) participated in the study and 46 podcasts were produced. Most professors being nurses (61 %), followed by biologists (28 %). Most have a doctorate degree (72 %). These podcasts were available for a mean of five days before the classes and their mean access rate by students was 58 %. There was no correlation between the access rate and the period of availability before the relative class. Most podcasts were informative (100 %) and monologues (98 %). The average duration was 6.2 min, which is within the ideal duration recommended in the literature. All of the podcasts included a description of the learning objectives at the beginning and most of them also included a closing message at the end.

CONCLUSION

The nursing lecturers were able to produce their podcasts, which met quality criteria and reached the standards suggested by experts in the field.

An overview of Instructional approaches and decision-making strategies to curtail curricular overload

OBJECTIVES

Curriculum overload often occurs when content is kept in the curriculum that may no longer be necessary to prepare students for professional practice. The overload becomes compounded by the addition of new content from the ever-changing professional practice needs and updates to accreditation standards. Challenges may occur when programs must first determine the "level" of proficiency a new graduate should attain and then determine the appropriate breadth and depth of educational outcomes in relation to proficiency, while examining what content should be retained from past curricula. Thus, the purpose of this manuscript is to summarize institutional approaches for making content delivery more effective and efficient with the goal of curtailing curriculum expansion.

FINDINGS

Four key elements were consistently identified in the literature as important considerations to address curriculum overload - 1) communication and coordination among faculty, 2) incorporation of active learning strategies, 3) effective utilization of technology, and 4) minimizing faculty and student workload and cognitive burden.

SUMMARY

Each pharmacy program will need to take an individualized approach in addressing curriculum overload; however, consideration of the aforementioned key elements can assist in making these decisions. With increased student engagement in the classroom, intentional design to reduce content and student workload, enhanced communication among faculty, and appropriate technology utilization, curriculum overload can be addressed at every level of pharmacy education.

The effect of the flipped learning approach designed with community of inquiry model to the development of students' critical thinking strategies and social, teaching and cognitive presences

Considering the lack of interaction and feedback process of the pre-class component of the flipped learning approach, in this research this component was designed with the community of inquiry model and an e-learning environment was developed in line with the model's theoretical framework. By exposing its impacts on students' development of critical thinking skills and social, teaching and cognitive presences, this study aimed to determine the working and failing aspects of this learning approach. In this study, in which repeated measures design was used, the study group consisted of 35 undergraduate students studying at a state university. Scales were used to measure students' critical thinking strategies and their perceived presences, and the forum tool was used to collect student posts. The implementation process lasted for 15 weeks. Findings demonstrated that it was possible to eliminate the lack of the interaction and feedback processes, and to develop students' critical thinking strategies and their perceptions of teaching, social and cognitive presences, by designing the pre-class component of the flipped learning approach with the community of inquiry framework. Additionally, it was discovered that the critical thinking strategy had a positive and significant link with how the community of inquiry was perceived, and that this relationship accounted for 60% of the variance in the perception of community of inquiry. The study's conclusions are supported by recommendations for future research.

Perspectives on opportunities and challenges in a predominantly flipped classroom-based pharmacy curriculum: A qualitative study

INTRODUCTION

To adapt to flipped classroom pedagogy in universities, factors such as the amount of the program that is flipped, students' pre-existing educational experiences, and cultural background may influence adjusting to the approach. We investigated students' perspectives across four years of a predominantly flipped classroom-based pharmacy curriculum in a low to middle income country.

METHODS

We conducted five semi-structured focus groups with 18 pharmacy students from years one to four of the bachelor of pharmacy program at Monash University Malaysia where students came from different pre-university backgrounds. Focus group recordings were transcribed verbatim and thematically analysed. Interrater reliability was performed to ascertain reliability of themes.

RESULTS

Three major themes were identified. Firstly, students cited issues moving past the initial barrier when starting flipped classrooms in terms of education background impacting adaptability and how/why they eventually adapted. Another theme was how flipped classrooms helped development of life skills such as adaptability, communication, teamwork, self-reflection, and time management. The final theme was on requiring a sufficient safety net and support system in flipped classrooms that included well designed pre-classroom materials and well-implemented feedback mechanisms.

CONCLUSIONS

We have identified students' perspectives on the benefits and challenges associated with a predominantly flipped classroom pharmacy curriculum in a low to middle income country setting. We suggest using scaffolding and effective feedback approaches to guide the implementation of flipped classrooms successfully. This work can aid future educational designers in preparation and supporting a more equitable learning experience regardless of student background.

The Medical Student Experience With Prework

OBJECTIVES

The objective of this study is to better understand the medical student experience with prework to determine what factors influence their motivation to complete prework.

INTRODUCTION

Medical education has been shifting to more active learning-type sessions such as flipped classrooms but these activities are unsuccessful when students do not complete the associated prework. The literature is lacking on why students do not complete prework and what would motivate them to do so. This qualitative study aims to answer those questions through the view of expectancy-value motivation theory.

METHODS

Thirteen preclinical medical students participated in a semistructured basic interview study investigating their experience with prework. Interview transcripts were coded, and codes were clustered and analyzed for themes.

RESULTS

Students develop particular routines they find successful for their studies. They explain how time in their schedules and the amount of time prework takes to complete plays a role in their study environment which must be favorable in order to complete prework. Students view video prework more favorably compared to reading assignments. Students note how the opinions of their peers influence their decision to complete prework. Each of these factors influences student motivation to complete prework.

CONCLUSION

This study finds that motivation to complete prework is influenced by the environment, format, and use of prework, student interest and prior knowledge, and peer influence. The combination of these factors determines whether a student believes they are capable of completing prework and if they find it valuable. In order to increase motivation to complete prework, faculty should consider how to address these factors in a way that students are able to fit prework into their study routines. This study provides the first step in understanding the medical student experience with prework and suggests directions for future studies to maximize student motivation to complete prework.

The impact of the transition from flipped classroom to online lectures on learning outcomes and student satisfaction in a rehabilitation medicine clerkship during the COVID-19 pandemic

BACKGROUND

The flipped classroom (FC) is a well-known active learning module that activates the prior knowledge of students and promotes their cognitive skills during in-class activities. However, most on-site teaching during the COVID-19 pandemic had to be conducted online. The FC in our rehabilitation medicine clerkship curriculum was also shifted to online asynchronous lectures (OLs), without real-time interactions. There is no previous comparison of effectiveness between these two methods. Therefore, this study aimed to compare learning outcomes and student satisfaction in both FC and OL models.

METHODS

The study design was a historically controlled study. A physical modality was chosen for the content. The FC group (n = 233), in the academic years 2018 and 2019, was assigned to perform a pre-class activity consisting of reading study materials. Thereafter, the in-class activity comprised a small-group case-based discussion. The OL group (n = 240) in the academic years 2020 and 2021 followed an online model during the COVID-19 lockdown. They were also asked to read the online materials and then watch a self-paced recorded lecture video on Learning Management Systems. The learning outcomes, including their multiple-choice questions (MCQs) scores, final exam scores, grade points, and letter grades, were evaluated. Their overall course satisfaction ratings were also collected.

RESULTS

The OL group had an overall higher MCQ score for the physical modality portion than the FC group (p = 0.047). The median (lower quartile, upper quartile) of the total 50-MCQ scores were 34 (31, 37) in the OL group and 33 (29, 36) in the FC group (p = 0.007). The median final exam scores of the OL and FC groups were 69.5 and 68.3, respectively (p = 0.026). The median grade points and the letter grades were not significantly different between the groups. The proportions of satisfaction were significantly higher in the FC group than in the OL group.

CONCLUSIONS

The OL group revealed significantly higher learning outcomes than the FC group. However, the FC group showed more satisfaction with interactivity than the OL group. The authors are of the view that a combination of both FC and OL methods will likely result in better outcomes.

Evaluating the impact of a flipped classroom model based on cognitive science of learning strategies in a pharmacotherapy course

INTRODUCTION

The purpose of this study was to determine the impact of a flipped classroom method based on cognitive science of learning strategies on student performance and experience in a third-year pharmacotherapy course.

METHODS

The cognitive science of learning flipped classroom (CSL-FC) strategies in this study included pre-class learning (Preview), in-class application to cases (Retrieval), after-class learning (Spaced Retrieval), and post-module reflection (Deliberate Reflection) in a required pharmacotherapy course. During fall 2017, one instructor piloted the CSL-FC method. During fall 2018, this method expanded to four instructors. All other instructors used traditional lecture-based methods. The same multiple-choice exam questions were used both years. The average exam question scores between teaching methods were compared by independent t-test. Student focus groups were conducted after the 2017 semester. In 2018, students were surveyed using a 5-point Likert rating (1 = strongly agree, 5 = strongly disagree) to evaluate their experience.

RESULTS

The 2017 and 2018 classes included 132 and 137 students, respectively. During the two years, exam question scores were significantly better with CSL-FC (n = 136 questions) compared to traditional (n = 110 questions) (88.8% vs 84.9%, respectively; P = .02). The focus group analysis revealed three main themes including a "love-hate relationship," "time," and "it works." Student agreement to the survey question "the cognitive science of learning flipped classroom helped me learn" was 2.18 (SD 1.12).

CONCLUSIONS

Implementing a flipped classroom approach based on cognitive science of learning strategies positively impacted student performance and experience in a pharmacotherapy course.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Examining the relationships between medical students' preferred online instructional strategies, course difficulty level, learning performance, and effectiveness

Students' preferences and engagement with online educational resources and activities are crucial for academic success in the context of online medical education. This study investigated the preferences of Chinese medical students regarding the teaching strategies used by instructors and their relationship with course difficulty level, student's academic performance, and perceived effectiveness. Survey data (n = 375) were collected from the medical students from one of the largest medical schools in Southern China during the spring semester of 2020. First, exploratory factor analysis demonstrated that there were three latent factors behind online teaching strategies, including teacher-led instructional strategies, supervised and monitored learning strategies, and self-directed learning strategies. Instructional activities under teacher supervision and monitoring received the highest rating while teacher-led strategies received the lowest ratings. Second, the popularity of the three online instructional strategies we have identified was positively associated with students' perceived effectiveness of online teaching and their self-reported academic performance. Third, analysis of the quantified answers to the open-ended question reported a positive association between the perceived difficulty level of the courses and students' preference of teacher-led strategies. It also manifested a positive correlation between perceived effectiveness level of the online teaching and the use of self-directed learning strategies before their online lectures. Further implications of the findings are fully discussed.

The Effects of Gamified Flipped Learning Method on Student’s Innovation Skills, Self-Efficacy towards Virtual Physics Lab Course and Perceptions

Laboratory courses are extremely important in Physics education in terms of providing a better understanding of the theoretical course subjects by the students. However, since the COVID-19 epidemic caused education to be carried out remotely and digitally all over the world, practical as well as theoretical courses were moved to digital platforms. Therefore, this study investigated the effects of the Gamified Flipped Learning (GFL) method on students’ physics self-efficacy and innovation skills in a virtual physics laboratory course. The study was carried out with true experimental design and the participants were a total of 70 first-year engineering students, which were randomly divided into two groups. The experimental group was trained with the GFL method, the control group was trained with Classical Flipped Learning (CFL) method. Data were collected from a physics self-efficacy questionnaire, innovative skills questionnaire, and semi-structured interviews form. The research results showed that GFL method has a positive impact on the innovation skills of students although insignificant improvement was introduced by gamified-flipped learning on students’ self-efficacy. In addition, the interviews with the students revealed a positive perception of gamification, by mentioning some important aspects of the process that were extremely beneficial.

Cumulative oral examinations in undergraduate human physiology: process, student perceptions, and outcomes

Assessment methods vary widely across undergraduate physiology courses. Here, a cumulative oral examination was administered in two sections of a 300-level undergraduate physiology course. Student performance was quantified via instructor grading using a rubric, and self-perceptions (n = 55) were collected via survey. Overall, students affirmed that the oral examination assisted in their learning, specifically by leading them to begin preparation for their final written exam earlier than they otherwise would. The instructor considered the oral exam useful for student learning by providing a scaffold to the written final exam and a way to connect with students before a high-stakes final exam. Specific details of the examination format and suggestions and considerations for those considering this assessment approach are provided.

Using Flipped Classroom to Improve the Learning Effectiveness of Digital Logic Courses

As a student-centered learning model, flipped classroom has been increasingly preferred among educators since it has changed the traditional teacher-centered learning model. This study conducted experiments and observations on the flipped classroom for digital logic courses for first-year students in the electrical engineering department of a junior college in Taiwan. Before each class, these students were required to watch the prescribed lecture video units. In class, students discussed with group members after thinking and completed the teacher’s requirements by collaboration. In addition to conducting the activities of thinking, discussion, collaboration and observation, these students also got to exercise their expression skills through interactive activities during class time. Analyzing the learning effectiveness with the Panel Data Method (PDM), this study, by comparing and statistically analyzing the data collected during the four years between 2016 and 2019, found that students reaped better learning performance with the flipped classroom model, as shown by a rise in both their average grade and the pass rate.

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

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

Blended Learning on Blood Pressure Measurement: Investigating Two In-Class Strategies in a Flipped Classroom-Like Setting to Teach Pharmacy Students Blood Pressure Measurement Skills

For reliable blood pressure measurement, various potential sources of inaccuracies need to be considered to avoid incorrect decision-making. Pharmacy students should be sensitized and taught the skill accordingly. One strategy to teach students’ blood pressure measurement skills might be through a blended learning approach in a flipped classroom-like setting. With a randomized two-arm study among pharmacy students in their eighth semester, the required extent of in-class session in the scope of a blended learning approach in a flipped classroom-like setting was evaluated. Participants’ self-confidence and self-perceived proficiency were evaluated through a survey, and participants’ blood pressure measurement performance was assessed by objective structured clinical examination (OSCE). Participants’ satisfaction with, and perception of, the flipped classroom were also surveyed. The extended in-class activities did not result in a significantly higher increase of participants’ OSCE score and self-assessment score when compared to the brief in-class session. Both in-class sessions yielded a significant increase in the OSCE scores as well as in the self-assessment scores. Moreover, the teaching approaches were predominantly well-received by the students. The use of both flipped classroom-like approaches improved pharmacy students’ blood pressure measurement performance, though the brief in-class session was sufficient. Students’ self-confidence/self-perceived proficiency in blood pressure measurement skills increased similarly in both settings.

Application of the Inverted Classroom Model for Teaching Pathophysiology to Chinese Undergraduate Medical Students: Usability Study

BACKGROUND

The inverted classroom model differs from the traditional teaching model as it reverses the pattern of knowledge transfer and internalization. In recent years, this new teaching model has received much attention in undergraduate medical education. Pathophysiology is a course in the undergraduate Chinese medical curriculum that is critical in bridging basic medical science and clinical medicine.

OBJECTIVE

The purpose of this study was to investigate the application of inverted classroom in delivering the course on pathophysiology to Chinese undergraduate medical students.

METHODS

In the spring semester of 2018, inverted classroom teaching was implemented for second-year clinical medicine students at the College of Medicine at Nanchang University. The topics of hypoxia and respiratory failure were selected for the inverted classroom study. The effect of the inverted classroom on teaching pathophysiology was evaluated using classroom performance metrics, a final examination, and questionnaires.

RESULTS

This study found that students in the inverted classroom group achieved higher scores in their in-course assessments (82.35 [SD 11.45] vs 81.33 [SD 9.51], respectively) and in their final exams (73.41 [SD 10.37] vs 71.13 [SD 11.22], respectively) than those in the traditional lecture-based group, but the scores were not significantly different (P=.13, unpaired two-tailed t test). There was also no significant difference in the distribution of the score segments in the class quiz (P=.09, chi-square test) and in the final exams (P=.25, chi-square test) between the 2 groups. Further, most of the students reported that the inverted classroom increased their learning motivation, made them more confident, and helped them understand the content on pathophysiology better. The students in the inverted classroom also improved in their problem-solving skills and teamwork abilities. However, some students from the inverted classroom group also reported that the self-learning and preparatory work before class increased their learning burden.

CONCLUSIONS

This study shows the feasibility and promise of inverted classroom for teaching pathophysiology to undergraduate Chinese medical students. The inverted classroom improves students' learning interests and attitudes toward learning. However, further studies are required to assess the benefits of broader acceptance and implementation of the inverted classroom among Chinese undergraduate medical students.

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.

Impact of blended learning on learning outcomes in the public healthcare education course: a review of flipped classroom with team-based learning

BACKGROUND

A flipped classroom with team-based learning is a blended educational strategy that guides active learning inside and outside the classroom. This study aimed to verify the effects of this innovative blended educational strategy on knowledge, problem-solving ability, and learning satisfaction of undergraduate nursing students undergoing public healthcare education.

METHODS

The subjects were undergraduate nursing students enrolled in H University in South Korea. The experiment was conducted over a period of 8 weeks in the public healthcare course. Two groups, blended learning (A flipped classroom with team-based learning) which was the experimental group and traditional lecture-based classroom group, the control group, were assessed. In the blended learning group, the students had pre-class, in-class (including team-based learning elements), and post-class learning elements. The two groups were compared on the following learning outcomes: knowledge, problem-solving ability, and learning satisfaction.

RESULTS

Results showed that the blended learning instructional methods, in comparison with traditional lectures, enhanced the students' knowledge, problem-solving ability, and learning satisfaction in the public healthcare course.

CONCLUSIONS

This study supports the feasibility of the flipped classroom with team-based learning as a blended learning strategy, able to produce improvements in nursing students' learning outcomes. Blended learning approaches may be an effective alternative to conventional approaches in nursing education.

Development and Psychometric Properties of the Questionnaire for Assessing Educational Podcasts (QAEP)

The aim of this research was to develop and validate the Questionnaire for Assessing Educational Podcasts (QAEP), an instrument designed to gather students' views about four dimensions of educational podcasts: access and use, design and structure, content adequacy, and value as an aid to learning. In study 1 we gathered validity evidence based on test content by asking a panel of experts to rate the clarity and relevance of items. Study 2 examined the psychometric properties of the QAEP, including confirmatory factor analysis with cross-validation to test the factor structure of the questionnaire, as well as item and reliability analysis. The results from study 1 showed that the experts considered the items to be clearly worded and relevant in terms of their content. The results from study 2 showed a factor structure consistent with the underlying dimensions, as well as configural and metric invariance across groups. The item analysis and internal consistency for scores on each factor and for total scores were also satisfactory. The scores obtained on the QAEP provide teachers with direct student feedback and highlight those aspects that need to be enhanced in order to improve the teaching/learning process.

Impact of readiness assurance process and faculty feedback on individual application exercises: a model for continuous assessment in physiology

This study is aimed at the implementation of a continuous assessment model in physiology for a large-enrollment classroom with 250 students. The readiness assurance process (RAP) and immediate feedback elements from team-based learning (TBL) methodology were adopted to test their ability to guide students to solve applications exercises individually. Three continuous assessments in physiology (CAPs) were conducted with the RAP to include individual (iRAT) and group readiness assurance tests (gRAT). Immediate feedback was provided with faculty-student discussion (FSD), and the individual application exercises (iAE) were designed to be answered individually. Each CAP was subjected to three types of experimental manipulation in subgroups created out of 250 students. The intervention began with iRAT for all three subgroups. The sequence of iRAT, gRAT, FSD, and iAE varied between subgroups within a CAP. In a cross-over study design, each subgroup of students was subjected to all three intervention types over three CAPs. The subgroup completing iAE after RAP and FSD showed higher scores than the subgroup with RAP alone. One hundred eight-two students (82.35% response rate; 101 women and 81 men) responded to the questionnaire. The majority of students (87.4%) felt that doing iRAT and gRAT at the beginning helped them to solve iAE better. Most of the students (86.8%) responded that they received useful feedback and clarification during the discussion with the teacher after the gRAT. In conclusion, the administration of iRAT first followed by gRAT and immediate feedback from faculty seem to be beneficial to prepare students to tackle application-based exercises.

Examination of the Relationship between Health-related Quality of Life and Academic Performance Among Student Pharmacists

INTRODUCTION

First-year student pharmacists (P1s) may experience a number of stressors that may affect academic performance due to the transition into a professional program. Study objectives were to evaluate student demographic and pre-pharmacy factors associated with perceived stress among P1s, analyze relative change in perceived stress over the P1 year, and assess associations between perceived stress and academic performance.

METHODS

The Perceived Stress Scale (PSS-10) was administered three times to P1s: during orientation, midpoint of fall semester, and midpoint of spring semester. Data were also collected using school records, including demographics, P1 fall grade point average (GPA), P1 spring GPA, and P1 year GPA. Paired-sample t-tests, independent samples t-tests, Analysis of Variance, correlational analysis, and multiple linear regression were conducted.

RESULTS

Of 202 P1s, 201 (99.5%) completed the orientation survey administration and 110 (54.5%) completed all three administrations. PSS-10 score significantly increased across survey administrations. Differences in PSS-10 scores at orientation were noted based on gender and race/ethnicity (P < .05), with female and minority students experiencing greater levels of stress. PSS-10 score (spring administration) was significantly, inversely correlated to P1 fall GPA, spring GPA, and year GPA (P < .05). Undergraduate science GPA, PSS-10 score (orientation administration), and age were included in the final version of the regression model as significant predictors of P1 year GPA.

CONCLUSIONS

Perceived stress increased over the P1 year, and higher perceived stress was associated with lower P1 academic performance. Future studies should examine strategies to assist P1s in managing stress.

Utilizing widely available podcasts to create a reflection activity for pharmacy students

BACKGROUND AND PURPOSE

Creative strategies can be employed to encourage development of affective domain skills. The purpose of this article is to describe and assess the creation of a written self-reflection assignment utilizing podcasts. Educational activity and setting: Second year pharmacy students (N = 122) in a skills laboratory course completed two written reflections that asked them to: (1) examine and reflect on personal beliefs, biases, motivations and emotions that were challenged while listening to a podcast; and (2) identify knowledge, skills, and abilities of a pharmacist that may impact the situation presented in the podcast. Students chose from a list of podcasts curated by faculty and completed two 450 to 600-word reflections. Students completed a pre-post modified Questionnaire for Reflective Thinking (mQRT). A one-tailed, paired t-test was used to assess the mQRT. The post-questionnaire survey also included questions related to student perceptions of the reflections. Descriptive statistics were used to summarize student perceptions.

FINDINGS

Out of 122 students, 116 (95.1%) completed both the pre- and post-mQRT and survey. The majority of students responded affirmatively that the reflections made them think about healthcare in a different way (91.4%) and challenged their beliefs/biases (81.9%). Students reported applying information from previous course material to the podcast concepts (75%) and vice versa (77.6%).

SUMMARY

Assignments using podcasts are a unique way of engaging student learners. These assignments may help to assess affective educational outcomes and be a way to increase self-reflection, self-awareness, and metacognition in pharmacy students.

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.

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.