Impact of Flipped Classroom Design on Student Performance and Perceptions in a Pharmacotherapy Course

Flipped classrooms in pharmacy education: A systematic review

Background

In recent years, flipped classrooms (FCs) have gained popularity in higher education, particularly among healthcare students. The FC model is a blended learning approach that combines online learning with in-class activity. This has prompted many instructors to assess how they teach and prepare successful graduate students for today's society. Additionally, colleges and universities have been challenged to deliver curricula that are relevant to the needs of students and to provide the rising skills and knowledge that are expected to be acquired by students.

Objective

This systematic review aims to evaluate the flipped classroom teaching approach in pharmacy education and to provide a summary of the guidance for the introduction and implementation of the flipped classroom model in pharmacy educational programs.

Method

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Eight databases were cross-screened by four reviewers, following key terms and predefined inclusion and exclusion criteria. A form was developed to extract relevant data from the reviewers. Qualitative data within the studies reporting students' and educators' perceptions and views on the FC model were also analyzed using a thematic analysis. Studies were appraised using the Medical Education Research Quality Instrument (MERSQI) and the Joanna Briggs Institute (JBI) checklist for qualitative research.

Results

The reviewers screened 330 articles, of which 35 were included in the review. The themes identified were implementation, academic performance outcomes, student satisfaction with the flipped classroom model, and long-term knowledge retention. Most studies (68%) have found that flipped learning enhances students' success and exam performance. Six (27%) studies reported no statistically significant difference in academic performance. However, two studies reported lower long-term knowledge retention in FC learning than in lecture-based learning. The students' perceptions of the FC approach were assessed in 26 studies, and the majority reported positive feedback. However, some students found the pre-class homework difficult to complete before class, and some expressed dissatisfaction with the inconsistent grading and unclear assessment questions in the FC model. Overall, the FC model was found to enhance the students' critical thinking and communication skills, self-confidence, and time management.

Conclusions

The findings of this review indicate that pharmacy students generally found the flipped classroom model preferable to traditional lectures. However, this preference is conditional on the effective implementation of this approach and alignment within the core instructional elements. The issue of increased workload for students associated with self-directed pre-class learning may present a challenge.

Effectiveness of flipped classroom in pharmacy education - a meta-analysis

BACKGROUND

Flipped classroom, blended with online and offline learning, was regarded as an effective learning approach in pharmacy education. This meta-analysis was to comprehensively compare the effectiveness of flipped classroom and traditional lecture-based approaches, attempting to generate a unified and firm conclusion of the effectiveness of flipped classroom in pharmacy education.

METHODS

Data were collected from 7 databases, involving Cochrane Library, PubMed, Embase, ScienceDirect, Web of Science, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature Service System (SinoMed). The studies were included if they included objective evaluation of students' performance between groups of flipped classroom and traditional approaches. The standardized mean difference (SMD) with a corresponding 95% confidence interval (95% CI) was used as the outcomes for data pooling.

RESULTS

A total of 22 studies (28 comparing groups) with 4379 participants were included in the meta-analysis. The risk of bias was relatively high. Results of the analysis revealed that flipped classroom presented significant advantages over traditional approaches in student performance improvement, with no evidence of publication bias. Through subgroup analysis, it showed better outcomes for flipped classrooms over traditional lectures for the other subgroups, including different performance, degree programs.

CONCLUSIONS

Current evidence reveals that the flipped classroom approach in pharmacy education yields a statistical improvement in student learning compared with traditional methods. In the future, instructors should introduce more online technology into classroom and construct an interactive learning environment.

MyDispense simulation in pharmacy education: a scoping review

BACKGROUND

MyDispense is a free online virtual simulation software developed by Monash University. The software facilitates students to practise, apply and hone the skills of a pharmacist in a realistic environment without the potentially life-threatening consequences of a real-life error. Although the focus of MyDispense was initially on exposure to community pharmacy practice scenarios, its modular build and customizability, indicate that there are a wide range of applications that could be incorporated into pharmacy education. Therefore, this study reviews and appraises the literature on the use of MyDispense within pharmacy education.

METHODS

A scoping review was conducted. The electronic databases (CINAHL, Ovid Embase, Ovid Medline, Google Scholar, and Scopus) were searched to identify scholarly articles related to MyDispense in pharmacy education from January 2011 and August 2022.

RESULTS

Forty-three papers met the inclusion criteria and were analysed in this scoping review. A total of 418 key sentences and segments of text were extracted from the papers and subsequently categorized into 10 subthemes. The 10 subthemes were dispensing skills, communication skills, decision-making/problem-solving skills, student performance, pharmacy law, applying theoretical knowledge, support educators, pharmacy practice, feedback/reflection and practice in a risk-free environment. In total, four overarching themes summarize how MyDispense is supporting pharmacy education: supporting education; skill development; application of knowledge and student outcomes.

CONCLUSION

The scoping review found that MyDispense was mostly used to support education and student skill development. These findings can be used to support pharmacy educators globally on the various uses and applications of MyDispense in their teaching.

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.

Implementation of a Clinical Problem-Solving Course for Students Challenged by Early Pharmacy Curriculum

OBJECTIVE

This study evaluates the impact of offering a clinical decision-making and problem-solving course to students academically challenged in early required clinical and pharmaceutical calculation courses on improving their ability to identify and solve drug-related problems.

METHODS

Faculty designed a course with a main objective for students with grades of C or lower in any of the 5 required first-year courses to gain plentiful practice with a systematic approach to identifying and solving drug therapy problems. Students' performance on course-embedded assessments mapped to problem-solver subdomain, a pre-Advanced Pharmacy Practice Experience (APPE) competency on the ability to identify drug-related problems, and performance on Pharmacy Curriculum Outcomes Assessment were compared to a control group of students from 2 previous cohorts who did not take the course but had a subpar academic performance. Pearson chi-square test and independent samples t test were utilized for categorical and continuous data, respectively.

RESULTS

The clinical decision-making and problem-solving course significantly improved student performance on pre-APPE competency to identify drug-related problems (first-attempt pass rate of 96% vs 30% when compared to a historic cohort), but not on Pharmacy Curriculum Outcomes Assessment. Student performance on case-based questions mapped to problem-solver subdomain exceeded internally set standard by 13.72% points.

CONCLUSION

Students demonstrated learning problem-solving and clinical decision-making, which improved their performance on course-embedded assessments and pre-APPE competency in identifying drug-related problems.

Application of Blended Learning to Veterinary Gross Anatomy Practical Sessions: Students' Perceptions of Their Learning Experience and Academic Outcomes

The use of blended learning strategies is increasingly common in health sciences, including veterinary medicine; however, there are very few descriptions of these methods being applied to practicals. We describe here the application of blended learning based on the implementation of flipped classrooms with collaborative learning and gamification to the 2020-2021 veterinary medicine gross anatomy practicals at CEU Cardenal Herrera University (Spain). Students prepared for the sessions by pre-viewing videos and taking a quiz before the start. The sessions were conducted in small groups where students learned through collaborative work and reviewed their learning with a card game. A small but significant increase was observed when comparing the scores of practical exams of the locomotor apparatus with those of 2018-2019 (6.79 ± 2.22 vs. 6.38 ± 2.24, p < 0.05), while the scores were similar (7.76 ± 1.99 vs. 7.64 ± 1.92) for the organ system exams. Students' responses in a satisfaction survey were mostly positive (>80%) regarding the motivating and learning-facilitating effect of this educational method. Our work shows that the application of blended learning in anatomy practicals based on a flipped classroom and with elements of gamification and collaborative work can be an effective way to improve the learning experience of students.

Integrated-Based Curriculum of Pharmaceutical Dosage Forms (ICPDF): What Factors Affect the Learning Outcome Attainment?

This study aimed to evaluate pharmacy students' perceptions regarding the correlations among the quality of faculty members, institutional resources, an integrated-based curriculum of pharmaceutical dosage forms (ICPDF), and learning outcome attainment. The current study participants have attended courses (semesters 2 to 6) through the ICPDF in the Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Indonesia. We distributed survey instruments to 212 pharmacy undergraduate students after one year of the curriculum implementation. We asked the students to fill in the instrument in which the indicators consist of a 7-point Likert scale. The data were analyzed using SmartPLS, which included measurement and structural models through PLS-SEM. The findings informed that the quality of faculty members and institutional resources significantly predict ICPDF. Similarly, ICPDF plays a significant role in affecting learning outcome attainment. The quality of faculty members and institutional resources were not related to learning outcome attainment. Significances of differences were informed among students' years in university regarding learning outcome attainment and ICPDF. However, insignificant differences emerged based on gender. The findings demonstrate the benefits of using the PLS-SEM approach to create a valid and reliable model, assessing the correlations between independent variables with the ICPDF and learning outcome attainment as two dependent variables.

Practising pharmacists want more nutrition education

BACKGROUND AND PURPOSE

Although pharmacists are first and foremost medication specialists and suppliers, in Australia they are also ideally positioned within the healthcare setting to encourage and support positive lifestyle choices in the community. Little has been done to assess their nutrition knowledge in over 20 years. We aimed to explore pharmacists' nutrition knowledge and associated practice and to subsequently develop and evaluate a short course to fill identified gaps.

EDUCATIONAL ACTIVITY AND SETTING

The General Nutrition Knowledge Questionnaire was revised for testing nutrition knowledge in the pharmacy setting. Once validated, the questionnaire was distributed to pharmacists using social/professional media advertising. A short course was then developed, and its effectiveness assessed on final-year pharmacy students.

FINDINGS

Pharmacists' (N = 258) mean score was 89.9 out of 121 (SD = 10.6) with significant variation. Nutrition education provision in practice was provided inconsistently and was associated with how strongly participants rated their own knowledge. Most pharmacists (95.7%) agreed they are well-placed to assist in disease burden reduction through nutrition education; however, most (98.4%) felt their knowledge needed improvement. The short course was well received by participants, deemed to be appropriate in context, and resulted in a median improvement in matched scores of 14.7% (P < .001) with no significant decline in knowledge when reassessed three weeks later (P = .383).

SUMMARY

Pharmacists' nutrition knowledge and practice was variable. Further education can improve knowledge without significant time outlay and is likely to improve associated counselling practices.

Relationships Between Remote Asynchronous Lectures and Summative Assessment Performance in four Pharmacotherapeutics Courses

Background: Synchronous education describes when teaching, learning, and assessment occur concurrently and asynchronous education describes when teaching, learning, and assessment occur anytime. Remote learning is where teaching and learning occur via technological means. Objective: This report describes a remote, asynchronous learning method implemented in a 3-year, block curriculum, Doctor of Pharmacy degree program. Methods: Remote asynchronous lectures embedded with quizzes were delivered to pharmacy students at the end of their first professional year and beginning of their second professional year. Camtasia software and Screencast.com were utilized during portions of 4 pharmacotherapeutic-based courses. Students completed time-spaced quizzes embedded every 5 to 15 minutes throughout the videos and quiz scores were recorded. Discrete watches, number of total watches, and average number of video quiz questions correctly answered were examined for Spearman's rank correlation coefficient (ρ) with end-of-course summative assessment scores. Results: There were no strong positive correlations between discrete watches, number of total watches, and average number of video quiz questions correctly answered and end-of-course assessment scores (ρ range: -0.47 to 0.25). There were weak to moderate correlations within the rheumatology and dermatology assessment scores based on the Screencast.com content questions and the number of unique video watches (ρ = 0.40), average number of total video watches (ρ = 0.28), and average percent of quiz questions correct (ρ = 0.40), all of which were statistically significant (P < 0.05). Conclusions: Remote asynchronous lectures including time-spaced quizzes were not associated with improvements in summative assessment performance. Mild positive correlations between remote asynchronous lectures and time-spaced quizzes may correspond with discrete questions on a summative assessment but those relationships may be influenced by the content within the remote asynchronous lectures.

Comparison between two asynchronous teaching methods in an undergraduate dental course: a pilot study

BACKGROUND

Properly designed and implemented eLearning can lead to improvement of dental teaching quality. Various strategies have been proposed to increase the effectiveness of eLearning in dental education, however, there is a lack of research to assess the effectiveness of these strategies.

OBJECTIVE

To investigate dental students' learning performance and perception of a virtual flipped learning format compared to a virtual traditional learning method.

METHODS

A crossover pilot study was conducted at the College of Dentistry, Princes Sattam Bin Abdulaziz University, Saudi Arabia. Computer-generated randomization, blinded from researchers who analyzed the results, was performed to allocate 32 participants (aged 23.27 ± 0.86 years) to one of two groups. Participants in the control group were taught through the virtual traditional learning method (VTL) using live video lectures. In contrast, participants in the intervention group were taught through the virtual flipped learning method (VFL) using recorded online lectures and post-lecture virtual discussions. Learning gain and preference were measured by pre- and post-test average score differences and a modified validated survey, respectively.

RESULTS

There was no significant difference in learning performance between VFL and VTL groups (P > 0.05). However, students preferred VFL over VTL and the differences were significant among all survey items, except for the opportunity to ask questions.

CONCLUSION

Health professions educators are encouraged to carefully design online curricula with efficient learning strategies that help students improve learning performance and foster self-directed learning skills while valuing active learning in an online environment.

TRIAL REGISTRATION

NCT04692142 , 31/12/2020.

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.

Multilevel factor analysis of flipped classroom in dental education: A 3-year randomized controlled trial

Purpose

Previous studies have rarely attempted to test the confounding factors that may affect learning outcomes of the flipped classroom. The purpose of this study was to assess how flipped classrooms affect the acquisition of knowledge in clinical dental education based on multilevel factor analysis.

Method

The authors conducted a 3-year (2017, 2018, and 2019) randomized controlled trial in a series of introductory prosthodontics courses in dental education. A total of 137 participants were randomly assigned to flipped classroom (n = 70, 51%) or lecture (n = 67, 49%) formats. The flipped group was instructed to self-learn knowledge-based content through online preparation materials, including videos and text, while the lecture group was given text only. Both groups were provided with the same study content and opportunities for different styles of learning. The session attendance rate and number of times the materials were accessed were monitored. Individual and team readiness assurance tests (IRAT/TRAT) were conducted to evaluate knowledge acquisition. A multilevel linear regression analysis was conducted on both instructional styles (flipped vs. lecture) as an intervention factor, and confounding factors that could affect the outcomes were implemented.

Results

The average number of online accesses was 2.5 times per session in the flipped group and 1.2 in the lecture group, with a significant difference (p < .05). The average IRAT score was significantly higher in the flipped than in the lecture group (effect size [ES] 0.58, p < .001). The number of online accesses was significantly and positively correlated with IRAT scores (0.6 [0.4, 0.8]). The instructional style was significantly and positively correlated with TRAT scores (coefficient [95% confidence interval]: 4.6 [2.0, 7.3]), but it was not correlated with IRAT (4.3 [-0.45, 9.0]).

Conclusions

The flipped classroom was more effective than the lecture format regarding knowledge acquisition; however, the decisive factor was not the instructional style but the number of individual learning occasions. The employment of the flipped classroom was the decisive factor for team-based learning outcomes.

Medical Education in Pathology: General Concepts and Strategies for Implementation

CONTEXT.—

Pathology education must evolve as medical knowledge expands and disruptive technologies emerge. The evolution in pathology teaching practices accelerated as traditional teaching modalities were suspended in March 2020 during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVES.—

To provide pathologists an overview of established teaching paradigms and practical examples of how these paradigms may be applied to pathology education, emphasizing differences in graduate and undergraduate medical education as well as the challenges and promises of remote learning, as revealed by the COVID-19 pandemic.

DATA SOURCES.—

Selected peer-reviewed publications representing the field of educational social science.

CONCLUSIONS.—

Evidence-based methods described in education and social sciences can be effectively deployed in pathology education and especially remote learning, as necessitated by the current COVID-19 pandemic. Understanding established principles, such as cognitive load, competency-based learning, peer-assisted learning, and flipped classrooms may prove useful in developing effective, learner-centric content for pathology education.

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.

Effectiveness of blended learning in pharmacy education: A systematic review and meta-analysis

Background & objective

Though blended learning (BL), is widely adopted in higher education, evaluating effectiveness of BL is difficult because the components of BL can be extremely heterogeneous. Purpose of this study was to evaluate the effectiveness of BL in improving knowledge and skill in pharmacy education.

Methods

PubMed/MEDLINE, Scopus and the Cochrane Library were searched to identify published literature. The retrieved studies from databases were screened for its title and abstracts followed by the full-text in accordance with the pre-defined inclusion and exclusion criteria. Methodological quality was appraised by modified Ottawa scale. Random effect model used for statistical modelling.

Key findings

A total of 26 studies were included for systematic review. Out of which 20 studies with 4525 participants for meta-analysis which employed traditional teaching in control group. Results showed a statistically significant positive effect size on knowledge (standardized mean difference [SMD]: 1.35, 95% confidence interval [CI]: 0.91 to 1.78, p<0.00001) and skill (SMD: 0.68; 95% CI: 0.19 to 1.16; p = 0.006) using a random effect model. Subgroup analysis of cohort studies showed, studies from developed countries had a larger effect size (SMD: 1.54, 95% CI: 1.01 to 2.06), than studies from developing countries(SMD: 0.44, 95% CI: 0.23 to 0.65, studies with MCQ pattern as outcome assessment had larger effect size (SMD: 2.81, 95% CI: 1.76 to 3.85) than non-MCQs (SMD 0.53, 95% CI 0.33 to 0.74), and BL with case studies (SMD 2.72, 95% CI 1.86–3.59) showed better effect size than non-case-based studies (SMD: 0.22, CI: 0.02 to 0.41).

Conclusion

BL is associated with better academic performance and achievement than didactic teaching in pharmacy education.

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.

An effective blended online teaching and learning strategy during the COVID-19 pandemic

The shift to distance teaching and learning during the COVID-19 pandemic brought about a real challenge for both instructors and students. To face these difficulties in teaching undergraduate Chemistry courses at the University of Santo Tomas, a blended learning strategy in the context of teaching and learning of Physical Chemistry 1 and Analytical Chemistry for Chemical Engineering students were employed. Here, we present an online strategy that facilitated the transition from traditional face-to-face learning to full online instruction. This is a five-component blended learning strategy referred to as Discover, Learn, Practice, Collaborate and Assess (DLPCA). In DLPCA, the asynchronous part of the teaching was achieved through broadcast of pre-recorded lecture videos on YouTube to allow students to study and progress with learning at their own pace. The synchronous part of the teaching was conducted using video conferencing platforms, such as Zoom or Google Meet. The DLPCA strategy was presented and discussed to the students prior to its implementation. The analysis of the teaching and learning experience based on three indicators (i) student’s learning experience, (ii) student’s academic performance and (iii) instructor observations showed that DLPCA had a positive impact on students and instructors. The identified challenges were stability of internet connection and instructor’s familiarity with readily available internet-based teaching tools, such as video conferencing software. Instructors must also find means to improve their interaction with students and maintain student interest and engagement during online classes. The survey also indicated that most of the students are satisfied with the DLCPA strategy. Hence, this strategy is considered a manageable and effective alternative that can be adapted to full online instruction to other undergraduate Chemistry lecture courses. Overall, the findings and insights in this study will add valuable resources for further hybrid instruction in the post-COVID-19 time in higher education.

Motivating Students to Engage in Preparation for Flipped Classrooms by Using Embedded Quizzes in Pre-class Videos

Background

The success of flipped classrooms is dependent upon students' preparation prior to class, the lack of which is the most common challenge associated with this teaching methodology. To mitigate this limitation, it is important to develop and assess methods of engaging learners during pre-class activities.

Objective

To determine if quiz delivery method (embedded throughout versus after pre-class videos) affects students' knowledge retention, grades, and video viewing behavior.

Methods

Participating students were randomized to take quizzes, either during pre-class videos via Panopto^™ (EQV) or after pre-class videos in the traditional manner via Moodle^™ (TMM). Outcomes assessed included students' knowledge retention, scores on pre- and post-class quizzes, and pre-class video viewing behavior (total views and minutes viewed per student) during a three-week period. Having experienced both quizzing modalities during the semester, the perceptions from students in the EQV group were surveyed.

Results

Baseline assessment results of both groups (n = 27 per group) were comparable with a median score of 33% (IQR: 17, 50) in both groups. Performance was also similar on knowledge retention [TMM: 67% (50, 83) vs. EQV: 83% (50, 83)], pre-class quiz scores [TMM: 90% (87, 97) vs. EQV: 93% (90, 95)], and post-class quiz scores [TMM: 93% (80, 100) vs. EQV: 87% (80, 100)], while students in the EQV group had more total views [10 (8, 12)] vs. [5 (2, 11)] and minutes viewed [71 (36, 108) vs. 35 (15, 81)]. Results from the perception survey administered to students in the EQV group (74.1% response rate) indicated a preference for embedded quizzes overall (58%) and for class preparation (75%) when compared with post-video quizzes.

Conclusion

Students' knowledge retention and performance were similar in both EQV and TMM groups, though students in the EQV group were more engaged with videos and most of them preferred this quiz delivery. Using embedded quizzes for formative rather than summative assessment might be an appropriate mechanism to encourage students' viewing of pre-class videos and their preparation for flipped classes.

Developing Dietetic Students' Confidence in Multicultural Communication through Flipped Learning

Problem: In a Master of Dietetics program, cultural competence was originally taught with lectures of cultural food practices. Course evaluations reflected that students wanted more opportunities to practice multicultural communication skills whereas lecturers felt that students' personal inquiry of cultural competence could be strengthened. This study explores whether the combination of self-directed pre-class learning and in-class activities through flipped learning could address these instructional issues. Three research questions were examined: (1) How did dietetic students' perceived confidence in multicultural communication change before and after undergoing flipped learning? (2) Which aspects of cultural competence influenced students' confidence in multicultural communication before and after flipped learning? (3) Which aspects of cultural competence were students' cultural learning goals based upon after flipped learning? Intervention: The intervention began with an introductory lesson in which students attended a lecture on New Zealand's cultural landscape, self-assessed their cultural influences, and completed self-directed learning of cultural competence concepts. After this, students participated in two flipped learning lessons; the first lesson focused on cultural knowledge and the second on multicultural communication skills. For both lessons, students completed preparatory activities before engaging in small-group activities during the class sessions. Before and after the flipped learning lessons, students wrote online reflections about the reasons underlying their confidence in multicultural communication. Context: The intervention was carried out with 32 early dietetic students who were in their first semester of postgraduate studies and 31 students consented to study participation. The majority of study participants were female (n = 30, 97%), European or Asian (n = 28, 91%), and between 21-30 years old (n = 27, 87%). Impact: Pre and post module surveys submitted by 31 students showed that more of them reported being confident or very confident in multicultural communication after flipped learning. Reflections submitted by 31 students before flipped learning showed that their confidence in multicultural communication was based upon their cultural knowledge and cultural interaction experiences. Reflections submitted by 19 students after flipped learning indicated that they developed cultural skill which helped them become confident in multicultural communication. These students set goals to continue developing their cultural knowledge, engaging in cultural interaction, and optimizing opportunities for applying cultural skill during clinical practice. Lessons learned: The study results showed that flipped learning can be used for cultural learning. As compared to lectures, flipped learning can provide students with more authentic contexts to practice multicultural communication. These learning experiences model how students might continue to self-direct their cultural competence development throughout their professional practice.

Coronavirus Disease 2019 (COVID-19) Learning Online: A Flipped Classroom Based on Micro-Learning Combined with Case-Based Learning in Undergraduate Medical Students

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, medical colleges in China had to use online teaching. This study explored the effect of COVID-19 knowledge learning online in a flipped classroom based on micro-learning combined with case-based learning (CBL).

METHODS

There were 74 undergraduate medical students who were randomly grouped to an observation group and a control group with 37 participants in each virtual classroom on the Network Teaching Platform. Students learning in the control group utilized face-to-face lecture with PowerPoint pre-provided, while students learning in the observation group were conducted in a flipped classroom based on micro-learning combined with CBL. We compared the effect of both formats of COVID-19 knowledge learning online and the impact on clinical practice attitude in two groups.

RESULTS

All 74 students (100%) responded pretest, posttest and retention test, and completed the questionnaire online. Both formats significantly improved COVID-19 knowledge acquisition at the conclusion of online COVID-19 curriculum. Students' knowledge test scores including total score and scores of five knowledge dimensions of COVID-19 were significantly higher in the observation group than those in the control group (P<0.05). Compared with students in the control group, students in the observation group performed better in retention test and had a significantly more positive clinical practice attitude (P<0.05 in all items).

CONCLUSION

A flipped classroom based on micro-learning combined with CBL showed greater effectiveness in COVID-19 knowledge gain in undergraduate medical students and made their attitude toward clinical practice more positive.

University Students’ Perception of the Usefulness of the Flipped Classroom Methodology

In a digital and interconnected context, where educational processes are in constant change, active methodologies take on a relevant role by making students the protagonists of their learning. Among the different possibilities, the flipped classroom stands out for its time optimization, the incorporation of technological resources, and the personalization of the processes. The aim of this research is to analyze the perception of higher education students about the usefulness of the flipped classroom as a methodology. The information was collected with a validated instrument, which was applied to a sample of 123 students from the Faculty of Educational Sciences of the University of Málaga (Spain). A positive evaluation of the usefulness of the flipped classroom as a learning methodology was reflected in the results, highlighting its instrumental dimension. Significant differences were perceived regarding the usefulness of the flipped classroom for the promotion of autonomous learning, which had a superior valuation according to women. In conclusion, the flipped classroom stands as a methodological alternative to promote learning that has a positive evaluation from the students that made up the sample.

The Effect of Pharmacy Students' Attendance on Examination Performance in Two Sequential Active-Learning Pharmacotherapy Courses

Objective. To examine the relationship between class attendance by Doctor of Pharmacy students and their performance on pharmacotherapy examinations within an active-learning classroom model. Methods. Second-year pharmacy students enrolled in a pharmacotherapy course series were included in the study (N=160). Class attendance was taken manually by members of the study team over a one-year study period (fall 2017 and spring 2018 semesters). Course attendance was not required and had no direct impact on student grades. Scores from the six competency-based examinations and overall course grades for each semester course, respectively, were then linked to class attendance records. Two additional examination attempts (retake and extended learning experience) were administered to students who did not receive a score of at least 80% on the initial exam or retake exam, respectively. Results. Class attendance was documented during 48 class sessions. Of the six examinations given each semester, students required an average of 1 retake of the examination during the fall semester and 1.5 retakes in the spring semester. A significant negative correlation was found in both courses between students missing more classes and receiving a lower final course grade. For each missed class session, there was a reduction in overall course grade of 0.18% and 0.14% in the fall and spring courses, respectively. Conclusion. Regular class attendance by pharmacy students enrolled in an active-learning pharmacotherapy curriculum was associated with higher scores on examinations. The results of this study illustrate the importance of attending active-learning sessions to attain higher examination scores. Further research is needed to determine whether class attendance is associated with students' improved ability to apply pharmacotherapy concepts.

Use of active learning and simulation to teach pharmacy students order verification and patient education best practices with oral oncolytic therapies

INTRODUCTION

The primary objective of this study was to describe the incorporation of the flipped classroom model and use of real-life oncology patients to facilitate student learning of oral oncolytic best safety practices and patient counseling. The secondary objective was to assess the impact of the flipped classroom learning activity on students' perceived confidence.

METHODS

This study was a prospective, single center, flipped classroom learning activity and pre/post assessment survey administered to third year doctor of pharmacy students enrolled in the Oncology Pharmacotherapy didactic elective in 2016 and 2017. A pre/post survey was used to assess student's perceived confidence with oral oncolytic best practice competencies.

RESULTS

Ten students participated in the flipped classroom learning activity and survey. Five students completed both the pre- and postsurvey. The overall change in student's mean scores for their confidence of oral oncolytic competencies improved significantly from 3 to 4.1 on a 6-point Likert Scale (p = 0.03) following the learning activity. Students perceived confidence in performing oral oncolytic order verification increased following the implementation of a flipped classroom learning activity and use of real-life cancer oncology patients.

CONCLUSION

This study describes the development and implementation of a flipped classroom learning activity and use of real-life patients with cancer that can be implemented at other institutions of higher education in a didactic or experiential learning environment. Additionally, this study demonstrated a potential benefit in student learning.

The refinement of flipped teaching implementation to include retrieval practice

There has been growing evidence that flipped teaching (FT) can increase student engagement. Traditional lecture-based teaching (TT) method was compared with FT and FT combined with retrieval practice (FTR) in a 400-level Exercise Physiology course over eight semesters. In the FT format, lecture content was assigned for students to prepare before class along with an online quiz. During class, the assigned content and quiz questions were reviewed, and a team-based learning (TBL) activity was conducted. Students found FT implementation three times a week (FT3) to be overwhelming, which led to reconfiguration of the FT design to minimize the quiz and TBL sessions to one per week. Subsequently, FT was combined with retrieval exercises (FTR), which involved recalling information, thus promoting retention. The students in the FTR format were given weekly quizzes in class, where no notes were allowed, which affected their quiz grade negatively compared with FT (P < 0.0001). Again, no resources were permitted during FTR's TBL sessions. When exam scores were compared with TT, student performance was significantly greater (P < 0.001) with the FT and FTR methods, suggesting these methods are superior to TT. While both male and female students benefited from FT and FTR methods compared with TT (P = 0.0008), male students benefited the most ((P = 0.0001). Similarly, when the exam scores were organized into upper and lower halves, both groups benefited from FT and FTR (P < 0.0001) approaches. In conclusion, both FT and FTR methods benefit students more compared with TT, and male students are impacted the most.

Implementation and evaluation of problem-based video podcasts in an introductory pharmacokinetics course

INTRODUCTION

The use of problem-based video podcasts in health sciences education is limited. Principles of Pharmacokinetics is an introductory course that establishes a foundation for understanding pharmacokinetic concepts. The primary objective was to determine the impact of problem-based video podcasts in an introductory pharmacokinetics course on student learning.

METHODS

Problem-based video podcasts were implemented in an introductory pharmacokinetics course in spring 2015. Student pharmacists in the first professional year enrolled in the course during spring 2015, 2016, and 2017 were included in the study with students enrolled in the course in spring 2014 serving as the control group. The primary outcome was the impact of problem-based video podcasts on student learning as assessed by student performance on the final exam. Other outcomes included student utilization of the video podcasts, overall course grades, and student perceptions of learning using video podcasts.

RESULTS

A total of 633 students in four academic years were included for analysis. Final exam scores were significantly higher in spring 2015 and 2016 compared to 2014. The 2017 final exam scores were similar to the final exam scores in 2014. Students perceived the problem-based video podcasts enhanced their ability to apply concepts to a patient case, reinforced concepts from lectures, and improved their understanding of clinical pharmacokinetics.

CONCLUSION

The use of problem-based video podcasts is an innovative method to augment learning outside of the traditional class time and may enhance learning without replacing direct instructor-student contact. Students reported the video podcasts improved their understanding of clinical pharmacokinetics.

Flipped Classroom to Improve University Student Centered Learning and Academic Performance

In recent years, educational research has focused on analyzing significant differences in the academic performance of university students according to the intervention model of the traditional methodology vs. the flipped classroom. This empirical-analytical research is based on a quasi-experimental design with non-equivalent groups. The results reveal significant differences on the average grades of university students; those participating in the flipped classroom obtained higher scores than students following a traditional methodology, regardless of the specialization. Moreover, this research concludes that the flipped classroom approach offers an opportunity to transform the traditional system by improving the classroom environment, the teaching-learning process and the student’s assessment.

A Review of Nontraditional Teaching Methods: Flipped Classroom, Gamification, Case Study, Self-Learning, and Social Media

Traditional teaching methods rely solely on the use of textbooks, but teaching effectiveness assessment methods have demonstrated that most students taught by this method do not absorb the course content up to the expected level. Multiple researchers have introduced nontraditional teaching methods, but there is no scientific consensus on the best nontraditional teaching methods that are tailored to learners’ abilities while most effectively addressing the course objectives. Therefore, the goal of this review was to address the following questions across all engineering disciplines, based on learners’ abilities and the course objectives: (a) What are the benefits of nontraditional teaching methods? and (b) How would you categorize the benefits of nontraditional teaching methods? A qualitative review was conducted to achieve these goals, and the initial search for papers, using relevant keywords, resulted in more than 2000 peer-reviewed articles that were published between 2000 and 2017. A total of 125 peer-reviewed articles pertaining to the most frequently studied nontraditional teaching methods were comprehensively studied and analyzed. The analysis resulted in practical guidelines, including a list of the benefits of the five studied nontraditional teaching methods (flipped classroom, gamification, case study, self-learning, and social media) belonging to four categories: technical/professional, personal skills/ability, personal attitude, and time and space. Based on the results, the authors established significant guidelines for instructors who aim to optimize learners’ achievements by adopting the most effective teaching styles, based on their course objectives and the learners’ abilities.

Effectiveness of flipped classroom as a teaching-learning method among undergraduate medical students - An interventional study

BACKGROUND

Attempts to put the available teaching-learning time to better use and address the needs of students by increasing active involvement led to the evolution of the flipped classroom (FC). It involves providing study resources for students to use outside the class so that class time is freed up for instructional activities. This study was done to assess the effectiveness of flipped classroom activity as a teaching-learning method.

MATERIALS AND METHODS

In this interventional study, 98 students were divided into two batches of flipped class and conventional small group teaching (SGT). An online Google group was created for the batch of FC. Brief introduction and prerecorded videos related to the assigned topic were posted in the Google group. Discussion was carried out in the form of solving cases and problem-solving exercises. Pretest and posttest were conducted at each session, and an end of module test was conducted for both the groups.

RESULTS

There was a significant difference between the pre- and posttest scores and also the mean scores of summative test between two groups (P < 0.001). The perception of the students regarding FC was also evaluated. Eighty-two percent strongly agreed that FC was more engaging and interesting in comparison to traditional class. Seventy-six percent strongly agreed that more such classes should be conducted in the future.

CONCLUSION

Flipped classroom improved the student performance and learning experience effectively as compared to conventional SGT, and students' response was also largely positive.

Learning Outcomes and Student Preferences with Flipped vs Lecture/Case Teaching Model in a Block Curriculum

Objective. To assess the impact of using a flipped classroom instructional approach on Doctor of Pharmacy (PharmD) students' learning outcomes and instructional preferences in a pharmacotherapy course within a block curriculum. Methods. Select topics in a gastrointestinal and liver pharmacotherapy course were taught using a flipped classroom method that required students to view lecture modules and respond to self-assessment questions prior to class. Classroom time included quizzes, application exercises, and discussion. The following year, teaching of these topics was switched back to a lecture/case format, and different topics were taught in the flipped classroom format, Student performance under each teaching method was examined, and student preferences and study habits were collected via a survey administered before and after experiencing the flipped classroom. Results. Combined mean formal assessment scores were higher for all four topics taught using the flipped classroom format compared to the lecture/case format. This pattern persisted when topics were examined individually, except for scores on one review topic. Survey responses reflected acknowledgement by about half of the students that the flipped format was more beneficial than traditional methods, but they still clearly preferred live lectures over prerecorded lectures. The majority of students reported that the amount of preparation time required for the flipped classroom was appropriate and that they had a positive or neutral experience with the flipped classroom overall. Conclusion. This study supports use of the flipped classroom method for teaching standard pharmacotherapy topics within a block curriculum, but underscores some of the resistance expressed by students despite understanding the potential benefits of the flipped format.

Flipped classroom as an effective approach in enhancing student learning of a pharmacy course with a historically low student pass rate

BACKGROUND AND PURPOSE

The flipped classroom has not been fully exploited to improve tertiary education in Malaysia. A transformation in pharmacy education using flipped classrooms will be pivotal to resolve poor academic performance in certain courses. This study aimed to investigate the effectiveness of the flipped classroom in improving student learning and academic performance in a course with a historically low pass rate.

EDUCATIONAL ACTIVITY AND SETTING

A quasi-experimental pre- and posttest control group design was employed. The experimental group experienced the flipped classroom for selected topics while the control group learned in a traditional classroom. Analysis of covariance was utilized to compare the performance on the final exam using the grade point of a pre-requisite course as the covariate. Students' perceptions of their experience in the flipped classroom were gauged through a web-based survey.

FINDINGS

Student performance on the final exam was significantly higher in the flipped classroom group. The lowest-scoring students benefitted the most in terms of academic performance. More than two-thirds of students responded positively to the use of the flipped classroom and felt more confident while participating in classes and tests.

SUMMARY

The flipped classroom is academically beneficial in a challenging course with a historically low pass rate; it was also effective in stimulating learning interest. The current study identified that for the flipped classroom to be successful, the role of educators, the feasibility of the approach, and the acceptance of students were important.

Evaluation of a Flipped Examination Model Implemented in a Final-Year Undergraduate Pharmacotherapeutics Course

Objective. To assess final-year pharmacy students' performance on and evaluate their experience with a "flipped examination" vs a traditional examination for an advanced clinical pharmacy course. Methods. Students devised multiple-choice questions for the flipped examination. The Biggs revised 2-factor Study Process Questionnaire was administered before and after the examination to assess any possible changes in the students' perceptions of their level of engagement in the learning process. Focus group discussions also were conducted to further gauge the students' feedback and insights into the flipped examination experience. Results. Changes in mean total study process scores at the deep and surface levels of learning were significant. The flipped examination experience was enjoyable, facilitated a less-stressful learning environment, and improved the students' learning satisfaction, knowledge, and assessment grades. Conclusion. The flipped examination model is an innovative instructional approach that can bring about significant educational gains if designed well pedagogically.

Impact of Novel Active-Learning Approaches Through iBooks and Gamification in a Reformatted Pharmacy Course

Objective. To compare pharmacy students' assessment and evaluation ratings of a newly formatted nonprescription products course that used innovative technology and gaming to that for a traditional nonprescription products course. Methods. Examination scores and course evaluations of students who completed the traditional course on nonprescription products were analyzed and compared with those of students who completed a revised course on nonprescription products that used teaching techniques in educational technology. Results. Students in the traditional course significantly outperformed those in the comparator group in eight nonprescription categories on examinations, while students in the new course significantly outperformed those in the comparator group in four categories. Students in the new course outperformed those in the traditional course in two additional examination categories, however these were not significant. Almost all students in both courses agreed or strongly agreed with each course evaluation item, including those items where use of gamification and iBooks were most likely considered. Conclusion. Improvements in student examination performance and course satisfaction may not be immediately seen in a course in which new teaching techniques using educational technology including gamification and iBooks are introduced.

Developing Cognitive Skills Through Active Learning: A Systematic Review of Health Care Professions

Objective

To systematically review current literature to determine whether active learning is more successful than passive learning at producing cognitive skills in health care professions students.

Data Sources

An electronic search was conducted in 4 databases: EBSCO-CINAHL, EBSCO-Sport Discus, Educational Resources Information Center, and PubMed. Search terms included: millennial AND health education, active learning AND knowledge retention, flipped classroom AND learning outcomes, problem based learning AND learning outcomes, problem based learning AND student confidence, active learning AND critical thinking, higher order thinking AND active learning.

Study Selection

We included studies if they were published in English between 2007 and 2017 and evaluated outcomes of an active learning intervention. Studies of nonhealth care disciplines, practicing health care practitioners, or studies that did not address the primary research questions were excluded.

Data Extraction

Study design, health care discipline, intervention used, assessment measures, outcome(s) measures, main results, and conclusions were extracted from each article, as appropriate.

Data Synthesis

Articles were categorized based on capacity to answer 1 or both of the research questions. Conclusions were summarized according to the learning technique used and its effectiveness in regard to studied learning outcome. Out of 85 studies on lower-order cognition, 61 (72%) indicated active learning techniques were effective at achieving improved recall, understanding, and/or application of course material. Of 69 studies on higher-order cognition, 58 (84%) supported active learning over passive instruction for improving students' confidence in or performance of analytical, evaluative, and creative skills.

Conclusions

Active learning produces gains to both lower- and higher-order cognition at levels equal to, and more often, greater than the use of passive learning methods. Despite this evidence, we believe more high-quality, well-designed prospective studies using validated assessment measures are needed to endorse the value of these methods in producing cognitive skills.

Flipped classroom narrows the performance gap between low- and high-performing dental students in physiology

The flipped classroom has been shown to have positive outcomes in learning. However, relatively little has been reported on the implementation of it in dental education. The purpose of this study was to evaluate the impact of the flipped classroom on predoctoral dental students' learning. Two consecutive classes of dental students learned the physiology of the autonomic nervous system through the nonflipped (traditional lecture) or the flipped approach. Students' learning was assessed with an identical quiz at the end of the module. The mean score in the flipped approach was higher than that in the nonflipped approach ( P < 0.01). Mean score on the content-based quiz questions in the flipped approach was higher than that in the nonflipped approach ( P < 0.05). Performance on case-based questions did not show a significant difference ( P = 0.12). Mean quiz performance of the lower 27% scorers in the flipped approach was higher than that in the nonflipped approach ( P < 0.05). Mean quiz performance of the upper 27% scorers showed an increase in the flipped approach as well ( P < 0.05), but to a less extent than that of the lower 27% scorers ( P < 0.01). The flipped approach also increased peer collaboration ( P < 0.01). In summary, the flipped classroom improved dental students' performance on content-based questions in physiology. The flipped classroom narrowed the performance gap between the low- and high-performing dental students.

A Meta-Analysis of Outcomes Comparing Flipped Classroom and Lecture

Objective. To examine the evidence of the effectiveness of flipped classroom compared to traditional lecture. Methods. Experimental and observational studies were included and obtained through searches of PubMed, Education Resources Information Center (ERIC), and Google Scholar. Publications from January 1, 2000 through July 1, 2017 were included. Studies were eligible for this research if: (a) the study compared student outcomes using flipped classroom versus lecture and (b) at least one outcome measure was final examination score or final course score. This analysis used a random effects model with weighted mean difference (WMD) as the outcome. Results. Six studies were included in the qualitative synthesis and five were included in the quantitative synthesis. To date, there has only been one prospective randomized comparison of flipped classroom to lecture in student pharmacist education. When comparing final examination scores, there was no significant difference between flipped classroom and lecture based instruction. Only two studies examined the effect of flipped classroom compared to lecture on final course score. This analysis also found no significant difference. Conclusion. Despite a lack of prospective randomized studies, findings from this meta-analysis suggest that flipped classroom may be associated with minimal gains in student knowledge compared to lecture. These findings are important because previous research has estimated that the flipped classroom requires more time to develop and implement. Future studies using prospective randomized designs need to be conducted before widespread adoption.

The use of an active learning approach in a SCALE-UP learning space improves academic performance in undergraduate General Biology

Active learning is a pedagogical approach that involves students engaging in collaborative learning, which enables them to take more responsibility for their learning and improve their critical thinking skills. While prior research examined student performance at majority universities, this study focuses on specifically Historically Black Colleges and Universities (HBCUs) for the first time. Here we present work that focuses on the impact of active learning interventions at Florida A&M University, where we measured the impact of active learning strategies coupled with a SCALE-UP (Student Centered Active Learning Environment with Upside-down Pedagogies) learning environment on student success in General Biology. In biology sections where active learning techniques were employed, students watched online videos and completed specific activities before class covering information previously presented in a traditional lecture format. In-class activities were then carefully planned to reinforce critical concepts and enhance critical thinking skills through active learning techniques such as the one-minute paper, think-pair-share, and the utilization of clickers. Students in the active learning and control groups covered the same topics, took the same summative examinations and completed identical homework sets. In addition, the same instructor taught all of the sections included in this study. Testing demonstrated that these interventions increased learning gains by as much as 16%, and students reported an increase in their positive perceptions of active learning and biology. Overall, our results suggest that active learning approaches coupled with the SCALE-UP environment may provide an added opportunity for student success when compared with the standard modes of instruction in General Biology.

Flipped classroom improves student learning in health professions education: a meta-analysis

BACKGROUND

The use of flipped classroom approach has become increasingly popular in health professions education. However, no meta-analysis has been published that specifically examines the effect of flipped classroom versus traditional classroom on student learning. This study examined the findings of comparative articles through a meta-analysis in order to summarize the overall effects of teaching with the flipped classroom approach. We focused specifically on a set of flipped classroom studies in which pre-recorded videos were provided before face-to-face class meetings. These comparative articles focused on health care professionals including medical students, residents, doctors, nurses, or learners in other health care professions and disciplines (e.g., dental, pharmacy, environmental or occupational health).

METHOD

Using predefined study eligibility criteria, seven electronic databases were searched in mid-April 2017 for relevant articles. Methodological quality was graded using the Medical Education Research Study Quality Instrument (MERSQI). Effect sizes, heterogeneity estimates, analysis of possible moderators, and publication bias were computed using the COMPREHENSIVE META-ANALYSIS software.

RESULTS

A meta-analysis of 28 eligible comparative studies (between-subject design) showed an overall significant effect in favor of flipped classrooms over traditional classrooms for health professions education (standardized mean difference, SMD = 0.33, 95% confidence interval, CI = 0.21-0.46, p < 0.001), with no evidence of publication bias. In addition, the flipped classroom approach was more effective when instructors used quizzes at the start of each in-class session. More respondents reported they preferred flipped to traditional classrooms.

CONCLUSIONS

Current evidence suggests that the flipped classroom approach in health professions education yields a significant improvement in student learning compared with traditional teaching methods.

Does personalized goal setting and study planning improve academic performance and perception of learning experience in a developing setting?

Objective

The learning process for pharmacists must enable the skillful harnessing of metacognition, critical thinking, and effective application of specialized skills. This study assessed the impact of self-developed academic goals and study plans on pharmacy students' academic performance and perception of learning experience in a developing setting.

Methods

A prospective cohort study was conducted at the College of Clinical Pharmacy, King Faisal University, KSA, in a compulsory 4th year course (Pharmacy management). The study group was exposed to goal setting and study planning while the control group had only routine teaching and learning activities planned for the course. Academic performance was determined with quizzes, midterm, and final exams, and the percentage achievement for the course objectives. An end-of-course evaluation, with a pre-tested questionnaire, was used to assess the perception of learning experience.

Results

The study group constituted 41.4% (29), while 58.6% (41) were in the control group, with a mean ± SD age of 22.9 (SD = 3.2) and 21.6 (SD = 6.1) years, respectively. The mean ± SD scores for quizzes (8.4 (SD = 2.2), mid-term (21.9 (SD = 3.7), and final exams (42.8 (SD = 5.3), and the percentage achievement for the course objectives A (77%) and B (78%) were significantly higher in the study group (P < 0.001). The end-of-course feedbacks showed key differences in the perception of learning experience between the study and control groups.

Conclusion

Personalized goal setting and study planning appeared to significantly improve continuous engagement with learning, focus on academic goals, and academic performance.

Student preparation time for traditional lecture versus team-based learning in a pharmacotherapy course

BACKGROUND AND PURPOSE

Determine how much time students spent preparing for traditional lecture versus team-based learning (TBL) for a pharmacotherapy course and determine if time spent in each pedagogy was within stated expectations for the course.

EDUCATIONAL ACTIVITY AND SETTING

Instructors used a combination of traditional lecture and TBL to deliver material. Before each lecture, instructors recorded the amount of time students spent preparing for each method using a one-question clicker-response survey.

FINDINGS

Instructors delivered 16 hours of TBL, 32 hours of traditional lecture, and eight hours of a mix of TBL and traditional lecture. The median of students completing the survey each week was 89. A large percentage of the class (40.9%) did not prepare for traditional lecture while only 3.4% did not prepare for TBL. About 61% of students spent between 30 min and two hours preparing for a two-hour TBL session and only 10% spent more than three hours preparing.

DISCUSSION AND SUMMARY

Results of this project show students spend little time preparing for traditional lectures without in-class accountability, which may give students the perception that TBL requires too much preparation time.

Replacing Lectures with Small Groups: The Impact of Flipping the Residency Conference Day

The flipped classroom, an educational alternative to the traditional lecture, has been widely adopted by educators at all levels of education and across many disciplines. In the flipped classroom, learners prepare in advance of the face-to-face meeting by learning content material on their own. Classroom time is reserved for application of the learned content to solving problems or discussing cases. Over the past year, we replaced most residency program lectures with small-group discussions using the flipped-classroom model, case-based learning, simulation and procedure labs. In the new model, residents prepared for conference by reviewing a patient case and studying suggested learning materials. Conference day was set aside for facilitated small-group discussions about the case. This is a cross-cohort study of emergency medicine residents who experienced the lecture-based curriculum to residents in the new flipped-classroom curriculum using paired comparisons (independent t-tests) on in-training exam scores while controlling for program year level. We also compared results of the evaluation of various program components. We observed no differences between cohorts on in-training examination scores. Small-group methods were rated the same across program years. Two program components in the new curriculum, an updated format of both adult and pediatric case conferences, were rated significantly higher on program quality. In preparation for didactics, residents in the new curriculum report spending more time on average with outside learning materials, including almost twice as much time reviewing textbooks. Residents found the new format of the case conferences to be of higher quality because of the inclusion of rapid-fire case discussions with targeted learning points.

Cross-year peer-assisted learning using the inverted ("flipped") classroom design: A pilot study in dentistry

BACKGROUND

The inverted classroom model (ICM) represents a special combination of online and attendance learning. The implementation of the didactic concept of "peer-assisted learning" (PAL) within an ICM design has not yet been described in the literature for the field of restorative dentistry.

OBJECTIVE

It was the goal of the present study to develop an ICM offering in a cross-year PAL format (ICM-cyPAL), and then introduce and evaluate it.

METHOD

The pilot project was conducted at the dental clinic at the Goethe University of Frankfurt/Main, where following its conceptual development and implementation with three consecutive cohorts of students in their first clinical semester (the sixth semester at university) the ICM-cyPAL offering was evaluated. Data on acceptance, tutor effectiveness, group interaction models and learning strategies were collected using an evaluative instrument.

RESULTS

121 students (tutees) participated in three cohorts. The response rate reached 98.3 %. In total, the offering was given an average rating of 6.97±1.93 (from 1 = unsatisfactory to 10 = excellent). As the tutees explained the attention that the tutors employed gave to the group was "just right" (4.65±1.04; where 1 = too controlling and 4 = just right to 7 = left the group on their own too long) and talked "just the right amount" (4.54±0.95; where 1 = too much and 4 = just right to 7 = talked too little). The results for tutor effectiveness reached values between 3.26±0.94 and 3.78±0.87; for the evaluation of group interaction models average values were obtained from 3.41±0.98 to 3.89±0.73 (on a Likert scale of 1 = do not at all agree to 5 = completely agree). Concerning the surveyed learning strategies, the dimensions of "resource management" and "implementation of the learning materials" were given the highest and lowest rankings, respectively.

CONCLUSION

The tutees' ratings of the newly developed and implemented ICM-cyPAL offering in the dental context were mainly positive. The thematic orientation of the structured training program needs to be optimized. The offering itself requires both a high degree of organization and solid financial and staffing resources.

Implementation of a “Flipped Classroom” for Neurosurgery Resident Education

Introduction: Engaging residents across a multiyear training spectrum is challenging given the heterogeneity of experience and limited time available for educational activities. A “flipped classroom” model, in which residents prepare ahead of time for mentored topic discussions, has potential advantages. Methods: We implemented a curriculum consisting of topics distributed across the specialty. Weekly, each resident was randomly assigned to research a specific aspect of an assigned topic appropriate to his or her level of experience: junior residents about what characterizes each clinical entity, midlevel residents about when to intervene, and chief residents about how to administer treatment. Residents completed an anonymous survey 6 months after implementation. Board examination performance was assessed before and after implementation. Results: A total of 12 residents participated in the program. Weekly, 1.75±0.40 hours were spent in preparation, with senior residents reporting less time than junior residents. All residents indicated that the accumulation of experience across 7 years of residency was a major advantage of this program, and all preferred it to lectures. Performance on the board examination significantly increased after implementation (from 316±36 to 468±45, p<0.05). Conclusions: The flipped classroom is a viable approach to resident education and is associated with increased engagement and improved performance using validated knowledge-assessment tools.

The effect of flipped teaching combined with modified team-based learning on student performance in physiology

Flipped classroom is a hybrid educational format that shifts guided teaching out of class, thus allowing class time for student-centered learning. Although this innovative teaching format is gaining attention, there is limited evidence on the effectiveness of flipped teaching on student performance. We compared student performance and student attitudes toward flipped teaching with that of traditional lectures using a partial flipped study design. Flipped teaching expected students to have completed preclass material, such as assigned reading, instructor-prepared lecture video(s), and PowerPoint slides. In-class activities included the review of difficult topics, a modified team-based learning (TBL) session, and an individual assessment. In the unflipped teaching format, students were given PowerPoint slides and reading assignment before their scheduled lectures. The class time consisted of podium-style lecture, which was captured in real time and was made available for students to use as needed. Comparison of student performance between flipped and unflipped teaching showed that flipped teaching improved student performance by 17.5%. This was true of students in both the upper and lower half of the class. A survey conducted during this study indicated that 65% of the students changed the way they normally studied, and 69% of the students believed that they were more prepared for class with flipped learning than in the unflipped class. These findings suggest that flipped teaching, combined with TBL, is more effective than the traditional lecture.

Qualitative Analysis of Student Perceptions Comparing Team-based Learning and Traditional Lecture in a Pharmacotherapeutics Course

Objective. To qualitatively compare students' attitudes and perceptions regarding team-based learning (TBL) and lecture. Design. Students were exposed to TBL and lecture in an elective pharmacotherapeutics course in a randomized, prospective, cross-over design. After completing the course, students provided their attitudes and perceptions through a written self-reflection and narrative questions on the end-of-course evaluation. Student responses were reviewed using a grounded theory coding method. Assessment. Students' responses yielded five major themes: impact of TBL on learning, perceptions about TBL learning methods, changes in approaches to learning, building skills for professional practice, and enduring challenges. Overall, students report TBL enhances their learning of course content (knowledge and application), teamwork skills, and lifelong learning skills. Conclusion. Students' attitudes and perceptions support TBL as a viable pedagogy for teaching pharmacotherapeutics.

A Novel Teaching Tool Combined With Active-Learning to Teach Antimicrobial Spectrum Activity

Objective. To design instructional methods that would promote long-term retention of knowledge of antimicrobial pharmacology, particularly the spectrum of activity for antimicrobial agents, in pharmacy students. Design. An active-learning approach was used to teach selected sessions in a required antimicrobial pharmacology course. Students were expected to review key concepts from the course reader prior to the in-class sessions. During class, brief concept reviews were followed by active-learning exercises, including a novel schematic method for learning antimicrobial spectrum of activity ("flower diagrams"). Assessment. At the beginning of the next quarter (approximately 10 weeks after the in-class sessions), 360 students (three yearly cohorts) completed a low-stakes multiple-choice examination on the concepts in antimicrobial spectrum of activity. When data for students was pooled across years, the mean number of correct items was 75.3% for the items that tested content delivered with the active-learning method vs 70.4% for items that tested content delivered via traditional lecture (mean difference 4.9%). Instructor ratings on student evaluations of the active-learning approach were high (mean scores 4.5-4.8 on a 5-point scale) and student comments were positive about the active-learning approach and flower diagrams. Conclusion. An active-learning approach led to modestly higher scores in a test of long-term retention of pharmacology knowledge and was well-received by students.