The Flipped Classroom - From Theory to Practice in Health Professional Education

Feasibility of the flipped classroom approach for health education in a clinical weight loss program

Aim

To assess the feasibility of the flipped classroom pedagogy in a clinical weight loss program and its impact on 6-month weight change.

Methods

Adults with overweight/obesity enrolled in a 6-month program with a structured diet (portion-controlled meals and fruits/vegetables) and exercise plan (≥150mins/week), plus weekly, 1-h group education sessions. Sessions used a flipped classroom approach: educational content was delivered beforehand via podcast/video and book readings and session time involved application-based activities (e.g., case studies, games). Satisfaction surveys were completed at 3 months. Weight change was assessed using paired t-tests (SAS 9.4, significance 0.05).

Results

Eighteen participants completed 6 months (retention 94%). Participants maintained diet adherence and exercise at 3 months (∼84% diet adherence, ∼153mins exercise/week) and 6 months (∼83% diet adherence, ∼158mins exercise/week), as well as attendance to behavioral sessions (3 months: 77%; 6mo: 71%). Satisfaction surveys showed high program enjoyment (∼8.1/10). Mean weight change at 3 and 6 months was -6.5 ± 4.2% and - 9.3 ± 5.0% (both p < 0.01), respectively.

Conclusion

The flipped classroom pedagogy was feasible for delivery in a clinical weight loss program and supported significant 6-month weight loss.

Innovation

This is the first evaluation of the flipped classroom in a clinical setting and supports the investigation of this pedagogy in weight management.

Strategies and interventions used to provide communication education for midwifery students. A scoping review

AIM

To examine the current literature on educational strategies and interventions developed with the objective of teaching or enhancing communication skills of student midwives during their pre-registration education programmes.

DESIGN

A scoping review based on the Joanna Briggs Institute framework was conducted using predefined criteria and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

METHODS

A comprehensive search was conducted using various databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, PsycINFO, Maternity and Infant Care Database (MIDIRS), Web of Science and Education Resources Information Centre (ERIC)) in October 2023.

RESULTS

A total of 120 titles and abstracts were screened. A final number of eight articles were subjected to quality appraisal and included in the scoping review. Five themes were identified which describe educational strategies and interventions including: simulation-based training, the use of role-play, pedagogical approaches, theory-based information workshops and debrief and reflection.

CONCLUSIONS

This review highlights a gap in research focusing on the importance of communication skills training for student midwives throughout midwifery education. Despite the limited numbers of studies, different interventions and educational strategies have been recognized for enhancing these skills. To equip midwives with strong communication skills, a combination of interventions is recommended, including communication-focused workshops tailored for midwifery education and debriefing and student reflection sessions specifically designed to enhanced communication skills.

REGISTRATION NUMBER

to be included in abstract after acceptance.

Developing education in environmental health and medicine focusing on neurology: Initiatives in Sweden (the UPRISE model), France, and Turkey

BACKGROUND

The role of environmental factors in neurological disorders constitutes a topic of increasing importance. Teaching in European universities should expand and update this field gaining future health professionals including adjacent disciplines.

AIM

To describe recent efforts to create courses that cover crucial interdisciplinary content that we believe should be included in modern education, and to adapt modern pedagogic strategies.

METHODS

In collaboration with RISE (Rencontres Internationales Santé Environnement), elective courses focused on Environmental Health and Medicine (EHM) were developed, in France, Sweden, and Turkey. The courses combined classic teaching methods and new pedagogic and digital solutions to create environment-related health awareness and facilitate future interprofessional collaboration in this field.

RESULTS

UPRISE is an innovative elective course introduced in 2020 in Sweden's Uppsala University with the participation of lecturers from several countries and aim to recruit students from different universities. A total of 45, mainly female students (68%), participated in the course. In Strasbourg, France, a novel course on environmental medicine was held in 2019-2023 and examined 90 students, of which more than half were female. Nine graduate nurse students in Turkey attended ten seminar series focused on EHM. Overall, students expressed satisfaction with the courses.

CONCLUSIONS

This European project for courses in higher education arising from RISE was met with appreciation and challenges from academic institutions. However, due to considerable efforts to introduce the EHM concept, a unique compulsory course for all medical students in the second year of training started in 2023 in all French medical faculties. In 2023, UPRISE was integrated into ENLIGHT, the European University Network to promote equitable quality of Life, sustainability, and Global engagement through Higher education Transformation.

Inverted Classroom Teaching of Physiology in Basic Medical Education: Bibliometric Visual Analysis

Background

Over the last decade, there has been growing interest in inverted classroom teaching (ICT) and its various forms within the education sector. Physiology is a core course that bridges basic and clinical medicine, and ICT in physiology has been sporadically practiced to different extents globally. However, students' and teachers' responses and feedback to ICT in physiology are diverse, and the effectiveness of a modified ICT model integrated into regular teaching practice in physiology courses is difficult to assess objectively and quantitatively.

Objective

This study aimed to explore the current status and development direction of ICT in physiology in basic medical education using bibliometric visual analysis of the related literature.

Methods

A bibliometric analysis of the ICT-related literature in physiology published between 2000 and 2023 was performed using CiteSpace, a bibliometric visualization tool, based on the Web of Science database. Moreover, an in-depth review was performed to summarize the application of ICT in physiology courses worldwide, along with identification of research hot spots and development trends.

Results

A total of 42 studies were included for this bibliometric analysis, with the year 2013 marking the commencement of the field. University staff and doctors working at affiliated hospitals represent the core authors of this field, with several research teams forming cooperative relationships and developing research networks. The development of ICT in physiology could be divided into several stages: the introduction stage (2013-2014), extensive practice stage (2015-2019), and modification and growth stage (2020-2023). Gopalan C is the author with the highest citation count of 5 cited publications and has published 14 relevant papers since 2016, with a significant surge from 2019 to 2022. Author collaboration is generally limited in this field, and most academic work has been conducted in independent teams, with minimal cross-team communication. Authors from the United States published the highest number of papers related to ICT in physiology (18 in total, accounting for over 43% of the total papers), and their intermediary centrality was 0.24, indicating strong connections both within the country and internationally. Chinese authors ranked second, publishing 8 papers in the field, although their intermediary centrality was only 0.02, suggesting limited international influence and lower overall research quality. The topics of ICT in physiology research have been multifaceted, covering active learning, autonomous learning, student performance, teaching effect, blended teaching, and others.

Conclusions

This bibliometric analysis and literature review provides a comprehensive overview of the history, development process, and future direction of the field of ICT in physiology. These findings can help to strengthen academic exchange and cooperation internationally, while promoting the diversification and effectiveness of ICT in physiology through building academic communities to jointly train emerging medical talents.

Biomedical students' self-efficacy and academic performance by gender in a flipped learning haematology course

INTRODUCTION

This study investigated the impact of flipped learning versus traditional instruction on medical students' academic performance and self-efficacy in a haematology course, and examined gender differences. Flipped learning is an instructional approach where students review pre-recorded lecture content at home, and active learning occurs in the classroom. Self-efficacy refers to students' beliefs in their ability to succeed and accomplish learning goals.

METHODS

A quasi-experimental study was conducted with 86 third-year Saudi medical students (46 males, 40 females) in a 10-week haematology course. Students were assigned to flipped learning group (n = 41) or traditional lecture group (n = 45). Both groups completed pre- and post-intervention academic tests and self-efficacy surveys. Data were analyzed using descriptive statistics and t-tests.

RESULTS

The flipped learning group showed an increase in academic scores (p <.05) and self-efficacy scores (p <.05) compared to the traditional group, but between group differences were not statistically significant. Female students in the flipped learning group showed the greatest increase in academic scores and self-efficacy. Most students perceived flipped learning positively for enhancing learning and preparation for class.

CONCLUSION

Flipped learning promoted self-efficacy compared to traditional lectures in medical students. Gender-specific benefits were observed, highlighting the need to design instruction to meet diverse student needs.

Teaching effects of the online and offline flipped classroom model (FCM) in the post-epidemic era: Development and feasibility study

With the rapid development of multimedia technology, the student centered flipped classroom model (FCM) and massive open online courses (MOOCs) have been increasingly introduced and implemented in higher medical education. However, comparative analyses of the offline face-to-face FCM and completely online FCM have been rarely reported. In this study, we focused specifically on a set of flipped classrooms in which prerecorded videos were provided before class. Using the Zhihuishu platform as the major online course platform, our team built a MOOC and evaluated the teaching effectiveness of the FCM in both the offline face-to-face class and the online electronic live class for medical genetics education. Questionnaires, paper-based and oral exams were used to collect data on the teaching effects of the different teaching methods. We found that student satisfaction and overall student performance in the offline FCM group was significantly higher than that in the completely online teaching group. Although online FCM allowed students to play back and review anywhere and anytime after class, students taught in offline FCM had a significantly higher degree of knowledge mastery, had a deeper understanding of theoretical knowledge, and were better at knowledge comprehensive application. The effects of their training on genetic disease clinical diagnosis and treatment skills were significantly better, and their capacity for scientific research was also significantly improved. Our research discussed the advantages of the online courses and the problems brought about by using these technologies, and it provided insight into online teaching practices in the era of internet-based medical education.

Dental students in an orthodontic course flipped classroom: A semi-experimental study on knowledge, practice, attitude, and satisfaction

OBJECTIVE

The purpose of this study was to determine the students' attitudes before and after the flipped classroom, and the effectiveness of this method to promote the students' lateral cephalograms tracing abilities, students' satisfaction and their final exam scores.

MATERIALS AND METHODS

This is a single-group quasi-experimental research conducted on dental students of Shiraz University of Medical Sciences (SUMS), Iran in 2019. The intervention was carried out in a blended learning approach with the flipped classroom model. Thirty-five fourth-year dental students participated in a flipped classroom held during a semester for the lateral cephalograms tracing course. The students were provided with the educational materials before the class time through multimedia learning tools and the class time was devoted to discussions. The students were asked to fill out four questionnaires (pretest/posttest attitudes, pretest/posttest self-assessments of theoretical knowledge and practical skills in cephalograms, posttest of satisfaction from quality of the course, and posttest of students' views about effectiveness of blended learning tools) and final exam scores of students.

RESULTS

Students' attitudes toward e-Learning were improved after the flipped classroom and the quality of this method was acceptable to the students (p < .001). Their self-assessment of theoretical knowledge and practical skills were promoted (p < .001). While all blended learning tools averaged more than the cut-off-point, short lecture (5.11 ± 0.98) and live feedback (4.98 ± 1.07) were considered to be the most efficient interactive tools.

CONCLUSION

It seems that the flipped classroom has a positive effect on increasing students' knowledge, attitude, and satisfaction. In general, this method of learning seems to be favored by dental students.

CLINICAL SIGNIFICANCE

The findings showed that blended learning had a positive effect on increasing knowledge, performance, and satisfaction among dental students. Therefore, blended learning as a reliable method might be used in training dental students.

A guide for a student-led doctoral-level qualitative methods short course in epidemiology: faculty and student perspectives

Qualitative research and mixed methods are core competencies for epidemiologists. In response to the shortage of guidance on graduate course development, we wrote a course development guide aimed at faculty and students designing similar courses in epidemiology curricula. The guide combines established educational theory with faculty and student experiences from a recent introductory course for epidemiology and biostatistics doctoral students at the University of Zurich and Swiss Federal Institute of Technology, Zurich. We propose a student-centred course with inverse classroom teaching and practice exercises with faculty input. Integration of student input during the course development process helps align the course syllabus with student needs. The proposed course comprises six sessions that cover learning outcomes in comprehension, knowledge, application, analysis, synthesis and evaluation. Following an introductory session, the students engage in face-to-face interviews, focus group interviews, observational methods, analysis and how qualitative and quantitative methods are integrated in mixed methods. Furthermore, the course covers interviewer safety, research ethics, quality in qualitative research and a practice session focused on the use of interview hardware, including video and audio recorders. The student-led teaching characteristic of the course allows for an immersive and reflective teaching-learning environment. After implementation of the course and learning from faculty and student perspectives, we propose these additional foci: a student project to apply learned knowledge to a case study; integration in mixed-methods; and providing faculty a larger space to cover theory and field anecdotes.

The application of flipped learning to a gross anatomy dissection course

We implemented flipped learning for a gross anatomy dissection course and compared its effects on students' motivation and academic achievement with those of traditional dissection methods. We invited 142 first-year medical students at Chonnam National University Medical School to participate in this study. All participants engaged in traditional dissection methods in the first part of the study and flipped learning in the latter part. Medical students' motivation to learn anatomy by cadaveric dissection was measured using the ARCS (Attention, Relevance, Confidence, and Satisfaction) model. Thereafter, all students completed a written examination consisting of 96 multiple-choice questions. The students' mean motivational score regarding attention was significantly higher in association with flipped learning than with traditional learning. However, the students' mean motivational scores regarding relevance, confidence, and satisfaction were not significantly different between the methods. Additionally, the mean anatomy practice test score was significantly higher in association with flipped learning than with traditional learning. The students' motivational scores and anatomy practice test scores associated with flipped learning positively correlated with the extent of learning material completion. The students' responses indicated that flipped learning helped enhance the learning process, improve time management, reduce confusion during practice, and promote independent practice. The application of flipped learning to a cadaveric dissection course increased individual learning motivation, which improved learning activities both in and out of class, as well as academic achievement.

Health professions learners' evaluation of e-learning scenario-based case study design: Reinvigorating flipped classroom modalities

OBJECTIVES

Interactive scenario-based learning (SBL) cases were developed using the SoftChalk platform to deliver content about patients' barriers to accessing healthcare and patient management strategies connecting oral to systemic health. The interactive cases were designed to engage the digital-savvy learners, meet them where they are by leveling up, and seek their feedback to determine flipped (FC) or modified flipped classroom (MFC) content delivery approaches.

METHODS

Health professions students completed interactive SBL cases (Phase-I) using either FC as assigning content outside of class time preparation or MFC as allocating time at the beginning of the class deliveries, and a 12-item post-completion survey. The senior dental student cohort (Phase-II) completed an anonymous Qualtrics survey that assessed their confidence leading to clinical competence two years after the interactive SBL case deliveries. The final survey (Phase-III) of first-year dental students evaluated the improved interactive scenario-based cases post modifications. [Corrections added on 03 October 2023: After first online publication the first sentence of methods section has been updated.] RESULTS: No significant differences existed between the FC and MFC content delivery scores; however, learners preferred the structured time allotted in the MFC approach as a learning style for participants (N=989). The overall means percent score was 93.2% (n = 398) for FC and 96.5% (n = 591) for MFC. Thematic analysis of written responses indicated that learners felt the vignettes were relevant, thought-provoking, incorporated decision-making, and provided feedback. Four themes about strengths emerged as engaging, interactive, relevant, and critical. Design and technological challenges emerged as interactive SBL improvements. A follow-up report (74/103, 2021) revealed that 48% of senior dental students surveyed recollected the SBL cases when they delivered preventive, patient-centered dental services as juniors and seniors. They also recalled that the interactive cases prepared them for clinical success. The Final comments (2022) did not commend any significant improvements.

CONCLUSION

Interactive scenario-based approaches nurture active learning and critical thinking. The educator can engage learners by incorporating teaching modalities as SBL cases to enhance their knowledge and create educational environments by meeting learners where they are. Learners can be valuable partners as educators define their instructional strategies to be equitable and student-centered. [Correction added on 04 October 2023: after first online publication, abstract section has been revised.].

"Learning to learn" in the Extended Inverted Classroom: An evaluation of the effects of interactive teaching on knowledge and cognitive regulation in medical students

INTRODUCTION

The evidence regarding the effects of the Inverted Classroom on students' metacognitive skills is limited. This study evaluates these effects on student perceptions about knowledge and cognitive regulation during a surgical course.

METHODS

We measured student perceptions before and after a conventional Inverted Classroom in surgery using the Metacognitive Awareness Inventory. We evaluated the mean differences between the scores of the two measurements using Student's t-test (p < 0.05), and the size of the effect on knowledge and cognitive regulation using Cohen's d test (95%CI).

RESULTS

A total of 158 students (pre-intervention) and 155 students (post-intervention) were included in the analysis. Significant differences were found (p < 0.05) in, as well as positive effects on, the students' abilities to know their own learning (declarative knowledge) (d = 0.24; 95%CI, 0.02-0.47), to use learning strategies (procedural knowledge) (d = 0.19; 95%CI, -0.02 to 0.41) and to understand when and why to use these strategies (conditional knowledge) (d = 0.20; 95%CI, -0.01 to 0.42), in addition to the abilities to plan (d = 0.31; 95%CI, 0.09-0.53) and to evaluate their learning (d = 0.31; 95%CI, 0.08-0.53).

CONCLUSIONS

The Inverted Classroom has positive effects on metacognitive skills according to students' perceptions. Further studies are required that compare these effects with other methodologies for teaching in the classroom and the workplace.

Application of flipped classroom combined with case-based learning in Introduction to Environmental Health Science

Objectives

To explore the effect of flipped classroom combined with case-based learning in Introduction to Environmental Health Science for the Master of Public Health (MPH).

Methods

The MPH Master's class of 2022 was selected as the experimental group at Guilin Medical University from September to December 2022, and the flipped classroom combined with the case-based learning was adopted. The class of 2021 was the control group, and we taught them with the traditional teaching method. A self-designed questionnaire and academic performance were used to evaluate the teaching effects of the two groups.

Results

There was no difference in the paper score between grades 2022 and 2021, and the design question score of grade 2022 was higher than that of grade 2021. The difference was statistically significant (p < 0.05). The students in grade 2022 had a high overall recognition of the teaching effect of the flipped classroom combined with case-based learning in Introduction to Environmental Health Science.

Conclusion

The teaching method of the flipped classroom combined with case-based learning is more suitable than the traditional teaching method in the Introduction to Environmental Health Science for MPH. It can stimulate the independent learning ability of MPH students and improve their ability to use knowledge and an innovative spirit.

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.

Reducing Student Workload Through Curricular Efficiency

OBJECTIVE

This integrative review will examine the current literature assessing student workload, outcomes of increased workload and cognitive load, and approaches to evaluate and reduce student workload. Recommendations to better inform curriculum planning efforts will be presented along with a call to action to address the dilemma of student workload and curricular efficiency efforts.

FINDINGS

Literature supports that perceptions of heavy workload can influence students' approach to learning and lead to the adoption of surface learning rather than a deep approach that involves higher-order processing and critical thinking. Additionally, ongoing evidence suggests that workload expansion affects student well-being and potential burnout in professional programs, and specifically that students perceive workload as directly related to their well-being and satisfaction. Intentional planning by faculty and programs can address this issue through streamlining classroom content, reducing lecture time, and modifying preclass work to allow for efficient learning. Even if the curriculum is lecture-based, workload perceptions can be affected by developing clearer guidance to set expectations for learners, intentionality in classroom design, and creating opportunities for student engagement.

SUMMARY

Cognitive overload is multifactorial and complicated, given the increased standards of professional education accreditation and licensure requirements. As the Academy deliberately considers methods to improve curricular efficiency, there is an opportunity to focus on curriculum delivery with an appropriate balance of breadth and depth of instruction to ensure effective assessment and cognitive load.

Use of Active Learning During Emergency Remote Teaching in COVID-19 Pandemic

The mandatory isolation caused by COVID-19 required the adoption of emergency remote teaching, which caused difficulties for instructors, especially for those who use active learning that depends on student participation in class. This study aimed to investigate the ability of instructors to apply active learning effectively given the pandemic context. This was a cross-sectional observational study carried out in an undergraduate medical school. The sample was composed from one to three classes of 28 instructors that were observed synchronously. Each class was analyzed using a form created from an adaptation of the PORTAAL tool, aiming to evaluate quantitatively essential elements for active learning. We observed that the mean times devoted to activities and active participation of students were 54.8% and 33.1% of the total class time, respectively. Among the time spent in student interactions, the intra-group demanded the highest percentage of the class time. Additionally, 22.0% of the activities presented a high level in Bloom's taxonomy and there was a positive correlation between the percentage of activities at higher Bloom levels and the percentage of class time with student participation, intra-group or between-group interactions, supporting the use of higher-order cognitive skills in a collaborative and student-centered context. In conclusion, our findings indicate that some instructors were able to apply essential elements for an active and collaborative learning even during the emergency remote teaching.

The effectiveness of the fully online flipped classroom for nursing undergraduates during the COVID-19: Historical control study

AIM

Evaluate the fully online flipped classroom's effects during the pandemic.

DESIGN

A comparative descriptive study with historical control design.

METHODS

In an internal medicine nursing course, the fully online flipped classroom instruction was used with 53 undergraduates in 2020. Their final examinations were compared with the 50 students taught with traditional offline methods in 2019. Online interactions and students' experiences were described. Pass rates in both classes were over 90% (Χ²  = 0.276, p = 0.60), but the median score in 2019 was higher than in 2020 (Z = -2.491, p = 0.01). There were 996 online interactions and 734 valid interactions in total. All 49 students believed the online flipped classroom schedule was reasonable and all but three said it was helpful. However, 19 students (39%) felt traditional teaching is more effective.

CONCLUSIONS

The fully online flipped classroom method was fairly effective during the pandemic. This model also did increase class participation and sufficient faculty-student interactions in remote education. However, fewer students earned outstanding scores, with possible reasons including the online flipped classroom, lack of clinical practice, stress from COVID-19 and the shortened exam time. Overall, the method is worth recommending under public health emergencies like COVID-19, and future research exploring potential concerns about scores is necessary.

Online Interactive Flipped Classroom Teaching in Pediatrics for Medical Undergraduates

OBJECTIVES

To introduce online flipped classroom teaching for medical undergraduates in Pediatrics and to assess students' engagement and satisfaction with the students and faculty with the flipped classroom teaching method.

METHODS

An interventional education study was conducted on online flipped classrooms for final-year medical undergraduates. The core team of faculty members was identified, students and faculty were sensitized, and pre-reading material and feedback forms were validated. Students were engaged using the Socrative app, and feedback from students and faculty was collected using Google Forms.

RESULTS

One hundred sixty students and six faculty members participated in the study. During the scheduled class, 91.9% of students were engaged. The majority of the students strongly agreed that the flipped classroom was interesting (87.2%) and interactive (87%) and developed an interest in the subject of Pediatrics (86%). Faculty were also motivated to adopt this method.

CONCLUSION

The present study revealed that introducing flipped classroom strategy in an online model improved students' engagement and increased their interest in the subject.

Changes in Pharmacy Students' Self-Reported Learning Strategies Across a Four-Year Doctor of Pharmacy Program

Objective. Few studies describe changes in students' class preparation, note-taking, and examination preparation over the course of professional school. This study aims to describe the use of these learning and study strategies by pharmacy students and to analyze changes during their education.Methods. We performed a prospective, observational cohort study of students at a single US pharmacy school from 2016-2019. Students completed an online survey on learning and study strategies at the beginning of each school year. Quantitative results were analyzed by level in pharmacy school during which the survey was completed as the primary predictor. Open-ended responses were thematically analyzed using an inductive approach.Results. We observed significant changes in strategies, including an increased use of audiovisual materials for course preparation, preference for electronic over manual notetaking, increasing use of lecture capture viewing, and increased use of peer materials in studying. Changes were generally largest between students' first (P1) and second (P2) years in pharmacy school, representing adjustments in student behaviors during the P1 year. In some cases, changes from the surveys in the P1 to P2 years were followed by a gradual return toward P1 survey levels. Three themes described students' comments: students' preferences shaped their learning strategies, their experiences guided changes in learning strategies, and they used additional strategies beyond those included in the survey items.Conclusions. Significant changes in pharmacy student study strategies occurred over the course of their education. This may represent an opportunity to promote use of more effective approaches for long-term learning.

Flipped classroom applied to Neurosurgery in undergraduate medical education

PURPOSE

To compare the academic achievement obtained in Neurosurgery in a class of undergraduate students according to the pedagogical methodology employed: flipped classroom (FC) versus traditional lecture. Students' satisfaction with the FC model is also analyzed.

METHODS

A quasi-experimental study was designed. The traditional lecture was the pedagogical method employed in teaching units (TUs) 1, 2, and 3 (61, 60, and 66 enrolled students, respectively), whereas TU 4 (69 enrolled students) used the FC methodology.

RESULTS

The dropout rate was lower, whereas the academic achievement and the rate of correct answers were higher in TU 4 compared to the rest of the TUs, but these results were not statistically significant. However, the mean score obtained in Neurosurgery was significantly higher in TU 4 compared to the rest of the TUs (p = 0.042). Active learning activities based on clinical cases were positively emphasized. The main weakness was with the time consumed for video-recorded lecture viewing.

CONCLUSIONS

The FC approach showed better academic results than traditional lectures when comparing students in the same Medical School during the same academic year undergoing the same exam. The students rated the FC approach positively, considering it stimulating and useful for learning.

Impact of an Online Program of Bubble Continuous Positive Airway Pressure Education in a Resource-Constrained Setting

Background

Respiratory distress is a leading cause of preterm infant mortality in sub-Saharan Africa. Bubble continuous positive airway pressure (CPAP) is emerging as a potentially safe, cost-effective way of delivering noninvasive respiratory support in low-income and middle-income countries. However, without healthcare providers who are knowledgeable and skilled in the use of this technology, suboptimal neonatal care and related health disparities are likely to persist.

Objective

We hypothesized that an Internet-based, blended curriculum on bubble CPAP for bedside providers in low-resource mother-baby units (MBUs) could be developed and implemented and lead to improvements in clinical knowledge, reasoning, and learner confidence in bubble CPAP.

Methods

Clinical educators from Israel, Ghana, and the United States used the analysis, design, development, implementation, and evaluation (ADDIE) design framework to create an online curriculum for two MBUs in Kumasi, in the Ashanti Region of Ghana. Participants completed pre and post curriculum knowledge tests and completed surveys on their perspectives.

Results

Fifty-four interdisciplinary health professionals from the MBUs participated in the curriculum. Median knowledge test scores improved from 64% (interquartile range [IQR] = 50-72%) to 81% (IQR = 71-89%) after participation in the curriculum (P < 0.001). Learners reported high levels of confidence with bubble CPAP after participating in the curriculum and evaluated the curricular components highly.

Conclusion

An online curriculum was successfully implemented and led to changes in healthcare worker knowledge in bubble CPAP. This may be an effective way to deliver education to healthcare professionals in resource-constrained countries and warrants further study.

Semi-flipped classroom-based learning interventions in a traditional curriculum of oral medicine: students' perceptions and teaching achievements

BACKGROUND

In recent years, flipped classes have emerged and become popular in college medical education. However, due to the huge medical learning system and the limited pre-class study time of students, it is difficult to implement in all courses. And then we adopted the semi-flipped classes (SFCs) to evaluate its teaching effect. This study analysed three educational methods that can be used in oral medicine courses: online education, offline education, and semi-flipped classes.

METHODS

We used two surveys to evaluate the three educational methods. In the first survey 46 teachers and 238 undergraduates shared their experience of the live-streaming and traditional offline courses offered in the different oral medicine curricula; we used anonymous questionnaires to evaluate their class experience. In the second survey 94 students shared their experience of the semi-flipped and traditional classrooms. Students who attended the SFCs in the experimental group learned about the oral mucosa disease by themselves using an online video course and then participated in offline interaction with teachers. The evaluation of the above educational methods was conducted using the anonymous questionnaires and final exam assessment.

RESULTS

According to the first survey, teachers and students both agreed that the overall teaching experience and learning effectiveness in offline education are superior to those in online education. According to the second survey, students who participated in the SFCs performed better in the final exam than those who participated in the simple offline classes. Additionally, the survey showed that the new teaching method helped students gain more knowledge and positively influenced their clinical practice.

CONCLUSIONS

Compared with the online and offline educational methods, the SFC showed better results in both the questionnaire and final exam assessment. Hence, the effectiveness of medical education can be improved by adopting a teaching mode that combines online and offline teaching methods. Scientific and logical SFCs designs, along with their effective implementation, would eventually make SFCs an important tool for medical education.

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

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

The Effect of the Flipped Classroom Model on Teaching Clinical Practice Skills

INTRODUCTION

No evidence was found in the literature for the use of the flipped classroom model in teaching clinical practice skills in paramedics. The study aimed to determine the effect of the flipped classroom model in teaching clinical practice skills to paramedic program students.

METHODS

The study was a single-center, randomized controlled, single-blind parallel-group study. The research was carried out with a university's first-year paramedic program students in the 2021 to 2022 academic year. The students were divided into groups by stratified sampling (intervention group = 21, control group = 21). Five clinical skills practices at various times were explained to the intervention group with the flipped classroom model and to the control group with the traditional lecture method. The research data were collected with the Introductory Characteristics Information Form, Checklists, Time Tracking Form, and Students' Questionnaire for Evaluating the flipped classroom model.

RESULTS

Although the students in the intervention group received a higher total score from all 5 clinical practice skills than the students in the control group, this difference was not statistically significant (P > .05). However, although the time allocated for applications in the intervention group was 40 to 75 minutes longer than in the control group, most students stated that this model successfully taught skills and theory, increased their motivation during the application, and reduced application and exam anxiety.

DISCUSSION

The flipped classroom model can be used as an alternative method to the traditional system in teaching clinical practice skills. This innovative educational approach can be recommended as a student-centered method in clinical skills teaching.

Maximizing student potential: Lessons for pharmacy programs from the patient safety movement

Higher education institutions (HEIs), including pharmacy programs, are experiencing growing pressure from the public and policy makers to develop student-centered learning experiences that meet societal needs. While HEIs may have in-house initiatives to meet such challenges, there are also opportunities for cross-domain learning and application of useful concepts from other sectors. One such sector that lends itself to cross-domain learning is the healthcare industry. Like HEIs, the healthcare industry has been experiencing pressure from its stakeholders, in this case, to address patient safety gaps. These forces intensified at the turn of the century leading to the emergence of what is now known as the patient safety movement, which enabled increased advocacy, education, and research to reduce healthcare-related harm. Despite persistent challenges, a key achievement of the patient safety movement has been application of a systems framework to understand and solve patient safety gaps. That is, patient safety gaps are often a result of system defects rather than isolated acts of individual workers operating in a complex social and technical work setting (often referred to as sociotechnical system). Commonly used systems frameworks describe a sociotechnical system through its components: 1) structure (e.g., people, tools/technology, physical workspaces); 2) processes (e.g., medication administration); and 3) outcomes (e.g., medication safety, patient satisfaction). At their core, both HEIs and healthcare organizations are complex sociotechnical systems that organize their structures to support specific processes - learning in HEIs and patient safety in healthcare - to ultimately improve outcomes for students and patients, respectively. This paper describes parallels between HEIs and the healthcare domain to illustrate how patient safety concepts and practices from healthcare can be adapted to HEIs in order to enhance educational structures, processes, and learning outcomes.

Interprofessional peer-assisted learning and tutor training practices in health professions education-A snapshot of Germany

Peer-assisted learning (PAL)-especially peer tutorials-are gaining momentum in health professions education, particularly in interprofessional education. As little is known about the use of peer tutorials or the preparation of tutors in this context in Germany and in other countries, this study aims to provide an overview of these interventions. A cross-sectional study with a descriptive-exploratory design was conducted. German institutions for health professions education were contacted, and individuals with pedagogical responsibilities were invited to participate in an online survey. The survey was informed by two studies in which seven domains were identified as important. These included facts about the institution, the offer of PAL, the use of tutorials, and the design of tutor training. The survey used mostly closed-ended questions. The questionnaire was completed by n = 100 participants. Overall, n = 46 participants indicated that PAL was offered at their institution. Of these 46 participants, 32 (70%) indicated that uniprofessional PAL was offered, 2 (4%) indicated that interprofessional PAL was offered, and 12 (26%) indicated that both forms of PAL were offered. Peer tutoring was the most common format in both cases (73% for uniprofessional and 64% for interprofessional PAL), and mandatory interventions were mostly used to prepare the tutors. These interventions were held by educators or lecturers and were offered mostly face-to-face as workshops or as discussions. Deepening the tutors' social competencies through training was given high relevance. Regarding content, focus was placed on communication, (self-)reflection, and group management. Eighty-eight participants expressed recommendations for future directions in terms of preparing tutors for interprofessional PAL. Minor differences between the use of uniprofessional and interprofessional PAL and tutor training were found. Nevertheless, implementation strategies varied. In future, preparatory measures for tutors should be more uniformly designed and geared to the specific requirements of uniprofessional and interprofessional learning, and that at best on an empirical basis.

Videos of demonstration versus text and image-based material for pre-skill conceptualisation in flipped newborn resuscitation training for medical students: a pilot study

BACKGROUND

The flipped skills lab is a student-centred approach which incorporates pre-class preparation (pre-skill conceptualization) followed by repeated, hands-on practice for practical skills training. Objective measures of skills acquisition in the flipped literature are few and conflicting. The importance of pre-skill conceptualization in flipped skills training suggests that pedagogically informed pre-skill conceptualization can enhance outcomes.

METHODS

A mixed quasi-experimental study was conducted on 41 final year medical students who followed a flipped newborn resuscitation skills lab. Pre-class preparatory material covered conceptual and procedural knowledge. Students in the traditional group (n = 19) and those in the interventionalmental group (n = 22) received identical reading material covering conceptual knowledge. Procedural knowledge was shared with the interventional group as demonstration videos, while the traditional group received a PowerPoint presentation with text and images covering the same material. Knowledge acquisition was assessed by 20 single best answer questions before and after hands-on practice in the skills lab and skill performance was tested post-intervention with a simulated scenario. Students' perceptions were collected by survey. Quantitative data was analysed using Wilcoxon Signed Ranks test and Mann-Whitney U test as appropriate. Qualitative data was analysed by thematic analysis.

RESULTS

Overall student rating of the intervention was positive with ratings of 4.54 and 4.46 out of 5 by the traditional group and the experimental group respectively. Post-intervention skill performance in the experimental group was significantly better (p < .05) in the interventional group (M = 87.86%, SD = 5.89) than in the traditional group (M = 83.44, SD = 5.30) with a medium effect size (r = .40). While both groups showed significant knowledge gains, only students in the experimental group showed a statistically significant gain in procedural knowledge (p < .05) following the flipped skills lab. Finally, while both groups self-reported feeling more knowledgeable and confident following the intervention, the level of confidence was superior in the experimental group.

CONCLUSIONS

Flipping the skills lab with pre-skill conceptualisation combining text-based conceptual knowledge and video-based procedural knowledge followed by simulation-based hands-on practice improves procedural knowledge and skills acquisition in newborn resuscitation training for medical students. This study shows that in addition to temporal benefits, pedagogically informed pre-skill conceptualization can confer procedure-specific cognitive and emotional benefits supporting skills acquisition.

Transforming postgraduate GP teaching through collaborative course design and peer-facilitated small-group, reflective learning

Shropshire Vocational Training Scheme's (VTS) traditional structure of peer-delivered teaching had received poor feedback from trainees. There is good evidence in the literature for stakeholder engagement in training design and participation in small group learning and case discussion as a bedrock of GP learning in the VTS. We introduced three new initiatives to improve half-day release (HDR): 1. collaborative course design; 2. reflective, case-based learning with flipped learning resources; and 3. peer-facilitated, small groups. The aim was to marry trainees' desire for clinical context with the need to comprehensively cover the professional knowledge, skills and attitudes of the 'Being a GP' Royal College of General Practitioner's curriculum.The new collaborative model has improved feedback, facilitated high-level small group reflection and resulted in a smooth transition to virtual HDR during Covid-19. We now have a cohort of highly motivated facilitators, with the opportunity to develop leadership skills, and a bank of complex clinical cases developed to facilitate useful, trainee-led, case-based discussion.Our model is deliverable in other VTS areas and could enhance trainee experience of HDR. Future challenges will be maintaining facilitator training, quality control for cases and discussion and how to ensure our near-peer facilitators successfully become future leaders in primary care.

Future Directions for Global Clinical Neurosurgical Training: Challenges and Opportunities

OBJECTIVE

Expanded access to training opportunities is necessary to address 5 million essential neurosurgical cases not performed annually, nearly all in low- and middle-income countries. To target this critical neurosurgical workforce issue and advance positive collaborations, a summit (Global Neurosurgery 2019: A Practical Symposium) was designed to assemble stakeholders in global neurosurgical clinical education to discuss innovative platforms for clinical neurosurgery fellowships.

METHODS

The Global Neurosurgery Education Summit was held in November 2021, with 30 presentations from directors and trainees in existing global neurosurgical clinical fellowships. Presenters were selected based on chain referral sampling from suggestions made primarily from young neurosurgeons in low- and middle-income countries. Presentations focused on the perspectives of hosts, local champions, and trainees on clinical global neurosurgery fellowships and virtual learning resources. This conference sought to identify factors for success in overcoming barriers to improving access, equity, throughput, and quality of clinical global neurosurgery fellowships. A preconference survey was disseminated to attendees.

RESULTS

Presentations included in-country training courses, twinning programs, provision of surgical laboratories and resources, existing virtual educational resources, and virtual teaching technologies, with reference to their applicability to hybrid training fellowships. Virtual learning resources developed during the coronavirus disease 2019 pandemic and high-fidelity surgical simulators were presented, some for the first time to this audience.

CONCLUSIONS

The summit provided a forum for discussion of challenges and opportunities for developing a collaborative consortium capable of designing a pilot program for efficient, sustainable, accessible, and affordable clinical neurosurgery fellowship models for the future.

Near-Peer Teaching in Conjunction with Flipped Classroom to Teach First-Year Medical Students Basic Surgical Skills

BACKGROUND

There is increasing evidence that students are completing medical school with insufficient surgical education. Near-peer tutoring and flipped classroom formatting may be used to enhance learning while simultaneously relieving faculty burden of teaching. Here, we qualitatively evaluate a 3-month course that integrates the use of near-peer teaching and flipped classroom formatting, with the goal of increasing first-year medical students' self-perceived confidence in performing basic sutures and knot-ties as well as interest in surgery.

METHODS

Twenty-one first-year medical students participated in a suturing and knot-tying course led by senior medical students. The course consisted of 2-h sessions held every 2 weeks for a total of five sessions. Students were sent publicly available videos prior to each session by which to learn the upcoming techniques and received live feedback from instructors during sessions. Questionnaires were completed pre-course and post-course.

RESULTS

Compared to pre-course ratings, post-course ratings of self-perceived confidence to perform various knot-ties and sutures all increased significantly (p < 0.05). All students stated that the course strengthened their desire to pursue a career in surgery. Student feedback of the course was overall positive.

CONCLUSIONS

Near-peer teaching can be used in conjunction with flipped classroom to increase first-year medical students' self-perceived confidence in surgical suturing and knot-tying as well as interest in surgery. This curriculum may serve as an outline for student-led courses at other institutions.

Building Capacity for Implementation Science in Precision Health and Society: Development of a Course for Professional and Graduate Students in Pharmacy

Training in the field of implementation science is critical for future pharmacists and pharmaceutical scientists to successfully implement precision health interventions in pharmacy practice. We developed an elective course for second- and third-year students at the UNC Eshelman School of Pharmacy to develop foundational knowledge in implementation science with a focus on precision health implementation. The eight-week course used a flipped classroom format featuring lecture videos, suggested readings, quizzes, guest lectures from experts, case studies, and a group project. We evaluated course quality through class participation, a pre- and post-test on course content, and a mixed-methods survey completed by the students. Overall engagement in in the course was high and students demonstrated significant improvement in understanding of implementation science and precision health. Strengths of the course as identified by students were the use of expert guest speakers, pre-class lectures, and case study exercises, while the ordering of content and improved connection between content and guest lectures were identified as areas for improvement. In conclusion, the elective course was well-received and meets a critical need in the field of pharmacy to build implementation science capacity. Future work is needed to expand and refine education for the implementation of precision health for pharmacy professionals.

Flipped classroom improves student learning outcome in Chinese pharmacy education: A systematic review and meta-analysis

Background: The application of flipped classroom (FC) pedagogy has recently become increasingly popular in Chinese pharmacy education. However, its effectiveness in improving student learning has not yet been assessed. This study aimed to evaluate the effects of teaching with such pedagogical approach by examining studies that compare the FC approach with the traditional lecture-based learning (LBL) module through a systematic review and meta-analysis.

Methods: Seven databases, including the PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Chinese Wanfang database, and China Biomedical Literature Database, were searched from the inception to 30 June 2021, to identify eligible articles of randomized controlled studies. The primary outcomes included the theoretical and experimental test scores, and the secondary outcomes were the results from questionnaires about the number of students who preferred the FC or endorsed its improving effects on their learning enthusiasm, self-learning ability, thinking skills, communication skills, and learning efficiency. The quantitative synthesis was conducted with Revman V.5.3 software following the Cochrane Reviewer’s Handbook guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results: Eleven eligible studies published from 2017 to 2020 enrolling 1,200 students were included in this meta-analysis. The quantitative synthesis demonstrated that the FC module presented an overall more significant effectiveness over traditional LBL approach for Chinese pharmacy education in improving student academic performance as measured by theoretical test scores (SMD = 1.08, 95% CI: 0.60–1.56, p < 0.00001) and experimental test scores (MD = 6.62, 95% CI: 4.42–8.82, p < 0.00001). Further sub-group analysis revealed that the preferable effectiveness of FC was also evident in both theory-oriented (SMD = 0.77, 95% CI: 0.10–1.45, p < 0.00001) and experiments-oriented courses (MD = 6.52, 95% CI: 3.48–9.56, p < 0.00001) for both undergraduate (SMD = 0.84, 95% CI: 0.31–1.37, p < 0.00001) and 3-year junior-college students (MD = 8.17, 95% CI: 6.44–9.89, p < 0.00001). Additionally, analysis on the questionnaire outcomes revealed that more respondents preferred for FC and endorsed its improvement effects on developing students’ learning enthusiasm, self-learning ability, thinking skills, communication skills, and learning efficiency.

Conclusion: Current evidence suggests that FC pedagogical approach can effectively improve student learning outcomes and is applicable to Chinese pharmacy education.

Hot topics and frontier evolution in college flipped classrooms based on mapping knowledge domains

With the outbreak of COVID-19 and the development of online teaching, the online flipping teaching mode has attracted increasing attention. Systematic analysis of the research status and development trend of the flipped classrooms is significant for guiding the improvement of the quality of online flipped teaching. This study used the metrology software CiteSpace to draw a scientific knowledge map of relevant research in the web of science database from 2013 to 2021. It performed visual analysis of research authors, research institutions and countries, keyword clustering, keywords co-occurrence, and keyword time zone distribution. The results showed that: (1) The flipped classrooms research has attracted increasing attention from the social and educational circles, however, the relationship between relevant research authors, institutions, and countries is not close enough, and there is little cooperation. We need to strengthen cooperation further and realize the sharing of high-quality resources; (2) Based on keyword co-occurrence cluster analysis, this study identified three hot topics, namely, preparation before class, classroom activities and consolidation after class; (3) According to the keyword time zone map, this study divided three frontier evolution trends: exploration period, adaptation period, and growth period; (4) Finally, with the spread of novel coronavirus, it is suggested to promote the online flipped classroom teaching mode, and put forward reasonable suggestions from the perspective of teachers, students and researchers, and look forward to the future digital development direction of the flipped classroom.

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.

Building a pharmacy workforce from the ground up to support the COVID ‐19 vaccine rollout: lessons learned and recommendations

The COVID‐19 pandemic has required an unprecedented surge in the pharmacy workforce to support mass vaccination hubs. This review discusses the challenges faced while training and credentialing a surge pharmacy workforce and how these challenges were overcome. The process used for training and credentialing new employees has been described and recommendations and insights have been provided based on the lessons learned at two COVID‐19 mass vaccination hubs in New South Wales. Operationalising one of the largest mass vaccination hubs in Australia required efficient training and credentialing of the pharmacy workforce. This process included the use of pharmacist‐extenders such as students, assistants, and those from other healthcare and non‐healthcare backgrounds. Training was optimised by using a flipped classroom model, so that the vaccine preparation process was provided via asynchronous online videos. The videos covered each step of vaccine dose preparation with visual cues to guide appropriate technique. On‐site training involved use of simulation and checklists for credentialing. Many factors contributed to the success of this process, including the use of triaging and the re‐allocation of personnel based on skill level, collaboration with the Sydney Pharmacy School to train and support a surge workforce involving students, initial on‐site information technology support in the form of pharmacy superusers, the use of checklists and guides for troubleshooting, and assigned pharmacy educators to train new employees. The public health response to the COVID‐19 pandemic forced us to rapidly adapt to build a pharmacy workforce in record time to support mass vaccination hubs. The recommendations and insights provided from our experience can guide future surges. Some of these concepts may also be applied to pharmacy practice in hospitals when resources are constrained.

Detecting latent topics and trends in blended learning using LDA topic modeling

With the rapid application of blended learning around the world, a large amount of literature has been accumulated. The analysis of the main research topics and development trends based on a large amount of literature is of great significance. To address this issue, this paper collected abstracts from 3772 eligible papers published between 2003 and 2021 from the Web of Science core collection. Through LDA topic modeling, abstract text content was analyzed, then 7 well-defined research topics were obtained. According to the topic development trends analysis results, the emphasis of topic research shifted from the initial courses about health, medicine, nursing, chemistry and mathematics to learning key elements such as learning outcomes, teacher factors, and presences. Among 7 research topics, the popularity of presences increased significantly, while formative assessment was a rare topic requiring careful intervention. The other five topics had no significant increase or decrease trends, but still accounted for a considerable proportion. Through word cloud analysis technology, the keyword characteristics of each stage and research focus changes of research were obtained. This study provides useful insights and implications for blended learning related research.

Beyond the Classroom: An Observational Study to Assess Student Pharmacists' Confidence and Perception of a High-Fidelity Manikin Chemotherapy Infusion Reaction Simulation

Objective: To assess the impact of a high-fidelity manikin chemotherapy infusion simulation on student pharmacists' confidence in applying clinical knowledge and perception of oncology pharmacy practice. Methods: One cohort of third professional year student pharmacists completed a high-fidelity manikin simulation during the last week of their didactic training. The 10-minute manikin experience simulated an acute paclitaxel infusion reaction, requiring students to apply their knowledge on how to provide patient care during a chemotherapy-induced infusion reaction. A pre- and post-survey was administered to determine whether there was a change in students' confidence and perception. Results: Thirty-three student pharmacists (62%) completed the pre- and post-surveys and manikin simulation. A statistically significant improvement was seen in median confidence scores when comparing pre- and post-questions of all 10 survey items (P < 0.001). Students' perception of oncology pharmacy and the manikin simulation had mean of 4.4 on a 0- to 5-point Likert scale. Conclusion: The high-fidelity manikin experience improved student pharmacists' post-survey confidence of applying clinical skills. In addition, students' perception of oncology pharmacy improved and the use of a manikin simulation to support didactic learning was seen as an additional avenue for delivering didactic curriculum. This study explored the feasibility of introducing a manikin simulation into the oncology pharmacy curriculum and the benefit of providing hands-on application of clinical skills to support didactic concept-based learning.

Meet EBE: The Development of an Evidence-Based Endoscopy Simulator

BACKGROUND AND AIMS

In the digital era of evidence-based medicine, there is a paucity of video endoscopy teaching platforms that use evidence-based medicine principles, or that allow for cognitive simulation of endoscopic management strategies. We created a guideline-based teaching platform for fellows that incorporates these features, and tested it.

METHODS

A pilot video module with embedded questions was drafted, and after incorporation of feedback from several attending gastroenterologists, an additional 2 modules were created. The embedded questions were designed to simulate cognitive management decisions as if the viewer were doing the endoscopy procedure in the video. A narrator explained the evidence behind the task being performed, and its certainty based on endoscopic guidelines. Quizzes and surveys were developed and administered to a sample of attendings and fellows who completed the video modules to test efficacy, usability, and likeability.

RESULTS

Three video modules, named evidence-based endoscopy (EBE), incorporating low fidelity simulation, and utilizing evidence-based medicine principles, were created. Eight fellows and 10 attendings completed the video modules and all quizzes and surveys. Mean test scores improved from before to after completing the video modules (56% to 92%; mean difference = -35%; 95% confidence interval, 27%-47%). Surveys indicated that the product was viewed favorably by participants, and that there is a strong desire for this type of educational product.

CONCLUSIONS

The EBE simulator is a unique, desirable, and effective educational platform based on evidence-based medicine principles that fills a gap in available tools for endoscopy education. Further studies are needed to assess whether EBE can aid in long-term knowledge retention and increase adherence to guideline recommendations.

Effect of flipped classroom approach in the teaching of a hematology course

The flipped classroom is a teaching strategy used to enhance the engagement of students in the learning process. Replacing didactic lectures with active learning strategies through flipped classroom sessions fosters independence and the opportunity for students to engage in different passive learning styles. Although many studies of the flipped classroom approach have been conducted with medical students, few have focused on the effect of flipped classroom sessions on students in other medical professional fields. The aim of this study was to assess the effect of the flipped classroom approach on the performance of medical laboratory science students in a hematology course and their perception of the flipped classroom as an active learning strategy. In addition, students’ perceptions regarding the flipped classroom as an active learning strategy were assessed. Of two cohorts in hematology courses, cohort 2 attended flipped classroom sessions, whereas cohort 1 underwent traditional class sessions. Students’ learning outcomes, achievements and performance on examinations in hematology courses were assessed. In addition, a satisfaction survey was distributed to the students to evaluate their perception of the flipped classroom as a student-centred learning strategy. Students in cohort 2 performed significantly better in the knowledge and cognitive domains than did those in cohort 1 (p < 0.001). Cohort 2 students completed the course successfully with an average grade of 81%, and few students received low grades; in comparison, cohort 1 students completed the course with an average grade of 73%, and 7 students received a grade of F. Of students in cohort 2, 83% believed that the flipped classroom provided a better understanding of the subject matter and appropriate knowledge and skills. The results indicate the effectiveness of flipped classrooms as an active learning style in enabling students to obtain desirable knowledge and improve their academic performance. Moreover, students zrecognized that the flipped classroom as an active learning style was more beneficial than the traditional teaching approach.

Retrospective study of online ligation student practice incorporating flipped learning into e-learning

Purpose

Flipped learning has been applied in various fields, including medical professional education. E-learning is compatible with flipped learning; however, it is considered to be unsuitable for providing training on surgical techniques. In this study, we retrospectively examined the ligation performance of online students who underwent training with flipped learning incorporated into e-learning.

Methods

We conducted a retrospective study of the ligation practices of online students at the Department of General Surgery from March 2020 to June 2021. The subjects included 134 fourth- and fifth-year medical students from Gunma University School of Medicine. We conducted mid-term checks on the 8th day of practice and an examination on the 19th day. Two instructors independently evaluated and calculated scores using the original Global Rating Scale of Gunma University. We also conducted a questionnaire survey on the ligation practice of online students.

Results

The total average score of the three tasks was 12.4 for Instructor 1 and 12.0 for Instructor 2. All students had a passing score. The questionnaire survey showed that 70% of the students were trained in ligation at the time of the first evaluation.

Conclusions

Our online training materials and training methods enabled the acquisition of ligation skills by students who had not previously received ligation training.

Implementing a flipped classroom model in an evidence-based medicine curriculum for pre-clinical medical students: evaluating learning effectiveness through prospective propensity score-matched cohorts

BACKGROUND

In a flipped classroom (FC) model, blended learning is used to increase student engagement and learning by having students finish their readings at home and work on problem-solving with tutors during class time. Evidence-based medicine (EBM) integrates clinical experience and patient values with the best evidence-based research to inform clinical decisions. To implement a FC and EBM, students require sufficient information acquisition and problem-solving skills. Therefore, a FC is regarded as an excellent teaching model for tutoring EBM skills. However, the effectiveness of a FC for teaching EBM competency has not been rigorously investigated in pre-clinical educational programs. In this study, we used an innovative FC model in a pre-clinical EBM teaching program.

METHODS

FC's teaching was compared with a traditional teaching model by using an assessment framework of prospective propensity score matching, which reduced the potential difference in basic characteristics between the two groups of students on 1:1 ratio. For the outcome assessments of EBM competency, we used an analysis of covariance and multivariate linear regression analysis to investigate comparative effectiveness between the two teaching models. A total of 90 students were prospectively enrolled and assigned to the experimental or control group using 1:1 propensity matching.

RESULTS

Compared with traditional teaching methods, the FC model was associated with better learning outcomes for the EBM competency categories of Ask, Acquire, Appraise, and Apply for both written and oral tests at the end of the course (all p-values< 0.001). In particular, the "appraise" skill for the written test (6.87 ± 2.20) vs. (1.47 ± 1.74), p < 0.001), and the "apply" skill for the oral test (7.34 ± 0.80 vs. 3.97 ± 1.24, p < 0.001) had the biggest difference between the two groups.

CONCLUSIONS

After adjusting for a number of potential confunding factors, our study findings support the effectiveness of applying an FC teaching model to cultivate medical students' EBM literacy.

Exploring Nursing Students' Experiences With Different Teaching Pedagogies: A Mixed-Methods Study

BACKGROUND

Educational methods continue to evolve to meet the challenge of teaching undergraduate nursing students. Innovative teaching pedagogies require nursing students to be actively involved in their own learning compared with traditional didactical styles.

METHOD

Students were exposed to three distinct teaching pedagogies: inquiry-based, online, and educator-led during their second year of study. Students' learning preferences were explored using a mixed-methods approach. Quantitative data were collected using an online questionnaire, followed by a focus group interview.

RESULTS

The quantitative data revealed students preferred being taught directly from educators rather than through self-directed and online study. Manifest content analysis of qualitative data revealed four categories that supported student learning and five categories that hindered student learning.

CONCLUSION

Students struggled when required to be self-directed in their learning. Students reported feeling uncertain and overwhelmed initially, which highlighted the importance of strong social and academic support to facilitate effective learning. [J Nurs Educ. 2022;61(3):147-152.].

Using a virtual flipped classroom model to promote critical thinking in online graduate courses in the United States: a case presentation

Flipped classroom models encourage student autonomy and reverse the order of traditional classroom content such as lectures and assignments. Virtual learning environments are ideal for executing flipped classroom models to improve critical thinking skills. This paper provides health professions faculty with guidance on developing a virtual flipped classroom in online graduate nutrition courses between September 2021 and January 2022 at the School of Health Professions, Rutgers The State University of New Jersey. Examples of pre-class, live virtual face-to-face, and post-class activities are provided. Active learning, immediate feedback, and enhanced student engagement in a flipped classroom may result in a more thorough synthesis of information, resulting in increased critical thinking skills. This article describes how a flipped classroom model design in graduate online courses that incorporate virtual face-to-face class sessions in a virtual learning environment can be utilized to promote critical thinking skills. Health professions faculty who teach online can apply the examples discussed to their online courses.

Anatomy education in US Medical Schools: before, during, and beyond COVID-19

BACKGROUND

Anatomy education in US medical schools has seen numerous changes since the call for medical education reform in 2010. The purpose of this study was to survey US medical schools to assess recent trends in anatomy education, the impact of the COVID-19 pandemic on anatomy teaching, and future directions of medical school anatomy curricula.

METHODS

We sent a 29-item survey to anatomy course directors of 145 AAMC-associated allopathic medical schools inquiring about their schools' anatomy curricula. The survey contained objective discrete questions concerning the curricula changes preceding COVID-19 and those directly related to COVID-19. We also asked subjective and open-ended questions about the impact of COVID-19 and future directions of anatomy education.

RESULTS

A total of 117/143 course directors (82%) completed the survey. Most schools (60%) reported a major change to their anatomy course within the past five years, including a decrease in total course time (20%), integration of anatomy into other courses (19%), and implementation of a "flipped classroom" (15%) teaching style. Due to COVID-19, there was a decrease in the fraction of course time dedicated to "hands-on" learning (p < 0.01) and teaching of clinical correlates (p = 0.02) and radiology (p < 0.01). Most course directors (79%) reported that COVID-19 had a negative impact on quality of learning due to decreased interactive or in-person (62%) learning and lack of dissection (44%). Incorporation of virtual-reality applications or 3D anatomy software (23%) and a decrease in cadaver dissection (13%) were the most common future anticipated changes.

CONCLUSION

The constraints conferred by COVID-19 highlight the importance of maximizing interactive learning in the discipline of anatomy. In an era of social distancing and decreased emphasis on conventional anatomy dissection, adaptations of new technologies and teaching modalities may allow for traditional educational rigor to be sustained.

Implementation of flipped classroom combined with case-based learning: A promising and effective teaching modality in undergraduate pathology education

The popularity of flipped classroom (FC) is growing in medical education. However, the application of FC in pathology teaching has not been well explored. This study assessed the efficacy of FC combined with case-based learning (CBL) in undergraduate pathology education via comparison with a traditional lecture-based classroom (LBC).A total of 117 third-year students were enrolled and assigned to the FC group (n = 59) or LBC group (n = 58) with demographic matches. Two sections in the pathology textbook (cardiovascular and respiratory system diseases) were chosen for the teaching content. Students in the FC group were required to study the preprovided course materials pre-class, followed by clinical case-based interactive group discussion in-class. Students in the LBC group were encouraged to preview and attended a didactic lecture in class. Post-class quizzes and Likert questionnaires were performed to investigate the efficacy and possible advantages of CBL-based FC over LBC.The scores of the 2 groups in the mid-term examination of pathology before interventions were comparable. However, students in the FC group gained significantly higher scores in the post-quizzes than those in the LBC group, especially the scores regarding the questions of clinical case analysis. In the questionnaires, more students considered CBL-based FC to be beneficial to learning motivation, knowledge comprehension, critical thinking, patient management and teamwork than LBC. In addition, more students agreed that the FC model increased pre-class burden than LBC, rather than in-class pressure.CBL-based FC modality has promising effects on undergraduate pathology education and may be a better choice than traditional LBC. Further optimizations are needed to implement this novel approach in pathology and other medicine curricula.

High-Fidelity Patient Simulation Incorporated Into a Flipped Classroom Improves Students' Long-Term Knowledge Retention of Acute Organophosphorus Pesticide Poisoning

INTRODUCTION

The flipped classroom (FC) approach and high-fidelity patient simulation (HFPS) training have shown promising effects in short-term acquisition or long-term retention of knowledge in medical education. In this study, we aimed to explore the incorporation of HFPS into the FC and the impact on the long-term (3 months after classes) knowledge retention of medical undergraduate students learning about acute organophosphorus pesticide poisoning (AOPP).

METHODS

Eighty-two fifth-year medical students were randomly divided into an HFPS group (HG, n = 40) and an FC group (FG, n = 42). A postclass quiz and preinternship quiz were performed to assess the short-term knowledge acquisition and long-term (3 months after classes) knowledge retention of both groups of students. Feedback questionnaires were administered immediately after the class and before the internship to assess the students' self-perceived competency.

RESULTS

In the postclass quiz, the scores achieved by the students from the HG and FG were 15.58 ± 2.69 and 14.62 ± 2.19, respectively. No significant difference was found between the 2 groups (P = 0.19). In the preinternship quiz, the scores achieved by the students from the HG (14.50 ± 2.16) were significantly higher than those achieved by the students from the FG (11.40 ± 2.07, P < 0.001). There was no significant difference between the postclass quiz and preinternship quiz scores achieved by the HG students (P = 0.05). However, scores in the preinternship quiz showed a significant decline compared with the postclass quiz for the FG students (P < 0.001). Students in the HG gave significantly higher scores for self-perceived confidence in dealing with AOPP patients in the forthcoming internship on the postclass and preinternship questionnaires.

CONCLUSIONS

The incorporation of HFPS into the FC approach could improve students' long-term knowledge retention of AOPP and enhance their confidence in caring for these patients in their internship.

The effect of the online flipped classroom on self-directed learning readiness and metacognitive awareness in nursing students during the COVID-19 pandemic

Background

The COVID-19 pandemic has initiated digital developments in higher education while closing in-person university classes. As this crisis continues, the need to revive virtual learning opportunities was seriously felt. The present study was conducted to determine the online flipped classroom’s effect on nursing students’ self-directed learning readiness and metacognitive awareness.

Methods

This quasi-experimental single-group study with pretest-posttest design recruited 34 sophomore students of a nursing school in Lorestan province, Western Iran selected by census according to the inclusion criteria. Online asynchronous learning and online flipped classrooms were used during the semester’s first and second eight weeks, respectively. Students filled out self-directed learning readiness scale and metacognitive awareness inventory online before, in the middle of, and at the end of the semester. Data were analyzed using paired t-test in Stata-14 software.

Results

There was no significant difference between the mean score of metacognitive awareness before and after Online asynchronous learning (P=0.15), but the mean score of self-directed learning readiness increased significantly after OA (P=0.0004). After applying online flipped classrooms, students’ mean (SD) scores of metacognitive awareness and self-directed learning readiness were 272.03 (53.03) and 162.03 (21.77), respectively, which confirmed their significant improvement compared to before the intervention. A comparison of the mean score changes of both methods indicated that their implementation did not lead to significant differences between the mean total score of metacognitive awareness (P=0.15) and the mean total score of self-directed learning readiness (P=0.07).

Discussion

Online flipped classroom approach can be used as an effective method in nursing education by improving self-directed learning and metacognitive awareness, which are essential in online education for nursing students.

An insightful estimation of undergraduate medical students' experience about the Flipped Classroom

Background and Objective:

The Flipped Classroom (FC) approach has become increasingly predominant and popular in medical education. This study aimed to explore the usefulness and the scope of FC based on medical students’ experience, with their adaptation challenges.

Methods:

The present study was a mixed-method accomplished during the academic years 2019-20, involving fourth-year students at the College of Medicine in Riyadh, Saudi Arabia. A self-administered questionnaire was used to seek their first experience and opinion of the FC.

Results:

A total of 234 questionnaires were distributed to the students, and 214 students completed the survey (response rate of 91.45%). Out of this total, 68.2 % were males and 31.8% were females. Most of the students agreed 156 (72.9%) that the flipped classroom was more engaging than the traditional lecture, among them 100 (68.5%) males and 56 (82.3) females agreed. Almost ~79% of students liked FC as it enabled them knowing the material in advance, and the class time was spent clarifying the facts and principles with active interaction, as commented during focus group discussion “More chance for discussing with the doctors, and I got the chance to answer” (St. 6).

Conclusion:

The results showed that the students like the FC more than the conventional classroom. Suggestions were given by students to improve the active learning sessions within the FC modality.

Cultural adaptation and validation of instruments for measuring the flipped classroom experience

INTRODUCTION

In 2017, a revamped bachelor of pharmacy program was introduced at Monash University and incorporated a predominantly flipped classroom-based pedagogy. The attitudes and preferences of students towards this program had yet to be assessed using a reliable instrument. Since no instrument was readily available, the objective of this study was to identify, contextualize, and validate a suitable instrument.

METHODS

We conducted a literature search to identify and adapt a validated instrument. Cognitive interviews were conducted to examine students' understanding of scales and definitions of items. The instrument was then evaluated by education experts for further refinement. The reliability of the final instrument was assessed in a cohort of students, and unsuitable items were removed.

RESULTS

Students had issues understanding the scales and specific terms used in the original instrument, potentially due to differences in terminologies used in the university's context and variance in English proficiency levels and exposure. In the preference domain, wording of the instrument to present exclusively traditional classroom or exclusively flipped classroom statements greatly influenced its reliability. This could be due to exposure of students to a predominantly flipped classroom environment since inception. The final instrument optimized in this study had α = 0.85, 0.86, and 0.9 for the pre-activities, in-class lectures, and in-class workshops attitude domains, respectively, and α = 0.73 for the preference domain.

CONCLUSIONS

Our study highlights the necessity of contextualizing instruments to fit the local context in which they are administered and provides key recommendations when conducting such adaptations.