Exploring Educational Transformations Through the Innovative Flipped Learning Instruction Project (IFLIP) Symposium

The flipped classroom is an innovative pedagogy that shifts content delivery outside the classroom, utilizing in-class time for interactive learning. The pre-class and in-class activities in this framework encourage individualized learning and collaborative problem-solving among students, fostering engagement. The Innovative Flipped Learning Instruction Project (IFLIP) conducted faculty development workshops over four years, guiding STEM faculty in integrating flipped teaching (FT) into their courses. The research aimed to assess its impact on pedagogical practices, explore its effectiveness, and provide a framework to implement FT across multiple institutions. It sought to evaluate the experiences of these educators throughout the transitional period of instructional change. In the fourth year of this project, a symposium was organized for IFLIP participants to share their experiences and findings concerning FT. This symposium helped promote collaboration among IFLIP participants and faculty interested in FT to disseminate participants' knowledge and experiences in implementing FT strategies. A survey conducted at the end of the symposium indicated that faculty participants with FT experience continued to embrace this pedagogy, and the new adopters expressed intentions to incorporate it into their courses. The survey revealed positive responses: 93% of respondents plan to integrate FT methods in future classes, 90% gained new information from the symposium and intend to implement it, and 91% are likely to recommend FT to colleagues. Ultimately, the symposium underscored the transformative impact of FT in empowering educators to deepen students' conceptual understanding, emphasizing the significance of this pedagogical approach in advancing the quality of education.

Comparison of intermittent fasting and voluntary wheel running on physical and cognitive abilities in high-fat diet-induced obese rats

Regular physical activity is a proven routine for weight management in addressing obesity. Another method that has gained attention for its health benefits is intermittent fasting (IF). Physical and cognitive abilities while on these routines are poorly understood in the obese population. Sixty-five male Sprague Dawley rats at 7 weeks of age were subjected to diet-induced obesity by feeding a high-fat diet (HFD) or a standard diet (SD) for 8 weeks, after which behavioral testing was performed to detect any changes in physical and cognitive abilities. Rats from the HFD-fed (now considered obese) and SD-fed groups were then subjected to IF (18-hour fast and 6-hour feeding daily), voluntary wheel running (VWR), or control conditions for 3 weeks before repeating the same behavioral testing protocol. IF resulted in less weight gain (p<0.05) and elevated ketone levels (p<0.05) in both SD and HFD-fed groups. IF improved physical activity when compared to VWR and control animals in both SD and HFD-fed groups (p<0.05) while the VWR group in the SD-fed rats exhibited less physical fatigue compared to IF and controls (p<0.05). Additionally, elevated ketone levels were weakly correlated with decreased physical (p<0.0001) and exploratory behavior (p<0.01). These results suggest that IF is more effective than VWR in HFD and SD-fed rats in minimizing weight gain and retaining physical activity, and ketones may play a part in establishing the reported physical benefits. Exploration of physiological mechanisms between ketones, diet, and exercise will help fight obesity and many associated diseases.

Flipped teaching transition to online teaching by STEM educators during the COVID-19 pandemic

COVID-19 necessitated online teaching (OT) during the second half of the spring 2020 semester. The perceptions of science, technology, engineering, and math (STEM) faculty of OT at a two-year (2-YI) and a four-year (4-YI) institution were examined during this sudden switchover. One group of educators had received flipped teaching (FT) training (FTEs, n = 23), whereas the other group was practicing traditional teaching (TTEs, n = 18). There were two cohorts of FTEs: cohort 1 were implementing FT for the third time in their classrooms, and cohort 2 had started for the first time. The survey results suggested that FTEs were more confident with OT than TTEs (P < 0.05). It was interesting to note that 62.5% of the FTEs, whether they were from cohort 1 or cohort 2, chose an asynchronous approach, whereas 37.5% delivered synchronous OT during the sudden transition. It was found that FT experience helped cohort 1 adjust to OT compared with cohort 2. Overall, these results suggest that FTEs were confident and their resources for FT eased the transition to OT.NEW & NOTEWORTHY COVID-19 necessitated online teaching (OT). The perceptions of STEM faculty of OT at two-year and four-year institutions were examined. One group had received flipped teaching (FT) training (FTEs), whereas the others practiced traditional teaching (TTEs). Among two cohorts of FTEs, cohort 1 had been practicing FT but not cohort 2. FTEs were more confident with OT than TTEs. FT experience helped cohort 1 adjust to OT more than cohort 2. Overall, FT eased the transition to OT.

Using the Teaching Career Enhancement Award from the American Physiological Society to train faculty to successfully implement flipped teaching

Flipped teaching (FT) is a student-centered instructional method that shifts lectures out of the classroom and uses a variety of activities to apply content during class time. FT has gained attention among educators as a student-centered instructional method. However, many faculty still lack the skills, knowledge, confidence, and expertise to implement FT in their classrooms. Therefore, course-specific training and focused mentorship are critical in successfully implementing FT. Four faculty members, from an adjunct professor to a full professor, from four diverse institutions around the country, were recruited and funded through the American Physiological Society's Teaching Career Enhancement Award to receive training in the implementation of FT in their courses. This study aimed to provide specific tools and strategies to engage students in deeper learning through activities in the participants' courses. A course was built using the Blackboard Learning Management System for the participants to receive relevant readings to be completed prior to the FT workshop. Upon completing this training, the participants examined the design and execution of FT in their classrooms and, subsequently, reflected on and refined their future course offerings. The facilitator mentored the participants throughout the process, including an on-site observation of a live FT session. Both qualitative and quantitative data were collected before and after their FT experiences. Based on the survey results, this study helped improve the FT knowledge and self-efficacy of all participants. In conclusion, the faculty utilized the training and mentoring to implement FT in their classrooms successfully and disseminate their experiences and findings.

Virtual flipped teaching during the COVID-19 pandemic

The COVID-19 pandemic forced teaching to be shifted to an online platform. Since the flipped teaching (FT) model has been shown to engage students through active learning strategies and adapt both synchronous and asynchronous components, it was a convenient choice for educators familiar with this instructional method. This study tested the effectiveness of a virtual FT method during the pandemic in a graduate-level physiology course. Besides assessing knowledge gained in the virtual FT format, student surveys were used to measure student perception of their adjustment to the new FT format, their confidence in completing the course successfully, and the usefulness of assessments and assignments in the remote FT. Students reported that they adjusted well to the remote FT method (P < 0.001), and their confidence in completing the course in this teaching mode successfully improved from the beginning to the end of the semester (P < 0.05). Students expressed a positive response to the synchronous computerized exams (90.32%) and the formative group (93.51%) and individual (80.65%) assessments. Both collaborative activities (93.55%) and in-class discussions (96.77%) were found to be effective. The course evaluations and the overall semester scores were comparable to the previous semesters of face-to-face FT. Overall, students' perceptions and performance suggested that they embraced the virtual FT method and the tested teaching method maintained the same strong outcome as before. Thus, this study presents a promising new instructional method in the teaching of future physiology courses.

Correlation between ketones and mental fatigue in high fat-induced obese and non-obese rats

Obesity, often caused by a diet high in calories and low physical activity, may induce physical fatigue, as experienced via decreased locomotor activity and mental fatigue such as impaired cognition. This study aims to evaluate glucose and ketone levels secondary to high-fat diet (HFD) exposure and signs of physical and mental fatigue. Fifty-four 7-week-old male Sprague Dawley rats (Rattus norvegicus) were assigned to either an HFD (n = 28) or a standard diet (SD; n = 26) for a 6-week period during which body weight, blood glucose, and ketones were measured twice per week. An open field (OF) paradigm was used to measure locomotor activity, while novel object recognition (NOR) test was used as an indicator of cognition. Animals in the HFD group weighed more than SD rats (8.4 g; p < 0.05) starting at Day 11, blood glucose levels were higher in the HFD group versus SD rats (3.9 mg/dl; p < 0.05) beginning in Week 5, and ketones were lower for the HFD versus the SD group throughout the study (0.34 mmol/L on average; p < 0.05). Although there was no significant difference in locomotor activity between the HFD and SD groups (p = 0.12), regardless of diet, higher ketone levels were associated with increased NOR time and ratio between the familiar and novel objects (p < 0.01). Thus, this study provides evidence that an increased level of ketones is associated with greater cognitive performance and a lesser probability of experiencing mental fatigue.

Flipped teaching eased the transition from face-to-face teaching to online instruction during the COVID-19 pandemic

Due to the COVID-19 pandemic, Rice University canceled classes for the week of March 9-13, 2020 and shifted all instruction to online only following spring break. For the second half of the semester, animal physiology was taught exclusively over Zoom. Here we describe how a flipped teaching format that was used before the pandemic eased the transition from face-to-face teaching to online instruction. The preclass preparation resources and the active learning materials that were already in place for flipped teaching were helpful in the transition to solely online teaching. Therefore, the focus during the transition was to reconfigure active learning and examinations from the face-to-face format to the online platform. Instead of small group discussions in the classroom, teams interacted in Zoom Breakout Rooms. Rather than taking exams in-person during scheduled class time, students submitted exams online. Additionally, students prerecorded their project presentations instead of presenting them "live" during the last week of classes. Overall, students felt that the class smoothly transitioned to a remote only format. These and other changes to the instructional methods will be implemented during the Spring 2021 semester when the course is taught fully online.

Nutrition education on obesity and diabetes to medical students

It is important for medical students to understand the relationship between nutrition, obesity, and diabetes to educate their patients in the future. However, medical training does not always include nutritional education. An experiential learning project was incorporated into the medical school curriculum as an effort to implement nutrition in the physiology course. First-year medical students (n = 140) received lectures on the regulation of blood glucose levels and their relationship to carbohydrates with different glycemic indexes (GI), obesity, and diabetes. Lectures were followed by a laboratory exercise where students calculated their body mass index (BMI), percentage body fat, and percentage muscle using a Bioelectrical Impedance Commercial Scale. While 63% of students had normal BMI, 31% were overweight or obese and 5% were underweight. A subgroup of 54 students tested different types of breakfasts with varying GI and provided blood samples at 0, 30, 60, 90, and 120 min. Their glucose responses were plotted based on the breakfast GI. Pre- and posttests were conducted to assess the teaching intervention where the Wilcoxon signed ranks test indicated that posttest ranks were significantly higher than pretest ranks (Z = -6.6, P < 0.001), suggesting the intervention was beneficial to students.

Remote Flipped Teaching during the COVID‐19 Pandemic

Flipped teaching (FT) is known to foster active learning and increase student engagement. The flipped classroom design organizes learning in such a way that the lower‐order thinking such as memorization is expected at the individual student level in the form of homework and the higher‐order thinking including application and analysis occurs in the classroom in the presence of the instructor. With the sudden onset of the COVID‐19 pandemic, instructors and students were given no time to adjust to the remote educational set up. Flipped teaching, like most other instructional modalities, had to be transformed into an online platform. The present study assessed the effectiveness of FT in a remote setting in a graduate‐level physiology course (n=33). The course content included lecture videos, slides, and reading assignments which were made available on BlackBoard, the Learning Management System. Students were expected to have reviewed the assigned content prior to the virtual synchronous sessions. During the synchronous meeting, a question‐answer (Q&A) session allowed students to review the content yet again. Followed by the Q&A session, an individual quiz, containing lower‐order questions, was given to assess student preparation. Soon after the review of the quiz, students in small groups (4‐5 students per group) were allowed to use breakout rooms to complete a set of questions which were designed at the higher order of Bloom's taxonomy and expected students to apply knowledge, analyze or synthesize their collaborative responses. The answers to these questions were reviewed during the first part of the following synchronous session where students were selected randomly to answer these questions which prompted them to come prepared. Student surveys were administered at the beginning and the end of the course to assess their knowledge gain, perception of the remote FT format, and confidence in completing the course. Based on the survey results, it was found that the students adjusted well to the remote course setting (p<0.001) and their confidence in completing the course successfully increased from the beginning to the end of the semester (p<0.05). Students also found that the collaborative activities (93.55%) and the in‐class discussions (96.77%) were effective and were well adjusted to the synchronous computerized exams (90.32%) and the individual in‐class assessments (80.65%). Overall, the remote FT method was successful and therefore, the principles behind FT could be employed in virtual teaching.

A Virtual International Faculty Development Design to Provide Remote Flipped Teaching Training During the COVID‐19 Pandemic

The COVID‐19 pandemic forced universities to adopt emergency remote teaching strategies. This sudden switch from face‐to‐face teaching to online format prompted appropriate faculty training by the institutions. A university in Saudi Arabia organized a faculty development program to train its educators to design and implement a virtual classroom using the flipped teaching (FT) method. The flipped classroom is a student‐centered instructional design where students are expected to learn basic concepts on their own using resources provided by the instructor outside of class. The class time is used to rehearse and master this knowledge through discussion and application. Moving lectures outside of class allows opportunity to engage students with the content using student‐centered activities during class where more interaction between the faculty and students as well as among peers is expected. The present study tested the effectiveness of a remote faculty training program at an international institution in the development of their own remote flipped courses. The training was stretched over six biweekly sessions for which a course was created on Moodle, the Learning Management System. The participants (n=13) were guided to develop pre‐class assignments such as lecture videos, formative assessments to encourage students in pre‐class preparation, in‐class student engagement activities, and assessments. The faculty participants were given a pre‐ and a post‐training survey to learn about their knowledge, attitude, and confidence towards FT. The pre‐course survey results indicated that 62% of the participants had never tried FT and about 46% were not familiar with FT prior to receiving training while only 54% felt ready to flip. However, all participants intended to implement the FT method after completing the course. Following the training, all participants reportedly felt they could confidently flip their courses and implement FT strategies. All participants valued the training and hoped to reconvene monthly as a group to continue meeting as a group to share their remote FT experiences. In conclusion, the virtual FT training helped improve the knowledge, skills, attitudes, and confidence of all participants in designing their flipped courses to engage students in the remote teaching mode.

Flipped Teaching Eased the Transition of Students to Online Learning During the COVID‐19 Pandemic

Flipped teaching (FT) has gained attention due to its method of teaching that allows students to learn basic concepts on their own using instructor‐provided resources before their scheduled class time. The class time is used in rehearsing and applying the knowledge using active learning approaches. The COVID‐19 pandemic caused an unexpected shift from face‐to‐face to remote learning during the middle of the spring 2020 semester challenging both students and faculty. This study examined the transition of students from the flipped classroom method to rapid online learning and whether the transition was dependent on the faculty experience with FT. The perception of the transition of students in the classrooms of faculty (n=12) with extensive experience in FT (cohort 1) was compared with that of a second cohort (n=11) who were in their first semester of FT implementation. Both qualitative and quantitative survey data were collected from 23 classrooms (n=256 students). It was found that the students in the courses taught by cohort 1 who had received intensive FT training and implemented FT in semesters prior to the COVID‐19 pandemic were able to facilitate a smoother transition and adjustment to fully online learning for their students compared to the students in the courses taught by cohort 2 (p< 0.01). The qualitative data analysis suggested that the students participating in the FT courses in the first half of the semester, before the pandemic, had an easier transition to fully online learning. Students also expressed concerns that online learning was affected by the lack of interaction with faculty and peers, lack of motivation, issues with time management, and personal and technological demands. In conclusion, this study found that faculty experience with FT helped ease the transition of students from the face‐to‐face FT to the online format during the COVID‐19 pandemic.

Flipped Teaching Eased the Transition of Faculty to Remote Teaching During the COVID‐19 Pandemic

Compared to the traditional teaching (TT) method where students are lectured during class time, the flipped teaching (FT) design shifts lecture out of the classroom, as homework, and uses the class time to engage students in discussion, peer collaboration, and knowledge application. The COVID‐19 pandemic displaced students and teachers from classrooms around the world. In response to these alterations, universities emergently transitioned to online course offerings. In this study, the perceptions and attitudes towards emergency remote teaching for faculty using the FT method were compared to those practicing the TT method, A survey instrument was used to collect the experiences of both FT educators (FTEs; n=23) and TT educators (TTEs; n=18) during their transition to mandatory online teaching. It was hypothesized that the FTEs would experience a smoother transition to online teaching compared to TTEs because FTEs had access to previously developed resources such as lecture videos and engaging resources for students to utilize outside the classroom. Three researchers coded the participants’ responses to the survey questions and extracted common and recurring themes. It was found that 47% of FTEs reported a smooth transition to online teaching whereas only 17% of TTEs made a similar claim. Conversely, only 4% of FTEs reported having a difficult transition to online teaching compared to 33% of TTEs. Moreover, 100% of FTEs felt that at least one aspect of their flipped classroom helped them transition their course to the online platform. FTEs generally reported higher levels of confidence and experience with online teaching. These findings suggest that FTEs were more experienced with online teaching, had greater confidence in their skillset, and FT strategies supported their transition to emergency remote learning. Thus, the FT model could be one of the remote teaching methods to be used.

Using dramatizations to teach cell signaling enhances learning and improves students' confidence in the concept

Certain physiology concepts can be difficult for students to understand, and new strategies need to be implemented to teach these concepts. Cell signaling is a core concept in physiology and is presented to undergraduate students starting with their first-year Principles of Biology course. Flipped teaching (FT) combined with dramatizations were used to teach steroid hormone and protein hormone cell signaling in an Animal Physiology course. Student knowledge level improved, as demonstrated by posttest scores compared to pretest scores. Their confidence level in the material improved after the dramatization activities were completed. In conclusion, the combination of FT with dramatizations enhances student learning and confidence level.

Benefits behind barriers in physiology education

The COVID-19 pandemic forced academics to switch to online teaching whether they were prepared or not. The speed and enthusiasm with which educators embraced online teaching suggest that challenges change the perspective for the better. The teaching challenges with the current coronavirus situation mimic the poliovirus attack Dr. Arthur C. Guyton encountered. Dr. Guyton was forced to switch his career from becoming a cardiovascular surgeon to a physiology educator and a researcher. His immense contributions to the field of physiology is an example of how challenges can bring benefits. Flipped teaching has been gaining attention among educators because of its ability to engage students in learning. The COVID-19 pandemic pushed educators to adopt this instructional design based on its conduciveness to technology, as well as its blend of both asynchronous and synchronous components of online teaching. Just like Dr. Guyton's enormous impact on medical education and research in spite of the challenges he faced, we must be creative during this pandemic through innovative teaching methods, which will serve as a gift for the future of physiology education.

Introducing physiology of diabetes to American Asian middle school and high school students

Diabetes, a chronic condition that impacts millions, is a complex disease. Understanding the disease can contribute to increasing awareness about this debilitating condition and preventing occurrences. Furthermore, inculcation of physiology knowledge may lead to an increased likelihood of career goals that align with this area of study. In pursuit of these goals, we set out to educate middle and high school students about diabetes. Thirty (16 high school; 14 middle school) students from a Sunday school program at an urban religious center completed a 10-question pretest as a way to measure initial knowledge about diabetes. Following completion of the survey, a 1-h education session was presented by a local physician who also brought a glucometer and insulin syringes for students to have a hands-on experience with some disease-specific tools. A posttest was administered following the presentation. The posttest consisted of 11 questions, where all but 2 questions were the same as for the pretest, measuring improvement of prior knowledge and engagement in the presentation. The overall posttest average score increased by approximately two correct responses, which was a significant improvement (P < 0.0001), suggesting that the students were motivated to and did learn diabetes concepts. This study also suggests that exposing students to educational activities related to physiology is beneficial and may lead to an increase in interest in physiology, an awareness of diabetes, and perhaps the development of healthy habits.

The refinement of flipped teaching implementation to include retrieval practice

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

Effect of flipped teaching on student performance and perceptions in an Introductory Physiology course

Flipped teaching (FT) has caught educators' attention due to its success in engaging students through pre- and in-class activities. To learn if FT improved student performance, scores from the quizzes and exams of a fully flipped classroom with retrieval exercises were compared with those of five semesters of traditional lecture-based [unflipped (UF)] teaching in an undergraduate sophomore-level physiology course. Student attitude surveys were also evaluated. Student performance on both the quizzes and exams was significantly higher in the FT class in general compared with that of the UF teaching. Interestingly, however, when the individual exam scores were compared between the two styles, the scores for students in the FT were significantly higher for exams 2 and 3, yet lower for exam 1. The shift in performance from exam 1 to exams 2 and 3 is likely explained by the need for time to adjust to the new teaching style. Students reported an overall positive perception of FT in their course evaluations at the end of the semester. In conclusion, FT improved student performance compared with that of lecture-based traditional teaching practice, but required some time to adjust in the beginning of the semester.

Symposium report on "Examining the Changing Landscape of Course Delivery and Student Learning": Experimental Biology 2017

An APS Teaching Section symposium entitled "Examining the Changing Landscape of Course Delivery and Student Learning" was offered at the Experimental Biology conference on April 24th, 2017, in Chicago, IL. The symposium focused on alternative delivery modes of physiology education, from undergraduate to professional programs. Lecture used to be the gold standard and proven method by which students learned, but the course delivery method is rapidly changing. While there is still significant skepticism about the quality and level of student engagement in online learning, it is being offered widely due to increased demand and due to other benefits, such as the flexibility and convenience. Universities with several campuses may now synchronize lectures between campuses, utilizing video conference technology, thus bypassing the need for instructors on each campus. Other modes of delivery include online lectures with laboratories scheduled on campus. Offering biology laboratories online is on the rise but to counter skepticism, more studies are needed to demonstrate that online laboratories effectively meet laboratory objectives. The Massive Open Online Course (MOOC) offers many courses for free and challenges the role of universities. Assessment of the effectiveness of MOOCs and online courses is critical, as some of the concerns raised about them include level of student engagement in learning and the social aspect of interaction with peers and faculty.

Embracing the flipped classroom: the planning and execution of a faculty workshop

A great deal of interest has emerged recently in the flipped classroom (FC), a student-centered teaching approach. After attending a presentation by the first author on the FC, a faculty member of a medical school in Mexico arranged for a 3-day workshop for 13 faculty members. The goal of the workshop was to train faculty to use the FC strategy in their classrooms to increase student engagement in learning. The workshop was in the FC style, where the participants would assume the role of students. Pre- and posttraining surveys were administered to examine participants' current teaching practices and to evaluate their perceptions of the FC. The participants overwhelmingly reported the need to change their lecture-based teaching, as it was not engaging students. Their large class size, lack of technology, training, and uncertainty of the effectiveness of new teaching methods had hindered participants from changing their teaching technique. The on-site training not only allowed the entire department to work closely and discuss the new teaching approach, but also reinforced the idea of changing their teaching strategy and embracing FC teaching method. After the workshop, participants reported being determined to use the FC strategy in their classrooms and felt more prepared to do so. The post-survey results indicated that participants valued the FC training in the flipped style and wanted more of the hands-on activities. In conclusion, the 3-day faculty workshop on the FC was successful, since every participant was motivated to use this teaching method.

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

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