Teaching diagnostic radiology to radiology majors: Implementation and evaluation of a flipped classroom model

PURPOSE

Radiology instruction focuses on cultivating medical students' diagnostic thinking skills and practical competence, and lecture-based learning (LBL) is the most commonly used teaching approach. While fact-based, this type of traditional instruction is often non-engaging, leading to a shift toward student-centered models, one of which is the flipped classroom (FC). However, studies involving a comprehensive evaluation of students' experiences using the FC approach and its effects on their learning are lacking. Therefore, this study analyzed the teaching efficacy of the FC approach based on data of large groups of radiology students, accumulated over time.

METHODS

Data from 636 medical radiology students taught using the FC and LBL models from 2012 to 2021 were retrospectively collected and analyzed.

RESULTS

The test scores of the FC group were significantly higher than those of the LBL group, and improvements in learning initiative and learning ability were notably higher in the FC than in the LBL group. The two groups showed no significant difference in the critical thinking disposition indicator, and the proportion of students with positive critical thinking tendencies was higher in the FC than in the LBL group. The academic and social self-perception scores of the FC group were significantly higher than those of the LBL group, and there was a significant difference in Kolb's learning style.

CONCLUSIONS

Based on evidence of completing pre-, in-, and after-class work, the FC approach improved students' academic performance, learning initiative, diagnostic ability, and satisfaction with learning and the teaching institution. Our findings suggest that FC instruction promotes students' assimilation and convergence of learning styles, and cultivates positive critical thinking.

Nursing students' experiences of flipped classroom teaching method in higher education: a systematic review

BACKGROUND

During the COVID-19 pandemic face-to-face activities were suspended, boosting the delivery of online teaching. As students returned to campuses, the delivery of active learning teaching methods followed a blended learning style. The flipped classroom, which is a student-centred approach, appears to be an effective teaching method, generating improved learning outcomes. No systematic review has so far explored students' experiences of this teaching method - a knowledge gap that this review aims to address.

METHODS

Studies published between 2012 and 2023 were identified from seven databases. The JBI critical appraisal tool was adopted to select high-quality studies and add credibility. Following extraction of qualitative data, meta-aggregation was used to identify synthesised findings.

RESULTS

The findings were aggregated into seven categories. Based on meaning similarity, three synthesised findings were identified to answer the research question on how nursing students experience the flipped classroom method.

CONCLUSION

Several factors affect the student experience. Although variables are interrelated and complex to analyse, this approach is a valuable teaching method, positively experienced by students with the potential to improve engagement and learning outcomes. The group activities used as a feature of the flipped classroom can be seen as an instrument to deliver a safer and high quality of care.

Effectiveness of a flipped classroom for undergraduate in implant dentistry hands-on course

PURPOSE

The purpose of this study was to compare the learning in the implant dentistry hands-on course to that of the flipped classroom (FC) and the traditional lecture cohorts (control).

MATERIALS AND METHODS

In this study,80 students were enrolled for the first time in an implant dentistry program. Subsequently, they were divided into two groups. The first, the FC group, which had free access to a video with a PowerPoint presentation on the Chaoxing-WHU-MOOC platform about the implant placement on first molar sites before class. The second, the control group, which attended a didactic lecture describing implant practice on the first molar site via a bidirectional multimedia interactive teaching demonstration and then operated on a simulation model. Cone beam computed tomography (CBCT) and the deviation gauge were utilized to analyze the accuracy of the implant placement in the students' models. An online satisfaction questionnaire was distributed to both groups one week after the class.

RESULTS

The linear deviation of the CBCT examination did not show any statistical difference between the two groups concerning cervical, apex, and angular. A significant buccal deviation was observed in the control group compared with the FC group (mean: 0.7436 mm vs. 0.2875 mm, p = 0.0035), according to the restoration-level deviation gauge. A total of 74.36% of students in the FC group placed implant within 0.5 mm buccal-to-lingual deviations, but only 41.03% of students in the control group reached within 0.5 mm buccal-to-lingual deviation ranges. Additionally, 91.67% of the students in the FC group and 97.5% of the students in the control group were satisfied with the practical implant class.

CONCLUSION

FC was more effective than a didactic lecture for implant dentistry practical skill acquisition.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Flipped Classroom: Improved team performance during resuscitation training through interactive pre-course content - a cluster-randomised controlled study

BACKGROUND

Resuscitation is a team effort, and it is increasingly acknowledged that team cooperation requires training. Staff shortages in many healthcare systems worldwide, as well as recent pandemic restrictions, limit opportunities for collaborative team training. To address this challenge, a learner-centred approach known as flipped learning has been successfully implemented. This model comprises self-directed, asynchronous pre-course learning, followed by knowledge application and skill training during in-class sessions. The existing evidence supports the effectiveness of this approach for the acquisition of cognitive skills, but it is uncertain whether the flipped classroom model is suitable for the acquisition of team skills. The objective of this study was to determine if a flipped classroom approach, with an online workshop prior to an instructor-led course could improve team performance and key resuscitation variables during classroom training.

METHODS

A single-centre, cluster-randomised, rater-blinded study was conducted on 114 final year medical students at a University Hospital in Germany. The study randomly assigned students to either the intervention or control group using a computer script. Each team, regardless of group, performed two advanced life support (ALS) scenarios on a simulator. The two groups differed in the order in which they completed the flipped e-learning curriculum. The intervention group started with the e-learning component, and the control group started with an ALS scenario. Simulators were used for recording and analysing resuscitation performance indicators, while professionals assessed team performance as a primary outcome.

RESULTS

The analysis was conducted on the data of 96 participants in 21 teams, comprising of 11 intervention groups and 10 control groups. The intervention teams achieved higher team performance ratings during the first scenario compared to the control teams (Estimated marginal mean of global rating: 7.5 vs 5.6, p < 0.01; performance score: 4.4 vs 3.8, p < 0.05; global score: 4.4 vs 3.7, p < 0.001). However, these differences were not observed in the second scenario, where both study groups had used the e-learning tool.

CONCLUSION

Flipped classroom approaches using learner-paced e-learning prior to hands-on training can improve team performance.

TRIAL REGISTRATION

German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00013096 ).

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.

Application of flipped classroom teaching method based on ADDIE concept in clinical teaching for neurology residents

BACKGROUND

As an important medical personnel training system in China, standardized residency training plays an important role in enriching residents' clinical experience, improving their ability to communicate with patients and their clinical expertise. The difficulty of teaching neurology lies in the fact that there are many types of diseases, complicated conditions, and strong specialisation, which puts higher requirements on residents' independent learning ability, the cultivation of critical thinking, and the learning effect. Based on the concept of ADDIE (Analysis-Design-Development-Implementation-Evaluation), this study combines the theory and clinical practice of flipped classroom teaching method to evaluate the teaching effect, so as to provide a basis and reference for the implementation of flipped classroom in the future of neurology residency training teaching.

METHODS

The participants of the study were 90 neurology residents in standardised training in our hospital in the classes of 2019 and 2020. A total of 90 residents were divided into a control group and an observation group of 45 cases each using the random number table method. The control group used traditional teaching methods, including problem based learning (PBL), case-based learning (CBL), and lecture-based learning (LBL). The observation group adopted the flipped classroom teaching method based on the ADDIE teaching concept. A unified assessment of the learning outcomes of the residents was conducted before they left the department in the fourth week, including the assessment of theoretical and skill knowledge, the assessment of independent learning ability, the assessment of critical thinking ability, and the assessment of clinical practice ability. Finally, the overall quality of teaching was assessed.

RESULTS

The theoretical and clinical skills assessment scores achieved by the observation group were significantly higher than those of the control group, and the results were statistically significant (P < 0.001). The scores of independent learning ability and critical thinking ability of the observation group were better than those of the control group, showing statistically significant differences (P < 0.001). The observation group was better than the control group in all indicators in terms of Mini-Cex score (P < 0.05). In addition, the observation group had better teaching quality compared to the control group (P < 0.001).

CONCLUSION

Based on the concept of ADDIE combined with flipped classroom teaching method can effectively improve the teaching effect of standardized training of neurology residents, and had a positive effect on the improvement of residents' autonomous learning ability, critical thinking ability, theoretical knowledge and clinical comprehensive ability.

Flipped classroom teaching model with video instruction improves skills in local anesthesia training

Background/purpose

Local anesthesia (LA) training is an essential clinical skill in dental education. However, the traditional teaching method of student-to-student injection has ethical concerns. This study investigated whether a flipped classroom (FC) teaching model with instructional videos improves students' skills in administering LA.

Materials and methods

Fourth-year dental students in 2017 (traditional teaching, n = 70) and 2018 (FC model, n = 79) were assessed for their ability to perform an inferior alveolar nerve block and lingual nerve block. The FC group watched pre-recorded videos prior to a hands-on training session. Skills were evaluated using a 24-item checklist converted to letter grades. Perceptions of the FC approach were also surveyed.

Results

The FC group showed statistically significantly higher final grades than the traditional teaching group (P < 0.05). Most FC students agreed that the videos improved clarity and learning objectives.

Conclusion

The FC teaching model with procedural video instruction improved skills and confidence in administering LA over traditional teaching methods. Videos can be a beneficial supplement in pre-clinical dental training.

Adopting video assignments as a tool to improve first-year pharmacy students class engagement

OBJECTIVES

The objective of this study was to evaluate the use of video assignments as a tool to improve students' engagement and maximize their benefit from the assigned homework in a pharmaceutical calculations course.

METHODS

This was an intervention study, including the use of a new electronic educational tool. The study was conducted during the academic year 2021-2022. Six video assignments were created for two of the four modules of the pharmaceutical calculations course for the first-year pharmacy students. The video assignments were employed in a flipped classroom mode, with each video including 3-4 questions on successive steps in one problem. Students' perceptions of the video assignments were assessed through a survey conducted at the end of the course. The survey items represented the five domains of the Technology Acceptance Model (TAM).

RESULTS

All the first-year students (n=356) were assigned to this new educational tool. A total of 296 students responded to the survey, with a response rate of 83%. The majority of students agreed with the perceived usefulness, ease of use, and behavioral intention to use the video assignment. Multiple linear regression analysis indicated a significant positive association between two items (perceived usefulness and attitude to use) and the outcome variable (behavioral intention to use).

CONCLUSIONS

The video assignment tool was successfully used to provide immediate feedback to a large class in a pharmaceutical calculations course. The students were in favor of the video assignment compared to traditional paper assignments. This finding could encourage other instructors to assess the benefit of implementing such tools in other pharmacy courses.

Combination of concept maps and case-based learning in a flipped classroom: A mixed-methods study

AIM

This study aimed to evaluate the impact of a hybrid learning method on the academic achievements, learning skills and experiences of undergraduate nursing students.

BACKGROUND

Case-based learning is a student-centered approach that is commonly integrated into the flipped classroom model in nursing education. However, effectively combining the flipped classroom model and case-based learning into a hybrid learning format is challenging. To address this gap, this study integrated concept maps with case-based learning and the flipped classroom and evaluated the impact of this hybrid learning method on the academic achievements, learning skills and experiences of undergraduate nursing students.

DESIGN

A mixed-methods approach, including a quasi-experimental study and semi-structured interviews, was employed.

METHODS

A total of 277 undergraduate nursing students participated, with 136 students in the control group undergoing case-based learning and 141 students in the experimental group taught using the hybrid learning approach, which combined concept maps, case-based learning and a flipped classroom. The study assessed self-directed learning, critical thinking, learning strategy and curriculum grades in both groups before and after the intervention. Additionally, students in the experimental group participated in semi-structured interviews.

RESULTS

The quantitative findings indicated that both case-based learning and the hybrid learning method (combined concept maps, case-based learning and a flipped classroom) had similar impacts on the curriculum grades, self-directed learning, cognitive maturity and learning strategy of nursing students. The qualitative results further demonstrated how the hybrid approach facilitated integrated learning, promoted self-evaluation, aided adaptation to the flipped classroom and enhanced teacher-student interaction.

CONCLUSIONS

Combining case-based learning, a flipped classroom and concept maps is an effective learning approach for undergraduate nursing students. It may improve students' self-directed learning, cognitive maturity and learning strategy. Additionally, concept maps are a beneficial supplement to case-based learning and a flipped classroom in terms of guiding integrated learning, promoting self-evaluation, enhancing adaptation to a flipped classroom and increasing interaction between teachers and students and between classmates.

Evaluation of the effectiveness of using flipped classroom in puncture skills teaching

BACKGROUND

The effectiveness of flipped classroom (FC) on puncture skills in medical education is still uncertain. This study aimed to assess the role of the FC model in puncture skills and investigate the acceptance and approval of FC among medical students and instructors.

METHODS

A mixed research approach of quasi-experimental research design and descriptive qualitative research was conducted in September 2022 for one month, using an FC teaching method that combined instructional videos and group learning. The study participants were 71 fifth-year medical students from two classes at a Chinese medical school and four instructors. The medical students were randomly divided into two groups: the traditional classroom (TC) group (Group A) and the FC group (Group B). For teaching, Group B used FC, and Group A used PowerPoint-based TC. The effectiveness of the two teaching models was assessed with Objective Structured Clinical Examination (OSCE), and questionnaires were distributed to the medical students and instructors after the assessment. Two independent sample t-tests were used to analyse the differences in demographic data and the OSCE scores of the two groups of medical students.

RESULTS

Group B scored higher in puncture skills than Group A, especially regarding abdominal puncture (p = 0.03), thoracentesis (p < 0.001), bone marrow puncture (p < 0.001) and average performance of puncture skills (p < 0.001). For lumbar puncture, no difference in skill scores was observed between groups A and B (p > 0.409). The medical students thought that the FC improved their self-learning ability and helped them acquire knowledge. Regarding the OSCE of their skills, most medical students thought that it was more innovative and objective than traditional examinations and that it was better for assessing their overall abilities. Both the FC and OSCE were supported by the medical students. The instructors were also satisfied with the students' performance in the FC and supported the teaching model, agreeing to continue using it.

CONCLUSIONS

This study shows that FC teaching that combines instructional videos and group learning is a reliable and well-received teaching method for puncture skills, which supplements and expands existing teaching methods in the medical field.

A comparative study on the effectiveness of online and in-class team-based learning on student performance and perceptions in virtual simulation experiments

BACKGROUND

The swift transition to online teaching in medical education has presented the challenge of replicating in-class engagement and interaction essential for active learning. Despite online team-based learning (TBL) offering potential solutions through structured cooperative activities, its efficacy in virtual simulation experiment courses remains scantily researched. This study investigates the effectiveness of online TBL for teaching virtual patient experiments in a basic medical laboratory course and contrasts it with traditional offline teaching in terms of student performance and perceptions.

METHODS

A comparative analysis involved 179 Year 3 medical students using online TBL, face-to-face TBL (FTF-TBL), and the flipped classroom (FC) approach. The learning outcomes were assessed based on experiment reports, IRAT scores, TRAT scores, and final exam performance. Students' perceptions of both online and in-class TBL methodologies were also surveyed.

RESULTS

Both online and in-class TBL groups demonstrated comparable academic outcomes and surpassed the FC group in academic performance. Students displayed a marked preference for the TBL format (whether online or in-class), valuing its enhancement of learning interest and practical knowledge application. Nevertheless, refinements in discussion efficiency, platform convenience, and student-instructor interaction were indicated as potential areas of improvement in the online setting.

CONCLUSIONS

Online TBL, along with its in-class counterpart, showed superior academic performance and a more positive learning experience compared to the FC group. These findings underscore the potential of online TBL in adapting to modern pedagogical challenges and enriching medical education through virtual simulation experiments.

Nursing students'experience of flipped classroom combined with problem-based learning in a paediatric nursing course: a qualitative study

BACKGROUND

Problem-based learning (PBL) is a student-centred approach that triggers learning by presenting problems cenarios early in the learning process.Flipped classrooms have been used in various disciplines using various models.Pre-class e- learning in aflipped classrooms can enrich knowledge acquisition in PBL teaching. This study was conducted to explore nursing students'experience of flipped classroom combined with problem-based learning in a paediatric nursing course.

METHOD

This descriptive qualitative study was conducted between January and June 2022.Semi-structured interviews were conducted with nursing students who were participated in flipped classrooms combined with PBL teaching in a paediatric nursing course at Soochow university in China. Nursing students were selected using a purposive sampling method until no new data were generated (n = 16).

RESULTS

We identified ten sub-themes and four higher-order themes based on these sub-themes: (1)stimulating interest in learning and enhancing autonomous learning,(2)improving independent thinking and problem-solving skills,(3)cultivating team work spirit, and (4) gaining knowledge and improving skills.The findings of our research contribute to show the effectiveness of the flipped classroom combined with PBL in a paediatric nursing course.

CONCLUSION

The flipped classroom combined with PBL in a paediatric nursing course can enhances communication and cooperation abilities among nursing students, promoting common progress and the comprehensive development of nursing students.

Learning Assistants in Flipped-Classrooms: A New Pedagogical Strategy for Pre-Clinical Medical Education

Problem-based learning has been widely incorporated into pre-clinical medical education to increase the applicability of pre-clinical knowledge. However, studies have demonstrated increased learning burden and decreased confidence in learning when adapting to this didactic medium. To the authors' knowledge, limited interventions target these shortcomings in real time. Thus, we adapted and implemented a "Learning Assistants" (LA) program that can be deployed in pre-clinical didactic sessions. In this prospective pilot study, trained LAs were deployed in the classroom to assist students in their clinical case vignettes under instructor supervision. Learning assistants and students completed pre-session and post-session evaluation surveys to assess LA helpfulness, student confidence, and interest in study material. Paired observations were evaluated using Wilcoxon signed-ranks tests, ANCOVA, and paired t-tests. Unstructured responses were evaluated using thematic analysis. A significant improvement in both student interest (p < 0.001) and confidence (p < 0.001) in the course material was observed after each surveyed session. No significant difference was observed in student-perceived LA helpfulness across the sessions (p = 0.12). Thematic analysis revealed common themes in student knowledge gaps, including challenges with understanding drug mechanisms of action and drug interactions. The results suggest that this program may consistently positively impact student interest and confidence. However, further research is needed to evaluate the impacts of this intervention on learning outcomes and standardized assessments. This study highlights the potential for such a program to bolster pre-clinical didactic sessions that utilize the problem-based learning instructional modality.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01958-x.

A full-flipped classroom mode from the perspective of Junior High School English teachers

Flipped classrooms have been shown to be an effective teaching mode that fosters students' self-learning, stimulates learning motivation, and improves academic performance. However, preparation work and after-class assignments take up a large portion of students' and teachers' time outside the classroom, putting enormous strain on both parties. This study explores the time spent by teachers and students under the current flipped classroom mode and its impact on them from the perspective of junior high school English teachers and then proposes a full-flipped classroom mode to solve these problems. To this end, eight junior high school English teachers who had implemented flipped classroom teaching in a specific district in China were interviewed. The collected data were processed using thematic analysis. The results showed that the current flipped classroom mode does increase the outside-classroom burden for both students and teachers. The learning burden leaves students lacking in exercise and opportunities to develop interests, which is detrimental to their physical, mental, and overall development. The out-of-class burden hinders teachers from achieving work-life balance and is detrimental to their physical and mental health, as well as their professional growth. Based on the views of the interviewees and existing in-class flipped mode, this study provides a full-flipped classroom mode that is in line with Chinese students' actual language learning to concretize the in-class flipped pattern and present its specific steps in language teaching, which integrates all preclass preparation, postclass assignments, and assignment evaluation into one class, including four teaching sessions: preview and lecture, preview tasks, consolidation assignments, and evaluation and feedback.

E-Learning and Flipped Classroom in Inclusive Education: The Case of Students with the Psychopathology of Language and Cognition

The study analyzed modern e-learning and flipped classroom methods in inclusive education, focusing on their impact on motivation, academic performance, and the effectiveness of the educational process. The experiment involved 648 first- and second-year students from Abai Kazakh National Pedagogical University, the Elabuga Institute (Branch) of Kazan Federal University, and I.M. Sechenov First Moscow State Medical University. According to the survey conducted in the first phase, 66% of students reported using e-learning and flipped classroom methods, while 34% indicated that these methods were not employed. Furthermore, 50% of respondents rated the development of these methods in their universities as low, suggesting a lack of attention, familiarity among teachers, or reluctance to adopt them. To study the psychopathology of language and cognitive functions among children with special needs, the authors used the ASEBA questionnaire algorithm. It allowed for a survey among children from specialized classes, mixed classes (E-learning and flipped classroom), and control classes. Each group consisted of 50 people, there were three classes in each category. The ASEBA questionnaire revealed information about various aspects of the psychological functioning of children, including their behavior, emotional state, social adaptation, as well as problems with language and communication. The use of the questionnaire in different types of classes helped to compare the results between groups and identify features and differences in the psychopathology of language and cognitive functions in children with special needs. The findings can contribute to a deeper understanding of the psychopathology of language and cognitive functions in this category of children.

Flipped classrooms in pharmacy education: A systematic review

Background

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

Objective

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

Method

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

Results

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

Conclusions

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

From tradition to innovation: a comparison of the traditional 4-step approach versus a blended learning modification for technical skills teaching

BACKGROUND

This experimental study was performed to evaluate the role of blended learning for technical skill teaching on the European Trauma Course (ETC). While online modules are extensively used for theoretical teaching, their role in skills training remains less well explored. The ETC currently relies on the established 4-step technique for teaching technical skills. However, the required large cohort of skilled instructors and the time intensity prove increasingly challenging in a current climate of staff shortages and funding constraints. This study assesses if blended learning, combining pre-course online elements with face-to-face training matches the effectiveness of the traditional 4-step approach whilst being more time-efficient.

METHODS

In a randomised, multi-centre trial, the conventional face-to-face 4-step technique for teaching a skill of medium complexity, the application of a pelvic binder, was compared with an innovative blended approach. It was hypothesised that the blended approach was non-inferior for skill performance measured after the teaching session and after two days (skill retention) with the time needed for teaching and student/teacher satisfaction as secondary outcomes.

RESULTS

Ninety participants, divided into 44 traditional and 46 blended method students, were analysed. Independent-samples t-test showed no significant difference in performance scores and non-inferiority of the blended approach with a half of one standard deviation margin. A statistically significant difference in mean retention scores favored the blended approach. A Mann-Whitney U Test revealed no significant difference in candidate satisfaction levels but a statistically significant difference in instructors' satisfaction levels in favour of the blended approach. Analysis with Welch' t-test demonstrated that the face-to-face teaching time needed for the blended approach was significantly shorter (by 6 min).

CONCLUSIONS

The integration of a blended approach with the 4-step technique for teaching pelvic binder application in the ETC streamlined teaching without compromising skill acquisition quality. This innovative approach addresses traditional limitations and shows promise in adapting medical education to modern learning and teaching demands. We suggest that blended learning could also be applied for other skills taught on life support courses.

TRIAL REGISTRATION

University of Dundee (Schools of Medicine and Life sciences Research Ethics Committee, REC number 22/59, 28th June 2022).

An outcomes-based module education via flipped classroom enhances undergraduate oral histopathology learning

INTRODUCTION

Oral histopathology is a bridge course connecting oral basic medicine and clinical dentistry. However, the application of outcomes-based education via flipped classroom (FC) in oral histopathology has not been well explored. This study has assessed the efficacy of outcomes-based education via FC in undergraduate oral histopathology module learning in Nanjing Medical University of China.

MATERIALS AND METHODS

A total of 214 third-year students were enrolled and assigned to the FC group of the batch 2022-23 (n = 110) and the traditional classroom (TC) group of the batch 2021-22 (n = 104) to participate the oral histopathology sessions respectively in the study. The FC group were required to preview the online course materials pre-class, followed by in-class quizz, in-class interactive group discussion, and slides microscopic observation. The outcomes-based formative and summative assessments for FC were designed. The TC group attended traditional laboratory class for the same glass slides microscopic observation. In addition, a questionnaire was performed to investigate the satisfaction of learning. Along with this, the performances of FC group in written theory tests and oral histopathology slide tests were compared with TC group.

RESULTS

Students in the FC group gained significantly final higher scores of the course than those in the TC group (score: 83.79 ± 11 vs. 76.73 ± 10.93, P<0.0001). Data from the student questionnaires indicated a preference for outcomes-based module education via FC. In the questionnaires, most students considered outcomes-based module education via FC to be beneficial to learning motivation, knowledge comprehension, critical thinking and teamwork. FC group had a higher level of satisfaction with oral histopathology teaching than TC group (satisfaction score: 4.599 ± 0.1027 vs. 4.423 ± 0.01366, P<0.01).

CONCLUSION

An outcomes-based module education via FC has a promising effect on undergraduate oral histopathology education.

Simulation in a blended learning curriculum for neonatology

Blended learning is a learner-centered educational method that combines online and traditional face-to-face educational strategies. Simulation is a commonly utilized platform for experiential learning and an ideal component of a blended learning curriculum. This section describes blended learning, including its strengths and limitations, educational frameworks, uses within health professions education, best practices, and challenges. Also included is a brief introduction to simulation-based education, along with theoretical and real-world examples of how simulation may be integrated into a blended learning curriculum. Examples of blended learning in Neonatal-Perinatal Medicine, specifically within the Neonatal Resuscitation Program, procedural skills training, and the National Neonatology Curriculum, are reviewed.

Factors affecting students' perception of flipped learning over time in a teacher training program

The flipped learning methodology could play a key role in teacher training, as it exposes future teachers to experience this active methodology as students. With the purpose of shedding light on how students' perceptions may vary over time and how they can be related to the improvement of the flipped learning methodology, our study explores different factors in an eight-year period. Specifically, we analyse teaching performance considering data on students' perceptions from the 2015-2016 academic year to 2022-2023 of a course embedded within a master s degree in teacher training in Spain. Once future teachers had experienced flipped learning as students, a sample of 338 completed a survey regarding their perceptions of the flipped classroom approach and the instructor role. In our study, the more experienced the instructor, the better perception the students showed on both the flipped learning methodology and the performance of their teacher. In particular, we found that future teachers had (i) a good or very good opinion about flipped learning, regardless of their gender (ii) a more positive perception about flipped learning, teaching performance and course development in the last five academic years, (iii) no remarkable differences between study specialisations in those last academic years, and (iv) a better opinion about the flipped learning model when they have best grades. We discuss our findings according to six factors that affect the flipped learning experience and, thus, students' perception of flipped learning over time: "student characteristics", "teacher characteristics", "implementation", "task characteristics", "out-of-class activities" and "in-class activities"-factors already unveiled by a recent state-of-the-art review to enhance the effectiveness of flipped classroom. We can conclude that the instructor's teaching experience is a key factor that affects the implementation of flipped learning, influencing students' perception and, consequently, the success of this active methodology.

Development and implementation of a student tumor board as a teaching format for medical students

PURPOSE

Tumor boards serve as established platforms for interdisciplinary expert discussions and therapeutic recommendations tailored to individual patient characteristics. Despite their significance, medical students often lack exposure to such interdisciplinary discussions as tumor boards are currently not integrated into medical curricula. To address this, we aimed to enhance future physicians' interdisciplinary communication skills and subject-specific knowledge by introducing an interactive series of five linked tumor board seminars within the domain of neuro-oncology.

METHODS

We developed a neuro-oncological student tumor board using a flipped-classroom format. The primary objectives of this case-centered approach included fostering an understanding of the tumor board process, active participation in multidisciplinary case discussions, honing appropriate communication strategies, and creating personalized therapy plans that consider inputs from all relevant disciplines, individual patient factors, and ethical considerations. To gauge the effectiveness of the seminar series, we administered structured pre- and post-course questionnaires.

RESULTS

Fourteen medical students in third to fifth year participated in the pilot series. Despite its organizational complexity, the interdisciplinary seminars were feasible. Students demonstrated significant growth in competence, aligned with predefined learning objectives. Notably, they appreciated the supportive learning environment and interactive teaching format, which kindled their interest in interdisciplinary oncology.

CONCLUSION

Active participation in a student tumor board can empower students to tackle the diverse challenges of caring for cancer patients within an interdisciplinary team during the early stages of their careers. The student tumor board represents an innovative, learner-centered approach to teach interdisciplinary cancer treatment, communication strategies, and ethical aspects of medical practice.

Application of flipped classroom combined with virtual simulation platform in clinical biochemistry practical course

BACKGROUND

The study explores an innovative teaching mode that integrates Icourse, DingTalk, and online experimental simulation platforms to provide online theoretical and experimental resources for clinical biochemistry practical courses. These platforms, combined with flipped classroom teaching, aim to increase student engagement and benefit in practical courses, ultimately improving the effectiveness of clinical biochemistry practical teaching.

METHODS

In a prospective cohort study, we examined the impact of integrating the Icourse and DingTalk platforms to provide theoretical knowledge resources and clinical cases to 48 medical laboratory science students from the 2019 and 2020 grades. Students were assigned to the experimental group using an overall sampling method, and had access to relevant videos through Icourse before and during class. Using a flipped classroom approach, students actively participated in the design, analysis, and discussion of the experimental technique. For the experimental operation part, students participated in virtual simulation experiments and actual experiments. Overall, the study aimed to evaluate students' theoretical and operational performance after completing the practical course. To collect feedback, we distributed a questionnaire to students in the experimental group. For comparison, we included 42 students from the grades of 2017 and 2018 who received traditional instruction and were evaluated using standard textbooks as the control group.

RESULTS

The experimental group scored significantly higher than the control group on both the theoretical and experimental operational tests (82.45 ± 3.76 vs. 76.36 ± 3.96, P = 0.0126; 92.03 ± 1.62 vs. 81.67 ± 4.19, P < 0.001). The survey revealed that the experimental group preferred the teaching mode that combined the flipped classroom with the virtual simulation platform. This mixed method effectively promoted understanding of basic knowledge (93.8%, 45/48), operative skills (89.6%, 43/48), learning interest (87.5%, 42/48), clinical thinking (85.4%, 41/48), self-learning ability (91.7%, 44/48), and overall satisfaction compared with traditional methods (P < 0.05). This study demonstrates that an innovative teaching approach significantly improves the quality of clinical biochemistry practical courses and promotes students' professional development and self-directed learning habits.

CONCLUSION

Incorporating virtual simulation with flipped classrooms into clinical biochemistry practical teaching is an efficient and well-received alternative to traditional methods.

Learning with, about, and from COVID-19: An interprofessional global comparison of pandemic responses

BACKGROUND AND PURPOSE

University of Kentucky developed a fully virtual course to educate global health learners about the COVID-19 pandemic and compare country responses to it.

EDUCATIONAL ACTIVITY AND SETTING

Forty-three students participated in 13 weeks of synchronous interprofessional group meetings via Zoom (Zoom Video Communications, Inc) and asynchronous modules. Interprofessionality was intentional yet implicit, and a flipped classroom was utilized. Assessment was accomplished with one instrument measuring learning outcomes associated with select Consortium of Universities of Global Health Interprofessional Global Health Competencies, Association of American Colleges and Universities Global Learning Value Rubric competencies, and course satisfaction and effectiveness utilizing a retrospective pre-/post-methodology.

FINDINGS

Positive pre-/post-change was observed in 10 survey items. Evaluation results concerning course structure and experience were uniformly high, with the key informant interview rated most helpful. Items with significant improvement included a better understanding of the student's place in the world; improved interprofessional communication skills; population health data skills; and understanding of health systems and entities that influence global health and development. Learners appreciated the value of interprofessional teamwork and gained a deeper understanding of the roles and training of colleagues from other programs, leading to a deeper understanding of the actions those professions may take within health systems.

SUMMARY

The pivot to all online global health education was a viable solution to addressing the pause in global travel and study abroad experiences at University of Kentucky.

Hybridizing video-based learning with simulation for flipping the clinical skills learning at a university hospital in Pakistan

BACKGROUND

While learning and practicing on actual patients is a major mode of teaching clinical skills, concerns about patient safety, unavailability, and lack of standardization have led to the development of simulation for medical education. Simulation-based teaching is affected by challenges such as lack of protected time for faculty, inexperienced learners, and the number of students per group. These have led to the integration of various eLearning formats in the curriculum. The hybridized format changes the traditional clinical skills teaching into the flipped classroom. This study aims to measure the effectiveness of hybridizing video-based learning with simulation for flipping the clinical skills teaching of fourth-year medical students at the Department of Paediatrics and Child Health at Aga Khan University, Pakistan.

METHODS

The study employed a mixed-methods design. Fourth-year medical students of the batch 2020-21 (n = 100) consented to participate in the study. The quantitative component focuses on identifying the effect of the intervention on the perceived self-efficacy of medical students (batch 2020-21) relevant to the clinical skill. Along with this, the performance of the intervention batch of 2020-21 on the end of clerkship objective structured clinical exam (OSCE) was compared with the previous batch of 2019-20, taught using simulation alone. Focused group discussions (FGDs) were used to explore the experiences of medical students (batch 2020-21) about the intervention. Quantitative data underwent descriptive and inferential analysis using Stata v16 while qualitative data underwent content analysis using NVivo software.

RESULTS

Hybridization of video-based learning with simulation significantly improved self-efficacy scores for all examinations (cardiovascular, respiratory, neurological, and abdomen) with p-value < 0.05. OSCE scores of the intervention group were significantly higher on the neurological and abdominal stations as compared to the previous batch (p-value < 0.05). In addition, the overall structure of the intervention was appreciated by all the students, who stated it allowed reinforcement of basic concepts, retention, and further insight into clinical applications.

CONCLUSION

The hybridization of video-based learning with simulation facilitated in creation of better opportunities for medical students to revive their prior knowledge, apply core concepts for the problem and engage in clinical reasoning.

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.

Knowledge acquisition efficacy of a remote flipped classroom on learning about removable partial dentures

PURPOSE

Coronavirus disease 2019 has forced the use of remote education worldwide. In 2020, the authors conducted a fully digitized, remote flipped (RF) classroom focusing on removable partial dentures. This study aimed to evaluate the learning outcomes of the RF classroom and compare these with those of the on-site classroom.

METHODS

The fourth-year dental students in 2017-2019 attended on-site flipped classroom (OF; n=70) or on-site lecture classroom (OL; n=67), and those in 2020 (n=58) attended the RF classroom. Lecture videos and text were provided online in the OF and RF groups, while only the text was given to the OL group. Individual and group tests were conducted to assess knowledge acquisition one week after all the classes ended. A one-way analysis of variance following Tukey's test was performed to compare individual/group test scores among the OF, OL, and RF groups. Multilevel linear regression analysis was performed to identify the factors associated with an increase in each test score.

RESULTS

The mean individual test scores in the RF and OF groups were significantly higher than in the OL group (P<0.01). The mean group test score in the RF group was significantly higher than in the OF and OL groups (P<0.001). The multilevel analysis identified remote and flipped classroom styles in the individual test, and the remote style in the group test, as significant effective factors in learning (P<0.05).

CONCLUSIONS

These results suggest that the RF classroom is more effective than the on-site lecture in knowledge acquisition in undergraduate prosthodontic education.

Integrating New Learning Methods into Equine Nutrition Classrooms: The Importance of Students' Perceptions

Despite greater efforts made over recent years to teach animal nutrition to veterinary students, more needs to be done to develop teaching methods and improve education on equine nutrition. The flipped classroom and peer-assisted learning (FC/PAL) approach is a teaching technique suggested to support learning; however, research into FC/PAL in veterinary education is scarce and little is known about students' views on this approach. This study examined the results of a questionnaire administered to assess veterinary students' perceptions of/views about the suitability of FC/PAL applied in an equine nutrition course. Correlation analysis of students' responses to questionnaire items and principal component analysis (PCA) was performed to analyze the variability in student perceptions. The results showed that although half the students reported to be uninterested in equine nutrition, most expressed positive attitudes towards FC/PAL. Comparing the perceptions/views towards FC/PAL among low and high achievers, a significant difference was found for the item considering the duration of FC/PAL (P = .002). Correlation analysis between questionnaire items showed a predominance of positive moderate correlations among high achievers and weak correlations among low achievers. PCA revealed three important findings. First, student interest towards equine nutrition explains the response variability among low achievers. Second, there was significant agreement among almost all high achievers regarding the duration of the FC/PAL. Third, in the item evaluating the usefulness of collaborating with peers, disagreement was only found among low achievers. In summary, a flipped classroom combined with the same level peer-assisted learning appears to encourage student interaction and collaboration in the classroom.

Effectiveness of the flipped classroom methodology on the learning of evidence-based practice of nursing students: Quasi-experimental design

BACKGROUND

International organizations recognize the importance of evidence-based practice (EBP) for nurses. The objective of teaching EBP in the Nursing degree is to train future nurses on this subject. Different teaching models exist for this, from less active traditional models to more active ones such as the flipped classroom.

OBJECTIVE

To compare the degree of EBP competence of undergraduate nursing students after an EBP course, through the application of a traditional methodology versus a flipped classroom methodology.

DESIGN

Quasi-experimental study of non-equivalent groups.

SETTING

The study was composed by a group of students who received training on EBP with the traditional model (face-to-face), and another intervention group with whom the flipped classroom model was utilized, using the online teaching platform EBP-eToolkit.

PARTICIPANTS

The study was conducted with 4th-year Nursing degree students enrolled in the course evidence-based practice, in academic years 2019/20 and 2021/2022.

METHODS

Before and after the course, the students completed a questionnaire about EBP competence (EBP-COQ), and an objective test was given at the end of the year.

RESULTS

A sample of 152 students in the face-to-face group (control), and 143 students in the flipped classroom group (intervention) participated. The intervention group significantly improved its competence on attitude (p = 0.01, η² = 0.022), skills (p = 0.019, η² = 0.018), and global competence in EBP (p = 0.003, η² = 0.030), with respect to those who were taught using the traditional method. However, there were no significant differences in the impact on knowledge, neither through the self-report dimension of the EBP-COQ (p = 0.188) nor the final test score, control group 6.89 (SD: 1.35) and flipped classroom group 7.12 (SD: 1.53) (p = 0.206).

CONCLUSIONS

The flipped classroom model is adequate for the teaching of EBP to undergraduate nursing students. It produced a slight increase in attitude, as well as in skills and global competence in EBP. Nevertheless, this increase was not significantly different from face-to-face learning in terms of impact on EBP knowledge.

A comparison between the impacts of lecturing and flipped classrooms in virtual learning on triage nurses' knowledge and professional capability: an experimental study

BACKGROUND

The quality of triage in emergency department depends on regular evaluation of triage nurses' professional capabilities and development of programs to improve them. Flipped classrooms are a new approach to learning which can be employed to improve professional capabilities. The present study aims to compare the impact of lecturing to flipped classrooms in virtual learning on the knowledge and professional capabilities of triage nurses in the emergency departments of the state hospitals of Yazd province in south-western Iran in 2022.

METHODS

The present study is an experimental work of research. Seventy-four triage nurses participated in the study. Seventy-four triage nurses were randomly allocated to the two groups, including flipped classrooms (group B) and lecturing (group A). The data collection instruments were an emergency department triage nurses' professional capability questionnaire and a triage knowledge questionnaire. The collected data were analyzed in SPSS v.22 using independent t-test, chi-squared test, and repeated measures analysis of variance. Level of significance was set at p ≥ 0.05.

RESULTS

The participants' mean age was 33.1 ± 4.3 years. As measured one month after the education, the triage knowledge mean score of the nurses who were educated using the flipped classroom method (9.29 ± 1.73) was higher than that of the nurses who were educated via lecturing (8.45 ± 1.788), and the difference was statistically significant (p = 0.001). Also, measured one month after the education, the professional capability mean score of the nurses who were educated using the flipped classroom method (140.27 ± 11.744) was higher than that of the nurses who were educated via lecturing (132.84 ± 10.817), and the difference was statistically significant (p = 0.006).

CONCLUSION

There was a significant difference between the pretest and posttest knowledge and professional capability mean scores of both groups immediately after the education. However, measured one month after the education, the mean and standard deviation of the knowledge and professional capability scores of the triage nurses who had been educated via flipped classrooms were higher than those of the nurses in the lecturing group. Thus, virtual learning using flipped classrooms is more effective than lecturing in improving triage nurses' knowledge and professional capability in the long run.

A Flipped Classroom Experiment in Growth Theory

This study utilizes a classroom experiment to determine the effectiveness of the flipped classroom in a growth theory module of intermediate macroeconomics. We compare the performance of small section flipped groups to control groups at a liberal arts college. The treatment groups watched growth lecture videos before class, while the control groups followed a traditional lecture format. The results provide no evidence of superior performance by the treatment sections. They show that the main determinant of a student's performance is high school quality. The careful preparation to minimize differences across students from different socio-economic backgrounds is essential.

Using cognitive load theory to evaluate and improve preparatory materials and study time for the flipped classroom

BACKGROUND

Preclinical medical education is content-dense and time-constrained. Flipped classroom approaches promote durable learning, but challenges with unsatisfactory student preparation and high workload remain. Cognitive load theory defines instructional design as "efficient" if learners can master the presented concepts without cognitive overload. We created a PReparatory Evaluation Process (PREP) to systematically assess and measure improvement in the cognitive-load efficiency of preparatory materials and impact on study time (time-efficiency).

METHODS

We conducted this study in a flipped, multidisciplinary course for ~ 170 first year students at Harvard Medical School using a naturalistic post-test design. For each flipped session (n = 97), we assessed cognitive load and preparatory study time by administering a 3-item PREP survey embedded within a short subject-matter quiz students completed before class. Over three years (2017-2019), we evaluated cognitive load- and time- based efficiency to guide iterative revisions of the materials by content experts. The ability of PREP to detect changes to the instructional design (sensitivity) was validated through a manual audit of the materials.

RESULTS

The average survey response rate was ≥ 94%. Content expertise was not required to interpret PREP data. Initially students did not necessarily allocate the most study time to the most difficult content. Over time, the iterative changes in instructional design increased the cognitive load- and time-based efficiency of preparatory materials with large effect sizes (p < .01). Furthermore, this increased the overall alignment of cognitive load with study time: students allocated more time to difficult content away from more familiar, less difficult content without increasing workload overall.

CONCLUSIONS

Cognitive load and time constraints are important parameters to consider when designing curricula. The PREP process is learner-centered, grounded in educational theory, and works independently of content knowledge. It can provide rich and actionable insights into instructional design of flipped classes not captured by traditional satisfaction-based evaluations.

Exploring lemology teaching with "internet plus" flipped classroom pedagogy

BACKGROUND

To investigate the use of flipped classroom pedagogy based on "Internet plus" in teaching viral hepatitis in the lemology course during the COVID-19 epidemic.

METHODS

This study included students from the clinical medicine general practitioner class at Nanjing Medical University's Kangda College, with the observation group consisting of 67 students from the 2020-2021 school year and the control group consisting of 70 students from the 2019-2020 school year. The observation group used "Internet plus" flipped classroom pedagogy, while the control group used conventional offline instruction. The theory course and case analysis ability scores from the two groups were compared and analyzed, and questionnaire surveys were administered to the observation group.

RESULT

After the flipped classroom, the observation group had significantly higher theoretical test scores (38.62 ± 4.52) and case analysis ability scores (21.08 ± 3.58) than the control group (37.37 ± 2.43) (t = 2.024, P = 0.045) and (19.16 ± 1.15) (t = 4.254, P < 0.001), respectively. The questionnaire survey in the observation group revealed that the "Internet plus" flipped classroom pedagogy approach can help enhance students' enthusiasm to learn, clinical thinking ability, practical application ability, and learning efficiency, with satisfaction rates of 81.7%, 85.0%, 83.3%, and 78.8%, respectively; 89.4% of students expressed hope that whenever physical classes resumed, the offline courses could be combined with this pedagogy approach.

CONCLUSION

The use of the "Internet plus" flipped classroom pedagogy technique for teaching viral hepatitis in a lemology course boosted students' theory learning ability as well as their case analysis ability. The majority of students were pleased with this type of instruction and hoped that whenever physical classes resumed, the offline courses may be integrated with the "Internet plus" flipped classroom pedagogical approach.

Counteracting Vaccine Misinformation: An Active Learning Module

Rises in vaccine hesitancy and the incidence of vaccine-preventable illnesses is, in part, due to an increase in vaccine misinformation. Consequently, many patients express skepticism and mistrust of vaccines. It is important that future clinicians are well equipped to understand vaccine-related literature to prepare them for difficult conversations with patients. This module incorporated various active learning approaches to evaluate vaccine-related literature, discuss true contraindications for vaccination, and aid students in approaching patient-clinician conversations about vaccines. Data gained from delivery of this module suggests that students benefit from gaining knowledge and cultivating communication skills about vaccines early in health professions education.

Student teachers' perceptions of flipped classroom in EFL teacher education

This paper aims to provide evidence on student teachers' perceptions of Flipped Classroom (FC) to help teacher educators (TEs) to make informed decisions about implementing FC and support student teachers to reflect on the value of FC in their teaching practice. FC, a pedagogical model requiring digital competence of students and teachers, has been a popular teaching approach for nearly two decades in K-12 and higher education. After the outbreak of Covid-19, more teachers have started to implement FC. In post-Covid-19, with the possibility of reusing video lectures made during the pandemic and the familiarity of digital skills to create digital lectures, a question for teachers is whether to continue with this approach. This paper follows an explanatory sequential mixed methods research approach. Insights from student teachers (STs) in the field of English as a foreign language (EFL) in Norway are the primary data, and surveys and focus group interviews are the main instruments to collect the data. FC's advantages and challenges perceived by STs are reported, and the possibility of STs becoming future flippers is explored. Findings from this paper indicate that STs would like to have more courses flipped in their studies, yet STs seem hesitant about flipping their courses in their teaching practice. STs also provide some practical suggestions on implementing the FC approach.

Examining the effects of student-centered flipped classroom in physiology education

BACKGROUND

The flipped classroom approach has gained increasing popularity in medical education. Physiology is a basic medical course that studies the phenomena and laws of human life activities, and is a crucial link course connecting preclinical courses and clinical courses. However, there is a paucity of data showing the effectiveness of the flipped classroom model for the entirety of physiology course in medical undergraduate students.

METHOD

131 sophomore students with clinical medicine major at Harbin Medical University were recruited and they were randomly allocated into two groups: the control group which was subjected to traditional lecture teaching (n = 69), and the experimental group which was subjected to flipped classroom teaching (n = 62). To assess the effect of flipped teaching, the usual performance and final exam scores were used to evaluate the physiology learning effectiveness of students. The correlation between the usual performance and final exam scores by Pearson method was also conducted in the two teaching groups. After course completion, an anonymous questionnaire survey was conducted among the subjects of flipped classroom group to assess students' opinion regarding the flipped classroom teaching.

RESULTS

Our results showed that the usual performance and final exam scores of students in the flipped classroom were both significantly higher than that in the traditional teaching class (P < 0.05). Moreover, our results also showed that the usual performance of students was significantly correlated with the final exam scores in the flipped classroom (r = 0.3945, P < 0.01), but not in the traditional teaching group (r = 0.1522, P = 0.2119). The results of questionnaire survey showed that 77.58% of the students believed flipped classroom teaching improved their knowledge acquisition. 70%~86% of students perceived that flipped classroom enhanced their learning abilities, including self-study ability, collaborative learning and problem-solving skills, and clinical thinking ability. In addition, about 60% of students acknowledged the teaching design and teaching environment, more students' engagement and presentation of group learning in the flipped classroom.

CONCLUSION

The flipped classroom teaching significantly improved students' learning effectiveness in physiology course, as indicated by final exam score and usual performance. It also promoted higher-order ability-set acquisition and allowed a rationalized formative evaluation system.

Application of flipped classroom based on CDIO concept combined with mini-CEX evaluation model in the clinical teaching of orthopedic nursing

BACKGROUND

After the COVID-19 epidemic, the state has paid more attention to the clinical teaching function of affiliated hospitals of colleges and universities. Strengthening the integration of medicine and education and improving the quality and effect of clinical practice teaching are critical challenges facing medical education. The difficulty of orthopedic teaching lies in the characteristics of a wide variety of diseases, strong professionalism, and relatively abstract characteristics, which affect the initiative, enthusiasm, and learning effect of nursing students. In this study, a flipped classroom teaching plan based on the CDIO (conceive-design-implement-operate) concept was constructed and practiced in the orthopedic nursing student training course to improve the effect of practical teaching, and it is convenient for teachers to implement more effective and targeted teaching in the flipped classroom of nursing education and even medical education in the future.

METHODS

Fifty undergraduate nursing students who practiced in the Orthopedics Department of a tertiary hospital in June 2017 were enrolled in the control group, while 50 undergraduate nursing students who practiced in the same department in June 2018 were enrolled in the intervention group. The intervention group adopted the flipped classroom teaching mode of the CDIO concept, whereas the control group adopted the traditional teaching mode. After finishing the department practice task, the students in the two groups completed the evaluation of theory, operation skills, independent learning ability, and critical thinking ability. They completed the evaluation of clinical practice ability in eight dimensions, including four processes of nursing procedures, humanistic care ability, and evaluation of clinical teaching quality for two groups of teachers.

RESULTS

After teaching, the clinical practice ability, critical thinking ability, autonomous learning ability, theoretical and operational performance, and evaluation of clinical teaching quality in the intervention group were significantly higher than those in the control group (all p < 0.05).

CONCLUSION

The CDIO-based teaching mode can stimulate the independent learning ability and critical thinking ability of nursing interns, promote the organic combination of theory and practice, improve their ability to comprehensively use theoretical knowledge to analyze and solve practical problems, and improve teaching effectiveness.

Teachers' instructional responses to the COVID-19 pandemic

In response to the COVID-19 pandemic, schools transitioned to Emergency Remote Teaching (ERT). In May 2020, as part of an existing study of flipped Algebra instruction, we interviewed eleven Missouri teachers to understand how their instruction changed as they moved to ERT. Drawing on practical rationality, we found the pandemic led to a breach of norms (assigning grades, synchronous meeting times, delivering new content, and students' completion of work). Findings highlight the interconnected nature of norms and reveal differences in teachers' responses to the breach of norms. We found administrative policies, particularly around grading, significantly impact teachers' decisions during ERT.

The role of pre-class and in-class behaviors in predicting learning performance and experience in flipped classrooms

The flipped classroom is a well-recognized instructional approach that improves learning performance and experience through two sequential phases: pre-class preparation and in-class collaboration. Despite the large differences between the two phases, few studies have explored their separate effects on flipped learning. This study conducted a hierarchical linear regression to investigate how the two sequential phases and their featured behaviors can predict learning performance and experience in a flipped classroom at the undergraduate level. The results indicated that students' pre-class discussion positively predicted their assignment scores to a moderate degree, while the in-class collaboration was negatively correlated with test scores. However, the two phases had a limited impact on students' flipped learning experience. The results also highlight the influence of students' initial interest and prior achievement on their flipped learning experience. The findings can extend our understanding of the flipped classroom approach and inform its design and implementation in higher education contexts.

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.

The effects of microlearning-supported flipped classroom on pre-service teachers' learning performance, motivation and engagement

Flipped classroom (FC) has recently attracted researchers' interest in teacher education thanks to its potential for promoting pre-service teachers' (PTs) professional development. However, some of major issues are the lack of interactivity, disengagement, and amotivation of PTs for pre-class activities due to poor online instruction design. This explanatory sequential mixed study explores the effects of the microlearning-supported FC on PTs' learning performance for professional development, motivation, and engagement. A total of 128 PTs participated in this study from a university in Turkey. In the quantitative phase, a quasi-experimental pretest-posttest design was conducted and the treatment lasted for 14 weeks. The PTs were divided into two experimental groups and one control groups using random sampling technique. In first experimental group (m-FC, n = 43), the participants learned with microlearning-supported (by using a-bit sized learning chunks outside the classroom) FC model. In the second experimental group (t-FC, n = 39), the participants learned with traditional FC model. A control group (non-FC, n = 46) was not taught using FC model and teacher-centered approach was adopted in this group. The findings indicated that FC model (in both experimental groups) increased learning performance, intrinsic motivation, emotional, and behavioral engagement compared to a group that was not used to FC. Moreover, m-FC group had better intrinsic motivation and engagement than both t-FC and non-FC groups. Semi-structured interviews showed that two major themes emerged regarding benefits and challenges of microlearning-supported FC. Most of PTs had positive perceptions that it enhances the willingness to participate in pre-class activities. The implications for teacher education, recommendations and directions for further studies were also discussed.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Student engagement in flipped classroom in nursing education: An integrative review

AIM

To summarize the effect of the flipped classroom method (FCM) on student engagement in nursing education and provide the implications for future practice.

BACKGROUND

Technological advancement of learning approaches including flipped classroom has become increasingly popular in nursing education. However, no integrative review has been published that specially explore the behaviour engagement, cognitive engagement and emotional engagement of flipped classroom use in nursing education.

METHODS

Population, Intervention, Comparison, Outcomes and Study (PICOS) strategies were implemented to investigate the literature from published peer-reviewed papers from 2013 to 2021 in CINAHL, MEDLINE and Web of Science.

RESULTS

The initial search identified 280 potentially relevant articles. After comprehensively reviewing the initial catchment using several analytical phases, 16 articles were considered for the final review. Most of articles targeted on undergraduate nursing students and were conducted in the USA and Australia. The review primarily identified positive learning outcomes among nursing students in term of student engagement. However, a few studies reported contrasting findings, possibly due to students are still dependent on traditional lecture-based classroom.

CONCLUSION

This review suggests that use of the FCM in nursing education could promote students' behavioral engagement and cognitive engagement but yield a mixed outcome in emotional engagement. This review contributed to our understanding of the effect of the flipped classroom method on student engagement in nursing education, the strategies for promoting student engagement in future flipped classroom practice and recommendation for future research on flipped classroom.

Investigating online learners' knowledge structure patterns by concept maps: A clustering analysis approach

A deep understanding of the learning level of online learners is a critical factor in promoting the success of online learning. Using knowledge structures as a way to understand learning can help analyze online students' learning levels. The study used concept maps and clustering analysis to investigate online learners' knowledge structures in a flipped classroom's online learning environment. Concept maps (n = 359) constructed by 36 students during one semester (11 weeks) through the online learning platform were collected as analysis objects of learners' knowledge structures. Clustering analysis was used to identify online learners' knowledge structure patterns and learner types, and a non-parametric test was used to analyze the differences in learning achievement among learner types. The results showed that (1) there were three online learners' knowledge structure patterns of increasing complexity, namely, spoke, small-network, and large-network patterns. Moreover, online learners with novice status mostly had spoke patterns in the context of flipped classrooms' online learning. (2) Two types of online learners were found to have different distributions of knowledge structure patterns, and the complex knowledge structure type of learners exhibited better learning achievement. The study explored a new way for educators to analyze knowledge structures by data mining automatically. The findings provide evidence in the online learning context for the relationship between complex knowledge structures and better learning achievement while suggesting the existence of inadequate knowledge preparedness for flipped classroom learners without a special instructional design.

Attendance Improves Student Electrocardiography Interpretation Skills Using the Flipped Classroom Format

The implementation of classroom capture and casting technologies has changed how content can be accessed. Students can access live, streaming, and/or recorded formats of material. Broadening this accessibility has, in turn, introduced flexibility for both the learner and the instructor. This flexibility has impacted the necessity of attendance to access classroom-delivered content. There are many reports that investigate the changing attendance climate as well as the potential impact of attendance on student outcomes. Here we investigated the impact of attending classroom activities on student performance with two common content delivery methods in an undergraduate, pre-clinical cardiology course. Electrocardiography (ECG) interpretation was taught using a flipped classroom format which allowed for the practice of interpretive skills with faculty guidance. Other components of the course related to the diagnosis, treatment, and management of cardiovascular disease were delivered using a lecture-based format. The results demonstrate that attendees outperform their classmates in the ability to interpret ECGs and related content. However, the attending student does not appear to have a performance advantage when content is delivered by lecture. The results provide evidence for students to prioritize their time when making decisions about attendance, based on teaching modality, when given a choice. Further, the information can guide curricular change and help colleges and programs identify curricular activities that have a clear attendance benefit for students.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01689-5.

Can Research Training be Improved in Health Professional Student Curricula? A Qualitative Descriptive Study of Health Students' Experiences with an Integrated Research Training Platform

INTRODUCTION

Project-based learning is currently the status quo for research training for health professional students; however, it alone is not sufficient for holistic development of research skills. One promising style of intervention that can complement project-based research training is a centralised hub of e-learning resources. Therefore, we explored the perception of health professionals in tertiary education, towards the E-learning hub named 'Health and Medical Sciences Research Modules'. Specifically, we explored (1) the role the Modules can play in supporting students in their research training courses, (2) the perception of the selection of topics and content quality and (3) student engagement with content.

METHODS

Semi-structured interviews were conducted via the online platform Zoom for University of Western Australia 3rd- and 4th-year Dental doctoral students, and 2nd-year Master of Pharmacy students. Interview transcripts were analysed using the framework method, to identify manifest and latent level themes.

RESULTS

Eleven participants completed the interview, including five dentistry and six pharmacy students. The analysis yielded numerous manifest level themes including selection and depth of topics, and four latent level themes: content volume and balance, relevance of content to project, alignment and sequencing, and interactivity.

DISCUSSION

The present study suggests the Modules content and the online platform were well received as a complementary intervention to project-based learning. However, issues such as content oversaturation emerged as topics which can be addressed to improve the learning experience. These topics should be considered when considering further implementation of e-learning hubs to complement project-based learning, across Australia and worldwide.

Implementation of a Web-Based Educational Intervention for Promoting Flipped Classroom Pedagogy: A Mixed-Methods Study

Introduction

Flipped classroom pedagogy (FCP) is recognised as an effective and efficient teaching-learning method. However, nursing students and teachers may be hesitant to adopt FCP due to technophobia and time constraints linked to academic and clinical responsibilities. This necessitates the provision of promotional training for adopting FCP. However, there is a dearth of research regarding how the practice of FCP could be promoted and in demonstrating its efficacy in developing countries. Thus, this study aimed to examine the educational impact of a web-based education intervention, branded as the Flipped Classroom Navigator (FCN), for promoting FCP in nursing education in Sri Lanka.

Methods

This mixed-methods study employed pre- and post-training knowledge tests, the Instructional Materials Motivation Survey (IMMS), the Perceived Transfer of Learning Questionnaire survey, and collected students' and teachers' open-ended responses to evaluate the impact of the FCN. Fifty-five undergraduate nursing students and 15 university teachers participated in the study from two state universities in Sri Lanka. Repeated-measures ANOVA, t-tests, Levene's test of homogeneity, Cohen's d, and an inductive thematic approach were employed in the data analysis.

Results

Post-training knowledge test scores were significantly higher than the pre-training knowledge test scores indicating improved understanding of FCP. Participants were also highly motivated to learn in the FCN instructional materials. Participants exhibited positive attitudes towards FCN training with transfer of learning to their teaching-learning practice. The inductive thematic analysis identified the following themes: user experiences, FCN learning content, behaviour changes, and suggested improvements.

Conclusion

Overall, the FCN enhanced both students' and teachers' knowledge and understanding of FCP in undergraduate nursing education.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01706-7.

Flipped versus traditional classroom and student achievement and cognitive engagement in an associate degree nursing fundamental course

BACKGROUND

There is a call for instructional transformation in nursing education to include an innovative approach. This study aimed to investigate the effects of the flipped classroom method on student achievement and engagement in an associate degree nursing course. This study investigated associate degree nursing studies students' achievement and cognitive engagement under traditional learning (n = 141) and flipped learning (n = 130). This study was conducted in two first-year cohorts enrolled in their nursing fundamental course, before and during the COVID-19 pandemic respectively at a Hong Kong community college.

METHOD

A mixed methods approach was used with quantitative (examination scores) and qualitative (semi-structured focus group interview) measures applied.

RESULTS

There was a significant increase in final exam scores for the flipped classroom, all p < 0.01, with a medium-to-large (d = 0.60) effect size. Students commented flipped classroom method promoted their cognitive engagement and the benefits that contributed to such a positive student achievement included more peer interaction and more opportunity to apply their knowledge.

CONCLUSION

This study contributed to our understanding of the effect of the flipped classroom method on student engagement in nursing education.

The effect of blended task-oriented flipped classroom on the core competencies of undergraduate nursing students: a quasi-experimental study

BACKGROUND

The flipped classroom (FC) method is becoming increasingly popular in China's nursing education. It is an important breakthrough improvement in the quality of learning in nursing education reforms.

PURPOSE

This study aimed to determine the effects of blended task-oriented flipped classroom (TFC) on nursing students undertaking the Fundamentals of Nursing course.

METHODS

A pre-and post-test quasi-experimental design was adopted. This study was conducted in the Autumn semester, 2021 academic year in a Chinese university. Using cluster sampling technique, this study enrolled second-year undergraduate nursing students from six classess who were studying Fundamentals of Nursing course. A blended TFC was developed and implemented with three classes (experimental group: n = 152). In-class traditional lectures were applied to the other three classes (control group: n = 151). The Self-Directed Learning Instrument, Problem-Solving Inventory, and California Critical Thinking Disposition Inventory were used to evaluate students' learning outcomes, and final examinations were conducted at the end of after course. In addition, students in the flipped classroom group were required to answer five open-ended questions concerning their flipped classroom learning experiences.

RESULTS

Students in the experimental group showed significant improvement in academic performance compared to those in the control group (p = 0.001). Considering total scale and factors, students in the experimental grouped recorded significantly higher scores in self-directed learning ability, problem-solving skills, and critical thinking ability compared to those in the control group (p < 0.05). Furthermore, improved abilities and skills such as team cooperation, communication, presentation, identifying /solving clinical problems, and accountability were reported.

CONCLUSION

A blended TFC teaching approach positively impacted students' core competencies and improved learning outcomes in the Fundamentals of Nursing course.