The Flipped Classroom: An Innovative Approach to Medical Education in Ophthalmology

The effectiveness of the technology-enhanced flipped class on the learning and satisfaction of nursing students in the immunology course: A quasi-experimental study

BACKGROUND

Health professions graduates are expected to have core competencies and the ability to provide safe, high-quality, patient-centered care. To guarantee this, active learning and learner-oriented learning approaches should be employed.

OBJECTIVE

This research was conducted to determine the effect of the technology-enhanced flipped classroom on the learning and satisfaction of nursing students in the medical immunology course.

DESIGN

Quasi-experimental study.

SETTINGS AND PARTICIPANTS

The participants were 80 nursing students recruited through convenience sampling from the Faculty of Nursing and Midwifery, Tehran University of Medical Sciences who were taking the medical immunology course.

METHODS

In the odd sessions, teaching was traditional, and in the even sessions was flipped. The tools of this study included a satisfaction questionnaire and a class test. Data were analyzed using descriptive statistics, paired t-test, and One-sample t-test by SPSS21.

RESULTS

Longitudinal analysis showed that there was no change in the level of students' learning in the traditional method over time but in the flipped classroom method, there was a positive effect in increasing students' learning. The comparison of students' average learning scores showed the average learning scores in the traditional approach increased from 10.049 to 10.590 But this difference was not statistically significant (P = 0.247). In the flipped classroom, the average learning scores increased from 7.745 to 10.440 which was significant (P < 0.001). The average score of students' satisfaction with the flipped classroom teaching method was 7.56 ± 1.81 and higher than the average level.

CONCLUSION

Technology-enhanced flipped classroom was effective in improving learning and high satisfaction of nursing students which shows that this approach is successful for teaching medical immunology to nursing students. This approach has the potential to be expanded to other nursing courses according to its correct application and implementation.

Flipped Classroom Based on Outcomes-Based Education Improves Student Engagement and Clinical Analysis Competence in Undergraduates Ophthalmology Clerkship

Objective

To investigate the effectiveness of flipped classrooms (FC) based on outcomes-based education (OBE) on clinical ophthalmology clerkships.

Methods

Ninety-nine undergraduates were non-randomly assigned to the FC based on the OBE (FC-OBE) group or traditional lecture (TL) group in the ophthalmology clerkship. Pre- and post-tests were performed to assess student learning outcomes. Anonymous questionnaires were collected to compare students' attitudes and classroom engagements between the two groups.

Results

More participants agreed FC-OBE was helpful in developing teamwork ability and knowing the work standard. Teaching staff in the FC-OBE classroom received higher evaluations. More participants in the FC-OBE group had higher classroom engagement in skills and emotions than in the TL group. The post-class test scores, mainly case analysis scores were higher in the FC-OBE group than in the TL group.

Conclusion

FC-OBE classroom improves student engagement and clinical analysis competence in undergraduate ophthalmology clerkship.

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 Case Learning vs Traditional Lecture-Based Learning in Medical School Ophthalmology Education: A Randomized Trial

PURPOSE

To address the problem of teaching noncore specialties, for which there is often limited teaching time and low student engagement, a flipped classroom case learning (FCCL) module was designed and implemented in a compulsory 5-day ophthalmology rotation for undergraduate medical students. The module consisted of a flipped classroom, online gamified clinical cases, and case-based learning.

METHOD

Final-year medical students in a 5-day ophthalmology rotation were randomized to the FCCL or a traditional lecture-based (TLB) module. The outcomes of subjective assessments (student-rated anonymous Likert scale questionnaire, scale 1 to 5, and course and teaching evaluation, scale 1 to 6) and objective assessments (end-of-rotation and post-MBChB multiple-choice questions, scale 0 to 60) were compared between the 2 groups.

RESULTS

Between May 2021 and June 2022, 216 students (108 in each group) completed the study. Compared with the TLB students, the students in the FCCL group rated various aspects of the course statistically significantly higher, including feeling more enthusiastic and engaged by the course and more encouraged to ask questions and participate in discussions (all P < .001). They also gave higher ratings for the instructional methods, course assignments, course outcomes, and course workload ( P < .001). They gave higher course and teaching evaluation scores to the tutors (5.7 ± 0.6 vs 5.0 ± 1.0, P < .001). The FCCL group scored higher than the TLB group on the end-of-rotation multiple-choice questions (53.6 ± 3.1 vs 51.8 ± 2.8, P < .001). When 32 FCCL students and 36 TLB students were reassessed approximately 20 weeks after the rotation, the FCCL group scored higher (40.3 ± 9.1) than the TLB group (34.3 ± 10.9, P = .018).

CONCLUSIONS

Applying the FCCL module in ophthalmology teaching enhanced medical students' satisfaction, examination performance, and knowledge retention. A similar model may be suitable for other specialties.

Self-Reported Perceptions of Preparedness among Incoming Ophthalmology Residents

Purpose  The purpose of this study was to assess the self-perceived preparedness of incoming postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) ophthalmology interns/residents to carry out core competencies in ophthalmology. Methods  An online survey was created using the Survey Monkey survey platform and distributed to all ophthalmology resident applicants to the Bascom Palmer Eye Institute from the 2021 to 2022 and 2022 to 2023 application cycles. The survey contained questions pertaining to demographics, prior ophthalmic experience, online resources that were used to prepare for ophthalmology, and self-perceived preparedness to carry out key clinical skills in ophthalmology. Results  A total of 170 responses were obtained (16.1% response rate). Of those, 119 (70%) were incoming PGY1 interns and 51 (30%) were incoming PGY2 residents for the 2022 to 2023 academic year. Most respondents (90.6%, n  = 154) reported that their ophthalmology residency was affiliated with an integrated ophthalmology intern year. Incoming PGY2s moderately agreed with the statement that they felt as prepared to see patients in ophthalmology as they do in other surgical subspecialties, whereas incoming PGY1s only mildly agreed with that statement ( p  = 0.003). Both incoming PGY1s and PGY2s felt most prepared to obtain histories relating to basic ophthalmic complaints and felt least prepared to read and interpret ophthalmic imaging studies. The most popular online resources used by respondents in order of popularity were EyeGuru (35.2%, n  = 60), EyeWiki (32.9%, n  = 56), Tim Root/OphthoBook (26.5%, n  = 45), American Academy of Ophthalmology (13.5%, n  = 23), and EyeRounds/University of Iowa (13.5%, n  = 23). Conclusion  A major challenge in integrating ophthalmic education into the medical school curricula is the gradual shift toward shorter preclinical curricula. However, having a core foundation of ophthalmic knowledge is critical for incoming ophthalmology residents to be able to maximize their specialty-specific training. Integrated ophthalmology intern years likely play a significant role in the increased self-efficacy of incoming PGY2s compared with incoming PGY1s. Adopting nontraditional teaching methods like flipped classroom learning, utilizing online medical education resources, and continuing to increase ophthalmology exposure during PGY1 year may better prepare incoming PGY2s to operate independently in ophthalmology settings.

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.

Flipped classroom approach to global outreach: cross-cultural teaching of horizontal strabismus to Chinese ophthalmology residents

AIM

To evaluate the flipped classroom model for teaching horizontal strabismus didactics in an ophthalmology residency program in China as part of a visiting professorship from the United States.

METHODS

Residents from an ophthalmology residency program in China were invited to participate in flipped classroom sessions taught by an experienced American ophthalmology faculty in 2018. Residents were instructed to watch a pre-class video lecture prior to the in-class-case-based activity. Content tests (5 Ophthalmic Knowledge Assessment Program style questions) and surveys were administered before and after the classroom sessions (100% response rate). These results were compared to that of an American cohort who were taught the same content.

RESULTS

The Chinese cohort of 12 residents preferred the flipped classroom to the traditional classroom at higher rates than the American cohort of 40 residents (92% vs 55%, P=0.04) and felt that all ophthalmology topics would be appropriate for the flipped classroom teaching style (P-values between 0.008 and <0.001). In both Chinese and American cohorts, we found that the exotropia curriculum saw a small but significant improvement in performance following the flipped classroom session (P=0.025 for Chinese residents; P=0.001 for US residents), whereas scores in both groups for the esotropia course did not significantly improve.

CONCLUSION

This is the first study to evaluate the flipped classroom model implemented by a visiting ophthalmology professor in a global outreach setting. The flipped classroom sessions are viewed favorably by the Chinese residents relative to the US cohort with a modest impact on knowledge. Decreased in-person interpreter requirement and increased student engagement make this model valuable in cross-cultural visiting professorship settings. Finally, the flipped classroom may lend itself well to a virtual format to prevent the transmission of COVID-19, although such a format requires further study.

"Flipped" clinical rotations: A novel approach

Background

Near the beginning of the COVID‐19 pandemic in the United States, medical students were pulled out of all in‐person patient care activities. This resulted in massive disruption to the required clinical rotations (clerkships), necessitating creative curricular solutions to ensure continued education for medical students.

Approach

In response to the lockout, our school adopted a “flipped” clinical rotations model that assigned students to remote learning activities prior to in‐person patient care activities. This approach allowed students to continue their clinical education virtually with a focus on knowledge for practice while awaiting return to the shortened in‐person portions of their rotation. In planning the modified clinical curriculum, educational leaders adhered to several guiding principles including ensuring flexible remote curricular components that would engage students in active learning, designating that no rotation would be completely virtual, and completing virtual educational activities and standardised exams before students returned to in‐person experiences.

Evaluation

End of rotation evaluations and standardised exam scores were analysed to determine the effectiveness of this model. Despite the disruption associated with the pandemic and the rapid implementation of the “flipped” rotations, students continued to rate the overall experiences as highly as traditional clinical rotations. Students also performed similarly on standardised exams when compared to cohorts from other classes at the same experience level.

Implications

While borne out of necessity during a pandemic, the lessons learned from our implementation of a “flipped” rotations model can be applied to address problems of capacity and clinical preparedness in the clinical setting.

A Comparison of the Flipped Classroom Model for Medical Student Education in Ophthalmology before and during the COVID-19 Pandemic

Background The coronavirus disease 2019 (COVID-19) pandemic has necessitated a shift of medical education to online learning in lieu of traditional clinic-based rotations. The flipped classroom model, which has been shown to be an effective approach to the medical student ophthalmology curriculum, shows promise as a method of learning that can be shared virtually. As such, the aim of this study was to investigate the effectiveness of a flipped classroom approach to the primary care-focused ophthalmology clerkship delivered entirely online in the face of the COVID-19 pandemic.

Methods Medical students who completed the 2-week introductory clinical ophthalmology clerkship from July 2019 to July 2020 were included in this study. The curriculum centers on a flipped classroom model and was delivered in person prior to March 2020, after which it transitioned to an online format for 5 months. A survey was administered to students completing this rotation, which utilized 6-point Likert scales to assess students' interest in the field of ophthalmology, perceptions of the flipped classroom curriculum, and confidence in evaluating ophthalmic complaints. The cohort that completed in-person learning was then compared with the cohort that completed online learning.

Results A total of 112 responding students were included in our analysis, with 68/82 students from the in-person cohort and 44/66 students in the online cohort responding to the survey. Students who participated in the online virtual clerkship were equally likely to feel comfortable evaluating eye complaints than those who participated in the in-person clerkship, and more likely to report that the course enhanced their interest in ophthalmology. However, online students were less likely to feel comfortable using the direct ophthalmoscope compared with those in the in-person cohort.

Conclusion Regardless of its mode of delivery, the flipped classroom model is able to impart confidence in evaluating ophthalmic complaints and interest in the field of ophthalmology to medical students. While online learning can never serve as a full replacement for learning physical examination skills and other important clinical experiences, there are aspects of the virtual flipped classroom that do not compromise student's learning and engagement and may be implemented into curricula even after clinical activities are allowed to resume.

Use of Commercially Produced Medical Education Videos in a Cardiovascular Curriculum: Multiple Cohort Study

BACKGROUND

Short instructional videos can make learning more efficient through the application of multimedia principles, and video animations can illustrate the complex concepts and dynamic processes that are common in health sciences education. Commercially produced videos are commonly used by medical students but are rarely integrated into curricula.

OBJECTIVE

Our goal was to examine student engagement with medical education videos incorporated into a preclinical Cardiovascular Systems course.

METHODS

Students who took the first-year 8-week Cardiovascular Systems course in 2019 and 2020 were included in the study. Videos from Osmosis were recommended to be watched before live sessions throughout the course. Video use was monitored through dashboards, and course credit was given for watching videos. All students were emailed electronic surveys after the final exam asking about the course's blended learning experience and use of videos. Osmosis usage data for number of video views, multiple choice questions, and flashcards were extracted from Osmosis dashboards.

RESULTS

Overall, 232/359 (64.6%) students completed surveys, with rates by class of 81/154 (52.6%) for MD Class of 2022, 39/50 (78%) for MD/MPH Class of 2022, and 112/155 (72.3%) for MD Class of 2023. Osmosis dashboard data were available for all 359 students. All students received the full credit offered for Osmosis engagement, and learning analytics demonstrated regular usage of videos and other digital platform features. Survey responses indicated that most students found Osmosis videos to be helpful for learning (204/232, 87.9%; P=.001) and preferred Osmosis videos to the traditional lecture format (134/232, 57.8%; P<.001).

CONCLUSIONS

Commercial medical education videos may enhance curriculum with low faculty effort and improve students' learning experiences. Findings from our experience at one medical school can guide the effective use of supplemental digital resources for learning, and related evaluation and research.