A Meta-Analysis of Outcomes Comparing Flipped Classroom and Lecture

Effects of flipped classroom teaching in anaesthesiology residents: a protocol for systematic review and meta-analysis

INTRODUCTION

The flipped classroom teaching model is widely used in medical education and is indicated to be better than traditional lecture approaches in many medical specialties. Emerging studies have evaluated the effects of the flipped classroom teaching model on anaesthesiology residents. This protocol aims to perform a systematic review and meta-analysis to determine whether the flipped classroom teaching model is superior to traditional teaching methods for anaesthesiology residents.

METHODS AND ANALYSIS

Seven databases, including PubMed, Web of Science, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure, Wanfang Data and the VIP database, will be systematically searched from their inception to 1 June 2024. Randomised controlled trials that compared the effects of flipped classrooms versus traditional teaching methods in anaesthesiology residents will be included. The primary outcome will be the theoretical knowledge score. The secondary outcomes will include skill scores and the proportion of anaesthesiology residents who preferred the flipped classroom model. RevMan V.5.4 software will be used to perform the statistical analysis. The Grading of Recommendation, Assessment, Development and Evaluation approach will assess the quality of evidence.

ETHICS AND DISSEMINATION

Ethical approval is not applicable to this protocol. The results of this study will be submitted to a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42024497935.

Flipped classroom in neurophysiology: performance analysis of a system focusing on intrinsic students' motivation

Introduction: Teaching methodologies promoting active learning result in higher-order knowledge application, a desirable outcome in health disciplines like Physiology. Flipped-classroom (FC) promotes active learning and engagement in the classroom. Although specialized research keeps accumulating, the advantages of FC for improving academic outcome and ultimately patient care remain controversial and open to further analysis. Objective: This study evaluates the benefits of applying FC to the Neurophysiology module of a Human Physiology course. Methods:We compare final grades of students exposed to standard lecturing (five-years) vs. FC (six-years), and study the FC impact on student motivation, study time and rewards. Differing from conventional FC, we performed no pre-class/in-class assessments, relying on the students' internal motivation to experience our FC model. A printed student workbook was designed as pre-class material for each session. Reading times respect the expected daily study time of students in our system. Results and discussion: Concerning academic performance, our long-term study reports a significant increase in average scores for FC groups. Overall, students get better scores in multiple choice tests than in problem-solving questions. A more detailed analysis uncovers that our FC model helps students to obtain better scores, reducing variability in performance due to assessment methods. Based on our open-ended survey questions, most students rate the FC environment and in-class activities positively and perceive a positive effect of FC on teachers' performance. An objective automatic Sentiment analysis of open-ended answers reveals that FC is positively appreciated by students, associating positive perceptions to their understanding of physiological concepts, and negative evaluations to their time management.

Comparison of Didactic Lectures and Activity-Based Learning for Teaching First-Professional MBBS Students in the Subject of Anatomy

Background In the field of medical education, traditional methods of teaching and learning have been used for a long time. Various new methods of learning, like activity-based learning (ABL), case-based discussion (CBD), and problem-based learning (PBL), are laying the foundation for this modern era of teaching. This study was a comparative study conducted to determine the effectiveness of activity-based learning and traditional lectures by teaching two topics to MBBS first-year professional students. Aims The study compares the effectiveness of didactic lectures and activity-based learning for MBBS first-year professional students in the subject of anatomy.  Methodology The study was conducted in the Department of Anatomy Hind Institute of Medical Sciences, Barabanki, and included 100 MBBS (2022-2023) first-year students randomly assigned to Group A (n=50, 16 females and 34 males) and Group B (n=50, 23 females and 27 males) through chit methods. The participants were exposed to two different topics of anatomy in the form of activity-based learning as well as didactic lectures. Assessments were done immediately after the exposure in the form of a post-test, and results were analyzed for both groups. Result The results of the study showed that both activity-based learning and didactic lectures were effective in teaching the two topics, but the didactic lecture group had higher retention rates than the activity-based learning group. The mean score of post-tests of students who attended a didactic lecture on the brachial plexus (6.166± 2.11) was slightly higher than that obtained by students who attended activity-based learning (5.625 ± 2.12), but the p-value obtained was not significant (0.249). Whereas the mean of the scores of the post-test obtained by students who attended a didactic lecture on mammary gland was (8.45± 1.20), slightly lower than the mean of the scores of the post-test of students who attended activity-based learning on mammary gland (8.60± 1.16), but the p-value obtained was not significant (0.520). Conclusion This study provides evidence that didactic lectures play an important role in teaching anatomy to MBBS first-year students and cannot be replaced by activity-based learning alone. Lectures followed by activity-based learning can prove to be a newer and more effective teaching-learning method with better outcomes in the form of retention and conceptual understanding of the topics in anatomy.

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.

The effects of flipped classrooms to improve learning outcomes in undergraduate health professional education: A systematic review

Background

The 'flipped classroom' approach is an innovative approach in educational delivery systems. In a typical flipped class model, work that is typically done as homework in the didactic model is interactively undertaken in the class with the guidance of the teacher, whereas listening to a lecture or watching course-related videos is undertaken at home. The essence of a flipped classroom is that the activities carried out during traditional class time and self-study time are reversed or 'flipped'.

Objectives

The primary objectives of this review were to assess the effectiveness of the flipped classroom intervention for undergraduate health professional students on their academic performance, and their course satisfaction.

Search Methods

We identified relevant studies by searching MEDLINE (Ovid), APA PsycINFO, Education Resources Information Center (ERIC) as well as several more electronic databases, registries, search engines, websites, and online directories. The last search update was performed in April 2022.

Selection Criteria

Included studies had to meet the following criteria: Participants: Undergraduate health professional students, regardless of the type of healthcare streams (e.g., medicine, pharmacy), duration of the learning activity, or the country of study. Intervention: We included any educational intervention that included the flipped classroom as a teaching and learning tool in undergraduate programs, regardless of the type of healthcare streams (e.g., medicine, pharmacy). We also included studies that aimed to improve student learning and/or student satisfaction if they included the flipped classroom for undergraduate students. We excluded studies on standard lectures and subsequent tutorial formats. We also excluded studies on flipped classroom methods, which did not belong to the health professional education(HPE) sector (e.g., engineering, economics). Outcomes: The included studies used primary outcomes such as academic performance as judged by final examination grades/scores or other formal assessment methods at the immediate post-test, as well as student satisfaction with the method of learning. Study design: We included randomised controlled trials (RCTs), quasi-experimental studies (QES), and two-group comparison designs. Although we had planned to include cluster-level RCTs, natural experiments, and regression discontinuity designs, these were not available. We did not include qualitative research.

Data Collection and Analysis

Two members of the review team independently screened the search results to assess articles for their eligibility for inclusion. The screening involved an initial screening of the title and abstracts, and subsequently, the full text of selected articles. Discrepancies between the two investigators were settled through discussion or consultation with a third author. Two members of the review team then extracted the descriptions and data from the included studies.

Main Results

We found 5873 potentially relevant records, of which we screened 118 of them in full text, and included 45 studies (11 RCTs, 19 QES, and 15 two-group observational studies) that met the inclusion criteria. Some studies assessed more than one outcome. We included 44 studies on academic performance and eight studies on students' satisfaction outcomes in the meta-analysis. The main reasons for excluding studies were that they had not implemented a flipped class approach or the participants were not undergraduate students in health professional education. A total of 8426 undergraduate students were included in 45 studies that were identified for this analysis. The majority of the studies were conducted by students from medical schools (53.3%, 24/45), nursing schools (17.8%, 8/45), pharmacy schools (15.6%, 7/45). medical, nursing, and dentistry schools (2.2%, 1/45), and other health professional education programs (11.1%, 5/45). Among these 45 studies identified, 16 (35.6%) were conducted in the United States, six studies in China, four studies in Taiwan, three in India, two studies each in Australia and Canada, followed by nine single studies from Brazil, German, Iran, Norway, South Korea, Spain, the United Kingdom, Saudi Arabia, and Turkey. Based on overall average effect sizes, there was better academic performance in the flipped class method of learning compared to traditional class learning (standardised mean difference [SMD] = 0.57, 95% confidence interval [CI] = 0.25 to 0.90, τ 2: 1.16; I 2: 98%; p < 0.00001, 44 studies, n = 7813). In a sensitivity analysis that excluded eleven studies with imputed data from the original analysis of 44 studies, academic performance in the flipped class method of learning was better than traditional class learning (SMD = 0.54, 95% CI = 0.24 to 0.85, τ 2: 0.76; I 2: 97%; p < 0.00001, 33 studies, n = 5924); all being low certainty of evidence. Overall, student satisfaction with flipped class learning was positive compared to traditional class learning (SMD = 0.48, 95% CI = 0.15 to 0.82, τ 2: 0.19, I 2:89%, p < 0.00001, 8 studies n = 1696); all being low certainty of evidence.

Authors' Conclusions

In this review, we aimed to find evidence of the flipped classroom intervention's effectiveness for undergraduate health professional students. We found only a few RCTs, and the risk of bias in the included non-randomised studies was high. Overall, implementing flipped classes may improve academic performance, and may support student satisfaction in undergraduate health professional programs. However, the certainty of evidence was low for both academic performance and students' satisfaction with the flipped method of learning compared to the traditional class learning. Future well-designed sufficiently powered RCTs with low risk of bias that report according to the CONSORT guidelines are needed.

Comparison of pharmacy student performance in a self-care therapeutics course conducted as a flipped classroom on-campus and remotely

BACKGROUND

The COVID-19 pandemic required the University of Arizona R. Ken Coit College of Pharmacy's Self-Care Therapeutics course to be taught as a synchronous, live online course. The course has traditionally utilized a flipped-classroom to increase student engagement and improve learning performance. The goal of this study is to compare student performance in a flipped-classroom self-care therapeutics course taught to students attending class on-campus versus online via web-conferencing.

METHODS

This study assessed examination performance of 118 students that took the class on-campus in 2019 and 125 students that took the class online in 2020. Course design was similar between the two cohorts, with each completing assigned pre-reading, an associated short multiple-choice quiz, in-class small group discussions and in-class large group faculty-led debrief. Both cohorts took pre-class quizzes and three examinations to assess their knowledge. Exam, quiz, overall class performance, and student experience was compared for the 2019 on-campus attending cohort and the 2020 online attending cohort.

RESULTS

No statistical differences were seen in the overall exam performance, the final course score, and the student experience between cohorts. Statistical differences (p = 0.02) were found between cohorts for the overall quiz performance, with the on-campus attending cohort performing slightly better than the online attending cohort (mean score of 88% compared to 84.4%).

CONCLUSION

Examination performance was similar for students taking a flipped-classroom course online and on-campus. Further research using data from multiple courses or from the same cohort, randomized, is needed to improve the internal and external validity of these findings.

Student Pharmacists' Perspectives Regarding a Virtually Delivered Research Proposal Course in the Doctor of Pharmacy Curriculum

This study aimed to assess third-year student pharmacists' perspectives regarding a virtually delivered research proposal course. A 23-item questionnaire was distributed to third-year student pharmacists enrolled in a research proposal course over three weeks in April 2021. The questionnaire contained 15 Likert-scale items, seven descriptive items, and a free-text item for additional comments about the course. Items were summarized using descriptive statistics. Fifty-four student pharmacists (response rate = 40.9%) participated in the survey. The student pharmacists surveyed generally had a positive perception of the virtually delivered research proposal course with median scores ≥ 4 (indicating agreement) for the majority (13/15) of survey items. Students did not agree that there was no difference in their motivation to succeed in the virtual course versus an in-person course and did not agree that they were more likely to pursue a career that involves undertaking a research project. This study found that student pharmacists generally had a positive perception of a virtually delivered research proposal course. These findings offer some support for the provision of an online, virtually delivered research proposal course for student pharmacists. Further research with a larger sample of students from multiple pharmacy schools is needed to improve the generalizability of the results.

The Medical Student Experience With Prework

OBJECTIVES

The objective of this study is to better understand the medical student experience with prework to determine what factors influence their motivation to complete prework.

INTRODUCTION

Medical education has been shifting to more active learning-type sessions such as flipped classrooms but these activities are unsuccessful when students do not complete the associated prework. The literature is lacking on why students do not complete prework and what would motivate them to do so. This qualitative study aims to answer those questions through the view of expectancy-value motivation theory.

METHODS

Thirteen preclinical medical students participated in a semistructured basic interview study investigating their experience with prework. Interview transcripts were coded, and codes were clustered and analyzed for themes.

RESULTS

Students develop particular routines they find successful for their studies. They explain how time in their schedules and the amount of time prework takes to complete plays a role in their study environment which must be favorable in order to complete prework. Students view video prework more favorably compared to reading assignments. Students note how the opinions of their peers influence their decision to complete prework. Each of these factors influences student motivation to complete prework.

CONCLUSION

This study finds that motivation to complete prework is influenced by the environment, format, and use of prework, student interest and prior knowledge, and peer influence. The combination of these factors determines whether a student believes they are capable of completing prework and if they find it valuable. In order to increase motivation to complete prework, faculty should consider how to address these factors in a way that students are able to fit prework into their study routines. This study provides the first step in understanding the medical student experience with prework and suggests directions for future studies to maximize student motivation to complete prework.

Active learning: a consideration in collection development in health sciences libraries?

Purpose

Active learning is an important component of medical education and information literacy instruction. The purpose of this study is to provide a preliminary investigation to determine whether health sciences librarians consider active learning when making decisions about the library collection.

Design/methodology/approach

An online survey was conducted among health sciences librarians.

Findings

Nineteen librarians completed the survey and most are not considering active learning when making collection decisions.

Originality/value

Very little literature has been published about active learning as a consideration in collection development decisions by health sciences librarians.

Ters Yüz Sınıf Modelinin Hemşirelik Öğrencilerinin Yaşamsal Belirti Becerileri Üzerindeki Öğrenme Etkileri: Yarı Deneysel Bir Çalışma

Amaç: Bu çalışmanın amacı, ters yüz sınıf sınıf öğrenme modeli ile verilen eğitimin hemşirelik psikomotor, bilişsel ve becerilerine etkisini değerlendirmektir.Yöntem: Çalışmada yarı deneysel deney (n=40) ve kontrol gruplu (n=40), ön son test ölçümleri olan bir bir tasarım kullanıldı. Deney grubu yaşamsal bulgular modülünde teorik ve pratik öğretimde ters yüz eğitim modeli ile eğitim alırken, kontrol grubunda sadece geleneksel öğretim modeli ile eğitim aldılar. Öğrenci performanslarını değerlendirmek için bir bilgi testi ve beceri kontrol listesi kullanıldı.Bulgular: Post-test bilgi sınavı ve beceri sınavlarında en yüksek puanları ters yüz sınıf eğitimi alan öğrenciler aldı (sırasıyla X̄ =62.15±16.55; X̄ =45.25±14.77). Ayrıca gruplar arası psikomotor beceri sınavı post-test toplam puanları incelendiğinde, deney grubunun kontrol grubuna göre daha yüksek puanlar aldığı bulundu (sırasıyla X̄=38.92±0.85, X̄=30.79±1.41).Sonuç: Ters yüz sınıf modelinin hemşirelik eğitiminde kullanılmasının hem teorik bilgileri hem de psikomotor beceri kazanımını olumlu yönde etkilediği bulundu.

Evaluating the impact of a flipped classroom model based on cognitive science of learning strategies in a pharmacotherapy course

INTRODUCTION

The purpose of this study was to determine the impact of a flipped classroom method based on cognitive science of learning strategies on student performance and experience in a third-year pharmacotherapy course.

METHODS

The cognitive science of learning flipped classroom (CSL-FC) strategies in this study included pre-class learning (Preview), in-class application to cases (Retrieval), after-class learning (Spaced Retrieval), and post-module reflection (Deliberate Reflection) in a required pharmacotherapy course. During fall 2017, one instructor piloted the CSL-FC method. During fall 2018, this method expanded to four instructors. All other instructors used traditional lecture-based methods. The same multiple-choice exam questions were used both years. The average exam question scores between teaching methods were compared by independent t-test. Student focus groups were conducted after the 2017 semester. In 2018, students were surveyed using a 5-point Likert rating (1 = strongly agree, 5 = strongly disagree) to evaluate their experience.

RESULTS

The 2017 and 2018 classes included 132 and 137 students, respectively. During the two years, exam question scores were significantly better with CSL-FC (n = 136 questions) compared to traditional (n = 110 questions) (88.8% vs 84.9%, respectively; P = .02). The focus group analysis revealed three main themes including a "love-hate relationship," "time," and "it works." Student agreement to the survey question "the cognitive science of learning flipped classroom helped me learn" was 2.18 (SD 1.12).

CONCLUSIONS

Implementing a flipped classroom approach based on cognitive science of learning strategies positively impacted student performance and experience in a pharmacotherapy course.

The Effectiveness of Flipped Classroom during the COVID-19 Pandemic in Higher Pharmaceutical Education

BACKGROUND: Despite the apparent advantages of the flipped classroom model especially during a pandemic or natural or technogenic disasters, its overall effectiveness in higher medical and pharmaceutical education continues to be debated. AIM: The goal of the study was to test the effectiveness and acceptability of using the flipped classroom model during the COVID-19 pandemic in higher pharmaceutical education based on the example of the “Pharmaceutical Marketing” discipline at Sechenov First Moscow State Medical University, Russia. METHODS: The study involved 156 fourth-year pharmacy students. They were divided into three clusters: FC – studying in accordance with the flipped classroom model, FC+TBL – using the flipped classroom technology combined with the team-based method, and CC – studying by the traditional scheme (control). The study used the Unified educational portal of the Sechenov University. Additional elements were developed for the electronic educational and methodical complex for the studied section “Analysis of the marketing environment of a pharmaceutical organization.” The effectiveness of the flipped classroom model was evaluated through test control (entrance, formative, thematic, and final) and control of the development of skills and abilities in solving situational problems (thematic and final). The study participants’ attitude toward the use of the flipped classroom model was assessed through a survey. RESULTS: The study demonstrated that students from the FC and FC+TBL clusters were significantly better prepared for practical lessons and worked more effectively and productively during these classes compared to the CC cluster students. The results of the final control also substantiate the advantages of the flipped classroom technology both in assessing practical skills and abilities and in testing. The opportunities for rational implementation of the complex technology (FC+TBL cluster) are identified. CONCLUSIONS: The analysis of students’ general opinion on the flipped classroom model shows that 90.4% of the FC cluster members and 84.6% of the FC+TBL cluster members are satisfied with the results of using this model and consider it suitable for studying both the “Analysis of the marketing environment of a pharmaceutical organization” section and the entire pharmaceutical marketing course. Students’ positive feedback on the use of the flipped classroom model provides grounds for further implementation of this technology in the “Pharmaceutical Marketing” discipline in its entirety and demonstrates that further research on the use of other blended learning models is quite promising.

Course design, delivery, and assessment strategies for pharmaceutical calculations course in a doctor of pharmacy program: A review

BACKGROUND

Pharmaceutical calculations is a fundamental course taken by doctor of pharmacy students in United States schools and colleges of pharmacy. To minimize medical errors and increase the accuracy with which future pharmacists perform calculations, a comprehensive training during the program is deemed. This review attempts to summarize research outcomes of interventions described thus far in the literature concerning the improvement of course design, delivery, and assessment strategies.

METHODS

A detailed literature review of various educational resources was conducted using pharmaceutical calculations and related terms.

RESULTS

The literature review outcomes were divided into three major categories: educational interventions in design, delivery, and assessment of pharmaceutical calculations courses. The research findings of course design describe a standalone course vs. an integrated course, a computer-aided course, use of compact disc read-only memory, and implementation of Gagne's Nine Events of Instructions. Findings in course delivery include the use of self-paced vs. integrated courses, flipped classroom vs. traditional lecture, Keller's Personalized System of Instruction, condensed videos, and podcasts. Finally, different types of assessments are presented such as those based on selected- vs. constructed-response questions, collaborative quizzes, the approach of repeated testing, and the use of technology.

IMPLICATIONS

While the review intends to present educational interventions available to construct and/or modify an existing pharmaceutical calculations course, the choice of design, delivery, and assessment approaches depends upon various factors such as the purpose of course modification, resources available, and the number of students in class.

Flipped Classroom versus Traditional Didactic Classroom in Medical Teaching: A Comparative Study

Background

The effective and efficient delivery of healthcare services that the National Medical Commission (NMC), India desires from Indian Medical Graduate (IMG) can only be fulfilled if the learner’s participation is extensive. Flipped classroom (FC) may promote enhanced as well as meaningful learning and critical thinking in students. By implementing this method trend can be changed from a teacher-centered approach to a student-centered approach, thus teaching-learning becomes more effective and interesting. It promotes learning and thinking helping the students in diagnosis and formulating appropriate management of patients during the clinical years of medical teaching of MBBS (Bachelor of Medicine and Bachelor of Surgery) and thereafter.

Aim

To compare FC and traditional didactic classroom (TDC) teaching for first-year MBBS students.

Objectives

-To evaluate FC method teaching for first-year MBBS students.

-To compare effectiveness of FC and TDC teaching for first-year MBBS students.

-To evaluate perception of students toward FC teaching method.

Methodology

The study was conducted after getting approval from the Institutional Ethics Committee. Total of 100 students volunteered to participate in the study after providing informed consent. Two groups based on pseudo randomization were created and subjected to the FC method and TDC method in module A and crossover of groups was done in module B. Both groups were subjected to post-test after intervention in modules. Feedback was obtained from students on their perception toward the FC method.

Results

There was a statistically significant difference (p<0.05) in post-test scores of both FC groups in both modules (FC Method: 14.77 ± 2.16 and 11.26 ± 1.76 vs TDC Method: 12.16 ± 2.05 and 10.03 ± 2.57). Overall positive feedback was received for FC method of teaching compared to TDC method.

Conclusions

Considering responses and results of the assessment, it can be concluded that the FC approach is beneficial for students. It enhances the learning of students. Perception of students toward medical teaching can be greatly improved. It helps students achieve better results in their learning. With larger sample size studies, this result of FC method being a better learning tool will gather more strength.

Promoting Pre-service Teacher Students' Learning Engagement: Design-Based Research in a Flipped Classroom

Students' learning engagement is recognized as one of the main components of effective instruction and a necessary prerequisite for learning, but students' learning engagement in flipped classroom poses some pedagogical challenges. This study aimed to promote students' learning engagement via the flipped classroom approach. Design-based research (DBR) was adopted in this study to conduct an experiment involving three iterations in a Modern Educational Technology (MET) course in a Chinese university. The participants included 36 third-year pre-service teacher undergraduates. Classroom observations and a learning engagement questionnaire were used to measure the effectiveness of the flipped instruction in terms of students' learning engagement. Data analysis applied descriptive statistics, ANOVA, and paired samples t tests. The results showed that after three rounds of iterative experiments, students' learning engagement (behavioral, cognitive, and emotional) significantly improved. Several principles are provided as guidelines for instructors to implement flipped classroom approach to promote students' learning engagement.

Application of WeChat-based flipped classroom on root canal filling teaching in a preclinical endodontic course

BACKGROUND

This study was aimed to evaluate the application of WeChat-based flipped classroom in root canal filling teaching in a preclinical endodontic course.

METHODS

A two-group comparative study was designed. The pre-class test, on-site quiz, and root canal filling on extracted premolars were performed by students from a lecture-based classroom group (LG, n = 30) and a WeChat-based flipped classroom group (WFG, n = 30). Results of the Pre-class test and on-site quiz were analyzed by independent samples t-test. Post-filling radiographs were taken and evaluated by a specialist in oral radiology who was blinded to grouping. Results of root canal fillings were analyzed by the Pearson chi-square test. Student responses in questionnaires were analyzed by Fisher's exact test.

RESULTS

The students in WFG could get significantly higher scores in the on-site test and make better performances in root canal filling than those in LG. In terms of questionnaires, students from WFG were perceived to be more motivated to learn, better to understand the knowledge, better to improve communication and clinical skills, easier to perform root canal filling but spending more time.

CONCLUSION

The WeChat-based flipped classroom teaching can have a better effect than lecture-based teaching on root canal filling learning for students with limited endodontic experiences.

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

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

The flipped classroom in medical education: A new standard in teaching

Many medical educators, out of necessity imposed by the COVID-19 pandemic, had to flip their classrooms. However, instead of adapting to this new teaching style, many have proceeded in the manner that they have always used to create content, opening a slide deck and inserting content until they are satisfied with the result. When in fact, we know based on evidence and our own experience, that educators should first plan, organize, and storyboard before collecting information into a presentation [1,2]. If educators need to replace real-world teaching and interaction, we believe the next best option is video education, although there are other forms of prework that can be utilized to flip medical classrooms, including short readings and exercises. We discuss the case for flipping medical classrooms, the limitations, and how educators can get started flipping their classrooms today.

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

Background and Objective:

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

Methods:

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

Results:

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

Conclusion:

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

Enhancing the effectiveness of flipped classroom in health science education: a state-of-the-art review

BACKGROUND

In a flipped classroom, students acquire knowledge before class and deepen and apply this knowledge during class. This way, lower-order learning goals are achieved before class and higher-order skills are reached during class. This study aims to provide an overview of the factors that contribute to the effectiveness of the flipped classroom and how these factors can be stimulated. The effectiveness of the flipped classroom is conceptualized in this study as test scores, the achievement of higher learning goals, and student perceptions.

METHODS

A state-of-the-art review was conducted. The databases MEDLINE, PsycINFO, PubMed, Web of Science, and Scopus were consulted. The timeframe is 2016 till 2020. The studies were qualitatively analyzed according to the grounded theory method.

RESULTS

After screening the studies based on the inclusion-and exclusion criteria, 88 studies were included in this review. The qualitative analysis of these studies revealed six main factors that affect the effectiveness of the flipped classroom: student characteristics, teacher characteristics, implementation, task characteristics, out-of-class activities, and in-class activities. Mediating factors are, amongst other factors, the learner's level of self-regulated learning, teacher's role and motivation, assessment approach, and guidance during self-study by means of prompts or feedback. These factors can be positively stimulated by structuring the learning process and focusing the teacher training on competencies and learning-and teaching approaches that are essential for the flipped classroom.

CONCLUSION

This paper provides insight into the factors that contribute to the effectiveness of the flipped classroom and how these factors could be stimulated. In order to stimulate the effectiveness of the flipped classroom, the positively and negatively affecting factors and mediating factors should be taken into account in the design of the flipped classroom. The interventions mentioned in this paper could also be used to enhance the effectiveness.

Do Medical Students' Learning Styles and Approaches Explain Their Views and Behavior Regarding Lecture Attendance?

INTRODUCTION

Medical students' attendance at lectures, particularly in the preclinical years, has been steadily declining over the years. One of the many explanations offered for this observation is that students have different learning styles and approaches, such that not all of them benefit from attending lectures; however, no studies have specifically examined this possibility. While there is evidence against learning styles as affecting objective measures of learning, they are associated with subjective measures of learning and may therefore influence student behavior. We hypothesized that students' learning styles and/or approaches influence their views about the value and purpose of lectures and their motivation to attend them, which, in turn will affect their behavior.

MATERIALS AND METHODS

A LimeSurvey was distributed to all preclinical students at the American University of Beirut. The survey included questions about demographic data, self-reported attendance rates in Year 1 of medical school, two validated and standardized questionnaires assessing the students' learning styles (visual, auditory, kinesthetic, tactile, group, individual) and learning approaches (superficial, deep, strategic), and a series of questions exploring the students' views about the purpose and value of lectures and their motivation to attend lectures.

RESULTS

No associations were found between learning styles or approaches and attendance rates, but this may have been confounded by the mandatory attendance policy at the time. There were, however, a few positive associations between some learning styles or approaches and the students' views about the value of attending lectures. In particular, students with high scores as auditory learners tended to see absolutely no value in attending lectures, and those with high scores as group, auditory or visual learners, tended to see less value in taking their own notes in lectures. Students with superficial approaches to learning felt that watching videos of a lecture provides equivalent education to attending a lecture. There were no statistically significant associations with either the perceived purpose of lectures or the motivation to attend lectures after correction for multiple testing.

CONCLUSIONS

This study reveals that except for some interesting findings related to auditory learners, differences in learning styles or approaches among students cannot adequately explain differences in their attitudes, and likely, behavior, regarding lecture attendance. The idea that learning styles and approaches can influence educational preferences and outcomes, while attractive and intuitive, continues to require supporting evidence.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01362-3.

Effectiveness of blended learning in pharmacy education: An experimental study using clinical research modules

BACKGROUND &OBJECTIVES

Though there are studies to evaluate the effectiveness of blended learning in pharmacy education, most of them originate from USA and have used previous year students' scores as control. Also there is less research in comparing use of self -regulated learning strategies between blended and other learning strategies. Primary aim was to evaluate the effectiveness of blended learning on knowledge score using clinical research modules. Secondary objective was designed to compare the use of self-regulated learning strategies between blended learning, web-based e-learning and didactic teaching.

MATERIALS AND METHODS

A prospective cluster randomized trial was conducted with didactic teaching as control and web-based e-learning and blended learning as interventions. The target population was final year Pharm D students. Outcome was assessed using a validated knowledge questionnaire, a motivated strategies for learning questionnaire and a feedback form. All statistical analyses were carried out using Statistical Package for Social Science (SPSS) Version 20.

RESULTS

A total of 241 students from 12 colleges completed the study. Mean knowledge score of students in blended learning group was higher than those in the didactic teaching and web- based e- learning program (64.26±18.19 Vs 56.65±8.73 Vs 52.11±22.06,p<0.001).Frequency of use of learning strategies namely rehearsal, elaboration, organization and critical thinking was statistically significantly higher in the blended learning group compared to those of didactic and web-based e-learning group (p<0.05) But there were no statistically significant difference of motivational orientations between didactic and blended learning group except strategies of extrinsic goal orientation and self-efficacy. Students preferred blended learning (86.5%) over didactic and web-based e-learning.

CONCLUSION

Blended learning approach is an effective way to teach clinical research module. Students of blended learning group employed all motivational and learning strategies more often than students of the didactic and web- based e-learning groups except strategies of intrinsic goal orientation, task value, control of learning belief and help seeking.

Medical Education in Pathology: General Concepts and Strategies for Implementation

CONTEXT.—

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

OBJECTIVES.—

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

DATA SOURCES.—

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

CONCLUSIONS.—

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

Methadone for Palliative Care Providers: A Case-Based Flipped Classroom Module for Faculty and Fellows

INTRODUCTION

Methadone is an effective medication for treating pain and has unique characteristics that require specialized knowledge to prescribe safely. Palliative care providers use methadone for analgesia in patients with a wide range of prognoses, goals of care, and comorbid conditions. New consensus guidelines for methadone use released in 2019 by the American Academy of Hospice and Palliative Medicine provide guidance for safe use in patients who have potentially life-limiting illnesses. A needs assessment of palliative care fellows and faculty at our institution highlighted lack of knowledge and confidence with regard to prescribing methadone.

METHODS

We created a virtual, flipped classroom, interactive learning module intended for palliative care fellows and practicing clinicians that emphasized updated practice recommendations. Participants took a pretest, reviewed an article and lecture, and completed practice cases prior to an interactive session conducted via videoconference. Following the session, participants completed a posttest to assess knowledge and confidence regarding the learning objectives.

RESULTS

A total of 28 clinicians at the fellow and faculty/staff levels completed the intervention during two sessions in 2020. Self-reported confidence in all educational objectives improved following the intervention. Participants demonstrated improved skill in calculating methadone doses, converting between modes of drug administration, and identifying safety guidelines during and after the intervention.

DISCUSSION

Following the intervention, participants reported improved confidence and demonstrated improved skills in prescribing methadone for pain. Additional benefits of this training model include ease of implementation, engaging format, and time and resource efficiency given its virtual format.

Effectiveness of Integrated Google Classroom, Reciprocal Peer Teaching and Flipped Classroom on Learning Outcomes of Research Methodology: A Natural Experiment

Background

To maintain physical distancing for reducing the spread of COVID-19, online learning appears to be a viable option to carry on teaching and learning.

Aim

The aim of study was to assess the effectiveness of integrated flipped classroom and reciprocal peer teaching (RPT) using Google Classroom as a learning management system (LMS) for teaching and learning, a module of Research Methodology. We also aimed to assess learner’s satisfaction.

Methods

An educational interventional study was conducted with 17 students enrolled in the Master of Public Health course, All India Institute of Medical Sciences, Rishikesh, for one month. As per protocol development and integration were conducted and validated pre- and post-tests were held for assessment of knowledge and skill component. Class normalized learning gain was used as objective measure for improvement in knowledge and skill. Students' feedback was collected using a structured questionnaire at the end of module.

Results

Mean test scores of knowledge and skill, improved significantly from 26.4 (11.95) to 33.64 (6.63) and 17.88 (5.7) to 62.76 (18.18) respectively. Class average normalized gain for knowledge and skill was 30.28% and 55.67, respectively. Students agreed that online learning imparted good understanding, at comfortable pace, opportunity for interaction. Students felt poor network affected their learning.

Conclusion

The study concluded that flipped classroom and RPT integrated with Google Classroom is an effective intervention.

Blended Learning on Blood Pressure Measurement: Investigating Two In-Class Strategies in a Flipped Classroom-Like Setting to Teach Pharmacy Students Blood Pressure Measurement Skills

For reliable blood pressure measurement, various potential sources of inaccuracies need to be considered to avoid incorrect decision-making. Pharmacy students should be sensitized and taught the skill accordingly. One strategy to teach students’ blood pressure measurement skills might be through a blended learning approach in a flipped classroom-like setting. With a randomized two-arm study among pharmacy students in their eighth semester, the required extent of in-class session in the scope of a blended learning approach in a flipped classroom-like setting was evaluated. Participants’ self-confidence and self-perceived proficiency were evaluated through a survey, and participants’ blood pressure measurement performance was assessed by objective structured clinical examination (OSCE). Participants’ satisfaction with, and perception of, the flipped classroom were also surveyed. The extended in-class activities did not result in a significantly higher increase of participants’ OSCE score and self-assessment score when compared to the brief in-class session. Both in-class sessions yielded a significant increase in the OSCE scores as well as in the self-assessment scores. Moreover, the teaching approaches were predominantly well-received by the students. The use of both flipped classroom-like approaches improved pharmacy students’ blood pressure measurement performance, though the brief in-class session was sufficient. Students’ self-confidence/self-perceived proficiency in blood pressure measurement skills increased similarly in both settings.

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

Background & objective

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

Methods

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

Key findings

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

Conclusion

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

Teaching advanced pharmacy practice experience students to be effective teachers of second-year pharmacotherapy students

INTRODUCTION

Academic advanced pharmacy practice experiences (APPEs) are unique elective opportunities for student pharmacists to engage with and learn about academia. The purpose of this research was to determine the impact of second-year (PY2) student participation in fourth-year (PY4) academic APPE student-delivered review sessions on individual pharmacotherapy examination scores.

METHODS

The PY2 cohort was evaluated by comparing their performance against the class average when they did and did not attend a review session. Utilizing a t-test, we sought to determine if there was a significant change in student performance. Qualitative evaluations were also performed on the PY4 students experience during their rotation.

RESULTS

A total of 28 PY2 student pharmacists took a total of 140 exams during the study period. Of the 140 exams taken, 54 individual exams were taken after attending a review session created and led by PY4 student pharmacists and 86 exams were taken in the absence of attending a review session. Analysis showed that student performance on exams after attending a review session was 0.4 SD above the class average, while performance was very close to the class average at 0.05 SD above the class average when review sessions were not attended.

CONCLUSIONS

PY4 student pharmacists trained on an academic APPE can improve PY2 student pharmacists' pharmacotherapy exam scores. APPE students also self-reported positive learning experiences while participating in this teaching.

Medical Student Engagement in a Virtual Learning Environment Positively Correlates with Course Performance and Satisfaction in Psychiatry

INTRODUCTION

There has been a move to a "flipped classroom" (FC) in medical education. The FC promotes active learning and utilizes independent preparation prior to in-class sessions. Few studies have evaluated the effectiveness of the FC approach in medical education, specifically via virtual learning. The purpose of this study evaluates student and faculty perceptions of the FC approach and relationships between student engagement and performance.

METHOD

The first-year medical student psychiatry curriculum was redesigned with an FC approach and subsequently altered by COVID-19 to a virtual learning environment. A mixed-method approach was used to examine both qualitative assessment and quantitative performance data. Students and facilitators were invited to participate in surveys regarding the curriculum changes. Student performance data was collected via quizzes and examinations. Engagement was evaluated by student participation in National Board of Medical Examiners-style multiple-choice questions delivered via Top Hat®. Correlational analyses were used to evaluate associations between engagement and performance. T-tests were used to compare student satisfaction across 2019 and 2020.

RESULTS

Performance on in-class questions was positively associated with class rank and performance (p < 0.005). More students were either satisfied or strongly satisfied (91.5%) in 2020 compared to 85.7% in 2019 (two-tailed t-test, p = 0.04). Most students (81.3%) preferred in-class questions to lectures. In 2020, 62.6% of student comments were positive regarding the psychiatry curriculum vs 33.3% in 2019. Over 61.5% of facilitators felt positive towards the changes.

CONCLUSION

Our results demonstrate a positive relationship between engagement and class performance. Students and facilitators positively perceived the approach, with students preferring in-class questions compared to lectures. Future research should evaluate overall performance on standardized tests, third-year clerkships, and number of students matching into psychiatry.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01287-x.

Massive Open Online Courses-based blended versus face-to-face classroom teaching methods for fundamental nursing course

An increasing number of studies focus on the effectiveness of Massive Open Online Courses (MOOC)-based blended learning, whereas none have yet studied using it for teaching fundamental nursing skills at an undergraduate level.To evaluate the effectiveness of MOOC-based blended learning versus face-to-face classroom teaching techniques within the fundamental nursing course at the Faculty of Nursing, University of Xiang Nan, China.This cluster randomized controlled trial enrolled 181 students and assigned them into either an MOOC-based blended or a face-to-face classroom teaching group, both involving the Fundamental Nursing course for undergraduate nursing students. The analyzed outcomes included test scores, critical thinking ability, and feedback received from the students on the Fundamental Nursing course.MOOC-based blended techniques versus face-to-face classroom teaching methods demonstrated higher daily performance (P = .014), operational performance (P = .001), theoretical achievements (P < .001), and final grades (P < .001) in Fundamental Nursing.Moreover, the mean change in the participants' critical thinking ability items between groups were, mostly, statistically significant. The items focusing on the feedback from the students demonstrated significant differences between the groups in terms of their satisfaction with the teaching they received (P < .001) and the overall learning effects (P = .030).This study confirmed that receiving MOOC-based blended learning was superior when compared against face-to-face classroom teaching techniques for learning within the Fundamental Nursing course.

The flipped classroom: a novel approach to physical examination skills for osteopathic medical students

CONTEXT

Medical students are faced with the challenge of synthesizing large volumes of information quickly. With the increasing accessibility of technology, a "flipped classroom" allows students to learn foundational material independently. Class time is instead devoted to in-depth skill building with instructors, promoting an active learning environment. This method of content delivery is also relevant given the current COVID-19 pandemic.

OBJECTIVES

To comprehensively evaluate the benefit of adopting a flipped classroom approach in teaching physical exam skills (PES) to first-year osteopathic medical students.

METHODS

A cohort study was conducted comparing first-year osteopathic students in the class of 2022 (n=201), who had taken the PES course traditionally, with the class of 2023 (n=203), who experienced the flipped classroom approach. Objective metrics such as cumulative grades, objective structural clinical examination performance (OSCE), and practical exam performance were compared using nonparametric Mann-Whitney U rank sum tests. Subjective measures such as student course evaluations were used to analyze course perceptions using independent sample t-tests assuming unequal variances. A faculty survey was administered to faculty who taught both cohorts to assess instructor attitudes toward the flipped classroom approach. Due to the COVID-19 pandemic, Spring 2020 quarter data was not included, given the transition of all classes to an online learning environment.

RESULTS

The flipped classroom approach significantly improved objective student performance for the Fall (p=0.009) and Winter (p<0.001) student cumulative grades and the History-Taking OSCE (p=0.010). Performance on Fall and Winter practical exam scores had no significant association with the flipped classroom. General student perceptions of the course remained unchanged between both cohorts. Faculty survey results from 10 faculty members showed that six (60%) faculty members preferred the traditional classroom, while four (40%) preferred the flipped classroom.

CONCLUSIONS

The flipped classroom approach showed some statistically significant improvement in student PES. Further studies are needed to evaluate the benefits of a flipped classroom approach using skills-based assessments styles to measure student performance, with a focus on standardization of in-classroom groupwork.

To Flip or Not to Flip: Learning Style Preferences among Millennial Physician Assistant Students

Introduction: Presenting material in a manner that is most palatable to students is important to improve the learning process. We evaluated the efficacy of different teaching styles including the flipped classroom and assessed the learning style preferences of a cohort of medical learners in a preclinical obstetrics and gynecology course.

Methods: We conducted three teaching sessions with 35 physician assistant students. A different teaching style was implemented for each session including a traditional lecture with interactive learning technology augmentation, a flipped classroom, and a hybrid approach incorporating lecture and group work. Students were surveyed using a Likert scale regarding the efficacy of the format, clinical relevance of the material, and their learning preference for future sessions.

Results: Students rated the traditional approach as the most effective, most relevant, and most preferred method. Students preferred the flipped classroom least, but they rated it as slightly more effective and relevant than the hybrid approach.

Conclusion: The teaching style of various coursework including the preclinical obstetrics and gynecology curriculum may not need to be altered for millennial learners. This study showed the flipped classroom was the least favored teaching style and that there was a marked preference by students for a more traditional didactic lecture.

Indonesian plastic surgeons' attitude during early period of the COVID-19 pandemic

Background

This study aims to report how the practice of plastic surgeons and their attitude was during the first measure period of coronavirus disease 2019 (COVID-19) pandemic.

Methods

A survey study was held among members of the Indonesian Association of Plastic Reconstructive and Aesthetic Surgeons during week 5 after the first report of COVID-19. A 10 multiple-choice questions (MCQs) and 1 essay covered key questions on the area of surgery and operating room, clinics, internal meeting, and consultation. The only open-ended question relates to the last MCQ addresses a future “flipped” medical practice.

Results

Response rate was 45.6% among 228 members, with 89.4% did no practice or limited their service to emergency and urgent cases only. Only 1.9% kept their official meeting as usual, while the majority modified it. The practice in the operating theatre and clinic were also altered to comply with the measures; with 21.2% from the total respondents only allowed patients with exposure to come for visit after taking 14 days of self-quarantine. Teleconsultation was practiced by 50% of the respondents, while 41.3% agreed and 10.6% disagreed upon the future “flipped” medical practice.

Conclusion

In general plastic surgeons have made supportive actions during the pandemic. Surgery was performed with all precautions at the utmost as a reflection of high alert of viral infection. Teleconsultation has been embraced via existing social media. Agreement upon the future “flipped” medical practice is reasonable. All in all, the actions were considered as most relevant.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

Faculty Self- and Needs Assessment of Preparedness for Integrating Active Learning Based on Medina's Conceptual Framework

BACKGROUND

Active learning (AL) is recognized as a valuable learning strategy.

OBJECTIVE

Using a conceptual framework, the objective of this study was to conduct a faculty self- and needs assessment to determine the extent to which the faculty at one college of pharmacy perceived they already carried out AL, describe faculty challenges, and evaluate faculty examples of AL techniques.

METHODS

A 19-question survey was administered in July 2017 to all 50 college faculty. Survey question types included multiple-choice single- or multiple-answer questions and open-ended questions. For validity, Medina's conceptual framework of 4 key elements for the effective administration of AL was used. For reliability, the draft survey questions were reviewed multiple times and revised accordingly.

RESULTS

Thirty-five faculty members, 70%, completed the survey in full. The majority of the faculty perceived that they carried out 3 of the 4 key elements during lectures: activate prior knowledge (74%), involve the majority of students (89%), and provide feedback (91%). However, only 37% stated they promoted metacognition, another key element. Our qualitative analysis identified (1) faculty had misconceptions about most of Medina's conceptual framework elements, (2) challenges to AL implementation included: need for more technology training, perception that AL requires cutting course material, beliefs that AL does not work, and fear of poor evaluations with AL implementation, and (3) suggestions to improve AL included: faculty development, training students on the importance of AL, and integrating AL throughout the curriculum.

CONCLUSIONS

Although most faculties indicated they integrated AL in their teaching, faculty misconceptions, and beliefs suggest the need for long-term faculty and organizational development using strategies aligned with or seeking to change the beliefs of the faculty and college system.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effectiveness of flipped classroom vs traditional lectures in radiology education: A meta-analysis

BACKGROUND

With the convert of educational concept, flipped classroom has been adopted gradually in radiology courses as a new teaching mode. Considering no evidence has been concluded to illustrate the effectiveness of of flipped classroom over traditional instructor-centered lectures in radiology education, this meta-analysis was conducted to provide empirical evidence for the reform of pedagogical.

METHODS

Studies were retrieved from six databases, including Pubmed, Embase, Web of Science, Wanfang Data, CNKI, and VIP, from their inception to 16 February 2020. Literature selection and data extraction were completed by two reviewers independently. The effect size of each index was expressed as the odds ratio (OR) for a categorical variable and standard mean difference (SMD) for a continuous variable, each with corresponding 95% confidence interval (95% CI).

RESULTS

A total of 19 studies with 2114 participants were deemed to be eligible for inclusion. The results of this meta-analysis indicated that: the newly emerged flipped classroom represented significant advantage versus traditional lecture in improving theoretical performance (SMD 1.12, 95% CI 0.61-1.63, P < .001), as well as in cultivating students' practical skills (SMD 2.59, 95% CI 1.69-3.59, P < .001). In the subjective findings of investigation, more positive responses were attained in students who took radiology subjects in flipped classroom, covering course satisfaction (OR 1.70, 95% CI 1.35-2.14, P < .001), improvement of teamwork ability (OR 1.80, 95% CI 1.21-2.67, P = .004), self-directed learning and reflection (OR 1.98, 95% CI 1.31-2.97, P = .001), and subjective cognition on consolidation of knowledge mastery (OR 1.38, 95% CI 1.19-1.60, P < .001).

CONCLUSION

Flipped classroom displays multiple advantages versus traditional lecture-based teaching mode, which is well worth further promoting and applying in the process of radiology education.

Flipped classroom improves results in pathophysiology learning: results of a nonrandomized controlled study

The flipped classroom has become increasingly popular in health professions education. The aim of this study was to analyze its effect on learning in a pathophysiology course. Flipped classroom was introduced to teach respiratory pathophysiology in 2018. We compared the exam results in respiratory pathophysiology in 2017 and 2018 and the exam results in blood pathophysiology from both years (taught by the same teacher, in a traditional way). Groups were compared with Student's t test. Students answered a survey after finishing the term. Two hundred and one students were examined in 2018 (and 229 in 2017). Gender distribution and the qualifications obtained in general pathology (in the previous year) were comparable in both years. Results in respiratory pathophysiology were significantly better in 2018 than in 2017 (mean: 48 vs. 42 out of 100; P = 0.004), but the results in blood pathophysiology remained similar. The improvement was significant only in students who scored below the median (mean: 40 vs. 33; P = 0.009) and was more evident in male than in female students (mean: 52 vs. 44; P = 0.01) and in those who did not have an academic delay (mean 51 vs. 44; P = 0.002). Most students considered that flipped classroom was more attractive and helped them to learn more and with less effort. Flipped classroom increased medical students' knowledge acquisitions in pathophysiology. It was more beneficial to male students and those with lower qualifications with no academic delay.

Flipped classroom improves nursing students' theoretical learning in China: A meta-analysis

OBJECTIVE

At present, current didactic teaching delivery method help nursing students apply theory to clinical situations in an inefficient way. The flipped classroom (FC), a novel teaching mode emphasizing self-study and critical thinking, has generated interest in nursing education in China. However, there are a gap in the literature and no consistent outcomes of current studies which compared FC and lecture-based learning (LBL), and no systematic review has comprehensively compared theoretical scores as an affected outcome in FC versus LBL modes.

METHODS

In this review, we analyze flipped-learning nursing students' scores, and aim to assess the efficacy and provide a deeper understanding of the FC in nursing education. Following the inclusion criteria, articles were obtained by searching PubMed, Embase and Chinese data, including the China National Knowledge Infrastructure, Wanfang Data, and VIP database until 3 January 2020. Data were extracted from eligible articles and quality was assessed. A meta-analysis was then performed using a random effects model with a standardized mean value (SMD) and a 95% confidence interval (CI).32 studies were included after reviewing 2,439 citations. All studies were randomized controlled trials (RCTs). The FC theoretical knowledge scores in FC were significantly positively affected compared to those of the traditional classroom (SMD = 1.33, 95% CI: 1.02-1.64; P < 0.001). In addition, 23 studies reported skill scores, indicating significant difference between the FC mode and LBL mode (SMD = 1.58, 95%CI: 1.23-1.93; P < 0.001).

CONCLUSIONS

The results of this meta-analysis suggest that compared to the LBL teaching method, the FC mode dose significantly improve Chinese nursing students' theoretical scores. However, the problems of heterogeneity and publication bias in this study need to be remedied high-quality future studies.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Flipping the Classroom in Otolaryngology Residencies

Objective To understand the use of the flipped classroom (FC) - learning core content prior to an academic session, with class time devoted to applying this content - in otolaryngology residency education. Methods An electronic survey of 107 otolaryngology program directors (PDs), including demographic details, the flipped classroom perception instrument (FCPI), and the otolaryngology programs' current use of FC. Results Forty-four (41%) PDs completed the FCPI. Seventy-one point one (71.1%) of respondents were male, 60% were 30-49 years, and the remainder were older. Sixty-two percent (62%) had fellowships associated with their program, 21.7% of programs used the FC model Very Often, 17.4% Somewhat Often, 28.3% Sometimes, 17.4% Somewhat Rarely, 8.7% Very Rarely, and 6.5% Never. Attitudes toward FC principles were positive with modes "strongly agree" for all, except for "online modules enhance learning" where the mode was "slightly agree" with significantly higher scores for PDs over age 50 than for those younger (4.17 vs. 3.63, p=0.033). There were no other significant differences comparing male vs. female PDs, younger vs. older PDs, smaller vs. larger programs, programs with or without fellowships, programs with 100% vs. <100% board exam pass rates, or programs in different geographical regions. The pre-class activity mean score was 4.34 (95% CI 4.12-4.56) and the in-class mean score was 4.18 (95% CI 3.99-4.37). There was no significant correlation between the likelihood of using a flipped classroom and attitude scores. Conclusion PDs value both the pre-class and interactive in-class principles of FCs but only 37.8% of programs use FC often, suggesting that practical approaches to implementation in this group could improve education in this population.

Pharmacy Education Crosses the Rubicon

The pandemic caused by the novel coronavirus identified in 2019 (COVID-19) has resulted in seismic changes throughout society. Accordingly, academia has been forced to adapt. Changes across all aspects of teaching and instruction have occurred. Students have departed campuses and prospects of their return remain unclear. The Academy, which is generally reluctant to change, has been forced to make rapid adjustments. Among other issues, pharmacy schools and colleges have been forced to mitigate changes to experiential education. Tremendous resources and energy have been invested to actuate the changes that have occurred. In many ways, the disruptions forced upon pharmacy education may usher in a new normal. The likelihood for even a partial return to the customary way of doing things appears increasingly unlikely.

Flipped classroom in dental education: A scoping review

INTRODUCTION

There is a pressing need to explore strategies which adopt and incorporate contemporary teaching methods to keep abreast with technological advances. Flipped classroom is a type of blended learning approach that has received considerable attention as an alternative to traditional lectures. The purpose of this scoping review is to explore the characteristics of the flipped classroom model implemented in undergraduate dental education.

MATERIALS AND METHODS

The scoping review has been reported under the PRISMA extension for scoping review guidelines. Systematic search of databases culminated in full-text papers that were evaluated for quality.

RESULTS

A systematic search on flipped classroom in dental education identified a total of 30 papers for full-text evaluation. After further exclusion, 17 studies were selected for data charting.

DISCUSSION

The student satisfaction, learning resources, pre-class and/or in-class activities, and academic scores are analysed and discussed.

CONCLUSION

Flipped classroom improves student satisfaction in majority of the studies, whilst its effect on academic scores, particularly for skill development, needs more research.

A Meta-Analysis of the Cognitive, Affective, and Interpersonal Outcomes of Flipped Classrooms in Higher Education

This paper aims to quantify the effects of flipped classrooms in higher education by reviewing 43 empirical studies of students’ cognitive, affective, and interpersonal outcomes. The innovative pedagogy of a flipped classroom in higher education fosters a sustainable, interactive, and student-centered learning environment (as opposed to the traditional lecture style, in which there is little room for interaction). This study’s results show the positive effects of flipped classrooms and highlight the improvement in students’ educational outcomes between 2012 and 2017. Overall, effect sizes were medium—effect size (ES) = 0.35, 95% confidence interval (CI) = 0.24 to 0.47—across three outcome domains using a random effects model. In the outcomes, affective (ES = 0.59), interpersonal (ES = 0.53), and cognitive (ES = 0.24) domains were of a higher order than the effect sizes. However, the results indicated that flipped classrooms benefitted students studying chemistry, engineering, mathematics, and physics less than they did students studying other subjects.

Education Research: Flipped classroom in neurology: Principles, practices, and perspectives

How to most effectively deliver a large amount of information in an engaging environment that encourages critical thinking is a question that has long plagued educators. With ever-increasing demands on both resident and faculty time, from shrinking duty hours to increased patient complexity, combined with the exponential growth of medical knowledge and unequal access to the spectrum of neurologic subspecialties around the country, this question has become especially pertinent to neurology residency training. A team of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review the current evidence regarding the implementation of the flipped classroom format. This educational model has only recently been applied to health care education along the training continuum, and a small collection of articles has, so far, used disparate methods of curricular implementation and assessment. While the feedback from learners is generally positive, a number of obstacles to implementation exist, most notably learner time commitments. These are presented with discussion of potential solutions along with suggestions for future studies.

The Effectiveness of Flipped Classroom in Health Professions Education in China: A Systematic Review

BACKGROUND

Flipped classroom has received much attention during the last few years in China, but inconsistent conclusions are made about the effectiveness this approach in health professions education. This review examined the findings of controlled studies published in Chinese in order to summarize the effects of the flipped classroom methodology. These studies focused specifically on undergraduate level of health professions students.

METHODS

A literature search was conducted using China National Knowledge Infrastructure (CNKI) and Wanfang Data Knowledge Service Platform in June 2019. No date restrictions were used. Peer-reviewed papers were reviewed and experimental studies were included if the study compared student outcomes using flipped classroom method versus traditional lectures. The revised version of the Kirkpatrick's model was applied to evaluate the effectiveness of the flipped classroom approach.

RESULTS

In total, 934 articles were obtained. Among them, 235 articles were full text reviewed and 59 met the inclusion criteria. Most of the student agreed that flipped classroom strategy was very helpful improving their self-learning ability, problem solving ability, teamwork, and communication skills, but reported increased workload and less-efficiency compared with traditional lectures. However, the majority of studies (n = 52) showed positive findings of the flipped classroom on changes in knowledge and skills, and 3 in negative. Among these 59 studies, there was little evidence of changes in behavior, organizational practice and patient outcome.

CONCLUSIONS

Better design with reduced content should be considered for instructors to promote learning effectiveness. Long-term effects of flipped classroom should be considered in future studies.

A multiyear comparison of flipped- vs. lecture-based teaching on student success in a pharmaceutical science class

BACKGROUND AND PURPOSE

To gauge the potential effect of mode of content delivery on overall student success in a pharmaceutical sciences course in a doctor of pharmacy program.

EDUCATIONAL ACTIVITY AND SETTING

Principles of Drug Action I (PDAI) is a first-year pharmaceutical science course typically taught by multiple faculty, and each utilizes their own approach to deliver course content. Over a seven year period, the course naturally separated into blocks. Block-1 was taught using a traditional lecture-based approach while Block-2 varied between either a lecture-based or a flipped-classroom format. Student success was evaluated by exam at the end of each block.

FINDINGS

For the four years in which Block-2 was taught by lecture, the number of exam failures was similar to Block-1. For each of the three years Block-2 was taught via the flipped-classroom format, the number of exam failures was approximately half that of Block-1. While grades for the lecture-based Block-1 trended downward over the seven-year evaluation period, average exam grades overall were similar between Block-1 and Block-2 each year regardless of teaching modality.

SUMMARY

Retrospective analysis of this novel blocked approach within PDAI provided a means of internally evaluating the potential effect of teaching format on overall student performance. The results described here support previous studies that indicate that the flipped-classroom approach can reduce course failures. These findings also show that flipped-classroom teaching may have a greater impact on improving learning in lower-performing students.