Does the Concept of the "Flipped Classroom" Extend to the Emergency Medicine Clinical Clerkship?

Second- and third-year medical students' clinical encounters in the emergency department

Background

Experiential learning theory suggests that direct clinical experiences facilitate learning. Previous literature has focused primarily on the experiences of fourth-year medical students. As more students gain early clinical exposure, it is important to understand the types of patients seen by junior students.

Objectives

This study aims to categorize the clinical experiences of early (M2 and M3) students in the emergency department (ED).

Methods

A retrospective review of the electronic health record of patients seen by M2s and M3s on a 2-week emergency medicine rotation at a single urban academic ED in the Midwest was performed. Data elements extracted included total number of patients seen, Emergency Severity Index (ESI), disposition, and chief complaint. Students were not mandated to see any particular patients.

Results

Medical students (248) saw 2994 total patients from 2018 to 2022. The median number of patients seen by each student was 12.0 (range 1-32). Pediatric patients made up 6.5% (n = 194) of total patients. Encounters were primarily ESI 2 or 3, which accounted for 89.4% of all patients (n = 2676). The most encountered complaints were abdominal pain, chest pain, and dyspnea, making up 15.6% (n = 467), 8.7% (n = 260), and 5.5% (n = 165), respectively, of total cases. Obstetrics/gynecology, hematologic, and environmental disorders were the least frequently encountered domains. No students saw all Clerkship Directors in Emergency Medicine (CDEM)-recommended complaints.

Conclusions

There is significant variability in the ED encounters of M2s and M3s, with wide ranges of patient volume and presentations. This study provides some evidence that early students may not be meeting CDEM recommendations.

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.

Flipped learning as an educational model in a cardiology residency program

INTRODUCTION

Flipped learning (FL) is a model which allows students to adjust their study rhythm by taking advantage of class time to apply their knowledge. Although FL meets many of the needs of the traditional lecture-based model and the exclusively virtual model, its effectiveness in medical residency programs has not been thoroughly studied. Our study evaluates the efficacy of an FL model in a cardiology residency program based on the satisfaction and academic performance of the participants.

METHOD

A prospective, observational, and descriptive study was conducted at Ignacio Chávez National Institute of Cardiology in Mexico City to evaluate the satisfaction and effectiveness of an FL model for acquiring competencies in electrocardiographic diagnosis among thirty-one first-year cardiology residents. The Advanced Electrocardiography Workshop and a virtual classroom were designed for the intervention. Four teachers taught the workshop and video classes, and ten medical specialists from the participants' areas of work performed evaluations of practical skills before and after the intervention.

RESULTS

75% of the participants rated the intervention as very favorable compared to the traditional and virtual models. The main advantages offered by the FL model were identified. An improvement of high statistical significance was observed in participants' academic performance after the intervention (P value < 0.001).

CONCLUSION

The FL model has a high degree of acceptance among participants and teachers. Our study shows an improvement in academic performance after the intervention. Considering that the FL model is flexible and reproducible in other areas of medicine, it represents an excellent educational alternative that meets current needs.

Examination performance with flipped classroom as instructional strategy in the carbohydrate metabolism course unit at a Philippine medical school: Estimation of average treatment effect from observational data

While the innovativeness of the flipped classroom (FC) approach promotes active participation and higher-order thinking among students, there are concerns about its effectiveness in terms of knowledge retention. Currently, there are no studies involving medical school biochemistry that evaluate this aspect of effectiveness. Thus, we conducted a historical control study that analyzed observational data from two freshman batches of the Doctor of Medicine program in our institution. Class 2021 (n = 250) served as the traditional lecture (TL) group while Class 2022 (n = 264) served as the FC group. Data on relevant observed covariates (age, sex, National Medical Admission Test or NMAT score, undergraduate degree) and the outcome variable (carbohydrate metabolism course unit examination percentage scores, as indicator of knowledge retention) were included in the analysis. Propensity scores were calculated using logit regression conditional on these observed covariates. Afterwards, 1:1 nearest-neighbor propensity score matching (PSM) was performed to produce an estimated average treatment effect (ATE) measure afforded by FC (as adjusted mean difference in examination scores between the two batches), balancing on the covariates. Nearest-neighbor matching using the calculated propensity scores effectively balanced the two groups (standardized bias <10%), producing 250 matched student-pairs that received either TL or FC. Following PSM, the FC group was found to have a significantly higher adjusted mean examination score compared to the TL group (adjusted mean difference = 5.62%, 95% CI: 2.54%, 8.72%; p < 0.001). Using this approach, we were able to demonstrate benefit of FC over TL in terms of knowledge retention, as reflected by the estimated ATE.

Effect of gamified flipped classroom on improving nursing students’ skills competency and learning motivation: a randomized controlled trial

Background

Flipped learning excessively boosts the conceptual understanding of students through the reversed arrangement of pre-learning and in classroom learning events and challenges students to independently achieve learning objectives. Using a gamification method in flipped classrooms can help students stay motivated and achieve their goals. 

Methods

This study adopted a randomized controlled study design with a pre-test and post-test and involved 128 nursing students at Mansoura University. This study randomly divided the students into the study and control groups. Data were collected at three time points using six tools. In the intervention group, Moodle was gamified for 6 weeks. 

Results

A significant difference in the students’ self-confidence (p = 0.021), skills knowledge (p < 0.001), intensity of preparation (p < 0.001), and motivation (p < 0.001) was observed between the two groups; however, no difference in the students’ skills performance (p = 0.163) was observed between the two groups after using gamified flipped classrooms.

Conclusions

Compared with the traditional flipped classrooms, gamified flipped classrooms improved nursing students’ motivation, intensity of preparation, skills knowledge, and self-confidence during laboratory clinical practice. Thus, gamification is a learning approach that can be implemented in conjunction with the flipped classroom model to motivate students to participate in the learning process.

Trial registration.

Prospectively registered with ClinicalTrials.gov on 26/04/2021; registration number NCT04859192.

Effectiveness of the combination of workshops and flipped classroom model to improve tube fixation training for nursing students

BACKGROUND

Tube indwelling is a key procedure in modern medicine. Careful tube setup is necessary to prevent unplanned extubation. The training for tube fixation is time- and resource-consuming, and optimal modes of training are currently being sought. Previous studies have compared workshops and flipped classroom models separately using conventional teaching strategies, but no study has examined a combination of both teaching models in nursing training.

AIM

To compare the effectiveness of workshops vs workshops combined with the flipped classroom model for improving tube fixation training for nursing students.

METHODS

This was a prospective cohort study. In this study, 149 nurses who joined our hospital in 2019 underwent training using workshops combined with the flipped classroom model (experimental group), while 159 nurses who joined the hospital in 2018 received only workshop-based training (control group). The combination of workshops with the flipped classroom training model was divided into two modules: pre-class and in-class training. The participation of nurses in the training activities, on-site assessment of training, nurses’ evaluation of their training, and related indicators of tube quality management were evaluated.

RESULTS

The average age of nurses in the control group was 22.94 ± 0.94 years and that of nurses in the experimental group was 25.42 ± 3.23 years (P < 0.01). The qualified rate of after-class assessments for the experimental and control groups was 100.00% (average score: 94.01 ± 2.78 points) and 91.82% (average score: 84.24 ± 2.94 points), respectively (P < 0.01). Most nurses in the experimental group completely agreed that the combined training was helpful to cultivate clinical thinking and independent learning ability and to master knowledge of tube fixation. In addition, the training content within the pre-class teaching video, pre-class tube atlas, pre-class main instructor guidance, in-class demonstration, and in-class practice was very informative. The experimental group had higher evaluation scores than the control group (4.88 ± 0.38 vs 4.67 ± 0.64; P < 0.01). Comparison of tube quality management before and after training in 2018 to 2019 revealed that the unplanned ureteral tube removal rate dropped from 0.25‰ to 0.06‰, the unplanned chest tube removal rate dropped from 1.07‰ to 0.78‰, and the unplanned gastric tube removal rate dropped from 0.36‰ to 0.17‰. The incidence rate of pressure ulcers caused by the tube decreased from 0.78‰ to 0.45‰.

CONCLUSION

The combination of workshop and flipped classroom training is effective in improving tube fixation training of nurses, cultivating nurses’ active learning abilities and clinical thinking, and improving the safety of the procedure.

Internal Medicine Clerkship ID Curriculum Flip: Will They Prefer to Pre-learn?

Varying pedagogical approaches of undergraduate medical education are utilized in clerkships to supplement bedside teaching. The flipped classroom mode, in which self-paced study precedes the in-person session, is often used in pre-clinical education. This shift allows time with the instructor to focus on guided application of pre-learned concepts. At our institution, the Internal Medicine Clerkship Infectious Diseases lecture was substituted to a flipped classroom with two pre-learning videos. Student satisfaction scores were higher for the flipped classroom and comments were more negative for the traditional lecture. This suggests that senior medical students favor flipped classroom pedagogy despite pre-learning requirements.

Evaluating the Efficacy and Optimisation of the Peer-Led Flipped Model Using TEL Resources Within Neuroanatomy

The flipped classroom (where students prepare before and then develop understanding during class) and technology-enhanced learning (audio-visual learning tools) are increasingly used to supplement anatomy teaching. However, the supporting literature lacks robust methodology and is conflicting in demonstrating efficacy outcomes. Contrastingly, near-peer teaching (where senior students teach juniors on the same academic programme) is well researched and reported to be both effective and versatile. This provides an ideal vehicle in which to investigate and potentially optimise these approaches.This study aims to assess educational impact of the peer-led flipped model and student engagement and perceptions regarding traditional and TEL resources.A quasi-randomised, cross-sectional study was conducted with 281 second-year University of Southampton medical students. Students were randomly allocated to 3 groups: traditional lecture (control), flipped text resource, or flipped video resource. The first group received no pre-teaching material, but the flipped groups received a text or video pre-teaching resource. Objective outcomes measured were: Knowledge gain and retention via multiple-choice questionnaires and formative exams Student perceptions and engagement using questionnaires and 2 focus groups All groups demonstrated significant knowledge gain post-teaching (p < 0.0001). However, regardless of engagement with pre-teaching material, no significant difference was found in knowledge gain or retention between the groups. Students engaged 21.1% more with the text rather than video resource (p = 0.0019), but spent equal time using both (p = 0.0948). All resources and teaching approaches were perceived 'very useful' with no significant differences found between groups. A qualitative approach utilising thematic analysis of focus groups identified 4 themes, including 'Attitudes towards flipped classroom', which revealed mixed reviews and perceptions from participants.This study has found the peer-led flipped model is of no detriment to educational impact compared to peer-led traditional approaches in a well-established peer teaching programme in undergraduate medicine at the University of Southampton. Students value traditional and video resources but engage with them differently. Additionally, it was reported that in this experiment, NPT did not seem well suited to the flipped classroom, suggesting a rare limitation of the utility of NPT application within an anatomy curriculum.

Improvement in Student Performance and Perceptions through a Flipped Anatomy Classroom: Shifting from Passive Traditional to Active Blended Learning

One of the major challenges facing anatomy educators is delivering the anatomy materials in fewer hours with a reduction of anatomy courses in the integrated curricula. The flipped classroom modality may be an innovative solution. However, its effectiveness remains under debate due to a lack of outcome-based research and the mixed results of students' performance. The present study aimed to determine the outcome of the flipped classroom based upon the level of student cognition. The study investigated performance on 17 multiple-choice anatomy questions as a part of the final examination of the musculoskeletal system module. The results were compared between the first-year female students of Qassim Medical College, specifically the flipped classroom group (46 students) of the academic year (2018-2019) and the traditional group (49 students) of the academic year (2017-2018). The mean differences in the students' grades on the anatomy questions at the level of knowledge, application, and analysis using Cohen's d test were 0.43, 1.41, and 1.01, respectively. These results suggest the positive impact of flipping the students' classrooms on improving their levels of thinking according to Bloom's taxonomy. Perception surveys also revealed students' enthusiasm for the pre-class activities, leading to a better performance in the class with more engagement with their peers and teachers. The present study suggested that the flipped classroom modality can be performed to compensate for the reduction of anatomy educational hours. However, further studies are recommended to investigate the best practices of the flipped classroom that fit with the students' needs and workloads.

Flipping a biochemistry class within a medical curriculum: Impacts on perception, engagement, and attainment

The flipped classroom has gained prominence in higher education, but little has been written about its application in the Middle East. This study aimed to assess the feasibility, acceptability, and impact of flipping biochemistry classes in comparison to the traditional didactic program. The study was conducted on first-year medical students taking biochemistry at a private University in Saudi Arabia. A series of short, pre-recorded videos were used to replace traditional lectures. The scheduled lecture time was used for problem solving and discussion sessions. To gather their evaluation of the learning approach, participants completed an online survey. To study the effect of the learning approach on exam performance, the scores of the participants were compared in questions taught using the flipped classroom versus the traditional didactic method. Participants noted that the effort needed for the course was similar regardless of the learning approach. Moreover, examination performance measured using single best answer multiple-choice questions showed no difference between the two teaching methods. However, the participants did report a significantly better perception of the flipped classroom compared to the traditional approach. Although no significant improvement in examination results was noted, the participants significantly favored the flipped classroom over traditional lectures. This study has demonstrated that the flipped classroom can be used in the teaching of the biosciences within a Middle Eastern setting, resulting in an improvement in student satisfaction and engagement in the course materials.

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.

Flipped classroom versus traditional lecture in training undergraduates in pediatric epilepsy

Introduction:

Pedagogical constructs such as flipped classroom are used to engage students in the learning process by their active participation. The aim of the present study was to compare the two models of flipped classroom and traditional lecture in training undergraduates in pediatric epilepsy.

Methods:

The study was conducted among the 3^rd-year undergraduate medical students. They were divided to either of Group I or II. Pediatric epilepsy was taught in two parts (clinical diagnosis and management). Group I received Part A as traditional lecture and Part B as the flipped classroom and the reverse for Group II. The difference in posttest and pretest scores was compared between two groups for each part.

Results:

There was a significant increase in posttest scores when compared to pretest scores in both the groups. Mean (standard deviation [SD]) difference in scores for epilepsy diagnosis was comparable in Group I (3.33 [2.3]) and Group II (2.46 [2.17]) (P = 0.16). Mean (SD) difference in scores for epilepsy management was significantly higher in Group I (3.41 [2.09]) when compared to Group II (1.30 [1.84]) (P < 0.01).

Conclusion:

Flipped classroom model resulted in better scores than the traditional teaching method for training undergraduates in the management of epilepsy in children. This teaching–learning method could be adopted in training of primary care physicians.

The Nephrology Immersion Classroom for Internal Medicine Residents

BACKGROUND

In graduate medical education (GME), there are many barriers to achieving a personalized learning process with standardized learning outcomes. One way to support this is through mobile-friendly digital blackboard videos. We sought to measure the effect of a mobile-friendly video curriculum on resident satisfaction, knowledge, and clinical skills during a nephrology rotation.

METHODS

This was a prospective, controlled, nonrandomized trial. The control group consisted of internal medicine residents who completed our inpatient nephrology consult rotation as usual. The classroom group had the same clinical experience, but also had access to a library (Nephrology Immersion Classroom) of mobile-friendly, nephrology-themed, digital blackboard videos. In a postrotation assessment, we measured resident satisfaction, clinical knowledge using 15 multiple-choice questions, and nephrology-specific clinical skills.

RESULTS

Of the residents in the classroom group, 77% enrolled in the online classroom, and the majority reported using the classroom occasionally or frequently. A majority found it very easy to use (86%) and strongly recommended having similar videos for other rotations (77%). We observed improved report of rotation-specific clinical skills, but no difference in short-term knowledge between the two study groups.

CONCLUSIONS

A mobile-friendly, digital video curriculum for internal medicine residents on an inpatient consult rotation was well utilized, highly rated, and associated with improved nephrology-specific clinical skills. Continued evaluation and incremental improvement of such resources could enhance implementation of GME core curricula.

Flipped Classroom Approach Used in the Training of Mass Casualty Triage for Medical Undergraduate Students

OBJECTIVE

The aim of this study was to explore the application of the flipped classroom approach in the training of Mass Casualty Triage (MCT) to medical undergraduate students.

METHODS

In this study, 103 fourth-year medical students were randomly divided into a Flipped Classroom (FC) group (n = 51) and a Traditional Lecture-based Classroom (TLC) group (n = 52). A post-class quiz, simulated field triage (SFT) and feedback questionnaires were performed to assess both groups of students for their learning of the course.

RESULTS

In the post-quiz, the median (IQR) scores achieved by students from the FC and TLC groups were 42(5) and 39(5.5), respectively. Significant differences were found between the two groups. In the SFT, overall triage accuracy was 67.06% for FC, and 64.23% for TLC students. Over-triage and under-triage errors occurred in 18.43% and 14.50% of the FC group, respectively. The TLC group had a similar pattern of 20.77% over-triage and 15.0% under-triage errors. No significant differences were found regarding overall triage accuracy or triage errors between the two groups.

CONCLUSIONS

The FC approach could enhance course grades reflected in the post-quiz and improve students' satisfaction with the class. However, there was no significant difference of competency between the two groups demonstrated in the SFT exercise.

Application of Ausubel cognitive assimilation theory in teaching/learning medical biochemistry and molecular biology

"Didn't understand or not fully understand" is the most common situation that students experience when they learn medical biochemistry and molecular biology (MBMB). Therefore, the primary task of teaching MBMB is to help students overcome the difficulties in "conceptual understanding." The core of the solution to these problems lies in the acquisition and application of cognitive skills. The key to applying Ausubel cognitive assimilation theory (A's CAT) is to expand the knowledge capacity of students' cognitive structure through the purposeful "production" and employment of advanced organizers, with which students can replace "rote learning" with "meaningful learning" and ultimately develop an interest in MBMB courses. The results showed that the application of A's CAT did not only encourage the students to use cognitive skills to learn and understand MBMB knowledge and overcome the barrier to learning that results from the characteristics of the MBMB course, but also expanded and deepened the MBMB course contents. As a branch of learning theory, A's CAT provides practical methods for the several hypotheses of learning theory. Among these, the advanced organizer strategy realizes the organization and reorganization of new knowledge; the progressive differentiation strategy reduces the difficulty of complex and abstract knowledge; the implementation of the advanced organizer strategy and integrative reconciliation strategy forms the concept map. Taken together, the application of A's CAT includes cognitive strategy and metacognitive strategy when the cognitive process is conducted in a meaningful way. More importantly, application of A's CAT guides students to participate in active learning and builds "scaffolding" for the teaching/learning MBMB of student-centered goals.

A unique flipped classroom approach shows promising results in physician assistant education

Aims: The flipped classroom (FC) model utilizes pre-class foundational learning with in-class higher-order application exercises. FC approaches have reported positive perceptions and mixed academic performance outcomes in medical education; however, little evidence exists on their impact in the 56-week didactic curriculum of Physician Assistant (PA) education.Methods: A 4-week FC curriculum was piloted in a PA behavioral medicine course (n = 34). Before class, students completed online video modules. During class, students completed a pre-class quiz and answered clinical case-based questions in a think-pair-share format.Results: Students rated in-class time higher than a lecture-based segment of the same course (p = 0.028). Assessment of achievement emotions demonstrated increased enjoyment (p = 0.028) and decreased boredom (p < 0.001) in the FC curriculum with no difference in anxiety. The FC curriculum produced a 57.2 min increase in pre-class preparation time with no change in post-class studying time. Compared to historical lecture-based controls (n = 35), students in the FC curriculum scored significantly higher on clinical vignette questions (p = 0.019) with equivalent performance on other question formats.Conclusions: This study offers the first positive outcomes of an FC approach in PA education and provides a framework for improving academic performance while scaling back in-class time.

Flipping Out! Utilizing an Online Micro-lecture for Asynchronous Learning Within the Acting Internship

BACKGROUND

The acting (Sub)internship (AI) provides fourth-year medical students the opportunity to gain essential clinical experience, making it challenging to develop an effective curriculum without detracting from clinical time.

ACTIVITY

This flipped classroom, asynchronous learning curriculum utilized a short online video, called a micro-lecture, to teach one to two key concepts, associated with online case-based questions.

RESULTS AND DISCUSSION

Over one academic year, 96% (64/67) of internal medicine AI students at our institution completed the online questions. The majority of students selected the single best response for both questions and preferred this online micro-lecture format over traditional methods.

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.

Clerkships in Emergency Medicine

Planning for clerkships in emergency medicine (EM) can be stressful, prolonged, and challenging. Therefore, medical students should start planning for them early. In this article, we offer guidance regarding several issues pertinent to the EM clerkship, such as the best time to schedule one (or more) during medical school, the most appropriate institution or program to schedule it, the process of selecting and applying for the clerkship, and the number of EM clerkships to consider. We will explain why an EM clerkship should be scheduled between June and October and the reason that 2 EM clerkships at different sites are sufficient for the majority of students. Additionally, we emphasize that clerkships in emergency departments associated with EM residency programs or with reputations for outstanding student teaching tend to be most beneficial. Above all, students interested in EM should attempt to leave a great impression after completing their clerkships by providing stellar patient care, demonstrating enthusiasm at all times, and maintaining professionalism. In turn, they will gain knowledge and clinical experiences that should prove valuable in their future.

Effectiveness of flipped classroom combined with team-, case-, lecture- and evidence-based learning on ophthalmology teaching for eight-year program students

BACKGROUND

This study aimed to investigate the benefits and challenges of the flipped classroom combined with team-, case-, lecture- and evidence-based learning (FC-TCLEBL) for ophthalmology teaching for eight-year program students.

METHODS

FC-TCLEBL and the traditional lecture-based classroom (LBC) were compared based on student and teacher feedback questionnaires, student learning burden, and scores on standardized tests as well as their effects on the abilities of clinical thinking, scientific research, active-learning, practical application, humanistic care and communication with patients.

RESULTS

Both the students and teachers were more satisfied with the FC-TCLEBL model. More students in the FC-TCLEBL group agreed that the course helped them to develop skills in creative thinking, problem solving, and teamwork. Students in the FC-TCLEBL group spent significantly more time preparing for class than those in the LBC group, but the time spent on review was significantly lower in the FC-TCLEBL group. The students from the FC-TCLEBL group performed better in a post-test on diabetic retinopathy (DR) as compared to the LBC group.

CONCLUSIONS

FC-TCLEBL teaching model is effective and suitable for ophthalmology teaching.

The Flipped Classroom: A Critical Appraisal

Introduction

The objective of this study was to review and critically appraise the medical education literature pertaining to a flipped-classroom (FC) education model, and to highlight influential papers that inform our current understanding of the role of the FC in medical education.

Methods

A search of the English-language literature querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 296 papers related to the FC using either quantitative, qualitative, or review methods. Two reviewers independently screened each category of publications using previously established exclusion criteria. Eight reviewers then independently scored the remaining 54 publications using either a qualitative, quantitative, or review-paper scoring system. Each scoring system consisted of nine criteria and used parallel metrics that have been previously used in critical appraisals of education research.

Results

A total of 54 papers (33 quantitative, four qualitative, and 17 review) on FC met a priori criteria for inclusion and were critically appraised and reviewed. The top 10 highest scoring articles (five quantitative studies, two qualitative studies, and three review papers) are summarized in this article.

Conclusion

This installment of the Council of Emergency Medicine Residency Directors (CORD) Academy Critical Appraisal series highlights 10 papers that describe the current state of literature on the flipped classroom, including an analysis of the benefits and drawbacks of an FC approach, practical implications for emergency medicine educators, and next steps for future research.

The use of flipped classroom as an active learning approach improves academic performance in social work: A randomized trial in a university

Background

The flipped classroom (FC) is a pedagogical approach that means that the activities that have traditionally taken place within the classroom are carried out outside the classroom. Fundamentally it implies the way in which the student studies the subject. This change of perspective in teaching—learning has raised many questions regarding its effectiveness and student satisfaction in the university studies in the degree of Social Work.

Objective

The main objective of this study was to evaluate the effectiveness of a Flipped Classroom methodology in the academic performance of students of the Social Work Degree.

Methods

An educational study, with two parallel groups was developed. The randomization was carried out by class groups. Group 1 was assigned an active teaching methodology of Flip Teaching and it was implemented during theoretical teaching hours. The other group of students, Group 2, was assigned a traditional lecturer-based learning (LB) methodology. The participants were all the students of the morning shift who studied the subject Social Work with Groups of the Social Work Degree during the academic year 2017–2018. The sample was composed of 110 subjects, with 60 subjects who developed an active teaching methodology and 50 subjects who received a LB.

Results

In terms of the academic performance result variable, the FT group had a mean of 6.56 (SD: 1.58) and the LB group had a mean of 5.42 (SD: 1.97) (p-value: 0.002). The FT group also had a higher percentage of students receiving merit and outstanding scores (34.5% and 6.9% respectively) and a lower percentage of students who failed (19%) as compared to the LB group in which 20.9% and 2.3% of the students received merit or outstanding grades and 46.5% failed (p-value = 0.025). No significant differences were found with regards to satisfaction with the subject and the methodology used, long-term learning and time spent preparing for the exam.

Conclusions

The FC teaching methodology in comparison with the LB methodology has shown to be a more effective tool regarding academic performance evaluated in a quantitative and qualitative way with regards to Social Work education at university level.

Effects of a Flipped Classroom Curriculum on Inpatient Cardiology Resident Education

BACKGROUND

The flipped classroom is designed to reinvigorate education and utilizes "at-home" time to learn concepts and "in-class" time for clinical application. While some studies have shown positive effects of the flipped classroom in undergraduate medical education, there is a paucity of data on its use in graduate medical education.

OBJECTIVE

We hypothesized that a flipped classroom curriculum of Medical Knowledge Self-Assessment Program (MKSAP) content with group case discussions could improve resident knowledge and preparedness in cardiology.

METHODS

Ninety-eight internal medicine residents who rotated on the inpatient cardiology service from March to October 2017 were quasi-randomized into control and intervention groups, with the intervention group assigned MKSAP readings and cases to review on their own, accompanied by weekly case discussion. Pre-post surveys evaluated for change in knowledge and preparedness, quantity of teaching received, and use of MKSAP.

RESULTS

A total of 93 of 98 residents (95%) participated in the curriculum. There were 37 of 51 residents (73%) in the control group and 37 of 47 residents (79%) in the intervention group who responded to pre-post assessments. In paired analysis, knowledge score did not improve significantly between the groups, nor did self-reported preparedness, number of teaching sessions per week, or reported MKSAP use. However, all participants had positive perceptions of the curriculum, and the majority felt it should be continued.

CONCLUSIONS

This flipped classroom curriculum did not affect knowledge, preparedness, or number of teaching sessions for internal medicine residents on a cardiology rotation when compared to usual teaching, although residents experiencing the new model expressed high satisfaction.

Flipped-classroom training in advanced cardiopulmonary life support

Background

The effects of the flipped classroom have been demonstrated in various fields of education in recent years. Training in emergency medicine is also beginning to gradually implement the flipped classroom; however, its practical effect in emergency medicine contexts is not yet clear.

Objective

The present study investigates the effects of the flipped classroom on advanced cardiopulmonary life support (ACLS) training implemented among practicum students in emergency medicine.

Methods

The study randomly assigned into control and experimental conditions 108 fourth year students in the College of Medicine at Yonsei University, in Seoul, who were scheduled to take clinical practice in emergency medicine between March and July 2017. Students were taught about ACLS in either a traditional lecture-based classroom (control condition) or a flipped classroom (experimental condition); then, simulation training with ACLS scenarios was carried out. Finally, each student was rated on performance using a rating form developed in advance.

Results

ACLS simulation scores of the students in the flipped classroom were 70.9±10.9, which was higher than those of the students in the traditional classroom (67.1±11.3); however, this difference was not statistically significant (p = 0.339). In addition, the difference in student satisfaction as measured on a survey was statistically insignificant (p = 0.655).

Conclusions

Competency assessment after simulation-based training in ACLS undergone by senior medical students randomly assigned to flipped and traditional classrooms showed no statistical difference in competency between the two groups.

Academic outcomes of flipped classroom learning: a meta-analysis

CONTEXT

The flipped classroom (FC), reversing lecture and homework elements of a course, is popular in medical education. The FC uses technology-enhanced pre-class learning to transmit knowledge, incorporating in-class interaction to enhance higher cognitive learning. However, the FC model is expensive and research on its effectiveness remains inconclusive. The aim of this study was to compare the efficacy of the FC model over traditional lecture-based (LB) learning by meta-analysis.

METHODS

We systematically searched MEDLINE, PubMed, ERIC, CINAHL, EMBASE, reference lists and Association for Medical Education in Europe (AMEE) conference books. Controlled trials comparing academic outcomes between the FC and LB approaches in higher education were considered eligible. The main findings were pooled using a random-effects model when appropriate.

RESULTS

Forty-six studies (9026 participants) were included, comprising four randomised controlled trials (RCTs), 19 quasi-experimental studies and 23 cohort studies. Study populations were health science (n = 32) and non health science (n = 14) students. The risk of bias was high (36/37 articles). Meta-analyses revealed that the FC had significantly better outcomes than the LB method in examination scores (post-intervention and pre-post change) and course grades, but not in objective structured clinical examination scores. Subgroup analyses showed the advantage of the FC was not observed in RCTs, non-USA countries, nursing and other health science disciplines and earlier publication years (2013 and 2014). Cumulative analysis and meta-regression suggested a tendency for progressively better outcomes by year. Outcome assessments rarely focused on behaviour change.

CONCLUSIONS

The FC method is associated with greater academic achievement than the LB approach for higher-level learning outcomes, which has become more obvious in recent years. However, results should be interpreted with caution because of the high methodological diversity, statistical heterogeneity and risk of bias in the studies used. Future studies should have high methodological rigour, a standardised FC format and utilise assessment tools evaluating higher cognitive learning and behaviour change to further examine differences between FC and LB learning.

Emergency medicine clerkship curriculum in a high-income developing country: methods for development and application

Background

The published recommendations for international emergency medicine curricula cover the content, but exclude teaching and learning methods, assessment, and evaluation. We aim to provide an overview on available emergency medicine clerkship curricula and report the development and application experience of our own curriculum.

Methods

Our curriculum is an outcome-based education, enriched by e-learning and various up-to-date pedagogic principles.

Results

Teaching and learning methods, assessment, and evaluation are described. The theory behind our practice in the light of recent literature is discussed aiming to help other colleagues from developing countries to have a clear map for developing and tailoring their own curricula depending on their needs. The details of our emergency medicine clerkship will serve as an example for developing and developed countries having immature undergraduate emergency medicine clerkship curricula. However, these recommendations will differ in various settings depending on available resources.

Conclusions

The main concept of curriculum development is to create a curriculum having learning outcomes and content relevant to the local context, and then align the teaching and learning activities, assessments, and evaluations to be in harmony. This may assure favorable educational outcome even in resource limited settings.

Electronic supplementary material

The online version of this article (10.1186/s12245-018-0190-y) contains supplementary material, which is available to authorized users.

Utilization of the Flipped Classroom in Anesthesiology Graduate Medical Education: An Initial Survey of Faculty Beliefs and Practices About Active Learning

BACKGROUND

Flipped classroom (FC) is an active learning (AL) technique thought to have potential benefits in anesthesiology resident education. This survey aimed to determine the frequency of FC utilization, barriers of utilization, and means to overcome these barriers.

METHOD

A web-based questionnaire was developed to survey anesthesiology faculty on their knowledge of and experience with FC. The Society of Academic Associations of Anesthesiology and Perioperative Medicine sent the survey to all United States core program directors (PD) via their list serve with a request for the PDs to forward the survey invitation to their clinical faculty. Descriptive statistics were summarized.

RESULTS

A total of 244 anesthesiology faculty completed the survey. Reported faculty understanding of AL and FC were 57%. Of these faculty, 87% utilized AL and 57% utilized FC in their personal teaching practice during the past year (spring 2015-spring 2016). The most prevalent barriers to utilization of FC were faculty concern that learners would not come to class prepared or participate in class, faculty comfort with delivering traditional lectures, lack of faculty knowledge of necessary technological tools, and faculty concern about perceived increase in time needed to create a FC session. Eighty-nine percent of all faculty desired education on FC with preference for institutional workshops or grand rounds.

CONCLUSIONS

Our survey found a discrepancy between faculty knowledge of FC and usage of this method in anesthesiology resident teaching. More educational resources are warranted to address barriers and familiarize faculty with FC applications in anesthesiology resident education.

Effectiveness of flipped classrooms in Chinese baccalaureate nursing education: A meta-analysis of randomized controlled trials

BACKGROUND

In recent years, the flipped classroom approach has been broadly applied to nursing courses in China. However, a systematic and quantitative assessment of the outcomes of this approach has not been conducted.

OBJECTIVE

The purpose of the meta-analysis is to evaluate the effectiveness of the flipped classroom pedagogy in Chinese baccalaureate nursing education.

DESIGN

Meta-analysis of randomized controlled studies.

DATA SOURCE

All randomized controlled trials relevant to the use of flipped classrooms in Chinese nursing education were retrieved from the following databases from their date of inception through September 23, 2017: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, the China National Knowledge Infrastructure, the Wanfang Database, and the Chinese Scientific Journals Database. Search terms including "flipp*", "inverted", "classroom", and "nurs*" were used to identify potential studies. We also manually searched the reference lists of the retrieved articles to identify potentially relevant studies.

REVIEW METHODS

Two reviewers independently assessed the eligibility of each study and extracted the data. The Cochrane risk-of-bias tool was used to evaluate the quality of the studies. RevMan (Version 5.3) was used to analyze the data. Theoretical knowledge scores and skill scores (continuous data) were synthesized using the standardized mean difference (SMD) and 95% confidence interval (CI). The statistical heterogeneity of the included studies was analyzed by calculating the I² statistic and applying a chi-square test. Publication bias was assessed by funnel plots. The quality of the combined results was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system.

RESULTS

Eleven randomized controlled trials published between 2015 and 2017 were selected. All the included studies had a moderate possibility of bias due to low methodological quality. The meta-analysis indicated that the theoretical knowledge scores and skill scores were significantly higher in the flipped classroom group than in the traditional lectures group (SMD=1.06, 95% CI: 0.70-1.41, P <0.001, and SMD=1.40, 95% CI: 0.46-2.34, P <0.001). There was no significant publication bias indicated in the primary analysis. Sensitivity analysis showed that the results of our meta-analysis were reliable. The evidence grades of the results regarding the theoretical knowledge and skill scores were low and very low, respectively.

CONCLUSION

Flipped classroom pedagogy is more effective than traditional lectures at improving students' theoretical knowledge and skill scores. Given the limitations of the included studies, more robust randomized controlled trials are warranted in a variety of educational settings to confirm our findings.

Curated Collection for Educators: Five Key Papers about the Flipped Classroom Methodology

The flipped classroom (FC) pedagogy is becoming increasingly popular in medical education due to its appeal to the millennial learner and potential benefits in knowledge acquisition. Despite its popularity and effectiveness, the FC educational method is not without challenges. In this article, we identify and summarize several key papers relevant to medical educators interested in exploring the FC teaching methodology.

The authors identified an extensive list of papers relevant to FC pedagogy via online discussions within the Academic Life in Emergency Medicine (ALiEM) Faculty Incubator. This list was augmented by an open call on Twitter (utilizing the #meded, #FOAMed, and #flippedclassroom hashtags) yielding a list of 33 papers. We then conducted a three-round modified Delphi process within the authorship group, which included both junior and senior clinician educators, to identify the most impactful papers for educators interested in FC pedagogy.

The three-round modified Delphi process ranked all of the selected papers and selected the five most highly-rated papers for inclusion. The authorship group reviewed and summarized these papers with specific consideration given to their value to junior faculty educators and faculty developers interested in the flipped classroom approach.

The list of papers featured in this article serves as a key reading list for junior clinician educators and faculty developers interested in the flipped classroom technique. The associated commentaries contextualize the importance of these papers for medical educators aiming to optimize their understanding and implementation of the flipped classroom methodology in their teaching and through faculty development.

Implementation of a “Flipped Classroom” for Neurosurgery Resident Education

Introduction: Engaging residents across a multiyear training spectrum is challenging given the heterogeneity of experience and limited time available for educational activities. A “flipped classroom” model, in which residents prepare ahead of time for mentored topic discussions, has potential advantages. Methods: We implemented a curriculum consisting of topics distributed across the specialty. Weekly, each resident was randomly assigned to research a specific aspect of an assigned topic appropriate to his or her level of experience: junior residents about what characterizes each clinical entity, midlevel residents about when to intervene, and chief residents about how to administer treatment. Residents completed an anonymous survey 6 months after implementation. Board examination performance was assessed before and after implementation. Results: A total of 12 residents participated in the program. Weekly, 1.75±0.40 hours were spent in preparation, with senior residents reporting less time than junior residents. All residents indicated that the accumulation of experience across 7 years of residency was a major advantage of this program, and all preferred it to lectures. Performance on the board examination significantly increased after implementation (from 316±36 to 468±45, p<0.05). Conclusions: The flipped classroom is a viable approach to resident education and is associated with increased engagement and improved performance using validated knowledge-assessment tools.

Concept and benefits of the Inverted Classroom method for a competency-based biochemistry course in the pre-clinical stage of a human medicine course of studies

Background: Medical students often have a problem recognising the relevance of basic science subjects for their later professional work in the pre-clinical stage of their studies. This can lead to a lower motivation to learn biochemical content and dissatisfaction in the courses amongst the students. Alternative teaching methods such as the Inverted Classroom (IC) method can address this deficiency. The goal of this study was: to analyse the motivation and satisfaction of the students in a biochemistry seminar through the use of the e-learning-based IC method, to investigate the acceptance against the IC teaching method in biochemistry, and to compare the learning success achieved using the IC approach with that of a traditional course. We also investigated how a biochemistry course in the pre-clinical stage of a human medicine course of studies can be successfully organised according to the IC method. Furthermore, we examined the benefits of the IC method over conventional teaching formats. Method: The IC method was implemented in accordance with the guidelines of the GMA committee "New Media" [30] in a biochemistry seminar for two student IC intervention groups with 42 students. A part of the factual knowledge from the on-site phase in the form of teaching videos together with self-learning control tasks were provided online before the seminar for both IC intervention groups. Exporting content to the self-learning phase creates new free time in the on-site phase, during which the content can be critically considered and processed and additional competency-based learning objectives can be taught. Identical biochemistry teaching content was taught in parallel control groups (14 student groups with n=299 students), but no material was handed out beforehand for a self-learning phase. These students only received the materials after the on-site phase. Motivation and satisfaction as well as the acceptance for the teaching methods were recorded by questionnaires, the acquisition of knowledge by MC exams. Results: On a Likert scale from 1 (strongly disagree) to 6 (strongly agree), the students in the IC intervention groups could be seen to be much more motivated (5.53) than students in the control group (4.01). Students in the IC intervention groups also recognised the relevance of the learning content much more clearly (5.44) than students in the control group (4.01). Furthermore, the IC group also observed that additional competencies were trained in addition to the biochemistry content. In addition, the IC intervention group award the event a school grade of 1.53, the traditional control group a grade of 2.96. The teaching videos were rated very positively by both groups with an average school grade of 1.3 in each case. A qualitative analysis showed that the motivation and a positive attitude of the lecturers played a decisive role in the successful implementation of the IC method. Discussion and conclusion: Pre-clinical students display a high acceptance of the e-learning-based IC method. Teaching communication competencies in a biochemistry seminar was also rated very positively by the students. The quality of the teaching video and the motivation of the lecturers were shown to be a critical parameter for the successful performance of the IC method. What's more, the IC method can contribute to implementing a competence orientation in medical studies.

Results of a Flipped Classroom Teaching Approach in Anesthesiology Residents

BACKGROUND

In a flipped classroom approach, learners view educational content prior to class and engage in active learning during didactic sessions.

OBJECTIVE

We hypothesized that a flipped classroom improves knowledge acquisition and retention for residents compared to traditional lecture, and that residents prefer this approach.

METHODS

We completed 2 iterations of a study in 2014 and 2015. Institutions were assigned to either flipped classroom or traditional lecture for 4 weekly sessions. The flipped classroom consisted of reviewing a 15-minute video, followed by 45-minute in-class interactive sessions with audience response questions, think-pair-share questions, and case discussions. The traditional lecture approach consisted of a 55-minute lecture given by faculty with 5 minutes for questions. Residents completed 3 knowledge tests (pretest, posttest, and 4-month retention) and surveys of their perceptions of the didactic sessions. A linear mixed model was used to compare the effect of both formats on knowledge acquisition and retention.

RESULTS

Of 182 eligible postgraduate year 2 anesthesiology residents, 155 (85%) participated in the entire intervention, and 142 (78%) completed all tests. The flipped classroom approach improved knowledge retention after 4 months (adjusted mean = 6%; P = .014; d = 0.56), and residents preferred the flipped classroom (pre = 46%; post = 82%; P < .001).

CONCLUSIONS

The flipped classroom approach to didactic education resulted in a small improvement in knowledge retention and was preferred by anesthesiology residents.

Does the Flipped Classroom improve exam performance in medical education? A systematic review

This article was migrated. The article was marked as recommended. Background: The 'flipped classroom' (FC) is a blended learning model in which educational material is delivered on-line prior to class, students then apply this knowledge through discussion and problem solving activities in class. Its effectiveness in medical education is debated. The aim of this systematic review is to assess the outcomes of studies which have compared the exam performance of traditional didactic teaching (DT) to the FC in medical education. Methods: A broad based literature search was performed in accordance with PRISMA protocol. MESH terms were 'flipped classroom', 'flipped teaching', 'blended learning' and 'medical education'. The outcomes of interest were test score results following FC compared to DT methods. Results: Eleven studies with a total of 2052 study participants were included in the review. Four studies demonstrated a significant improvement in test scores using FC compared to DT; four showed no significant difference and three demonstrated mixed results. Discussion and Conclusions: The results of this review are equivocal. Study heterogeneity in design, participants and subject covered may account for some of this disparity. Two studies provide evidence that the FC results in improved performance on higher cognitive tasks however further robust, in depth studies are required to demonstrate this conclusively.

A systematic review of the effectiveness of flipped classrooms in medical education

CONTEXT

There are inconsistent claims made about the effectiveness of the flipped classroom (FC) in medical education; however, the quality of the empirical evidence used to back up these claims is not evident. The aims of this review are to examine the scope and quality of studies on the FC teaching approach in medical education and to assess the effects of FCs on medical learning.

METHODS

A literature search was conducted using the major electronic databases in 2016. Peer-reviewed papers were screened and reviewed according to explicit inclusion criteria. The scope and quality of all resultant studies were evaluated. Studies identified as using controlled designs were further synthesised to assess the effects of FCs on learning.

RESULTS

A total of 118 articles were obtained. Full texts of 82 articles were reviewed. Nine of the included 46 articles used a controlled design when examining the effects of the FC. There were generally positive perceptions of the FC approach. However, the effects of FCs on changes in knowledge and skills were less conclusive as the effect sizes ranged from d = -0.27 to 1.21, with a median of 0.08. The varying direction and magnitude of the effect sizes, together with their 95% confidence interval, which contained zero, suggested the lack of strong evidence for the effectiveness of FCs in promoting knowledge acquisition above and beyond the traditional learning methods.

CONCLUSIONS

There has been a recent increase of research rigor and variety in measures of effectiveness in studies on the FC in medical education. The FC is a promising teaching approach to increase learners' motivation and engagement. More solid evidence on its effect on changes in knowledge and skills are warranted. Further studies should also examine the long-term effects of FCs with regard to knowledge retention and transfer of knowledge to professional practice and patient care.

Comparison between flipped classroom and lecture-based classroom in ophthalmology clerkship

BACKGROUND

In recent years, the flipped classroom method of teaching has received much attention in health sciences education. However, the application of flipped classrooms in ophthalmology education has not been well investigated.

OBJECTIVE

The goal of this study was to investigate the effectiveness and acceptability of the flipped classroom approach to teaching ophthalmology at the clerkship level.

DESIGN

Ninety-five fourth year medical students in an ophthalmology clerkship were randomly divided into two groups. An ocular trauma module was chosen for the content of this study. One group (FG (flipped group), n = 48) participated in flipped classroom instruction and was asked to watch a recorded lecture video and to read study materials before a face-to-face class meeting. They used the in-class time for discussion. The other group (TG (traditional group), n = 47) was assigned to traditional lecture-based instruction. These students attended a didactic lecture and completed assigned homework after the lecture. Feedback questionnaires were collected to compare students' perspectives on the teaching approach they experienced and to evaluate students' self-perceived competence and interest in ocular trauma. Pre- and post-tests were performed to assess student learning of the course materials.

RESULTS

More students in the FG agreed that the classroom helped to promote their learning motivation, improve their understanding of the course materials, and enhance their communication skill and clinical thinking. However, students in the FG did not show a preference for this method of teaching, and also reported more burden and pressure than those from the TG. Students from the FG performed better on the post test over the ocular trauma-related questions when compared to those from the TG.

CONCLUSIONS

The flipped classroom approach shows promise in ophthalmology clerkship teaching. However, it has some drawbacks. Further evaluation and modifications are required before it can be widely accepted and implemented. Abbreviations FG: Flipped classroom group; TG: Traditional lecture-based classroom group; TBL: Team-based learning; PBL: Problem-based learning; ZOC: Zhongshan Ophthalmic Center.

Flipping the Continuing Medical Education Classroom: Validating a Measure of Attendees' Perceptions

INTRODUCTION

New teaching approaches for CME are needed. In flipped classrooms, coursework is completed beforehand and applied during class time. Studies of flipped classrooms and their potential benefits in CME have not been published. We sought to develop and validate an instrument measuring flipped classroom perceptions, identify whether participation changed perceptions, and determine which flipped classroom components were perceived as most effective.

METHODS

In this cross-sectional validation study, 167 participants in the Mayo Clinic's 2015 Internal Medicine Board Review course received surveys. Online modules were developed to deliver content before flipped classroom courses on acid-base disorders and electrolyte disorders. A flipped classroom perception instrument (FCPI) was developed and validated. The FCPI, with eight items structured on 5-point Likert scales, was given to participants before and after their flipped classroom experiences.

RESULTS

Of the 167 participants, 111 returned surveys. Flipped classroom perceptions improved, with mean (SD) FCPI scores increasing from 3.74 (0.75) to 3.94 (0.76) (P < .001). The percentage of participants who preferred flipped classrooms increased from 38% before the course to 53% after (P = .002). Positive changes in FCPI scores were unrelated to module completion. Most participants thought knowledge was enhanced by in-class sessions and online modules equally.

DISCUSSION

The FCPI, the first validated measure of participants' perceptions of a CME flipped classroom, has strong validity evidence. Participants' perceptions of and preference for the flipped classroom improved after experiencing the flipped CME classroom. These findings support the need to further explore flipped classroom models in CME.