Providing the choice of in-person or videoconference attendance in a clinical physiology course may harm learning outcomes for the entire cohort

Clinical Physiology 1 and 2 are flipped classes in which students watch prerecorded videos before class. During the 3-h class, students take practice assessments, work in groups on critical thinking exercises, work through case studies, and engage in drawing exercises. Due to the COVID pandemic, these courses were transitioned from in-person classes to online classes. Despite the university's return-to-class policy, some students were reluctant to return to in-person classes; therefore during the 2021-2022 academic year, Clinical Physiology 1 and 2 were offered as flipped, hybrid courses. In a hybrid format, students either attended the synchronous class in person or online. Here we evaluate the learning outcomes and the perceptions of the learning experience for students who attended Clinical Physiology 1 and 2 either online (2020-2021) or in a hybrid format (2021-2022). In addition to exam scores, in-class surveys and end of course evaluations were compiled to describe the student experience in the flipped hybrid setting. Retrospective linear mixed-model regression analysis of exam scores revealed that a hybrid modality (2021-2022) was associated with lower exam scores when controlling for sex, graduate/undergraduate status, delivery method, and the order in which the courses were taken (F test: F = 8.65, df1 = 2, df2 = 179.28, P = 0.0003). In addition, being a Black Indigenous Person of Color (BIPOC) student is associated with a lower exam score, controlling for the same previous factors (F test: F = 4.23, df1 = 1, df2 = 130.28, P = 0.04), albeit with lower confidence; the BIPOC representation in this sample is small (BIPOC: n = 144; total: n = 504). There is no significant interaction between the hybrid modality and race, meaning that BIPOC and White students are both negatively affected in a hybrid flipped course. Instructors should consider carefully about offering hybrid courses and build in extra student support.NEW & NOTEWORTHY The transition from online to in-person teaching has been as challenging as the original transition to remote teaching with the onset of the pandemic. Since not all students were ready to return to the classroom, students could choose to take this course in person or online. This arrangement provided flexibility and opportunities for innovative class activities for students but introduced tradeoffs in lower test scores from the hybrid modality than fully online or fully in-person modalities.

The impact of flipped teaching on EFL students' academic resilience, self-directed learning, and learners' autonomy

Introduction

This study attempted to investigate the impact of flipped teaching (FT) on EFL (English Foreign Language) students' academic resilience (AR), self-directed learning (SDL), and learners' autonomy (LA).

Method

To do this, the researcher selected 354 participants by the two-stage cluster sampling method. This research was quasi-experimental based on the pretest, and post-test, with experimental and control groups. Three questionnaires were administered to collect data. The questionnaires were analyzed using SPSS 24 software and inferred analysis of covariance (ANCOVA).

Results

The covariance study showed that FT significantly affected AR, SDL, and LA in learning with the help of the pre-test covariate variable (p<00.5). Also, the mean scores of students in the pre-test and post-test in the experimental group were significantly different. The mean scores of EFL students' AR, SDL, and LA were higher through FT. It is suggested that school principals provide the ground for teachers' participation in workshops on new teaching strategies so that teachers can benefit from new teaching approaches, including FT in the classroom.

Discussion

The study results showed that the mean AR of students in the experimental group's post-test compared to the pre-test in both groups has significantly increased. The research findings indicate a positive effect of the flipped class on the levels of SDL. Based on the results, the flipped lesson class approach significantly affected the LA of English language learners as a foreign language. The findings of this study confirm previous relevant studies on the impact of flipped course classes on the LA of English language learners as a foreign language.

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

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

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

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

Virtual flipped teaching during the COVID-19 pandemic

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

[Improvement of Medical Alarm Management Accuracy for Critical Care Nurses in a Continuous Renal Replacement Therapy Unit]

BACKGROUND

Continuous renal replacement therapy (CRRT) is a common medical treatment for critically ill patients. The alarm management component of CRRT is urgent and time sensitive. Patient safety and survival rates are jeopardized if critical care nurses do not handle this situation properly. However, clinical settings cannot provide nurses with the opportunity to practice alarm management, which results in related training difficulties. Based on a survey conducted in May 2018, the rate of proper alarm management for the nurses in our CRRT unit was only 53.1%. An investigation attributed this low rate to inadequacies in standard procedures, resources for reference, opportunities for hands-on experience, professional training at different levels, immediate assistance from industry, and lack of familiarity with the purpose and handling of alarm incidents. These findings motivated our project team to improve alarm management.

PURPOSE

To increase the accuracy of alarm management in CRRT critical care nurses to more than 90%.

RESOLUTIONS

This project, which was implemented from September 8th, 2018 to August 31st, 2019, adopted a diverse and effective teaching strategy that included establishing standard procedures and technical tests; creating a plan for a case scenario simulation course using flipped teaching; providing scenario simulation videos; and designing online scenario simulation interactive exercises, nursing manuals, and flashcards of simplified procedures.

RESULTS

The accuracy rate of proper alarm management for CCRT critical care nurses increased from 53.1% to 98.9%.

CONCLUSIONS

Diverse teaching strategies may be used to effectively enhance the care provided by critical care nurses, increase patient safety, and improve the quality of care. The findings and strategies in this study may also be applied to other intensive care units.

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

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

[Action Research on the Use of the Flipped Teaching Model in Obstetric Nursing Laboratory Classes]

BACKGROUND

Obstetric nursing laboratory courses typically involve both time and credit limitations. Using traditional teaching methods such as "teacher demonstrate, students imitate" in these courses provides insufficient opportunities for students to develop the ideal level of maternity nursing expertise. Lack of sufficient familiarity with the relevant techniques, procedures, and clinical scenarios prior to participation in internships reduces the level of safety in clinical care environments.

PURPOSES

(1) To explore the effectiveness as perceived by baccalaureate nursing students of an obstetric nursing laboratory classes based on a flipped teaching model; (2) To examine the application of a flipped teaching model in obstetric nursing laboratory classes as well as the problems encountered and the actions necessary to resolve these problems. The findings may be used as a reference for future teaching and guidance.

METHODS

This study used an action research framework as a guide and employed focus groups and questionnaires to collect student perceptions of the flipped teaching model.

RESULTS

The feedback of students was highly positive because the classes involved repeated practice, were integrated into the clinical context, and allowed active learning independent of time and space restrictions. These attributes affected learning efficiency positively. The following four themes emerged from the focus group analysis: helps improve self-directed learning, helps integrate into the clinical context, helps peers learn from each other, and helps bring teachers and students closer.

CONCLUSIONS / IMPLICATIONS FOR PRACTICE

This study demonstrated an actual implementation of the flipped teaching model in obstetric nursing laboratory classes as well as assessed the learning perceptions of students. This teaching method provides opportunities for teachers and students to discuss and practice nursing skills, strengthen students' self-directed learning capabilities, and improve students' learning motivation. The author recommends that this innovative teaching strategy may be used to teach various subjects and different disciplines in nursing.

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

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

Benefits behind barriers in physiology education

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

Students from a large Australian university use Twitter to identify difficult course concepts to review during face-to-face lectorial sessions

Engaging undergraduate students in large classes is a constant challenge for many lecturers, as student participation and engagement can be limited. This is a concern since there is a positive correlation between increased engagement and student success. The lack of student feedback on content delivery prevents lecturers from identifying topics that would benefit students if reviewed. Implementing novel methods to engage the students in course content and create ways by which they can inform the lecturer of the difficult concepts is needed to increase student success. In the present study, we investigated the use of Twitter as a scalable approach to enhance engagement with course content and peer-to-peer interaction in a large course. In this pilot study, students were instructed to tweet the difficult concepts identified from content delivered by videos. A software program automatically collected and parsed the tweets to extract summary statistics on the most common difficult concepts, and the lecturer used the information to prepare face-to-face (F2F) lectorial sessions. The key findings of the study were 1) the uptake of Twitter (i.e., registration on the platform) was similar to the proportion of students who participated in F2F lectorials, 2) students reviewed content soon after delivery to tweet difficult concepts to lecturer, 3) Twitter increased engagement with lecturers, 4) the difficult concepts were similar to previous years, yet the automated gathering of Twitter data was more efficient and time saving for the lecturer, and 5) students found the lectorial review sessions very valuable.

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

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

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

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

[Application of Flipped Classroom Teaching Strategy in Nursing Education]

The ultimate purpose of education is to provide students with the skills and motivation necessary for lifelong learning. Students with lifelong learning abilities are better able to continue improving their professional core competencies, especially in terms of problem solving and clinical reasoning. Prior to enhancing lifelong learning abilities, students must learn self-directed learning. Studies have shown that flipped classroom learning has the potential to improve self-directed learning. Flipped classroom teaching requires prerecorded lectures, strengthened teacher-student interaction, and assisting students to learn in-depth. The authors developed a four-phase dynamic case-based learning (4D CBL) innovative teaching strategy and then assimilated this strategy into flipped classroom teaching. This innovative teaching strategy may be used in various academic nursing programs to reinforce self-directed learning and clinical reasoning abilities. After introducing the concepts of flipped classroom teaching and 4-D CBL, how to merge 4D CBL with the flipped classroom model and the effectiveness of this innovative teaching strategy are demonstrated. Nurse educators may use the flipped classroom teaching strategy with 4D CBL in their future practice.

[Approach to Evidence-based Medicine Exercises Using Flipped Teaching: Introductory Education for Clinical Practice for 4th-Year Pharmacy Students]

　Osaka University of Pharmaceutical Sciences has included an evidence-based medicine (EBM) exercise in the introductory education for clinical practice for 4th-year pharmacy students since 2015. The purpose of this exercise is to learn the process of practice and basic concepts of EBM, especially to cultivate the practical ability to solve patients' problems and answer their questions. Additionally, in 2016, we have attempted flipped teaching. The students are instructed to review the basic knowledge necessary for active learning in this exercise by watching video teaching materials and to bring reports summarizing the contents on the flipped teaching days. The program includes short lectures [overview of EBM, document retrieval, randomized controlled trials (RCTs), and systematic review], exercises [patient, intervention, comparison, outcome (PICO) structuring, critical appraisal of papers in small groups with tutors], and presentations. The program includes: step 1, PICO structuring based on scenarios; step 2, critical appraisal of English-language papers on RCTs using evaluation worksheets; and step 3, reviewing the results of the PICO exercise with patients. The results of the review are shared among groups through general discussion. In this symposium, I discuss students' attitudes, the effectiveness of small group discussions using flipped teaching, and future challenges to be addressed in this program.