Flipped Classroom Model for Undergraduate Teaching Using Mixed-methods Approach: A Pilot Project

INTRODUCTION

The flipped classroom teaching strategy uses a pedagogical approach by providing appropriate resource material to students beforehand for pre-class learning. The class proceeds by building up on the preliminary concept using group discussion. Interactive methodologies such as reciprocal questioning and peer review can be applied during the discussions, enhancing learning through the active participation of students. Psychologists believe that how a student prefers to learn is the single most important factor affecting academic performance.¹

In compliance with the recommendations of the National Medical Council which emphasizes competency-based medical education, educators are experimenting with different teaching-learning strategies. The backbone of a successful competency-based curriculum is strategies that are learner-oriented and provide an opportunity for self-participation, self-direction, higher-order thinking, and the promotion of self-directed learning (SDL).²

Traditionally, didactic lectures have been an important part of medical education in India. We are now innovating the existing techniques in an attempt to discover strategies that work best for medical students. The flipped classroom method is an active teaching strategy that involves providing appropriate resource material beforehand, followed by group discussion involving interactive methodologies such as reciprocal questioning, peer review, etc. This method was first used in the 1980s, however, it was popularized by Harvard Professor Eric Mazur in the 1990s. He provided material for students to prepare before class while class time was used for instructor challenge, peer interaction and better understanding also named “just-in-time teaching”.³

The present study is a pilot project, conducted to explore the perception and acceptance amongst medical students and educators to flipped classroom teaching methodology.

MATERIALS AND METHODS

This was a questionnaire-based mixed-methods study conducted at Era’s Lucknow Medical College and Hospital, India over 3 months. Institutional ethical clearance was obtained before recruitment and duly written; informed consent was taken. Study participants were medical undergraduate students in their second semester attending classes in Obstetrics and Gynaecology and facilitators involved in conducting the flipped classroom. The students were asked to fill in a prevalidated questionnaire regarding aspects of the session. Feedback from facilitators was taken by conducting a focused group discussion (FGD) regarding the session focussing on its merits and demerits and a comparative analysis vis-a-vis traditional methods of teaching.

RESULTS

Fifty students (31 girls; 62% and 19 boys; 38%) were enrolled for the sessions. Table 1 shows the scoring of the active teaching-learning strategy as given by our students. Overall, 68% of students found teaching by flipped classroom method as excellent– 58% (usefulness), 64% (content), and 64% (teaching). No student found the method bad for learning and retaining.

Table 2 shows the perception of confidence levels as scored by the students. About 72% of students felt an increase in confidence levels; 20% were unsure of whether they had benefitted and 8% did not find any increase in confidence levels. The majority of students (76%) found these classes more interactive and easier to comprehend. There were many suggestions for more frequent sessions of a similar nature. Focused group discussion was conducted for 5 teachers who were involved in carrying out the flipped classroom sessions.

DISCUSSION

Though it had been previously used, ‘Flipped classroom teaching’ is an active teaching-learning technique that was first documented for teaching in 2012 by Bergmann and Sams, two high school chemistry teachers from Colorado, USA.⁴ As part of the methodology, the learners are expected to switch the in-class with at-home activities by initially performing self-directed pre-class studying and progressing to in-class, face-to-face discussions in small groups. A successful model is purported to provide deeper insight into the subject, increasing active learner participation and engagement in discussion, thus making the process learner-centric. It is theorized that this approach cuts down on unnecessary wastage of time and energy for both learners and facilitators by preparing a preliminary background.

The present study found that the majority of students (94%) graded the sessions as good or excellent. Similarly, high likability rates have been observed by other investigators. McLaughlin et al., in their research on pharmacy students, found that 95.6% of students preferred flipped classrooms, citing better understanding and ability to apply key concepts in clinical situations.⁵ Davies et al. also showed the superiority of flipped classroom methodology to other instructional strategies.⁶ Nouri observed that 75% of students expressed a positive attitude toward flipped classrooms after completion of the course.⁷ Similarly, Veeramani et al. found flipped classroom teaching to enhance the performance of students in exams.⁸ A meta-analysis of 225 studies concluded that using active teaching-learning methods in undergraduate science courses resulted in a 6% improvement in student performance in exams. Additionally, students being taught with the traditional methods were 50% more likely to fail the examination, reinforcing that flipping increases class time for more engaging instruction, increased student engagement, and focused classroom discussion.^9,10

While this was outside the scope of the present study, we found that 72% of the students perceived an elevation in confidence levels after the sessions. However, other authors have argued that the likability of sessions does not translate into improving knowledge retention. Since learner motivation is an essential component of any self-directed learning (SDL) technology, it could be argued that students who are motivated perform equally irrespective of traditional lectures or flipped classroom teaching.

In our qualitative assessment using initial codes (Table 3), the maximum scores were given to having sufficient time for learner-facilitator interaction. However, that does involve considerable effort on the part of the facilitator. McLaughlin et al. recommend an additional 127%-time investment by the facilitator to course development and 57% extra time to maintain the standards of the course in comparison to the traditional lecture. The FGD with facilitators explored this aspect in detail (Table 4). All agreed that the initial effort was indeed massive and daunting especially because the curriculum was still not in sync with active teaching-learning methodologies. The learners were also experiencing it for the first time, so more time was required for sensitization. It was accepted, however, that with time the sessions became easier. Student enthusiasm was an additional encouraging factor. All agreed that the same pre-class material could be used on successive cohorts of students, easing the classroom time so that more focus could be given to discussions.

CONCLUSION

• Flipped classroom teaching is acceptable and finds high satisfaction levels among medical students.

• It involves the investment of extra time and energy by facilitators, especially initially.

ORCID

Saxena Shoadashi https://orcid.org/0000-0002-1102-3289

REFERENCES

1. Bhat MA. Understanding the learning styles and its influence on teaching/learning process. International Journal of Education and Psychological Research 2014;3(1):9–13. Available from: https://www.researchgate.net/publication/262727448.

2. Ramnanan CJ, Pound LD. Advances in medical education and practice: Student perceptions of the flipped classroom. Adv Med Educ Pract 2017;8:63–73. DOI: 10.2147/AMEP.S109037

3. Crouch CH, Mazur E. Peer instruction: Ten years of experience and results. Am J Phys 2001;69(9):970–977. DOI: 10.1119/1.1374249.

4. Enfield J. Looking at the impact of the flipped classroom model of instruction on undergraduate multimedia students at CSUN. Tech Trends 2013;57:14–27. DOI: https://doi.org/10.1007/s11528-013-0698-1.

5. McLaughlin JE, Roth MT, Glatt DM, et al. The flipped classroom: A course redesign to foster learning and engagement in a health professions school. Acad Med 2014;89(2):236–243. DOI: 10.1097/ACM.0000000000000086.

6. Dean DL, Davies R, Ball N, et al. Flipping the classroom and instructional technology integration in a college-level information systems spreadsheet course. Educational Technology Research and Development (ETR&D) 2013;61(4):563–580. Available from: https://www.researchgate.net/publication/256446014.

7. Nouri J. The flipped classroom: For active, effective and increased learning – Especially for low achievers. Int J Educ Technol High Educ 2016;13(1):33. DOI: http://dx.doi.org/10.1186/s41239-016-0032-z.

8. Veeramani R, Madhugiri VS, Chand P. Perception of MBBS students to “flipped class room” approach in neuroanatomy module. Anat Cell Biol 2015;48(2):138–143. DOI: 10.5115/acb.2015.48.2.138.

9. Freeman S, Eddy SL, McDonough M, et al. Active learning increases student performance in science, engineering, and mathematics. Proc Natl Acad Sci USA 2014;111(23):8410–8415. DOI: 10.1073/pnas.1319030111.

10. Milman N. The flipped classroom strategy: What is it and how can it be used? Distance Learn 2012;9(3):85–87. Available from: https://www.researchgate.net/publication/311396228.