Researches related to flipped classroom in health care education.

1. Flipped classroom
Han Hung Lee

2. Bloom’s taxonomy

3. Flipped classroom
• Before class: finish the online-content of pre-
recorded videos, reading materials at their
own pace of learning
• In class: focus on the activities with ‘higher-
level learning’ – group discussion, debate,
presentation, role playing, etc.

4. What do students really care?

5. • Method: Open-response surveys with the
following questions:
• Participants: from a mix of 100-level, 300-level
and 400-level university courses at a public
institution.
• Result:
– Face-to-face: Interaction (55%), instructor (31%)
– Online: Class structure (43%), interaction (15%)

6. What is the professional’s
perception on technology-
mediated education?

7. • Method: modified Delphi method, with the
questions of each round as follow:
– Round 1: What do we want our healthcare graduates
to be, as opposed to what we want them to do?
– Round 2: What teaching strategies would you use in
order to develop the attributes identified in the first
round?
– Round 3: What are the ways in which technology-
mediated instruction can be used to support the
teaching strategies identified in round two?

8. • Results:
– Round 1: (students) be part of a developmental
process, in addition to “having” knowledge, skills,
understanding and attitudes, which were seen as
products of learning
– Round 2: combinations of teaching strategies -
safe space for students to explore the domain
independently, in-class reflective components
– Round 3: interactive, integrative and reflective
technical tools that enhanced student-centered
and self-directed learning; ICTs (Information and
Communication Technology) offered a more
flexible approach to learning; content to be
available anywhere, anytime.

9. Any examples?

10. • Course:
• Participants: 162 students, with 22 through
teleconference in satellite campus

11. • Details:
– Offloaded contents: as integrated learning
accelerator module (iLAM) to a website which
could be addressed by internet-enabled device
– Student-centered learning:
• Audience responses and open questions
• Pair & share activities
• Student presentations and discussion
• Individual or paired quiz
• Microlectures (optional)
– Appropriate assessments: in-class activities + final
examination

12. • 127% more time to prepare than the
traditional class
– capture lectures, prepare active learning exercises,
and grade projects and examinations.
• Required highly trained teaching assistants,
– efficiency and expertise of the instructor,
especially as it related to providing thoughtful
written feedback.
– employing senior medical students who already
have completed the course and/or PhD students
who are enrolled in graduate medical programs

13. • Online engagement measures and final exam
performance were weak (rp = −0.04 to rp =
0.20).
•

14. •
• The actual practice of offloading content and
engaging in active learning in the classroom is far
more important than the specific methods.

15. • Same course design, but evaluate the
consequence of students in satellite classroom
•

16. • Qualitative findings:
– Engagement: with other learners and instructor,
content to address or solve real-life problems
– Empowerment: created an environment that
facilitated enhanced learning and increased
confidence
– Development: critical thinking, problem solving,
professionalism, studying
• Learning experience improved, yet no
significant examination performance
difference

17. Other designs?

18. • Method: Environmental and occupational health
(EOH) course redesigned with flipped
classroom/NextGenU DOOHICHEs (Democratically-Open
Outstanding Hybrids of Internet-aided, Computer-aided, and Human-aided
Education, pronounced as “doohickey”)
– Offloaded contents: NextGenU DOOHICHEs
– In-class activities: mini- lesson addressing concepts or
aspects, brief question and answer period, active
learning activities (e.g. a toxicology problem set that students worked on in
pairs; an occupational health case-study examined in small groups; and a whole-class
debate on the topic of environmental health decision-making); writing 4
reflective responses
– final exam at the end of the semester

20. • Participants: MPH students (n = 11) enrolled in
the 2013 spring session of an EOHC at a
Canadian university.
• Results:
– Self-perceived knowledge assessment: significant
increase for every competency
– Student’s perception of the NextGenU/flipped
classroom model: highly favorable overall
– Comparison of examination scores: no statistically
significant difference

21. • Key themes from focus group:
– Factors influencing positive experience:
interaction, class size, active in-class learning
activities and reflective responses, engagement
with content online before attending in-class
– Attitude change toward EOH: this course
contributed to greater interest in environmental
health and issues in general
• ‘flipping’ the classroom is not simply about
shifting lectures out- side of the classroom.
Content delivery is “just one small piece of the
overall learning experience...” , STRUCTURE!!

22. • Course design: (for example)
• Participants: 148 students were enrolled in 4
sections of PS (Professional Skills in Dietetics ) and 48
students were in 2 sections of CN (Community Nutrition)

23. • Details:
– Before class: mini-lectures (between 10 and 15
minutes), videos obtained from sources such as
Khan Academy or TED Talks, completed a table as
a low-stakes assessment
– During class: choose only a few active learning
strategies to use throughout the course rather
than a different one for each class
– After class: Assessment
• formative (eg, at the end of the class assignment)
• summative (eg, exam, or portion of an exam that covers
several weeks of content)

24. •
• Time to digitalize lectures as well as think of
appropriate active learning strategies to use in
class is extensive.

25. No difference in performance?

26. • Course design:

27. • Participants: 27 graduated student, with 14 in
tradition course and 13 in the flipped one
•

28. • Quizzes or written homework assignments (25% of
final grade) at the beginning of each class followed
by discussion – allowed the faculty to better engage
the students
•

29. Cost?
• The baseline cost for the course in 2011
was $5,965.00. Costs above baseline were
$8,763.00 in 2012 for one-time course
implementation and $2,657.00 annually for
course continuation
• Less than 1% of the tuition at the school
• What is the cost of a failed student? And
perhaps more important: What is the cost of a
less competent professional?