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Flipping the classroom in nursing education

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Flipping the classroom is a technique used to increase opportunities for application of concepts and critical thinking, with guidance from the instructor in the classromm.

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Flipping the classroom in nursing education

  1. 1. Flipping the Classroom with Low- Fidelity Simulation Lynne Massaro & Andrew Wolf
  2. 2. Background Results of a Carnegie Foundation study (Benner, Sutphen, Leonard, & Day, 2010) indicated that nursing education programs lack opportunities for students to apply basic scientific theoretical knowledge in real life settings prior to program completion. Current educational formats provide students with facts and concepts to memorize without allowing opportunities for active engagement in synthesizing or application. The authors recommend that nursing programs restructure classroom environments to provide students practice in clinic-like experiences. Results of a study by Deslauriers, Schelew, and Wieman (2011) compared a flipped classroom to standard lecture delivery in 2 groups of an undergraduate physics class. The students in the flipped classroom had improved test score results with an effect size of 2.5%. A randomized trial by Schroedl et al. (2012) evaluated the learning of clinical skills in traditional lecture based education versus simulation for training residents prior to MICU rotation. The simulation training resulted in significantly better results in bedside tests of applied clinical skills such as respiratory mechanics, ventilator management, and circulatory resuscitation.
  3. 3. Background Flipping the classroom moves traditional lecture content to a structured online learning environment. This opens up the classroom for face-to-face active learning opportunities including problem sets, writing exercises, case based learning, or simulation exercises. Question for evaluation: Does the redesign of a traditional lecture based course with structured online lessons and in-class low-fidelity simulation increase satisfaction and impressions of learning effectiveness from students and faculty?
  4. 4. Program Methods Specific required online learning activities were completed outside of the classroom prior to a three-hour active learning in-class session. The face-to-face class began with a 10-minute lecture summarizing the key concepts of management and treatment of the common complaint. The in-class low-fidelity simulations of provider/patient interactions were designed around the learning outcomes. One student enacted the role of patient while another enacted the role of the nurse practitioner (NP). The NP completed a full patient history and physical while other students provided guidance. Students then worked in small groups to think through the presenting symptoms to develop a list of differential diagnoses and a workup and treatment plan using critical thinking and decision-making skills. After completing their individual group work, the class debriefed in a large group about the process of diagnosing and managing the patient.
  5. 5. Evaluation Methods The quantitative data from student course evaluations was compared from courses taught in 2011 and 2013. In 2011 the course was a traditional lecture based course. In 2013, the classroom was “flipped” and included low-fidelity simulation. Qualitative data was collected from student course evaluations and emails in 2013 to determine themes on student satisfaction and impressions of learning effectiveness. Qualitative data was collected from a faculty debriefing about satisfaction and impression of student learning.
  6. 6. Results Student course evaluation data comparing a traditional lecture based classroom in 2011 with a “flipped” classroom in 2013.
  7. 7. Results Student course evaluation data comparing a traditional lecture based classroom in 2011 with a “flipped” classroom in 2013.
  8. 8. Student Qualitative Data Case Studies Improved Learning: “I was wondering if we will be doing more examples of how to write a HPI's in class, like we did the first few weeks? I felt those were helping me become more precise” “…the case study discussions really help pull things together. I have learned so much, yet feel not so stressed as in previous classes” Pre-tests Helped Student Prepare for Low Fidelity Simulation: “The pre and post test on line were wise. Case studies in class were helpful” “ I loved the testing layout with pre-tests based on the reading and post-tests based on the lectures. It forced me to stay on track with the material.
  9. 9. Appreciated Learning Opportunities: “. . . thank you for the excellent semester of education. . . .This semester, by far, has been superior to the rest in the Masters program.” “Thanks so much I learned a great deal in the class” “I am humbled and appreciative of my experiences this semester.” “I just have to write and tell you how much I love your class! . . . I learned so much . . . Just wanted to tell you both! (and no, I’m not trying to get extra credits! . . . )” Student Qualitative Data
  10. 10. Faculty Observations Student attendance remained high throughout the entire semester. Students were engaged and intrinsically motivated. They frequently requested additional learning activities to support their academic and professional goals. Students appreciated the opportunity to practice role behaviors in a non-threatening environment and expressed confidence in their skills in patient evaluation and management using evidence-based treatment plans. Clinical papers demonstrated improved proficiency in applying scientific and theoretical knowledge. Students voiced decreased anxiety in role transition from RN to NP.
  11. 11. Recommendations for Practice Provide well designed structured online lessons with outline, readings, lecture materials, practice problems, and quizzes. Low-tech works great. Simple text based lessons can be as effective as multimedia. Employ low-stakes pre-tests to provide formative assessment of comprehension prior to face-to-face classes. Online discussion is not always necessary in a course with rich face-to-face interaction. Use face-to-face courses for guided practice activities in which faculty and peers can provide formative feedback and assistance. Mini-lectures in a face-to-face class can provide an opportunity for students to ask for clarification prior to starting practice activities.
  12. 12. References Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass. Deslauriers, L., Schelew, E., & Wieman, C. (2011). Improved learning in a large-enrollment physics class. Science, 332(6031), 862-864. doi:10.1126/science.1201783 Schroedl, C. J., Corbridge, T. C., Cohen, E. R., Fakhran, S. S., Schimmel, D., McGaghie, W. C., & Wayne, D. B. (2012). Use of simulation-based education to improve resident learning and patient care in the medical intensive care unit: A randomized trial. Journal of Critical Care, 27(2), 219.e7-219.e13. doi:10.1016/j.jcrc.2011.08.006

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