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Year : 2021  |  Volume : 14  |  Issue : 6  |  Page : 642-645  

Efficacy of flipped classroom teaching on the cognitive domain in second-year physiotherapy students

Department of Neurosciences, P.T, TMV's Lokmanya Medical College of Physiotherapy (Kharghar), Affiliated to Maharashtra University of Health Sciences, Nashik, Maharashtra, India

Date of Submission20-Jun-2020
Date of Decision16-Mar-2021
Date of Acceptance26-Mar-2021
Date of Web Publication24-Jun-2021

Correspondence Address:
Pranjal Grover
TMV's Lokmanya Medical College of Physiotherapy (Kharghar), Affiliated to Maharashtra University of Health Sciences, Nashik, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_290_20

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Introduction: Flipped learning is an instructional strategy and a type of blended learning that reverses the traditional learning environment by delivering instructional content, often online, outside the classroom. It moves activities, including those that may have conventionally been considered homework, into the classroom. With the availability of resources but restrictions on time, flipped learning can replace or be an adjunct to conventional classroom teaching as per the need. Objectives: (1) Comparison of the MCQ test scores pre- and postflipped learning classroom. (2) Analyze the feedback of the students on flipped learning through structured questionnaire. Materials and Methods: This study included 36 second-year students from TMV's Lokmanya Medical College of Physiotherapy. After approval from the Institutional Ethical Committee, written consent was obtained from the participants. The study material was mailed to all the participants. Flipped classroom instructional strategy was employed with videos of “Gait-Kinetics and Kinematics” that were uploaded. Two classroom lectures were conducted for in-depth exploration and problem-solving done. Pre- and postMCQ test administered and feedback was taken. Results: A significant improvement was seen in the MCQ test score post two flipped learning sessions (P < 0.001). The feedback questionnaire analysis established that flipped classroom technique is an effective teaching method. Conclusion: Flipped classroom teaching is an effective teaching method in bringing about a change in the cognitive domain of second-year physiotherapy students.

Keywords: E-learning, flipped learning, instructional strategy

How to cite this article:
Grover P, Phadke S. Efficacy of flipped classroom teaching on the cognitive domain in second-year physiotherapy students. Med J DY Patil Vidyapeeth 2021;14:642-5

How to cite this URL:
Grover P, Phadke S. Efficacy of flipped classroom teaching on the cognitive domain in second-year physiotherapy students. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Dec 6];14:642-5. Available from: https://www.mjdrdypv.org/text.asp?2021/14/6/642/319174

  Introduction Top

The conduct of education in this 21st century has been witnessed with a paradigm shift from face-to-face teaching environment to a more technology-based learning environment.[1],[2] Conventional teaching or traditional teaching refers to a teaching method involving instructors and the students interacting in a face-to-face manner in the classroom. These instructors initiate discussions in the classroom and focus exclusively on knowing content in textbooks and notes. Students receive the information passively and reiterate the information memorized in the examinations.[3] Many teachers are still teaching their students in the same manner as how they were taught and how their own teachers were taught, not much progress in terms of the teaching perspectives. Conventional teaching may limit the room for more creative thinking. There are likely to be variations in the level of understanding of students and time taken to grasp a particular topic. It is imperative to realize these limitations in conventional teaching.[3] The Internet is a common tool which students of this generation use for understanding and learning, besides the conventional teaching environment. Students find learning technology helpful to their study as it is informative and yet not boring. Technology has made e-learning more interactive and engaging. Hence, it is easy to engage students actively in the virtual classroom.[4],[5] Each student is motivated to offer a personal contribution to the common cause in class and thereby adding to the common knowledge pool.[6],[7],[8] The recent COVID 19 pandemic has made the reduction of interpersonal contact imperative. Emergency e-learning systems are being put in place. It is a challenge for educational institutes all over the world to put in place e-learning strategies best suited to their needs.[9],[10]

Flipped learning is a type of blended synchronous e-learning strategy that reverses the traditional learning environment by delivering instructional content, often online, outside the classroom. It is also a form of interactive learning.[11] It moves activities, including those that may have traditionally been considered homework, into the classroom. Here, the real didactic lecture time is channelized toward the application of the concepts imbibed invoking active learning methods which result in higher student achievement.[1],[12] With the availability of resources but restrictions on time, flipped learning can replace conventional classroom teaching according to the need. It allows the faculty to engage students both inside and outside of classroom and to employ a range of modern technology tools. This may be effective in medical and allied health settings where the clinical duties of staff and students lead to a shortage of time to cover the vast syllabus. This model is learner-centric as it allows the students to learn and understand a particular topic at their own pace and in comfortable settings.[13],[14] It may prove to be a useful adjunct to conventional teaching, especially in the cognitive domain. In view of the recent COVID-19 pandemic where social distancing is the new norm and virtual teachinglearning platforms needed more than ever, flipped classroom learning may be a compelling option. It reduces the classroom hours and provides conceptual learning through online videos and resource material. In-class time, under the guidance of the teacher, is dedicated to discussions, interactive exercises, and independent work that would have been previously completed at home. The teacher is available to respond to any questions that may arise thereafter.

With this background, a study was conducted to understand whether flipped classroom teaching was effective in improving learning in the cognitive domain of second-year physiotherapy students. The present study has used the flipped classroom teaching to give students a better theoretical understanding and visualization of a complex topic such as Gait-Kinetics and Kinematics.

  Materials and Methods Top

This study was undertaken at TMV's Lokmanya Medical College of Physiotherapy, Navi Mumbai.

Study design

This is pretest–posttest experimental study was conducted at TMV's Lokmanya Medical College of Physiotherapy, Kharghar, Navi Mumbai. Consent was obtained from the Institutional Ethics Committee (O.W. No.: LMCOP/2020/32, dated - March 5, 2020). The topic “Gait-kinetics and kinematics” which deals with the study of human motion and the forces that generate were chosen. This topic requires an understanding of anatomy and biomechanics combined with visualization of human motion hence it is taught in the second year of the course. Using the complete enumeration technique, the inclusion criteria were all 36 students of second year physiotherapy course at the institute who were to be taught this topic. The study was carried out in the 2nd and 3rd week of March 2020. An initial introductory lecture on gait parameters was conducted in the 1st week of March. After the initial lecture, study material and videos on “Gait-kinetics and kinematics” were mailed to the participants 4 days before the flipped classroom session. Participants were instructed to study the source content. Flipped classroom gave students the benefit of revision through provided study material and the advantage of going through the recorded lectures at their own pace. This topic has been designated 3 h of didactic lecture time as per the syllabus designed by the Maharashtra University of Health Sciences. Two sessions of flipped classroom activity (1.5 h each) as per the guidelines were conducted. These included reasoning, brainstorming, and problem-solving.


  1. The pre-and posttest question sheet consisted of ten multiple-choice questions which aimed at testing the knowledge of kinetics and kinematics of the normal gait cycle. The questions were validated by subject experts
  2. The feedback questionnaire (ten Likert scale response-based questions) comprised (i) two questions to evaluate the adequacy of the provided study material and the time allotted for preparation (ii) two questions to evaluate the content, quality, and relevance of the e-lecture (iii) two questions to evaluate the efficacy of the e-lecture in terms of understanding, motivation for further learning (iv) four questions to evaluate classroom arrangements during group discussion, clarification of doubts and engagement of the students during the flipped classroom session.

Data analysis

Descriptive statistical analysis was done using IBM© SPSS© Statistics Version 23, 1 New Orchard Road, Armonk, New York 10504-1722, United States. VassarStats software was used for paired t-test and feedback questionnaire analysis.

  Results Top

All participants comprising second-year physiotherapy students responded to the tests and submitted their feedback in an uninhibited manner as anonymity was preserved.


Comparison of the pre- and postMCQ test scores shows that there is a significant difference in the pre- and postvalues (P < 0.001).


The flipped classroom sessions were evaluated for the quality, content, and usefulness. Around 90% of the participants agreed that adequate content and time were provided before the flipped classroom sessions. Nearly 92% of the participants felt that content was relevant to the topic being taught. Nearly 87% of the participants agreed that problem-solving and clarification of doubts were adequately done and they were motivated for further learning. Classroom arrangements were satisfactory according to 83% of the participants. An average of 31 out of 36 participants with a standard deviation of 1.50 strongly agreed on the efficacy of the flipped classroom teaching method.

  Discussion Top

The analysis of human gait is a complex skill for physical therapy students to learn. It requires a good understanding of biomechanics and the ability to visualize human gait from all angles and dimensions. Didactic lectures have been the mainstay for teaching the theory of normal human gait. This method of teaching may not be able to provide an adequate experience of learning for a topic that requires an understanding of various isolated elements in different joints of the body before combining them into complex motion analysis.

A study by Sabale et al. was carried in the Community Medicine Department to train the second M.B.B.S students using flipped classroom methodology. Forty-eight 2nd year M.B.B.S students participated in the study. The present study was conducted among second-year physiotherapy students. Selected topics (nutrition under-five children) were taught using the flipped classroom model Sabale et al. A pretest assessment was done. After 3 months a posttest was conducted in the classroom to assess retention in the knowledge and significant improvement was observed. The results of the study were similar to the present one.[11]

In a study, Fatima et al. implemented the flipped classroom model. The study was conducted to enhance active learning among medical students with the neurosciences module at Aga Khan University in Karachi. The study materials were provided to students in the form of video lectures and reading material. This was for nonface-to-face sitting while face-to-face time was spent on activities such as case solving, group discussions, and quizzes to consolidate learning. Pre- and postclass quizzes, worksheets, and blog posts were used to ensure better learning for each session. Students reported that their queries and misconceptions were cleared in a much better way in the face-to-face session. Following flipped classroom as compared to traditional settings. The present study also observed similar results.[13]

In this study, the flipped classroom instructional model for Gait analysis (Kinesiology Module) replaced instructor lectures with highly interactive studentinstructor dominated activities. Flipped classes enable instructors to engage the participants and facilitate them in critical thinking resulting in a better understanding of the subject by promoting active learning. Prereading lecture recording was viewed independently by students before the flipped classroom activity. The flipped lecture had the advantage of easy availability and repeated viewings, keeping in mind that the learning speed of students may vary. The scheduled lecture time was used primarily for assessing student knowledge and foster learning through MCQ tests and group discussions. The main purpose of this was to create an interest in active learning and transmission of information. Inter-student discussions helped in greater and thorough understanding of the proposed topic followed by group discussions which were helmed and guided by the instructor. Doubts were cleared in classroom itself by the teacher and other students. It was observed by the researcher that the students learned to take ownership of their learning and enjoyed working actively with their peers. This learner-centric model resulted in a better performance and culminated in higher achievement. The brainstorming and group discussions also provided a feedback to the teacher on the level of understanding among the students. A significant difference in the pre- and postMCQ test scores reflected that the instructor was able to provide clarification on difficult concepts and was able to expand on the e-lectures and prereading materials.[14],[15],[16]

The use of the flipped classroom has the potential to be an effective and beneficial method of education. Replacing direct instruction (the explicit scripted presentation or delivery of information or a task) from the class time with video lectures observed outside of the classroom allows for more class-time to be used for active learning. This use of class-time can create a classroom environment which uses collaborative and constructivist learning; blending with the direct instruction used outside the classroom.[7] Constructivist learning takes place when students gain knowledge through direct personal experiences such as activities, projects, and discussions. The frequency of these personal experiences can be increased in a flipped classroom through the use of activities, creating students who are active learners (learning by engaging in analysis, synthesis, and evaluation), rather than passive learners (learning by the absorption of information from hearing, seeing, and reading). Active learning has been found to produce better grades than passive learning.[15],[16] The passive learning of a flipped classroom happens during the video lectures outside of class, freeing up in class time for active learning.[17],[18] The problem of limited attention spans of students is countered effectively by interactive learning and group exercise.[19] The main focus of the study was an improvement in the cognitive domain of the students in the concerned topic. Not only was this achieved satisfactorily but also this new teachinglearning method was received with a high level of enthusiasm and positive response as reflected in the results of the feedback questionnaire. Hence, the cardinal objectives of the study were achieved.

  Conclusion Top

Flipped classroom teaching is an effective teaching method in bringing about a change in the cognitive domain of second-year physiotherapy students. Our study did not assess the practical knowledge of the students in the concerned topic and this can provide future scope for study. It can be safely said that flipped classroom is an effective instructional strategy. With the availability of the right resources, it can easily be blended with the conventional teaching methods to obtain better understanding amongst students and thereby lead to higher competency.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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