|Ahead of print publication
Use of flipped classroom for the teaching of postgraduate students: An experience
Anand Nair1, Arun Kumar Yadav2
1 Resident, Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
2 Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
|Date of Submission||15-Aug-2020|
|Date of Decision||20-Dec-2020|
|Date of Acceptance||20-Dec-2020|
Arun Kumar Yadav,
Department of Community Medicine, Armed Forces Medical College, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Flipped classroom uses a face-to-face approach and delivery of content to the students on an online platform. It combines principles of self-directed learning and active participation. There are not many studies that analyzed the benefits of this approach in India. Methods: A flipped classroom session was planned for postgraduate students of community medicine. The faculty conducted discussion on topic and content. The content was selected and sent to students. Students were divided into three groups. A small group teaching session was held after 1 week. Improvement was objectively measured using a pre-posttest. Feedback from the students was taken on Likert's scale and open-ended questionnaire. Results: All students (n = 10) agreed with topic selection and quality of content. All were satisfied with the approach and admitted to being interested in attending another session. Eighty percent agreed that teacher-student interaction was better as compared to a regular classroom. Average pre-test multiple-choice question score was 60% and posttest score 87.7% (p < 0.001). Conclusion: Flipped classroom is a useful tool to improve the learning experience of students. However, sessions should be well planned with discussion and consensus among stakeholders. Further research is required for evaluating the benefits of this method on larger scales.
Keywords: Flipped classroom, innovation, teaching
| Introduction|| |
The flipped classroom technique is an approach that is gaining momentum in teaching in the current technologically advanced scenario. In India, there has been the launch of Operation digital blackboard on February 19 to encourage digital learning, including “flipped learning.” It represents the change in emphasis from the teacher-centric approach in vogue since time immemorial to strategies aimed at improving students' role, engaging them positively in a class/lecture. A flipped classroom is one in which, the basic concepts of the topic to be discussed is provided to the students in advance (usually on an online platform) so that the students can go through the same, develop their concepts and subsequently, build upon this during the class session., The delivery of prereading material to the students an be done through various modalities such as video lectures, podcasts, web-based modules, animated e-books, or the traditional methods such as texts and articles.
There are several benefits of providing the students with crucial content before class.,, It enables the students' engagement with the topic at their own pace, with them having the autonomy on the time and quantity of learning they want to undergo at any point. This also promotes their interest in the subject and better understanding, further reinforced during the classroom session.
Although technology is not necessary for this approach, it has been seen that currently, students are more receptive to the use of technology. In this digital era, students have access to a plethora of quality information/content on the internet, which they utilize for their daily academic purposes, apart from other internet uses. Using technology appeals to the students, making them self-motivated to go through the prereading content and prepare for the class.
When designed appropriately and effectively, a flipped classroom provides a better education foundation, as evidence suggests from various studies.,,
The flipped classroom is a pedagogical approach in which fundamental concepts are provided to learners for preclass learning so that class time can apply and build upon those basic concepts. It is also known as reverse, inverse, or backward classroom. However, this approach is yet to be a mainstream strategy, as evidence is continuously emerging, and the technique is still evolving. There are not many studies that analyzed the benefits of this approach in the Indian context. With this background, this study was carried out to find the feasibility and generate evidence on the benefits of using a flipped classroom on postgraduate medical students.
| Methods|| |
The study was carried out in November 2018 among postgraduate students of a medical college in Western Maharashtra. The training of postgraduate consists of didactic lectures, practical classes and on job training. A project was undertaken to introduce the flipped classroom as a teaching-learning method among 1st year resident in Community Medicine. The project was ethically cleared by Institution Ethical Committee vide their letter number IEC/2018/212.
The first activity carried out was the topic selection. It is one of the most crucial aspects, as the selected topic has to be one, which generates and maintains an interest in the students. An in-depth discussion was carried out among the faculty members of the medical college. A senior resident was also included as a stakeholder in this discussion. The discussions were moderated by the authors. The topic was decided based on needs assessment, intended learning outcomes, and complexity of the topic. The final topic decided was Systematic Review and Meta-Analysis. This was followed up by determining the exact nature of the study material that had to be sent to the students before the classroom activity. It is again an essential step as the content has to be of adequate quality and quantity. Faculty and the senior resident gave their inputs on the matter, and the content was selected and disseminated to the students online via email.
A Google group was then formed, which allowed for daily interaction with the students. The faculty of the medical college was trained to conduct small group teaching. Small group teaching sessions were held 1 week after the content for the flipped classroom was distributed. The period of 1 week was decided based on the consensus among faculty members and students. The students were divided into three groups, and faculty were allotted to each group. The students were given time to discuss problems, clarify among themselves, and later on, faculty members explain their' problems. The discussion was aligned to the overall objectives of the session.
The students were administered a pretest questionnaire to assess their baseline level of knowledge. Following the classroom activity, feedback was obtained from the students on Likerts scale and an open-ended questionnaire. At the same time, informal feedback was taken from the faculty. The students were further administered a posttest to assess their improvement. A mean score of 85% in the posttest was used to indicate the technique's effectiveness after an in-depth discussion among experienced faculty members.
Descriptive analysis was done using mean and standard deviation for quantitative variables and frequency and percentages for qualitative data. The data were entered into MS Excel and analyzed using StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX, USA: StataCorp LP. A P = 0.05 was taken as statistically significant.
| Results|| |
The study sample consisted of n = 10 students (11 who gave pretest, one did not complete). This included nine male and one female student. The mean age of the class was 32.41 years (3.4 years).
Content and preparation
All of the students had agreed that the topic selected was appropriate and the quality of the prereading material given was good. Sixty percent felt that the quantity of the material was just right whereas the rest thought it was more than what they could handle. Only one student felt that adequate time was not given for preparation of the class [Figure 1].
All the students were self-motivated to go through the prereading material and agreed that the technique improves the class's attention. Ninety percent of the students agreed that the flipped classroom approach promotes a better understanding of the topic and enhances the students' contribution to the class [Figure 2].
Eighty percent of the students agreed that the teacher–student interaction improved in a flipped classroom and was better than a regular classroom.
The average pretest multiple-choice question score of the class was 60% whereas compared to the posttest score of 87.7% (P ≤ 0.001) [Figure 3].
The students were all asked about what they liked best about the classroom. A qualitative analysis of their feedback was also taken, and the common themes that were observed were that the flipped classroom increases the self-motivation and the effort put in by the student in preparing for the topic, that it allows a better and more precise understanding of the subject and that the approach aroused the interest of the students.
Based on the students' feedback, all of them were satisfied with the approach and admitted to being interested in attending another session of similar nature.
| Discussion|| |
There has been a gradual but definite shift in medical education away from the traditional lecture approach toward approaches that encourage a higher hierarchy of learning in the cognitive, psychomotor, and affective domains. The flipped classroom is one such approach in which students learn about the foundation concepts as homework and then are provided with opportunities for critical thinking and application of knowledge. However, evidence for the effectiveness of the flipped classroom has been inconsistent. The systematic review done by Chen et al. observed that the effect sizes ranged from d = −0.27 to 1.21 and suggested a lack of evidence for the effectiveness of flipped classrooms. Another systematic review done only for studies in Turkish education of flipped classrooms found that students taught in the flipped classroom increased their achievements and reported to be more motivated.
In our study, we found that overall satisfaction with the flipped classroom approach among the students was high, with the majority agreeing that they could find adequate time and motivation levels to prepare for the class as well having a positive effect on their attention, understanding, and participation in the classroom activity. The mean test score had seen an improvement rising to over an average of 87% from an average of 60% (P < 0.001). We also achieved the predefined criteria of average marks of 85%. The feedback from the students during the group discussion and the feedback form suggest the technique being appreciated and them more receptive to incorporating technology in daily learning. Thus our study shows effectiveness as well as acceptability of method among students.
The motivation level for newer techniques may be high, however, sustaining it over a period of time may become difficult. Therefore, long term effects may differ from short term effects. It would be essential to adopt measures like constant interaction with the students to keep student motivated for self-directed learning in long term.
The technique has been used in various other subjects such as engineering and arts and has been found useful. Maheswari et al. described the various subjects in which it has been used and discussed the challenges in implementing it. Our study also found difficulties such as selecting the topic, quality, quantity of the material, and timing of the small group teaching session. Another challenge faced in implementing the flipped classroom was the faculty's availability for conducting small group sessions. The faculty needs to be trained for conducting small group sessions. Hence, flipped classrooms benefit not only students but faculty development also. Another challenge was to ensure that the students have read the sent material. In our study, we use innovative Google groups and encourage the student to ask questions on the Google group, which may be taken as a surrogate for reading.
The challenge to this technique includes constraints of time and resources with respect to the training and development of material. Another limitation of the study is that there was no control group in the study. Second, we have implemented it in a smaller group; it needs to be implemented in a large group before being accepted as an established teaching-learning method. Third, average age of postgraduate students were higher in the particular college as the postgraduate are admitted 5 years after completion MBBS, this might have effect on generazibility of the study. However, the study proves that it is feasible to carry out flipped classroom teaching for the subject of community medicine. The study also provides evidence of effectiveness by achieving predefined-criteria in the study.
| Conclusion|| |
A flipped classroom is a newer teaching approach with unlimited potential. It efficiently engages students and promotes active learning. However, to be implemented on a large scale would be time and resource-consuming, but at the same time would improve the learning experience of the students in the current technologically advanced world. More studies of similar nature on larger groups of students at various medical colleges may be carried out to further assess flipped classroom techniques' effectiveness and whether to include the same as part of the mainstream curriculum at various levels.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]