Flipped classroom improves student learning in health professions education: a meta-analysis

Khe Foon Hew, Chung Kwan Lo, Khe Foon Hew, Chung Kwan Lo

Abstract

Background: The use of flipped classroom approach has become increasingly popular in health professions education. However, no meta-analysis has been published that specifically examines the effect of flipped classroom versus traditional classroom on student learning. This study examined the findings of comparative articles through a meta-analysis in order to summarize the overall effects of teaching with the flipped classroom approach. We focused specifically on a set of flipped classroom studies in which pre-recorded videos were provided before face-to-face class meetings. These comparative articles focused on health care professionals including medical students, residents, doctors, nurses, or learners in other health care professions and disciplines (e.g., dental, pharmacy, environmental or occupational health).

Method: Using predefined study eligibility criteria, seven electronic databases were searched in mid-April 2017 for relevant articles. Methodological quality was graded using the Medical Education Research Study Quality Instrument (MERSQI). Effect sizes, heterogeneity estimates, analysis of possible moderators, and publication bias were computed using the COMPREHENSIVE META-ANALYSIS software.

Results: A meta-analysis of 28 eligible comparative studies (between-subject design) showed an overall significant effect in favor of flipped classrooms over traditional classrooms for health professions education (standardized mean difference, SMD = 0.33, 95% confidence interval, CI = 0.21-0.46, p < 0.001), with no evidence of publication bias. In addition, the flipped classroom approach was more effective when instructors used quizzes at the start of each in-class session. More respondents reported they preferred flipped to traditional classrooms.

Conclusions: Current evidence suggests that the flipped classroom approach in health professions education yields a significant improvement in student learning compared with traditional teaching methods.

Keywords: Flipped classroom; Flipped learning; Health professions education; Meta-analysis.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval and consent to participate are not applicable for this study.

Consent for publication

Consent for publication is not applicable for this work.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of article selection
Fig. 2
Fig. 2
Forest plot of effect sizes (standardized mean difference) using random effect model. Note that data in Pierce and Fox [6] were provided by the corresponding author
Fig. 3
Fig. 3
Funnel plot assessing publication bias

References

    1. Horn MB, Staker HC. The rise of K-12 blended learning. San Mateo: Innosight Institute, Inc.; Retrieved from . 2011.
    1. Giannakos MN, Krogstie J, Chrisochoides N. Proceedings of the computer science education research conference. 2014. Reviewing the flipped classroom research: reflections for computer science education; pp. 23–29.
    1. Karabulut-Ilgu A, Jaramillo Cherrez N, Jahren CT. A systematic review of research on the flipped learning method in engineering education. Br J Educ Technol. 2017; [cited 2017 Mar 29]. Available from:
    1. O’Flaherty J, Phillips C. The use of flipped classrooms in higher education: a scoping review. Internet High Educ. 2015;25:85–95. doi: 10.1016/j.iheduc.2015.02.002.
    1. Bergmann J, Sams A. Remixing chemistry class. Learn Lead Technol. 2008;36(4):24–27.
    1. Pierce R, Fox J. Vodcasts and active-learning exercises in a “flipped classroom” model of a renal pharmacotherapy module. Am J Pharm Educ. 2012;76(10):196. doi: 10.5688/ajpe7610196.
    1. Mehta NB, Hull AL, Young JB, Stoller JK. Just imagine: new paradigms for medical education. Acad Med. 2013;88(10):1418–1423. doi: 10.1097/ACM.0b013e3182a36a07.
    1. 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.
    1. Ilic D, Nordin RB, Glasziou P, Tilson JK, Villanueva EA. Randomised controlled trial of a blended learning evaluation intervention for teaching evidence-based medicine. BMC Med Educ. 2015;15:39. doi: 10.1186/s12909-015-0321-6.
    1. Betihavas V, Bridgman H, Kornhaber R, Cross M. (2016). The evidence for ‘flipping out’: a systematic review of the flipped classroom in nursing education. Nurse Educ Today. 2016;38:15–21. doi: 10.1016/j.nedt.2015.12.010.
    1. Presti CR. The flipped learning approach in nursing education: a literature review. J Nurs Educ. 2016;55(5):252–257. doi: 10.3928/01484834-20160414-03.
    1. Chen F, Lui AM, Martinelli SM. A systematic review of the effectiveness of flipped classrooms in medical education. Med Educ. 2017;51(6):585–597. doi: 10.1111/medu.13272.
    1. Cotta KI, Shah S, Almgren MM, Macías-Moriarity LZ, Mody V. Effectiveness of flipped classroom instructional model in teaching pharmaceutical calculations. Curr Pharm Teach Learn. 2016;8(5):646–653. doi: 10.1016/j.cptl.2016.06.011.
    1. Lin Y, Zhu Y, Chen C, Wang W, Chen T, Li T, Li Y, Liu B, Lian Y, Lu L, Zou Y, Liu Y. Facing the challenges in ophthalmology clerkship teaching: is flipped classroom the answer? PLoS One. 2017;12(4):e0174829. doi: 10.1371/journal.pone.0174829.
    1. O’Connor EE, Fried J, McNulty N, Shah P, Hogg JP, Lewis P, Zeffiro T, Agarwal V, Reddy S. Flipping radiology education right side up. Acad Radiol. 2016;23(7):810–822. doi: 10.1016/j.acra.2016.02.011.
    1. Educause. 7 things you should know about flipped classrooms. [cited 2017 Mar 29]. Available from . 2012.
    1. Street SE, Gilliland KO, McNeil C, Royal K. The flipped classroom improved medical student performance and satisfaction in a pre-clinical physiology course. Med Sci Educ. 2015;25(1):35–43. doi: 10.1007/s40670-014-0092-4.
    1. Bishop JL, Verleger MA. Proceedings of the 120th ASEE National Conference and exposition, Atlanta, GA (paper ID 6219) 2013. The flipped classroom: a survey of the research.
    1. Love B, Hodge A, Corritore C, Ernst DC. Inquiry-based learning and the flipped classroom model. Primus. 2015;25(8):745–762. doi: 10.1080/10511970.2015.1046005.
    1. Lo CK, Hew KFA. Critical review of flipped classroom challenges in K-12 education: possible solutions and recommendations for future research. Res Pract Technol Enhanc Learn. 2017;12(1):4. doi: 10.1186/s41039-016-0044-2.
    1. Muir T, Geiger V. The affordances of using a flipped classroom approach in the teaching of mathematics: a case study of a grade 10 mathematics class. Math Educ Res J. 2016;28(1):149–171. doi: 10.1007/s13394-015-0165-8.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–269. doi: 10.7326/0003-4819-151-4-200908180-00135.
    1. Prober CG, Heath C. Lecture halls without lectures – a proposal for medical education. N Engl J Med. 2012;366(18):1657–1659. doi: 10.1056/NEJMp1202451.
    1. Abeysekera L, Dawson P. Motivation and cognitive load in the flipped classroom: definition, rationale and a call for research. High Educ Res Dev. 2015;34(1):1–14. doi: 10.1080/07294360.2014.934336.
    1. Williams DE. The future of medical education: flipping the classroom and education technology. Ochsner J. 2016;16(1):14–15.
    1. Korpershoek H, Harms T, de Boer H, van Kuijk M, Doolaard S. A meta-analysis of the effects of classroom management strategies and classroom management programs on students’ academic, behavioral, emotional, and motivational outcomes. Rev Educ Res. 2016;86(3):643–680. doi: 10.3102/0034654315626799.
    1. Freeman S, Eddy SL, McDonough M, Smith MK, Okoroafor N, Jordt H, Wenderoth MP. Active learning increases student performance in science, engineering, and mathematics. Proc Natl Acad Sci U S A. 2014;111(23):8410–8415. doi: 10.1073/pnas.1319030111.
    1. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis. Chichester, UK: Wiley; 2009.
    1. Altman DG, Bland JM. Standard deviations and standard errors. BMJ. 2005;331(7521):903. doi: 10.1136/bmj.331.7521.903.
    1. Lipsey MW, Wilson DB. Practical meta-analysis. Thousand Oaks, CA: Sage; 2001.
    1. Bakr MM, Massey WL, Massa HM. Flipping a dental anatomy course: a retrospective study over four years. Educ Res Int. 2016;2016:7097398.
    1. Bossaer JB, Panus P, Stewart DW, Hagemeier NE, George J. Student performance in a pharmacotherapy oncology module before and after flipping the classroom. Am J Pharm Educ. 2016;80(2):31. doi: 10.5688/ajpe80231.
    1. Cheng X, Lee KKH, Chang EY, Yang X. The “flipped classroom” approach: stimulating positive learning attitudes and improving mastery of histology among medical students. Anat Sci Educ. 2016; 10.1002/ase.1664.
    1. Galway LP, Corbett KK, Takaro TK, Tairyan K, Frank EA. Novel integration of online and flipped classroom instructional models in public health higher education. BMC Med Educ. 2014;14(1):181. doi: 10.1186/1472-6920-14-181.
    1. Gillispie V. Using the flipped classroom to bridge the gap to generation Y. Ochsner J. 2016;16(1):32–36.
    1. Giuliano CA, Moser LR. Evaluation of a flipped drug literature evaluation course. Am J Pharm Educ. 2016;80(4):66. doi: 10.5688/ajpe80466.
    1. Harrington SA, Bosch MV, Schoofs N, Beel-Bates C, Anderson K. Quantitative outcomes for nursing students in a flipped classroom. Nurs Educ Perspect. 2015;36(3):179–181. doi: 10.5480/13-1255.
    1. Hsu SD, Chen CJ, Chang WK, An HYJ. Investigation of the outcomes of PGY students’ cognition of and persistent behavior in learning through the intervention of the flipped classroom in Taiwan. PLoS One. 2016;11(12):e0167598. doi: 10.1371/journal.pone.0167598.
    1. Kiviniemi MT. Effects of a blended learning approach on student outcomes in a graduate-level public health course. BMC Med Educ. 2014;14:181. doi: 10.1186/1472-6920-14-47.
    1. Koo CL, Demps EL, Farris C, Bowman JD, Panahi L, Boyle P. Impact of flipped classroom design on student performance and perceptions in a pharmacotherapy course. Am J Pharm Educ. 2016;80(2):33. doi: 10.5688/ajpe80233.
    1. Liebert CA, Lin DT, Mazer LM, Bereknyei S, Lau JN. Effectiveness of the surgery core clerkship flipped classroom: a prospective cohort trial. Am J Surg. 2016;211(2):451–457. doi: 10.1016/j.amjsurg.2015.10.004.
    1. McLaughlin JE, Griffin LM, Esserman DA, Davidson CA, Glatt DM, Roth MT, Gharkholonarehe N, Mumper RJ. Pharmacy student engagement, performance, and perception in a flipped satellite classroom. Am J Pharm Educ. 2013;77(9):196. doi: 10.5688/ajpe779196.
    1. McLaughlin JE, Roth MT, Glatt DM, Gharkholonarehe N, Davidson CA, Griffin LM, Esserman DA, Mumper RJ. 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.
    1. Morton DA, Colbert-Getz JM. Measuring the impact of the flipped anatomy classroom: the importance of categorizing an assessment by Bloom’s taxonomy. Anat Sci Educ. 2016;10(2):170–175. doi: 10.1002/ase.1635.
    1. Munson A, Pierce R. Flipping content to improve student examination performance in a pharmacogenomics course. Am J Pharm Educ. 2015;79(7):103. doi: 10.5688/ajpe797103.
    1. Porcaro PA, Jackson DE, McLaughlin PM, O’Malley CJ. Curriculum design of a flipped classroom to enhance haematology learning. J Sci Educ Technol. 2016;25(3):345–357. doi: 10.1007/s10956-015-9599-8.
    1. Prescott Jr WA, Woodruff A, Prescott GM, Albanese N, Bernhardi C, Doloresco F. Introduction and assessment of a blended-learning model to teach patient assessment in a doctor of pharmacy program. Am J Pharm Educ. 2016;80(10):176.
    1. Rui Z, Lian-rui X, Rong-zheng Y, Jing Z, Xue-hong W, Chuan Z. Friend or foe? Flipped classroom for undergraduate electrocardiogram learning: a randomized controlled study. BMC Med Educ. 2017;17:53. doi: 10.1186/s12909-017-0881-8.
    1. Sajid MR, Laheji AF, Abothenain F, Salam Y, AlJayar D, Obeidat A. Can blended learning and the flipped classroom improve student learning and satisfaction in Saudi Arabia? Int J Med Educ. 2016;7:281–285. doi: 10.5116/ijme.57a7.83d4.
    1. Tune JD, Sturek M, Basile DP. Flipped classroom model improves graduate student performance in cardiovascular, respiratory, and renal physiology. AJP Adv Physiol Educ. 2013;37(4):316–320. doi: 10.1152/advan.00091.2013.
    1. Whillier S, Lystad RP. No differences in grades or level of satisfaction in a flipped classroom for neuroanatomy. J Chiropr Educ. 2015;29(2):127–133. doi: 10.7899/JCE-14-28.
    1. Wong TH, Ip EJ, Lopes I, Rajagopalan V. Pharmacy students’ performance and perceptions in a flipped teaching pilot on cardiac arrhythmias. Am J Pharm Educ. 2014;78(10):185. doi: 10.5688/ajpe7810185.
    1. Reed DA, Cook DA, Beckman TJ, Levine RB, Kern DE, Wright SM. Association between funding and quality of published medical education research. JAMA. 2007;298:1002–1009. doi: 10.1001/jama.298.9.1002.
    1. Hailikari T, Katajavuori N, Lindblom-Ylanne S. The relevance of prior knowledge in learning and instructional design. Am J Pharm Educ. 2008;72(5):113. doi: 10.5688/aj7205113.
    1. Merrill MD. First principles of instruction. Educ Technol Res Dev. 2002;50(3):43–59. doi: 10.1007/BF02505024.
    1. Dirkx KJH, Kester L, Kirschner PA. The testing effect for learning principles and procedures from texts. J Educ Res. 2014;107:357–364. doi: 10.1080/00220671.2013.823370.
    1. Murphy J, Chang JM, Suaray K. Student performance and attitudes in a collaborative and flipped linear algebra course. Int J Math Educ Sci Technol. 2016;47(5):653–673. doi: 10.1080/0020739X.2015.1102979.
    1. McGivney-Burelle J, Xue F. Flipping calculus. Primus. 2013;23(5):477–486. doi: 10.1080/10511970.2012.757571.
    1. Vazquez JJ, Chiang EP. Flipping out! A case study on how to flip the principles of economics classroom. Int Adv Econ Res. 2015;21:379–390. doi: 10.1007/s11294-015-9549-5.
    1. Chen CM, Wu CH. Effects of different video lecture types on sustained attention, emotion, cognitive load, and learning performance. Comput Educ. 2015;80:108–121. doi: 10.1016/j.compedu.2014.08.015.
    1. Chorianopoulos K, Giannakos MN. Proceedings of the 11th European conference on interactive TV and video. 2013. Usability design for video lectures; pp. 163–164.
    1. Guo PJ, Kim J, Rubin R. Proceedings of the first ACM conference on learning@ scale conference. 2014. How video production affects student engagement: an empirical study of MOOC videos; pp. 41–50.
    1. Peplow M. Social Sciences suffer from severe publication bias. Nature. Retrieved on August 25, 2017 from .

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa