|Ahead of print publication
A comparative study of students' perception of flipped classroom teaching and traditional classroom teaching among final-year medical students
Kavitha Balasubramanian, Vinoth Kumar Sethuraman, Balasubramanian Ramachandran
Department of General Medicine, Indiragandhi Medical College and Research Institute, Puducherry, India
|Date of Submission||14-Sep-2021|
|Date of Decision||19-Dec-2021|
|Date of Acceptance||08-Jan-2022|
|Date of Web Publication||18-May-2022|
Department of General Medicine, Indiragandhi Medical College and Research Institute, Vazhudavur Road, Kadirkamam, Puducherry - 605 009
Source of Support: None, Conflict of Interest: None
Introduction: Recently, flipped classrooms (FCs) have emerged as a new pedagogical method in which students are given study resource material to develop a basic understanding of the topic before class, and in-class precious time is used for learner-centric activities. Accordingly, the study objective was to determine the student's perception of flipped and traditional teaching methods.
Materials and Methods: In this analytical cross-sectional study, students attending medicine clinics were divided into two groups of roughly forty students each. One group received FC teaching and the other traditional lecture on hypo- and hyperthyroidism topics. A structured questionnaire on students' perception of FC teaching and traditional teaching technique was used for both groups. Different parameters related to the learning process about hypothyroidism and hyperthyroidism were considered as primary outcome variables. Coguide software was used for statistical analysis.
Results: The students' age range was between 21 and 23 years. The majority were males (>55%). Among the students who attended FCs, the majority (>60%) agreed to follow the same method in future. Majority (>75%) of the students agreed that the reading materials were useful. Overall, a positive perception was observed in the FCs compared to that of the traditional classroom method.
Conclusion: FC compared with traditional teaching methods had a good response from the medical students. Students' perception of FC method was positive.
Keywords: Active learning, flipped classroom, medical students, thyroid disorders, traditional teaching
|How to cite this URL:|
Balasubramanian K, Sethuraman VK, Ramachandran B. A comparative study of students' perception of flipped classroom teaching and traditional classroom teaching among final-year medical students. J Curr Res Sci Med [Epub ahead of print] [cited 2022 Jun 29]. Available from: https://www.jcrsmed.org/preprintarticle.asp?id=345492
| Introduction|| |
Recently, a large number of higher educational institutions are implementing combined or blended learning, where students first learn on campus via face-to-face teaching and later with the help of the Internet as per students' wish and will of location and speed. Out of various other methods of combined learning, flipped classroom (FC) methods' use has gained immense popularity.,, Initially popularized in the United States, FCs replace teacher-led, in-class instructions with individual homework or group activities.
Lately, the FC method has made advancements in the health-care industry and is been promoted as “a new standard” for medicinal learnings. A large number of health-care professionals have included this teaching method in their academics. In a review done to understand learner perceptions toward this new method, it was found that students who attended flipped courses gave an overwhelmingly positive response. This method gave students the option to access preclass lectures as per their comfort and learning abilities, which were a major reason for their satisfaction. The students strongly considered the utilization of small group discussion-based activities in FC face-to-face sessions as they helped them to enhance their level of engagement, increase their motivation to learn, and make the subject matter interesting.
The flip of the evidence-based medicine (EBM) course by Ilic et al., when compared to its traditional equivalent, failed to show improvement on the Berlin objective assessment of EBM despite students' positive perception. To date, the benefits of FC approach when compared with those of the traditional classroom are not entrenched. Even when numerous studies are carried out among health-care students such as nursing, and medical education,, there are lacunae in the students' perception and readiness in accepting a change in the teaching modality. Hence, this study was planned to compare the perceptions of students toward FCs compared to traditional lectures.
| Materials and Methods|| |
This analytical cross-sectional study was done at the Department of Medicine in Indra Gandhi Medical College. The human institutional ethical committee approved (IEC No 3/224/IEC-26/PP/2019) the study and informed written consents were obtained from the participants. The study was conducted in September 2019. Eighty final-year medical students posted in Medicine at the medical college were enrolled for the study. Due to absentees in the class, there was unequal sample distribution in the study groups (SGs). Thyroid disorders were chosen for the content of this study. Content validation was done by subject experts of the medicine department (reviewed by three different faculties). The content was in the English language. The participants were randomly allocated to either the SG of FC method or the traditional lecture-based classroom group. Randomization was done using a random number table. The students' attitudes and perceptions about flipped class were compared with those of the lecture class using a 4-point Likert scaled questionnaire. The questionnaire was filled through Google Forms.
The students in the SGs were briefed about the FC method and were provided with a soft copy of the study material which included PowerPoint slides and videos on hypothyroidism and hyperthyroidism 1 week before the class. This quick summary (micro-lecture) of the study material was delivered by the instructor. Following this, the class was divided into five groups (eight in each group), to whom a discussion question was presented to each group and the students were given time to pair together and share ideas (pair and share activity). The students showcased their ideas to the classrooms followed by feedback and expanded discussion. Micro lecture (1–3 min) was used to reinforce and redirect students' learning. A pretested, structured anonymous questionnaire was used to obtain information on students' perceptions about different aspects of the FCs from students of the SG.
In the traditional didactic lecture group, the students were taught hyperthyroidism and hypothyroidism in the traditional didactic lecture method. A pretested, structured anonymous questionnaire was used to obtain information on students' perceptions of this method of teaching. Feedbacks were cumulated using a 4-point Likert scale.
Different parameters related to the learning process about hypothyroidism and hyperthyroidism were considered as primary outcome variables. Flipped class and lecture were considered primary explanatory variables. Descriptive analysis was carried out by frequency and proportion for categorical variables. Data were analyzed by using CoGuide software, V.1.03. (BDSS corp, Bangalore, India).
| Results|| |
The mean age of the students was 23.11 ± 1.20 years (ranged from 21 to 23) in the hypothyroidism flipped class. The mean age of the students was 21.51 ± 0.50 years (ranged from 21 to 22) in the hypothyroidism lecture. The mean age of the students was 22.12 ± 2.10 years (ranged from 21 to 23) in the hyperthyroidism flipped class. The mean age of the students was 21.01 ± 3.50 years (ranged from 21 to 22) in the hyperthyroidism lecture. A majority of students (35 [72.92%]) were female in the hyperthyroidism lecture flipped class [Table 1].
Among the students in the hypothyroidism flipped class, the majority (90.24%) strongly agreed that prereading materials were available. Nearly 82.93% of the students strongly agreed that adequate time was provided to spend on the prereading materials. Approximately 78.05% strongly agreed that prereading materials were relevant for the FC. Nearly 80.48% strongly agreed that learning was the key foundational content before coming to class. Overall 72.15% strongly agreed that interactive applied in-class activities greatly enhances(d) their learning of the topic discussed in class. There was a strong agreement on participation and engagement in discussions in class among 63.41% of the study population. Nearly 60.98% of the students strongly agreed that in-class discussions of course concepts with their peers greatly enhance (d) their learning, 34.15% strongly agreed that they read assigned readings before coming to class, 56.09% strongly agreed on the classroom arrangements, 78.05% strongly agreed that the activities during FC session improved their overall understanding of the key concepts, 70.73% strongly agreed that the FC session inspired them to pursue further learning for the module, 73.17% strongly agreed that the instructor was able to expand on prereading materials, 70.73% strongly agreed that the instructor was able to engage them in the FC activity. Similarly, 70.73% of the students strongly agreed that the instructor was able to provide clarification on each difficult concept and 26.82% strongly agreed that more lectures should be conducted [Table 2].
|Table 2: Summary of hypothyroidism flipped class in the study population (n=41)|
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Among the students in the hypothyroidism lecture, majority (52.5%) agreed that they participated and engaged in discussions in class, 62.5% agreed in-class discussions of the topics and concepts with their peers greatly enhanced their learning; 72.5% agreed that instruction was able to engage them throughout the lecture; 80% agreed that the instructor was able to provide clarification on difficult concepts during the lecture class; 62.5% agreed that the method of lecture class motivates them to further read on this topic; 52.5% agreed that there was interaction between the students and the instructor during the class; 47.5% disagreed that the lecture was too lengthy and time consuming; 62.5% agreed that the class was interactive, which helped them gain knowledge of key concepts on hyperthyroidism; 60% agreed that the method of lecture class improved their clinical thinking skills and learning abilities; 50% disagreed that the method of traditional lecture has improved their communication skills; 40% strongly disagreed that they have done some self-learning prior to attending the lecture class; 45% disagreed that they have attained teamwork ability by attending this traditional method of lecturing; 47.5% agreed that they have improved their presentation and expression ability by this lecture class; and 62.5% agreed that they prefer this method of lecture to an interactive session; and 47.5% agreed that classes should be conducted in this method of traditional teaching only [Table 3].
|Table 3: Summary of hypothyroidism lecture in the study population (n=40)|
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Among the students in the hyperthyroidism flipped class, majority (88.1%) strongly agreed that prereading materials were available, 85.71% strongly agreed that adequate time was provided to spend on the prereading materials, 80.95% strongly agreed that prereading materials were relevant for the FC, 66.67% strongly agreed that learning was the key foundational content before coming to class, and 35.71% strongly disagreed that interactive applied in-class activities greatly enhances (d) their learning of the topic discussed in the class. There was a strong agreement on participation and engagement in discussions in class among 47.62% of the study population. Nearly 47.62% of the students strongly agreed that in-class discussions of course concepts with their peers greatly enhance (d) their learning, 42.86% strongly agreed that they read assigned readings before coming to the class, 54.76% strongly agreed on the classroom arrangements, 35.71% strongly agreed that the activities during FC session improved their overall understanding of the key concepts, 59.52% strongly agreed that the FC session inspired them to pursue further learning for the module, 40.48% agreed that the instructor was able to expand on prereading materials, 38.01% agreed that the instructor was able to engage them in the FC activity, 71.43% strongly agreed that the instructor was able to provide clarification on difficult concepts, and 69.05% strongly agreed that more lectures should be conducted [Table 4].
|Table 4: Summary of hyperthyroidism flipped class in the study population (n=42)|
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Among the students in the hyperthyroidism lecture, majority (62.5%) agreed that they participated and engaged in discussions in class; 60.42% agreed that in-class discussions of the topics and concepts with their peers greatly enhanced their learning; 62.5% agreed that the instruction was able to engage them throughout the lecture; 58.33% agreed that the instructor was able to provide clarification on difficult concepts during the lecture class; 64.58% agreed that the method of lecture class motivates them to further read on this topic; 50% agreed there was interaction between the students and the instructor during the class; 54.17% agreed that the lecture was too lengthy and time consuming, 56.25% agreed that the class was interactive, which helped them gain knowledge of key concepts on hyperthyroidism; 64.58% agreed that the method of lecture class improved their clinical thinking skills and learning abilities; 50% disagreed that this method of traditional lecture has improved their communication skills; 54.17% disagreed that they have done some self-learning prior to attending the lecture class; 47.92% agreed they have attained teamwork ability by attending this traditional method of lecturing; 52.08% agreed that they have improved their presentation and expression ability by this lecture class; 66.67% agreed that they prefer this method of lecture to an interactive session; and 43.75% agreed that classes should be conducted in this method of traditional teaching only [Table 5]. The students' perception of the lecture class and flipped class is represented in [Figure 1] and [Figure 2].
|Table 5: Summary of hyperthyroidism lecture in the study population (n=48)|
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| Discussion|| |
The current study analyzed and compared the thyroid disorders' topic taken through FC method and traditional classroom method in final-year medical students. The feedback from the students showed that their perception of FCs was positive.
Health care and medicines are changing at a rapid pace both in the content and relevance of medical education. The goal of medical education is to develop not only knowledge but also communication skills and attitude. Learning should be an active instead of being a passive process where the teacher's role would be to mentor and facilitate such a learning process.
In this study, 68.29% of the students who attended the FC hypothyroid session agreed and 31.71% strongly agreed that similar sessions be taken in future. Among those who attended the same topic in traditional classroom method, 47.5% strongly agreed and 10% agreed that similar traditional method of teaching should be conducted in future. Similar to these findings, a study by Ojennus showed that even though the learning was not affected, students reported high satisfaction and support to FC method. Another study by Kühl et al. showed that FC method was preferred by students in biochemistry classes. Various other studies have shown a mixed opinion among students regarding FCs and traditional classroom methods.,,,,
High-quality study materials were given to the students before class in FC method. The majority (more than 78%) agreed that these reading materials were relevant and helped them in understanding the topic better. Similar support toward reading materials and their impact were documented by Kühl et al.
The authors observed that the interaction between student and teacher was relatively better in the flipped method as compared to the traditional one. Negative feedback to some responses may be attributed to students' reluctance and apprehension to adopt new teaching methods. Students might be apprehensive to read a difficult topic for which they have little or no background knowledge. Such findings had been well documented previously.,, The classroom teaching majorly depends on the instructor. In the current study, 100% of the students in the hypothyroidism FC felt that the instructor was able to engage them in FC activity, whereas only 71.34% felt the same in the hyperthyroidism flipped class. This difference can be attributed to the instructor and his/her overall engagement, which will affect the students' perception toward new learning methods.
Limitation of this study
Active learning increases student engagement and leads to improved retention of learning gain. A long-term learning gain and communication skill acquired by the students in the traditional and flipped classes were not assessed in the current study. Such assessment may be more meaningful when applied to multiple topics and diverse subjects. The current study's questionnaire has response miscategorization, which can be considered as one of the limitations.
| Conclusion|| |
The perception of students toward medical teaching with FCs was positive compared to that of the traditional classroom method. The FC approach can improve the students' performance and perceptions of the learning experience. Students' response to the FC structure was largely positive, indicating it to be an approach worth pursuing in future years for advancement in medical education technologies.
This project is done as a part of 8th ACME course at MCI Nodal Centre for National Faculty Development at Sri Ramachandra Medical College, Porur. We also thank the study participants. We acknowledge the technical support in data entry, analysis, and manuscript editing by “Evidencian Research Associates.”
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Horn MB, Staker H. The rise of K-12 blended learning. Innosight Inst 2011;24:384-94.
Giannakos MN, Krogstie J, Chrisochoides N. Reviewing the flipped classroom research: Reflections for computer science education. Comput Sci Educ Res Conf 2014:23-9.
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 2018;49:398-411.
O'Flaherty J, Phillips C. The use of flipped classrooms in higher education: A scoping review. Internet High Educ 2015;25:85-95.
Bergmann J, Sams A. Remixing chemistry class. Learn Lead with Technol 2008;36:24-7.
Pierce R, Fox J. Vodcasts and active-learning exercises in a “flipped classroom” model of a renal pharmacotherapy module. Am J Pharm Educ 2012;76:196.
Mehta NB, Hull AL, Young JB, Stoller JK. Just imagine: New paradigms for medical education. Acad Med 2013;88:1418-23.
Ilic D, Nordin RB, Glasziou P, Tilson JK, Villanueva E. Randomised controlled trial of a blended learning evaluation intervention for teaching evidencebased medicine. BMC Med Educ 2015;15:39.
Betihavas V, Bridgman H, Kornhaber R, Cross M. The evidence for 'flipping out': A systematic review of the flipped classroom in nursing education. Nurse Educ Today 2016;38:15-21.
Presti CR. The flipped learning approach in nursing education: A literature review. J Nurs Educ 2016;55:252-7.
Sait MS, Siddiqui Z, Ashraf Y. Advances in medical education and practice: Student perceptions of the flipped classroom. Adv Med Educ Pract 2017;8:317-20.
Chen F, Lui AM, Martinelli SM. A systematic review of the effectiveness of flipped classrooms in medical education. Med Educ 2017;51:585-97.
BDSS Corp. Coguide Statistics Software, Version 1.0. India: BDSS Corp; 2020. Available from: https://www.coguide.in
. [Last accessed on 2021 Sep 12].
Ojennus DD. Assessment of learning gains in a flipped biochemistry classroom. Biochem Mol Biol Educ 2016;44:20-7.
Kühl SJ, Toberer M, Keis O, Tolks D, Fischer MR, Kühl M. Concept and benefits of the Inverted Classroom method for a competency-based biochemistry course in the pre-clinical stage of a human medicine course of studies. GMS J Med Educ 2017;34:Doc31.
Riddell J, Jhun P, Fung CC, Comes J, Sawtelle S, Tabatabai R, et al.
Does the flipped classroom improve learning in graduate medical education? J Grad Med Educ 2017;9:491-6.
Gopalan C. Effect of flipped teaching on student performance and perceptions in an Introductory Physiology course. Adv Physiol Educ 2019;43:28-33.
Veeramani R, Madhugiri VS, Chand P. Perception of MBBS students to “flipped class room” approach in neuroanatomy module. Anat Cell Biol 2015;48:138-43.
Tang F, Chen C, Zhu Y, Zuo C, Zhong Y, Wang N, et al.
Comparison between flipped classroom and lecture-based classroom in ophthalmology clerkship. Med Educ Online 2017;22:1395679.
Sreegiri S, Madhavi D, Kumari L. Student's perception of flipped classroom teaching method in andhra medical college, visakhapatnam. J Dent Med Sci 2018;17:6-09.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]