Rationale and Objectives
In flipped learning, medical students independently learn facts and concepts outside the classroom, and then participate in interactive classes to learn to apply these facts. Although there are recent calls for medical education reform using flipped learning, little has been published on its effectiveness. Our study compares the effects of flipped learning to traditional didactic instruction on students’ academic achievement, task value, and achievement emotions.
Materials and Methods
At three institutions, we alternated flipped learning with traditional didactic lectures during radiology clerkships, with 175 medical students completing a pretest on general diagnostic imaging knowledge to assess baseline cohort comparability. Following instruction, posttests and survey examinations of task value and achievement emotions were administered. Linear mixed effects analysis was used to examine the relationship between test scores and instruction type. Survey responses were modeled using ordinal category logistic regression. Instructor surveys were also collected.
Results
There were no baseline differences in test scores. Mean posttest minus pretest scores were 10.5% higher in the flipped learning group than in the didactic instruction group ( P = 0.013). Assessment of task value and achievement emotions showed greater task value, increased enjoyment, and decreased boredom with flipped learning (all P < 0.01). All instructors preferred the flipped learning condition.
Conclusions
Flipped learning was associated with increased academic achievement, greater task value, and more positive achievement emotions when compared to traditional didactic instruction. Further investigation of flipped learning methods in radiology education is needed to determine whether flipped learning improves long-term retention of knowledge, academic success, and patient care.
Introduction
Medical students must master an extraordinarily large knowledge base and associated technical vocabulary in a very short time period. To this end, undergraduate radiology education has been largely dominated by didactic teaching methods designed to expeditiously deliver large volumes of information with a minimum student/instructor interaction . However, traditional large group lectures may not be ideal for the facilitation of development of the types of knowledge discovery and problem-solving skills required in radiology and other types of medical practice .
To address this problem, there is growing interest in exploring complementary medical instructional approaches that would more efficiently fill in existing knowledge gaps, foster application of knowledge stores, promote higher order thinking, and better prepare students for the challenges of clinical decision-making encountered in patient care contexts . Although many medical schools have begun to integrate problem- and team-based learning into their curricula, the transition to these interactive learning methods has been slow, and the use of didactic lectures still predominates . It is difficult to assess the learning outcomes associated with the ongoing slow reform in undergraduate medical education over the past decade, because medical educators have historically adopted varying definitions of what constitutes a problem-based learning curriculum, and not all have adopted the criteria advocated by Barrows, who developed the first problem-based learning curriculum at McMasters University . Moreover, estimates of the efficacy of problem-based learning in medical curricula vary .
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Methods
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Data Collection and Analysis
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Results
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Table 1
Student Survey Results for Didactic and Flipped Classroom Types
TV-SUM AE-E-SUM AE-A-SUM AE-B-SUM Didactic Strongly Disagree 2 0 70 48 Disagree 23 19 177 91 Neutral 106 88 97 72 Agree 303 194 55 80 Strongly Agree 184 111 13 18 Flipped Strongly Disagree 0 0 57 44 Disagree 2 3 98 108 Neutral 42 28 50 37 Agree 175 118 72 26 Strongly Agree 213 139 11 1 Coefficients Estimate −1.09 −1.15 −0.17 0.90P 0.00040 0.00022 0.59 0.0032
Summed survey responses are grouped by categories.
AE-A, achievement emotions—anxiety; AE-B, achievement emotions—boredom; AE-E, achievement emotions—enjoyment; TV, task value.
Coefficient estimates and their associated P values are shown for the didactic vs flipped condition contrast.
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Table 2
Instructor Survey Responses
Instructor 1 Instructor 2 Instructor 3 Instructor 4 Easy to give a traditional didactic lecture. Disagree Strongly Agree Disagree Agree Easy to give a flipped classroom workshop. Strongly Agree Neutral Agree Agree Students found it easy to learn in a traditional didactic lecture. Disagree Agree Disagree Disagree Students found it easy to learn in a flipped classroom workshop. Agree Strongly agree Agree Agree Satisfied with the instruction I gave in the traditional lecture format. Disagree Agree Strongly disagree Neutral Satisfied with the instruction I gave in the flipped classroom workshop format. Strongly agree Agree Strongly agree Strongly agree The traditional didactic lectures promoted learning. Neutral Neutral Neutral Agree Aspects of the traditional didactic lectures that promoted learning The information was there Instructor determines pace and thus can cover all material. Structured and sequential approach Predictable content. Material presented clearly. Thoroughness and consistency among different groups of students. The flipped classroom workshops promoted learning. Strongly agree Agree Strongly agree Strongly agree Aspects of the flipped classroom workshops that promoted learning. Easier to pay attention. Information seems more easily absorbed. Able to gauge the students’ level of understanding and dispel any misconceptions. Students more comfortable asking questions. Ability to alter teaching when student misconceptions are identified. Students are asked to apply their knowledge. Require higher order cognitive skills. Varied amount of time spent on concepts depending on which concepts the particular group of students found more challenging. The traditional didactic lectures hindered learning. Neutral Strongly disagree Neutral Disagree Aspects of traditional didactic lectures that hindered learning. Mind may wander sometimes Students less engaged. Instructor unable to gauge the students’ depth of knowledge until the end Inability of students to ask questions or clarify understanding during the didactics. Time wasted discussing concepts already mastered, leaving less time to spend on more difficult concepts. The flipped classroom workshops hindered learning. Strongly disagree Neutral Strongly disagree Disagree Aspects of the flipped classroom workshops that hindered learning. If the student did not complete the assigned homework, he/she was lost. Difficult to pace. Variations in knowledge base may have slowed the pace of instruction None Some students feel intimidated by requirement to participate Overall preference using traditional didactic lectures versus flipped classroom workshops for instruction. Greatly prefer flipped classroom workshops Greatly prefer flipped classroom workshops Somewhat prefer flipped classroom workshops Greatly prefer flipped classroom workshops
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Discussion
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Acknowledgments
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Appendix
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