Table 3.
Studies that characterized medical student perceptions to FC approaches in clinical education
| Study authors, year | Subject matter (learner level, if described) | Primary pre-session online resources | In-session active learning activities | Comparison group | Main outcomes from flipped elements |
|---|---|---|---|---|---|
| Patwari and Yiu,21 2014 | Emergency medicine (M3) | Lecture videos | Active learning on wards | None | Positive overall reception toward online resources, with some caveats noteda |
| Lew,22 2016 | Emergency medicine clerkship (M3 and M4) | Lecture videos | Case-based small group discussion | None | Student surveys report preference for flipped approach vs lectures; facilitators reported perceived high levels of student engagement |
| Ilic et al,23 2013 | EBM (M2) | Self-directed learning tools (including lecture videos) | Facilitated workshop (with journal club elements) | Control group (LB) | Berlin tool (quantitative objective assessment of EBM competency) did not indicate an effect, though self-perceived skills in specific areas were improved; qualitative data from focus groups indicated benefits (self-directed learning) and limitations (lack of student preparedness) |
| Ilic et al,24 2015 | EBM (M3) | Online self-directed learning tools (including lecture videos) | Application of knowledge activities on wards | Randomized control group | No impact on learning or skills; positive effect on attitudes toward EBM (surveys) and the use of EBM in clinic (self-reported) |
| Gillespie,25 2016 | Obstetrics and gynecology clerkship (M3 and M4) | Lecture videos (narrated presentations) | PBL sessions | Previous cohort (LB) | Flipped approach led to increased performance on various assessments (exams and OSCEs), but led to reduced scores on gynecology-related items on exams |
| Morgan et al,26 2014 | Obstetrics–gynecology (M4) | Videos and readings | CBL sessions | Didactic components of same course | Students preferred flipped elements over didactic elements; knowledge increased (pretest vs posttest) |
| Morgan et al,27 2015 | FC approach to obstetrics–gynecology (M4) | Videos, narrated presentations | CBL sessions | Previous cohorts (LB) | Flipped elements were positively received (student surveys); no evidence of knowledge gain (NBME results) |
| Liebert et al,28 2016 | Surgery clerkship | Video lectures | Review of pretest, case-based clinical reasoning | Previous cohorts (LB) | Self-reported increases in interest in surgical careers; no difference in NBME results |
| Liebert et al,29 2016 | Simulation-based surgery clerkship | Video lectures | Review of pretest, case-based clinical reasoning | None | Perceived benefits related to self-directed learning, student accountability |
| Bosner et al,30 2015 | Primary care diagnosis skills (M4 and M5) | Video and audio-recorded lectures | Interactive small group laboratory exercises | None | Positive student perceptions toward interactive small group approach; interest and engagement were also enhanced per student surveys and focus groups; knowledge gained (pretest vs posttest) |
| Belfi et al,31 2015 | Radiology clerkship (M3) | Interactive modules, games, and simulator | Modified approaches to CBL and TBL | Didactic components of same course | Student surveys characterized positive perceptions to flipped elements relative to didactic elements; knowledge increased (pretest vs posttest) |
| O’Connor et al,32 2016 | Radiology clerkship (M3 and M4) | Web-based tutorials | Interactive workshops | Control cohort (LB) | Increased enjoyment, task value, and reduced boredom (student surveys) and better student performance; instructors noted preference for FC approach |
| Duque et al,33 2013 | Geriatric medicine (M3 and M4) | e-Learning modules, video game | Weekly case conference with interprofessional team | None | Approach led to positive attitudes regarding geriatric medicine; knowledge increased (assessed via pretests vs posttests) as a function of modules |
| Ingrassia et al,34 2014 | Blended learning approach to disaster medicine (M4–M6) | e-Learning modules | Workshops including PBL and simulation activities | None | Student surveys characterized generally strong perceptions; knowledge increased (pretest vs posttest) |
| Boysen-Osborn et al,35 2016 | Advanced cardiac life support | Podcasts | TBL activities | Previous cohorts (LB) | Small improvements in examination results |
| Robinson,36 2016 | Medicine as business elective (M4) | Online videos | Small group discussion-based activities | Subsequent cohort with MOOC approach | Student evaluations were similar for MOOC and FC approaches |
Note:
a
Student perception data related to this innovation was derived from personal communication (Yiu et al, 2016).
Abbreviations: FC, flipped classroom; TBL, team-based learning; CBL, case-based learning; M1, first-year medical students; M2, second-year medical students; M3, third year medical students; M4, fourth-year medical students; M5, fifth-year medical students; M6, sixth-year medical students; EBM, evidence-based medicine; LB, lecture-based or teacher-centered approach; MOOC, massive open online course; NBME, National Board of Medical Examiners; OSCEs, Objective Structured Clinical Examinations.