The Flipped Classroom

Tiffany Khieu, PharmD

PGY-2 Psychiatric Pharmacy Resident

University of Maryland School of Pharmacy

“We follow a flipped model of instruction,” answered my interviewer at Oregon State University in 2016 after I had asked what made their pharmacy program unique. At the time, I wasn’t too familiar with this approach, but was impressed by what I’ve learned about the model in addition to their graduation rates compared to previous years. According to a review article by Persky et al, “flipping the classroom” is an evidence-based, hybrid, pedagogical approach that enhances student learning, engagement, and critical thinking.1 Moreover, it is described as a combination of technology, pre-class learning and in-class activities compared to traditional lecture-based learning (attending class with no or little knowledge, receive the knowledge via didactic lecture, and complete assignments related to the lecture). As healthcare education moves towards the flipped classroom model, it is important to understand the core elements that make the approach successful and how to apply it into practice.

While lecture-based learning is one of the most common methods utilized in healthcare education, it elicits students to recite or describe facts rather than evaluate or synthesize information.2 Further, it promotes superficial and passive learning, leaving students with insufficient exposure to build their skills and apply their knowledge to real-world settings.3 Flipped-based learning, in contrast, is based on constructivist learning theory that begins with a set of clear learning objectives and supported by activities before, during, and after a lecture. As students progress towards the end the course, they should be able to transfer their knowledge and skills into practice and develop self-regulated behaviors to promote their own learning.

The first and foundational step in a flipped classroom model is establishing clear course objectives that communicates expectations to the students. Without these objectives, students will not connect the relevance of what they are learning to their practice or have guidance throughout the course. Persky et al. further describes objectives should go beyond content knowledge to address practical skills required to be successful beyond a classroom setting. For example, objectives should be relevant to teamwork, communication, and problem-solving skills, as these elements are highly valued in the healthcare field.

After establishing course objectives, pre-class learning assignments is essential in the flipped classroom approach. Compared to traditional learning, this is one of the biggest differences in the flipped model to help students be engaged and develop interpersonal skills. Learners are expected to come into the classroom prepared with baseline knowledge obtained from pre-class readings, either from assigned textbook chapters, narrated PowerPoints, or other video media. Without student preparedness, the flipped model would “fail”, but this failure can also serve as preemptive motivation to self-regulate learning behaviors. For example, a student who comes to class unprepared and is unable to participate in discussion can modulate the amount of time and effort spent in pre-classroom learning for subsequent sessions. This is an advantage for students in the flipped classroom model because it allows autonomy to learn material at their own pace, an intrinsic element in self-determination theory.1 In fact, when pre-class learning is optimized through students’ self-motivation, they can learn up to one-third faster than in an instructor-controlled environment.1 However, it is important to keep in mind the materials assigned and amount of time spent in pre-class assignments for the flipped model to be sustainable and realistic. For example, reading a treatment guideline with new vocabulary may take longer to read and lose students’ motivation to continue learning because of the difficulty level. With this in mind, the importance of obtaining foundational knowledge prior to class additionally teaches learners accountability for preparation and an incentive for in-class learning.

Class time in the flipped learning approach is dedicated to discussions or team-based activities rather than didactic lectures. Its effectiveness is rooted in active-learning, which has demonstrated to cultivate student self-awareness, critical thinking, and collaboration skills.1 In a study of ninety-five fourth year medical students in an ophthalmology clerkship comparing flipped versus traditional teaching, more students in the flipped group agreed that the teaching method improved their clinical thinking and communication skills by completing pre-class assignments but also from increased student-to-student interactions in group discussions.4 Since their dialogue were based on real world examples in the ophthalmology practice, the relevance to their own practice enhanced their motivation to learn, contributing to developing higher order thinking skills. It also reflects a real-life example of communicating with other professionals when a complex case presents itself in their practice. It is important to understand that for these discussions to take place, instructors must be properly trained in facilitation skills through workshops or meeting with experts.1 This should be a consideration for educators who are interested in taking the flipped model approach.

Flipping a classroom is a contemporary pedagogical approach that shifts away from traditional lecture-based learning to a hybrid, comprehensive teaching model that increases student engagement and learning. For it to be successful, course objectives, pre-class assignments, and in-class activities need to be carefully crafted to motivate students to learn and develop their own interpersonal and professional skills. Educators who are interested in the flipped model approach can incorporate some elements of the flipped approach to their current instructional methods before committing to a complete flip. For example, lecture-based learning can still be utilized but enhanced with pre-class readings and in-class discussions. Overall, there are advantages to the flipped classroom approach that may result in long-term benefits, such as long-term retention of knowledge and transfer of skills. It should be considered by passionate instructors who are invested in their students’ knowledge and success.

References:

1. Persky AM, McLaughlin JE. The Flipped Classroom - From Theory to Practice in Health Professional Education. Am J Pharm Educ. 2017 Aug;81(6):118. doi: 10.5688/ajpe816118. PMID: 28970619; PMCID: PMC5607728.

2. Faisal R; Khalil-ur-Rehman, Bahadur S, Shinwari L. Problem-based learning in comparison with lecture-based learning among medical students. J Pak Med Assoc. 2016 Jun;66(6):650-3. PMID: 27339562.

3. Alaagib NA, Musa OA, Saeed AM. Comparison of the effectiveness of lectures based on problems and traditional lectures in physiology teaching in Sudan. BMC Med Educ. 2019 Sep 23;19(1):365. doi: 10.1186/s12909-019-1799-0. PMID: 31547817; PMCID: PMC6757398.

4. Tang F, Chen C, Zhu Y, Zuo C, Zhong Y, Wang N, Zhou L, Zou Y, Liang D. Comparison between flipped classroom and lecture-based classroom in ophthalmology clerkship. Med Educ Online. 2017;22(1):1395679. doi: 10.1080/10872981.2017.1395679. Erratum in: Med Educ Online. 2017;22(1):1406198. PMID: 29096591; PMCID: PMC5678346.