• Clinical reasoning requires physicians to cognitively integrate two types of knowledge: 1) Conceptual (biomedical sciences); and 2) Problem-solving (application of concepts)¹.
• The ‘flipped’ classroom is one method for integrating conceptual and problem-solving knowledge in large classrooms.
• Flipped classrooms involve pre-study of knowledge with in-class time used to apply the pre-acquired knowledge in the context of problem-solving². 
• Despite the recent popularity of the flipped classroom approach, the experiences of students are not well described in the medical education literature.
• This poster describes student experiences with flipping three traditional first-year pulmonary physiology lectures in the MD Undergraduate Program at the University of British Columbia. 

​Pre-class learning materials:

• 3-5 voice-over-powerpoint podcasts per lecture, each 5-7 mins in length.
• Summary notes pacakge.
• Practice problem sets.
• Pre-class learning activities were limited to 25 mins or less.
• All materials were housed on an interactive website (See Details for more information).

In-class activiy:

• Active problem solving session using videoconferencing with class of ~300 students at four sites.
• Clicker-driven MCQ questions (See Details for example questions).
• 3 mins to answer the question, 5 mins for discussion.
• Team facilitated (foundational scientist and a clinican).
• A student experience survey was distributed electronically to the entire class; completed surveys were collected anonymously by the Evaulation Studies Unit.

• The response rate for the survey was 57%. 

​Preference for teaching model:

• Overall, 44% of students preferred the flipped classroom model, 29% answered neutrally and 27% preferred the traditional lecture-based model (Figure 1).

Value and usage of pre-class learning materials:

• Despite concerns about long term “buy-in” in and student resistance to increased preparation time, 91% of our respondents agreed that the pre-class workload was reasonable.
• The majority of students (70%) reported using both podcasts and summary notes prior to the in-class. session, whereas 23% viewed podcasts only and 7% reported using notes only (Figure 2).
• 69% of respondents viewed the individual podcasts at least once before the in-class session, 28% viewed the podcasts twice, and 4% viewed the podcasts 3 or more times (Figure 3).
• Students valued the pre-class learning materials, commenting that the podcasts allowed them to learn at their own pace.
• Students appreciated having access to both podcasts and summary notes.

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Value of the in-class problem solving session:

• The in-class session received mixed reviews.
• Overall, students appreciated the concept of active problem-solving but felt this was challenging in a large, multi-site lecture theatre setting.
• Some students found the calculations to be challenging in real time and requested practice problem sets prior to the sessions.
• Students perceived the in-class questions as being too focused on pure physiology. There was a universal request to increase the complexity and the clinical relevance in our questions. (See Table 1, Details).

Value of the team-taught session:

• A team-taught approach was used in the problem-solving session to promote integration. 
• Most students valued the team-taught approach; particularly the different perspectives and alternative explanations. (See Table 1, Details). 
• Some students felt the sessions were disjointed when delivered as a team.