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Authors

David A. Morton
Geoffrey T. Dorius
Lenora M. Olson
Jorie M. Colbert-Getz

Institutions

University of Utah School of Medicine - United States of America

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Theme

3BB The lecture and the flipped classroom

Title

Evaluating the Impact of the Flipped Anatomy Classroom: What is the Correct Outcome?

Background

Based upon principles of active learning the Flipped Classroom (FC) method of teaching should lead to better retention, understanding and problem solving at a higher cognitive level.^1,2,3
However, research results are mixed.
One reason for the mixed results may be the cognitive level assessed. The FC is designed to promote higher cognitive levels (e.g. application) so a lower level assessment (e.g. recall) may not be an appropriate outcome for the FC.

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Hypothesis. FC students would perform better than lecture students on an assessment requiring higher cognition and there would be no difference in performance for an assessment requiring lower cognition.

FC content followed this pattern for each large classroom session:

Students completed a summative exam on all course topics, including Anatomy.

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Summary of Results

Retention: 150-item multiple choice final examination where items were catagorized as requiring lower or higher cognition according to Bloom's taxonomy.
Lower cognition and higher cognition means were compared between lecture and FC groups using Mann-Whitney U tests.

Sample of qualitative feedback from students participating in the FC model:

Take-home Messages

If research regarding the FC method uses student learning as a basis for effectiveness and the assessment of student learning only requires a low level of cognition we will not fully understand the potential benefit of the FC.

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Acknowledgement

Sections of this paper were presented at the April 2015 Association of American Medical Colleges (AAMC)’s Western Groups of Education Affairs conference in San Diego, CA.
A special thanks to John Bell and William Bradshaw from Brigham Young University for their support and guidance over the years in this project.

References

McLaughlin JE, Roth MT, Glatt DM, Gharkholonarehe N, Davidson CA, Griffin LM, Esserman DA, Munper RJ. The flipped classroom: A course redesign to foster learning and engagement in a health processions school. Acad Med. 2014; 89: 236-43.
Lape NK, Levy R. Probing the inverted classroom: a controlled study of teaching and learning outcomes in undergraduate engineering and mathematics. ASEE National Conference Proceedings, Indianapolis, IN. 2014.
Missildine K, Fountain R, Summers L, Gosselin K. Flipping the classroom to improve student performance and satisfaction. J Nurs Educ. 2013;52:597-599.
Bloom BS, Engelhart MD, Furst EJ, Hill WH, Krathwohl DR. Taxonomy of educational objectives: The classification of educational goals. Handbook I: Cognitive domain. 1956. New York: David McKay Company.

Background

The anatomy component of foundations of medicine remained the same for fall 2013 and 2014, with the exception of the large group instruction time. In 2013 large group instruction for the 30 lecture hours was delivered in a traditional lecture format, but with active learning. These fall 2013 lectures followed the same format: lecture on a learning objective for 10 minutes followed by practice questions for 5 minutes to be solved using the “think-pair-share” model (repeated 4-5 times during a 50 min lecture).

In 2014, content from the 30 lecture hours was delivered with the FC approach. For each hour of lecture pre-class work was assigned to students in the form of 3-4 short video tutorials (5-8 minutes each). Students recorded their notes in an accompanying workbook, which contained the outline of the video tutorials in illustrations and text. The completed workbook was brought to the lecture hall and during the face-to-face time students answered clinical questions. For each question, time was given to students to reference notes from their workbook and discuss with their peers possible solutions. The professor then directed a large group discussion having the students share their proposed solutions. For each 50-minute face-to-face session in fall 2014 the professor covered 8-10 problem sets guiding student discussion and helping students in their line of reasoning.

Foundations of medicine is a 17 week long course that includes 98 hours of anatomy content (30 hours of lecture and 68 hours of dissection). At the end of the course students complete a comprehensive 150 item final examination on all course topics, including Anatomy. The final examination is worth 30% of the overall course grade. This study was deemed exempt as part of a program evaluation of the M.D. curriculum by the Institutional Review Board at the UofU SOM.