This study explored a new type of teaching model, the FC-integration model that integrates FC, PBL, TBL and CBL and is assisted by RC. Although previous studies have tried to evaluate new teaching models, they have only focused on one or two teaching method(s) [19–21]. In the present research, the FC-integration teaching model was used in the teaching of periodontology, a highly practical subject. Fortunately, the results of our research demonstrate the effectiveness and advantages of the novel model.
Our results demonstrate that the FC model can help students improve their self-learning abilities. A total of 85.59% of the students believed that the preclass preparation activities developed their self-learning potential, while 68.64% believed the FC model made the best use of class time. A meta-analysis reported that the FC method is associated with greater academic achievement than the traditional approach to higher-level learning outcomes in medical education [22]. Some researchers have used the FC model in stomatology education, for example, in dental anatomy [23, 24], a practical preclinical dental skills course [25] and a fixed prosthodontic course [20], and have achieved satisfactory results. Only one study reported finding the FC model effective when applied in the practice plan on periodontal diagnosis and treatment [26]. However, as opposed to our research, they used no other teaching method.
In the present research, regarding the CBL, PBL and TBL methods, the students highly praised their efficacy. Students believed that the CBL and PBL could help improve their future clinical practice. Furthermore, they believed that TBL could improve their abilities to communicate with each other and solve difficulties. Previous studies have demonstrated that CBL, PBL and TBL can obtain excellent outcomes in various courses [27–29]. In this study, we integrated CBL, PBL and TBL with the flipped classroom to form an organic integrity: the FC-integration model. By combining the advantages of these teaching models, students' initiative and interest in learning were enhanced, and their comprehensive analysis ability was improved.
In this study, most students provided positive comments about RC-assisted teaching. They believed that RC, a crucial teaching method, could assist teaching in a convenient and timely manner. These evaluation results demonstrate that RC is an efficient platform that can improve teaching efficiency. In previous studies, several platforms have been used to assist the application of the FC model. Real-time communication software plays an indispensable role in contemporary education and can improve teaching efficiency [30, 31]. Some scholars used networks such as the NextGenU website [32] and the Virtual Learning Environment (VLE) [25] established on the network to provide students with learning materials. However, compared with RC, these network platforms have some shortcomings. They lack the real-time communication function of RC. Moreover, their interfaces are not as concise and friendly as those in the RC. More importantly, RC helps students make use of their discrete time to study using their mobile phones.
The FC-integration model improves student test scores. We found that the scores of the F group were significantly higher than those of the T group. The objective choice questions mainly examine the students' mastery of the knowledge points, while short-answer questions mainly examine the students' ability to apply that knowledge. The above results indicate that students in the F group can grasp more knowledge points in a short time. The average of the total score of the control groups was 55.03 ± 16.83 (T group 1) and 63.92 ± 12.34 (T group 2), which indicates that it is difficult for students to grasp new knowledge efficiently when they receive only traditional classroom lectures.
Although the FC-integration model obtained positive feedback from the students in the present study, it nonetheless has some limitations. Stephney et al. [33] found that in a neuroanatomy course, the flipped classroom model did not improve the teaching process and results. A probable explanation is that the flipped classroom model may be not applicable to courses with complex and abstract contents. Therefore, this FC model is more suitable for teaching concrete and plain contents in medical education.