This study targeted sophomore students taking part in the pharmacology course offered at Ohu University School of Pharmaceutical Sciences from 2017 to 2019. The pharmacology course consisted of 13 categories from their sophomore year to the 4th grade. Topics lectured were taught as 4th category in the sophomore year along with endocrine systems; moreover, this included the hypothalamus, pituitary abnormality, adrenal cortical hormone, adrenal medulla hormone, and adrenal cortical dysfunction. These topics were lectured twice a week for two weeks (1.5 hrs /class, 6 h) in the fall quarter. The TFF lectures were performed in 2017; the ARS lectures were carried out in 2018; and the FC plus ARS lectures were performed in 2019. Scores of external exams and prerequisite grade point averages (GPAs) in the freshman year were collected to obtain academic background information regarding sophomore students in 2017, 2018, and 2019. Prerequisite subjects included chemistry, biology, physics, mathematics, introductory chemical thermodynamics, basic science exercises, basic pharmaceutical training, biochemistry, functional morphology, organic chemistry, basic analytical chemistry, and physical chemistry.
The pharmacology course placed an emphasis on being knowledge-based, so the expected outcomes were that sophomore students fully understood the concept of endocrine systems.
Audience response system (ARS)
The ARS lectures were carried out using ClicaTM (http://clica.jp/LP/). This active learning tool collected the students' understanding, reactions, and opinions in real time during a lecture; subsequently, all of the posts can be displayed on the students’ smartphones as well as on a screen in the class. Students can view items and collaborate with each other; this activity can also happen between the lecturer and the students. This is so they can understand the lecture from various perspectives while comparing it with their own opinions. The lecture explained each topic in the class, and multiple-choice questions were administered to the students through ClicaTM during the lecture. They responded as quickly as possible and the lecturer and the students viewed their responses on the screen and the lecturer added extra explanations depending on the students’ incorrect responses using handouts of the topics.
Flipped classroom (FC) plus ARS
Six-hour lectures/four classes were flipped. Prerequisite videos were uploaded on YouTube beforehand, and the URLs of each video were sent to students’ emails at least three days before the lecture. Video times for the first, second, third, and fourth video were 10 min, 16 s; 10 min, 50 s; 13 min, 16 s; and 10 min, 18 s, respectively. Data regarding the video views and watch times were retrieved from YouTube Analytics. During the class, multiple-choice questions were administered to students through ClicaTM at the beginning of each lecture. The lecturer and the students viewed their responses on the screen, and the lecturer added extra explanations depending on the students’ incorrect responses using handouts of the topics.
A primary outcome of the study was to compare the correct rates of exams for endocrine systems in the pharmacology course between three ways of teaching such as the TFF lectures, the ARS lectures, and the FC plus ARS lectures. An exam consisted of 30 multiple-choice questions. Identical questions were administered to each of the three classes’ cohort but multiple choices were completely reshuffled every year. A subgroup analysis was performed in terms of gender difference.
Anonymous questionnaire survey
Anonymous questionnaire surveys were conducted at the last lecture on the endocrine systems in the pharmacology course in 2018 and 2019. This was done in order to examine the students’ preference for the ARS and the FC plus ARS.
This study was approved by the ethics committee of Ohu University (No. 220). The lecturer issued a letter to the students to inform them of the purpose of this study at the end of the last lecture. Written informed consent was obtained from those students who were willing to participate in this study. All methods were performed in accordance with the relevant guidelines and regulations.
The sample size for the study was calculated using G*Power software; subsequently, the total sample size was calculated as 159. This figure was arrived at by assuming the use a one-way analysis of variance (ANOVA) for statistical analysis with an effect size of 0.25, alpha error probability of 0.05, power of 80%, and the number of groups being set a three.
The Kruskal-Wallis test was carried out for nonparametric distribution data; duly, a one-way ANOVA was carried out for parametric distribution data. Categorical data were analyzed using the Chi square test and the Fisher’s exact test. The ANCOVA was performed if background information between the three cohorts was significantly different. P values less than 0.05 were considered statistically significant. All statistical analyses were performed with EZR (“Easy R”) (Saitama Medical Center, Jichi Medical University, Saitama, Japan), which is a graphical user interface for the programming language, R (The R Foundation for Statistical Computing). More precisely, it is a modified version of R commander designed to add statistical functions that are frequently used in biostatistics (16).