Assessing the Implementation Requirements of the Flipped Classroom Model for Medical Students: A Multi-Domain Evaluation

doi:10.21203/rs.3.rs-3145552/v1

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Assessing the Implementation Requirements of the Flipped Classroom Model for Medical Students: A Multi-Domain Evaluation

https://doi.org/10.21203/rs.3.rs-3145552/v1

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The flipped classroom model (FCM) is recognized for its learner-centered approach, which promotes active learning, enhances student engagement, and provides meaningful learning opportunities. However, the successful implementation of this approach necessitates specific prerequisites that may limit its application. This study evaluated the implementation and requirements of the FCM for medical students.

Possible prerequisites for implementing the FCM were identified through a literature review and expert panel discussions. An instrument for implementation of FCM were developed and after validation were used to assess the status of FCM implementation in Mashhad medical school, by attending medical students, medical teachers, and technology specialists.

The prerequisites of FCM were identified in three domains: students' preparedness, teachers' preparation, and technology provisions. Evaluation of FCM implementation in Mashhad medical schools showed that medical teachers were well-prepared to provide a flexible learning environment, attend to individual learning needs, create engaging content, and offer professional coaching. Students were well-prepared in computer skills, motivation, comprehension of online technology, attitude towards success, and access to technology, but their scores were not desirable in online skills and the ability to discuss a topic online. Technology provisions were desirable in the software aspect and relatively desirable in the hardware aspect. This study emphasizes the importance of considering the prerequisites of FCM for successful implementation in medical education. Both students and teachers need to be prepared and equipped with the necessary skills to effectively use FCM, also having adequate technology resources to support FCM implementation is necessary.

Flipped Classroom

Technology

Medical Students

Medical Teachers

Backward Class

Reverse Teaching

The flipped educational model is a learner-centered and practice-oriented approach in which students review educational material before class and engage in collaborative activities during class (Kazeminia et al., 2022; Noori et al., 2022). The different terminologies used for the flipped classroom model (FCM), such as flip teaching, backward class, reverse teaching, substitute class, reverse instruction, and blended learning, all emphasize the importance of active student engagement and participation in the learning process (Hew & Lo, 2018; Pirmukhammadovich, 2022; Tsao et al., 2022).

In FCM students received educational material, often in the form of teacher-produced video lessons or selected documents, before class, and they then participated in different class activities, traditionally considered homework, such as collaborating in discussions, problem-solving, or conducting research (Kazeminia et al., 2022; Noori et al., 2022; Tsao et al., 2022). The teachers act as a consultant and facilitator, and the students engage in independent learning of new educational material and apply their knowledge to practical tasks during classroom sessions, where they participate in discussions and analyses of various aspects and complex issues related to the topic, that make them responsible for their education and engaged in the learning process ( Hew & Lo, 2018).

The flipped educational model has been implemented in different medical universities worldwide has garnered positive feedback from both students and teachers (Alabiad et al., 2020; Bergmann & Sams, 2009; Pierce & Fox, 2012). The FCM has been shown to be a cost-effective approach that not only facilitates the learning process of medical students but also provides them with the opportunity to engage in active learning, critical thinking, and problem-solving, leading to a deeper understanding of the subject matter (Alabiad et al., 2020; Mehta et al., 2013; Pirmukhammadovich, 2022).

Although the FCM has demonstrable benefits, students may face challenges such as weak motivation, lack of academic and cognitive responsibility, unwillingness and inability to acquire knowledge independently, and time limitations that hinder their ability to engage in independent learning and work (Pirmukhammadovich, 2022). Furthermore, teachers' ability to provide quality materials for self-learning, the quality of video lectures, and the accessibility and provision of technology are critical factors that can impact the effectiveness of the FCM (Crothers et al., 2017; Akçayır & Akçayır, 2018).

Several studies have demonstrated the effectiveness of the FCM and positive student attitudes toward the approach; however, ongoing debate surrounds evaluating the implementation and requirements of this model for medical students (Cotta et al., 2016; Kazeminia et al., 2022; Noori et al., 2022).This study aimed to evaluate the implementation and requirements of the FCM for medical students, identify its strengths and weaknesses, and provide recommendations for its successful implementation.

Assessing flipped classroom requirements

The first step towards identifying the prerequisites for implementing the FCM involved reviewing available evidence and conducting expert panel discussions. Faculty members of Mashhad medical school, who are experts in medical education, were invited to participate in this assessment. The outcome of this process was a chart that illustrates the feasibility and requirements of implementing the flipped approach. This chart summarizes the prerequisites of the FCM in three domains: students' preparedness, teachers' preparation, and technology provisions (Fig. 1).

Possible prerequisites for implementing the flipped classroom model (FCM) were identified through a literature review and expert panel discussions. The prerequisites of FCM were explored across three domains: students' preparedness, teachers' preparation, and technology provisions. An instrument for implementation of FCM (Two questionnaires and one checklist) were developed and after validation were used to assess the status of FCM implementation in Mashhad medical school, by 250 medical students, 60 medical teachers, and 7 educational technology specialists who participated in the study.

Designing questionnaire

To assess students' preparedness, teachers' preparation, and technology provision, two questionnaires and one checklist were designed. The students' preparedness questionnaire included access to technology, computer skills, online skills, motivation, ability to understand online audio and video, ability to discuss a subject online, and students' attitude towards success. The teachers' preparation questionnaire, on the other hand, assessed the ability to provide a flexible learning environment, pay attention to individual learning, create desirable content, and coach professionally. The technology checklist was divided into two domains: software and hardware facilities, each with several subdomains. The scoring was based on a Likert scale with five scores, ranging from totally agree to totally disagree.

Validity and reliability.

The validity of the final questionnaire was confirmed by a panel of medical experts' opinions. The reliability of the questionnaire was evaluated using Cronbach's alpha coefficient, which was calculated to be 0.92 for the students' preparedness questionnaire and 0.89 for the teachers' preparation questionnaire.

Data collection

In the second phase of the study, the valid and reliable questionnaires were used to collect data from pre-clinical medical students and their teachers. Additionally, the checklist provided for the technology part was completed by seven information technology experts in Mashhad medical school, Iran.

Statistical analysis

The Likert scores ranged from 0 to 4, with completely agree assigned 4 scores and completely disagree assigned 0 score. Mean scores with standard deviations (SD) were calculated, and the status was classified based on the calculated scores. A score of 0 to 1.33 was considered undesirable, 1.34 to 2.66 was relatively desirable, and 2.67 to 4 was considered desirable.

Possible prerequisites for implementing the flipped classroom model (FCM) were identified in three domains: students' preparedness, teachers' preparation, and technology provisions. The students’ preparedness domain assessed subject of: “Access to technology, Computer skills, Online skills, Motivation, Ability to understanding online audio and video, Ability to discussing a subject online, Attitude towards success”, teachers’ preparation domain assessed subject of: “Ability to provide a flexible learning environment, Ability to pay attention to individual learning, Ability to create desirable content, Ability to coach professionally” and technology provision domain assessed Hardware and Software facilities.

Evaluation of implementation of FCM in Mashhad medical school with designed instruments showed that the mean scores for FCM implementation in domains of students' preparedness, teachers’ preparation, and technology provision were 2.82 ± 0.49, 3.56 ± 0.16, and 3.0 ± 0.58 respectively.

Students’ online skills and ability to discussing a subject online had not get desirable status and were the lowest score in the students' preparedness domain (2.16 ± 0.85 and 2.32 ± 0.84 respectively). In contrast students’ access to technology and their attitude towards success were the highest score in that domain (3.31 ± 0.27 and 3.10 ± 0.88 respectively).

From the different features of teachers' preparation domain for FCM teachers’ ability to pay attention to individual learning, coach professionally, and create desirable content had the highest scores (3.62 ± 0.33, 3.61 ± 0.26, and 3.57 ± 0.31respectively), the ability to provide a flexible learning environment had the lowest score in that domain (3.45 ± 0.29). In technology provision domain, the hardware facilities had lower score comparing software facilities (3.57 ± 0.53 vs. 3.0 ± 0.58).

Table 2 provides the details on scoring of medical students’ preparedness, teachers’ preparation, and technology provision for the flipped classroom model.

Table 1

The basic information of the study participants
Participants		Number	Years of employment/study Mean ± SD	Age Mean ± SD
Medical teachers	Assistant Professor	12	7.5 ± 3	46 ± 8
	Associate Professor	38	15 ± 5	48 ± 10
	Professor	10	21 ± 7	52 ± 11
Medical students		250	2.5 ± 1	22 ± 3
Information technology experts		7	8.2 ± 4	32 ± 5

Table 2

Scoring of Medical Students’ Preparedness, Teachers’ Preparation, and Technology Provision for the Flipped Classroom Model.
Domains	Features	Score Mean ± SD	Relative Percent (%)	Status
Medical Students' Preparedness	Access to technology	3.31 ± 0.27	82	Desirable
	Computer skills	2.70 ± 0.97	67	Desirable
	Online skills	2.16 ± 0.85	54	Relatively desirable
	Motivation	3.45 ± 0.29	86	Desirable
	Ability to understanding online audio and video	2.78 ± 1.03	69.5	Desirable
	Ability to discussing a subject online	2.32 ± 0.84	58	Relatively desirable
	Attitude towards success	3.10 ± 0.88	77	Desirable
	Total students’ preparedness for flipping	2.82 ± 0.49	70.5	Desirable
Medical Teachers’ Preparation	Ability to provide a flexible learning environment	3.45 ± 0.29	86	Desirable
	Ability to pay attention to individual learning	3.62 ± 0.33	90	Desirable
	Ability to create desirable content	3.57 ± 0.31	89	Desirable
	Ability to coach professionally	3.61 ± 0.26	90	Desirable
	Total teachers’ preparation for flipping	3.56 ± 0.16	91	Desirable
Technology Provision	Hardware facilities	2.43 ± 1.13	60.7	Relatively desirable
	Software facilities	3.57 ± 0.53	89	Desirable
	Total technology status	3.0 ± 0.58	75	Desirable

This study underscores the importance of a comprehensive approach to FCM implementation that addresses the prerequisites across all three domains of students' preparedness, teachers' preparation, and technology provisions.

The FCM has demonstrated several advantages compared to traditional lecture classes, and both teachers and students express satisfaction and a positive attitude towards FCM (Cotta et al., 2016; Pirmukhammadovich, 2022).

One of the key requirements for the successful implementation of the flipped classroom approach is that students are well-prepared for in-class activities and active discussions, which are important factors for promoting student learning in this model (Galway et al., 2014; Goedhart et al., 2019). However, the results of the present study revealed that medical students did not perform well in online discussions, which is a crucial component of the FCM. The students also scored poorly in their online abilities, which is another important factor for sharing information in flipped classrooms. Improving medical students' abilities to effectively use online materials such as web lectures, text selections, scientific papers, and formative test questions is crucial for the successful implementation of FCM (Goedhart et al., 2019).

In Mashhad Medical School, teachers' abilities were generally considered desirable, but their ability to provide a flexible learning environment received a lower score in the teachers’ preparation domain. Creating a flexible and engaging learning environment and providing professional coaching to students are important for improving motivation and engagement in flipped classrooms. One approach to achieve this is by making student assessments more flexible, which can include incorporating learning activities and assessing skills such as creativity and collaboration during the flipped classroom model (Goedhart et al., 2019; Bouwmeester et al., 2019).

Apart from human factors, technology also plays an important role in the success of FCM. In recent years, advances in educational technology innovation have played a significant role in increasing the use of active learning approaches such as the flipped model (Baytiyeh, 2017). However, the implementation of the FCM has also presented technical challenges. The quality of shared videos has been identified as the most important aspect to consider (Moraros et al., 2015). Other important issues include the inequality of technology accessibility, cost, the need for technology competency among both teachers and learners, and the requirements of specific infrastructure, as well as institutional support (Chen et al., 2015; Leo and Puzio, 2016; Porcaro et al., 2016; Sun et al., 2017).

In the case of Mashhad Medical School, evaluation in the technology provision domain showed that the hardware part was not completely desirable, and hardware infrastructure needs improvement. Although technology accessibility alone is not sufficient for the success of the FCM, technology acts as an intermediary for students' learning, and their success will depend on their skills and abilities (Gaida et al., 2016).

This study emphasizes the importance of considering the prerequisites of FCM for successful implementation in medical education. It suggests that both students and teachers need to be prepared and equipped with the necessary skills and resources to effectively use FCM, also having adequate technology resources to support FCM implementation is necessary.

This study assessed the FCM implementation in Mashhad medical schools, by assessment of the human resources and infrastructure. However, the findings are limited to an Iranian population of medical students. Further studies should be conducted on other populations in other institutions, with a particular focus on medical students as there is currently insufficient evidence about this group.

Acknowledgments

This research was supported by Mashhad University of medical sciences in Mashhad, Iran.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Funding

No funding.

Data Availability Statement

The data presented in this study are available on request from the first author.

Contribution:

A.E, L.J and M.R contributed to the design and implementation of the research. L.J and A.G collected the data, performed the analysis and drafted the manuscript. All authors reviewed the manuscript.

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No competing interests reported.

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Assessing the Implementation Requirements of the Flipped Classroom Model for Medical Students: A Multi-Domain Evaluation

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Abstract

Figures

Introduction

Method

Assessing flipped classroom requirements

Designing questionnaire

Data collection

Statistical analysis

Results

Discussion

Conclusion

Limitation

Declarations

References

Additional Declarations

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