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5 Q&As: The Flipped Classroom In Medical Education

5 Q&As: The Flipped Classroom in Medical Education

What is the Flipped Classroom?

The flipped classroom is a blended learning model.  In this model, educational resources are delivered via an online education platform to students before class starts (Hughes & Lyons, 2017).  Students are expected to access and understand the materials prior to class.  During class time, students then discuss and apply the new material in problem-solving activities (Hughes & Lyons, 2017).  Unlike in a didactic teaching model, in a flipped classroom new information is disseminated outside of class time to maximize the time in the classroom spent on critical-thinking activities (Hughes & Lyons, 2017).

Why is a Flipped Classroom Suited for Medical Students?

There are a number of reasons why a flipped classroom is well-suited for medical students.  One reason is because of the large volume of information medical students must learn as a part of their training (Hughes & Lyons, 2017).  The variety of ways information can be disseminated online via an online education platform (e.g., simulation videos; new study findings presented in research articles, podcasts, and quizzes) enhances the learning process, making it easier to adopt new materials.  Additionally, medical students are highly motivated, so increasing their access to medical resources through an online education platform in a flipped classroom may improve the level of learning that otherwise could not be achieved in a traditional classroom with fewer resources.  Along with being very motivated, this population typically consists of independent learners (Hughes & Lyons, 2017).  When educational materials are provided before class, this allows these independent learners to teach themselves in a way that optimizes their absorption of new information.  Coming to class to apply this information with peers allows for a wealth of subjective takeaways to be pooled together in solving a problem, also enabling peers to correct one another in cases in which information was incorrectly interpreted.

Why Choose a Flipped Classroom Over a Solely Distance Learning Format?

True, distance learning is less expensive than a flipped classroom.  However, there are key components to a flipped classroom that are lost with a distance learning continuing medical education.  For one, a distance learning format, that solely relies upon an online education platform, does not support the development of effective communication skills (Hughes & Lyons, 2017).  In any health care profession, face-to-face rapport with patients is vital to a practice’s success.  Without in-person rapport building, health care professionals will be ill-equipped when entering their health care careers.  Secondly, medical students typically have increased engagement with training materials in a flipped classroom than in a solely distance learning program.  This increased engagement enhances the learning process and better prepares students for careers in medicine.  Additionally, an online education platform provided by a solely distance learning program does not support the effective collaborative learning environment needed when entering a medical profession.  True, there are instant messaging services and video conferencing features which can be integrated into a distance learning management system; however, it is difficult to have these collaborations on an ongoing basis due to people’s varying schedules in a distance learning program (Hughes & Lyons, 2017).  It is necessary to have face-to-face collaborations which mimic a medical setting in which in-person higher-order thinking, evaluation, and synthesis of knowledge is needed to optimally provide care to patients (Hughes & Lyons, 2017).  The flipped classroom provides optimal classroom time to work through challenging cases with classmates and come to conclusions on best procedures in a timely fashion.

Is the Flipped Classroom More Effective Than Traditional Didactical Lecture?

Flipped Learning vs. Traditional Learning

Systematic reviews focused on the effectiveness of the flipped classroom yield mixed results.  Hughes and Lyons (2017) investigated 11 studies, of which, four studies demonstrated a significantly greater improvement in test scores for the flipped classroom group than the didactical lecture group.  Another four studies showed no significant difference in test scores between the flipped classroom group and the didactical lecture group.  Finally, three studies demonstrated mixed results.  For example, in some studies, students reported greater satisfaction with the flipped classroom and performed the new skill better when taught in the flipped classroom group, yet exam scores were higher for those taught in the didactical lecture group (Hughes & Lyons, 2017).  It may be that skill performance may be better in the flipped classroom because the flipped classroom environment provides a space for higher-order problem solving and clinical-reasoning skills to flourish.  If this is the case, further investigation is necessary to test if clinical competence developed in a flipped classroom remains strong in the long term.  Due to the heterogeneity of studies on the flipped classroom, and the lack of studies that followed student compliance with the material on their respective online education platform, it is difficult to assert that the flipped classroom is more effective in increasing learning outcomes for medical students than the traditional didactical lecture classroom (Hughes & Lyons, 2017).  Further studies are necessary to determine if the flipped classroom should be the medical education classroom of the future, or if it is only more effective for certain subjects in medical curricula.

What Is One Subject a Flipped Classroom Is Useful for in Medical Education?

It improves the quality of delirium care!  Sockalingham et al. (2016) created a 3-hour training program in a flipped classroom format and measured participants’ resulting knowledge outcomes on the subject of delirium, skills outcomes regarding delirium assessment behaviors, and perceived abilities to manage patient delirium.  Self-efficacy and knowledge scores were measured prior to the flipped classroom experience, after the flipped classroom experience, and 6 months following the flipped classroom experience.  After measuring self-efficacy and knowledge scores at these different time periods, it was found that knowledge about proper delirium care and self-efficacy regarding abilities to manage patient delirium were significantly higher after the flipped classroom experience, and remained significantly higher at 6-month follow-up than scores observed prior to the flipped classroom experience.  Due to the delirium training, clinician delirium assessment rates improved significantly as well.  This study provides a model for a time-efficient, flipped classroom delirium training which can easily be implemented in hospitals on a national or international scale to improve delirium care (Sockalingham et al., 2016).




Hughes, Y., & Lyons, N. (2017). Does the flipped classroom improve exam performance in medical education? A systematic review. AMEE MedEdPublish. Advance online publication. doi:10.15694/mep.2017.000100

Sockalingham, S., James, S. L., Sinyi, R., Caroll, A., Laidlaw, J., Yanofsky, R., & Sheehan, K. (2016). A flipped classroom approach to improving the quality of delirium care using an interprofessional train-the-trainer program. Journal of Continuing Education in the Health Professions, 36, 17–23. doi:10.1097/CEH.0000000000000025

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