Design principles for fully online flipped learning in health professions education: a systematic review of research during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, some instructors transitioned their courses into a fully online environment by adopting flipped learning. In this context, this review examined the challenges to fully online flipped learning and identified useful course-design elements for practicing this instructional approach in health professions education. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for selecting relevant articles. Thirty-three empirical studies (with 32 unique interventions) published between 2020 and 2021 (i.e., the first 2 years of the pandemic) were selected for analysis. RESULTS: When the instructors in the reviewed studies designed and implemented their online flipped courses, numerous challenges emerged, which could be broadly categorized into student-related challenges (e.g., unfamiliarity with online flipped learning; N = 5), faculty challenges (e.g., increased workload; N = 8), and operational challenges (e.g., students' technical problems; N = 9). Nevertheless, we identified various useful elements for online flipped learning practice and organized them based on the following components of the Revised Community of Inquiry (RCoI) framework: cognitive presence (e.g., application of knowledge/skills; N = 12), social presence (e.g., peer interaction; N = 11), teaching presence (e.g., instructors' real-time demonstration/facilitation; N = 17), and learner presence (e.g., care and emotional support; N = 4). CONCLUSIONS: Based on the findings from the review and the RCoI framework, we developed nine principles for the effective practice of online flipped learning. These principles appear crucial for sustaining quality health professions education in a fully online flipped learning environment.

Flipped classroom improves student learning in health professions education: a meta-analysis.

BACKGROUND: The use of flipped classroom approach has become increasingly popular in health professions education. However, no meta-analysis has been published that specifically examines the effect of flipped classroom versus traditional classroom on student learning. This study examined the findings of comparative articles through a meta-analysis in order to summarize the overall effects of teaching with the flipped classroom approach. We focused specifically on a set of flipped classroom studies in which pre-recorded videos were provided before face-to-face class meetings. These comparative articles focused on health care professionals including medical students, residents, doctors, nurses, or learners in other health care professions and disciplines (e.g., dental, pharmacy, environmental or occupational health). METHOD: Using predefined study eligibility criteria, seven electronic databases were searched in mid-April 2017 for relevant articles. Methodological quality was graded using the Medical Education Research Study Quality Instrument (MERSQI). Effect sizes, heterogeneity estimates, analysis of possible moderators, and publication bias were computed using the COMPREHENSIVE META-ANALYSIS software. RESULTS: A meta-analysis of 28 eligible comparative studies (between-subject design) showed an overall significant effect in favor of flipped classrooms over traditional classrooms for health professions education (standardized mean difference, SMD = 0.33, 95% confidence interval, CI = 0.21-0.46, p < 0.001), with no evidence of publication bias. In addition, the flipped classroom approach was more effective when instructors used quizzes at the start of each in-class session. More respondents reported they preferred flipped to traditional classrooms. CONCLUSIONS: Current evidence suggests that the flipped classroom approach in health professions education yields a significant improvement in student learning compared with traditional teaching methods.

Using chatbots to support student goal setting and social presence in fully online activities: learner engagement and perceptions.

Although fully online learning is now the 'new normal' in many parts of the world, its implementation is often beset by challenges such as the lack of student self-regulation, and the sense of isolation. In this paper, we explored the use of chatbots to support student goal setting (Study 1) and social presence (Study 2) in online activities. In Study 1, participants in a fully online course were invited to complete a goal setting activity prior to attending class via a goal-setting chatbot. The chatbot engaged participants with five questions developed based on the SMART (specific, measurable, achievable, realistic, and timely) goal setting framework. In Study 2, English-as-Foreign-Language participants in a fully online course were tasked to complete listening practices. The learning buddy chatbot was designed based on the social presence framework (interpersonal communication, open communication, cohesive communication) to guide students through listening exercises. In both Study 1 and 2, we evaluated participants' behavioral engagement by measuring their conversation records with the chatbots, as well as participants' perceived usefulness and ease of use of the chatbots. We also gathered in-depth interview data concerning the participants' perceptions of interacting with the chatbots. Overall, our findings found positive learner experiences with both chatbots with regard to the chatbots' perceived usefulness and perceived ease of use. We also provided suggestions for instructors to apply chatbots in teaching and learning.

Effects of using mobile instant messaging on student behavioral, emotional, and cognitive engagement: a quasi-experimental study.

Mobile instant messaging (MIM) has become the most popular means for young people to communicate. MIM apps typically come with a myriad of features that educators may leverage to increase student learning. However, it remains poorly understood to what extent and in what aspect MIM can facilitate student engagement. We address the gap by comparing the effects of using MIM and asynchronous online discussion (AOD) on student online engagement, using a quasi-experimental study involving a historical cohort control group. Understanding which communication mode can better promote student online engagement is particularly important during the current widespread use of online learning. Specifically, we examined engagement from the behavioral, emotional, and cognitive dimensions. The results showed that the MIM group was more behaviorally engaged in discussion activities, producing more messages, more words, and higher rates of participation, task completion, and interaction. Emotionally, no statistically significant difference was found in students' affective evaluation of course interaction and satisfaction between the two groups. However, MIM appeared to help students with improved intimacy and interpersonal relationships. Cognitively, the MIM group was more engaged than the AOD group. In particular, MIM seemed to facilitate interactive idea exchange and thus contributing to more "creating" activities. We conclude by providing suggestions for future instructional practice and research directions.

Incorporating fantasy into gamification promotes student learning and quality of online interaction.

We used the design-based research approach to test and refine a theoretically grounded goal-access-feedback-challenge-collaboration gamification model. The testbed was a 10-week, university-level e-learning design course offered in two consecutive semesters. In Study 1, we implemented the initial goal-access-feedback-challenge-collaboration model in semester one of the 2020-2021 academic year (N = 26). The aim was to enhance student behavioral engagement in online discussion forums, affective engagement in the class, and learning performance. The results of Study 1 showed that although most participants were engaged in this gamified learning experience during the first two sessions, they gradually lost interest and their participation in online discussions dropped over the next eight weeks. Thus, we introduced a new element, fantasy, into the original model. In Study 2, we tested the effectiveness of the goal-access-feedback-challenge-collaboration-fantasy model on students' learning outcomes in semester two of 2020-2021 (N = 23). The results of Study 2 suggested that, compared to the original model, the goal-access-feedback-challenge-collaboration-fantasy model can better promote students' engagement in online discussion, as measured by increased interaction with peers, learning experience, and learning performance.

Student Engagement in Mathematics Flipped Classrooms: Implications of Journal Publications From 2011 to 2020.

Mathematics is one of the core STEM (science, technology, engineering, and mathematics) subject disciplines. Engaging students in learning mathematics helps retain students in STEM fields and thus contributes to the sustainable development of society. To increase student engagement, some mathematics instructors have redesigned their courses using the flipped classroom approach. In this review, we examined the results of comparative studies published between 2011 and 2020 to summarize the effects of this instructional approach (vs. traditional lecturing) on students' behavioral, emotional, and cognitive engagement with mathematics courses. Thirty-three articles in K-12 and higher education contexts were included for analysis. The results suggest that the use of the flipped classroom approach may increase some aspects of behavioral engagement (e.g., interaction and attention/participation), emotional engagement (e.g., course satisfaction), and cognitive engagement (e.g., understanding of mathematics). However, we discovered that several aspects (e.g., students' attendance, mathematics anxiety, and self-regulation) of student engagement have not been thoroughly explored and are worthy of further study. The results of this review have important implications for future flipped classroom practice (e.g., engaging students in solving real-world problems), and for research on student engagement (e.g., using more objective measures, such as classroom observation) in mathematics education.

Transitioning to the "new normal" of learning in unpredictable times: pedagogical practices and learning performance in fully online flipped classrooms.

The COVID-19 outbreak has compelled many universities to immediately switch to the online delivery of lessons. Many instructors, however, have found developing effective online lessons in a very short period of time very stressful and difficult. This study describes how we successfully addressed this crisis by transforming two conventional flipped classes into fully online flipped classes with the help of a cloud-based video conferencing app. As in a conventional flipped course, in a fully online flipped course students are encouraged to complete online pre-class work. But unlike in the conventional flipped approach, students do not subsequently meet face-to-face in physical classrooms, but rather online. This study examines the effect of fully online flipped classrooms on student learning performance in two stages. In Stage One, we explain how we drew on the 5E framework to design two conventional flipped classes. The 5E framework consists of five phases-Engage, Explore, Explain, Elaborate, and Evaluate. In Stage Two, we describe how we transformed the two conventional flipped classes into fully online flipped classes. Quantitative analyses of students' final course marks reveal that the participants in the fully online flipped classes performed as effectively as participants in the conventional flipped learning classes. Our qualitative analyses of student and staff reflection data identify seven good practices for videoconferencing-assisted online flipped classrooms.

An online listserv for nurse practitioners: a viable venue for continuous nursing professional development?

This study reports the results of a qualitative study involving a large and longstanding online nurse listserv in the United States. A sample of 27 critical care and advanced-practice nurse practitioners was interviewed using semi-structured individual interviews. This study found evidence that participation in an online listserv offers a viable avenue for the continuous professional development of nurses by providing nurses the opportunity to make more informed decisions about their professional practice and keeping abreast with up-to-date changes in their specialty areas when they shared knowledge with one another. Follow-up interviews with 10 nurses who frequently shared their knowledge revealed six motivators that helped promote knowledge sharing: (a) reciprocity, (b) collectivism, (c) personal gain, (d) respectful environment, (e) altruism, and (f) technology. Implications for sustaining knowledge sharing in an online listserv are discussed. The finding will inform educators and administrators who support continuing education and professional development of healthcare professionals.

A critical review of flipped classroom challenges in K-12 education: possible solutions and recommendations for future research.

An increasing number of teachers are using flipped classroom approach in their teaching. This instructional approach combines video-based learning outside the classroom and interactive group learning activities inside the classroom. The purpose of the present review is to provide an overview of flipped classroom studies in K-12 education. Particularly, we put emphasis on revealing and addressing the potential challenges of flipped classroom approach. Fifteen journal publications of K-12 flipped classrooms were analyzed in terms of their flipped learning activities, student achievement, student attitude, and challenges encountered. The results suggested that a variety of pre-class (e.g., online exercises) and in-class (e.g., brief review, individual practices) activities were provided in addition to instructional videos and small-group activities respectively. The use of flipped classroom approach in K-12 education yielded a neutral or positive impact on student achievement when compared to traditional classroom. Mixed results of student attitude toward flipped classroom approach were discovered. Challenges of implementing flipped classrooms were identified and categorized into student-related challenges, faculty challenges, and operational challenges. Based on the suggestions of previous studies together with relevant empirical supports, we propose a rudimentary flipped classroom model and a set of 10 guidelines to address these challenges. Finally, several recommendations of future research are provided.

Knowledge for games, games for knowledge: designing a digital roll-and-move board game for a law of torts class.

Game-based constructivist learning has gained considerable attention as educational institutions aim to move from traditional instructional teaching to interactive and collaborative methods. The question is less asked of whether games should be used in teaching but rather how games should be used to create deep learning in students. In light of this movement, the Grade Inflation Game, or GIGAME, was developed. This case study tackles the research question of how games may be designed to harness the benefits of constructivist learning. It first documents the conceptualization of GIGAME and next proposes theoretical frameworks that can be used to guide the development and evaluation of constructivist learning games. Through trial runs on two undergraduate law of torts classes, feedback was gathered from students and the instructor of these classes regarding their perceptions of GIGAME, including learning effectiveness and satisfaction. The feedback suggests that GIGAME can serve as a form of game-based constructivist learning as most students indicated that the game helped consolidate their course knowledge while having fun. These qualitative findings are useful for guiding the development of other games that similarly aim to promote socially interactive and constructivist learning environments. This case study recommends the use of GIGAME in classes, although refinements can still be made to its gameplay.

Predictors of Information Technology Integration in Secondary Schools: Evidence from a Large Scale Study of More than 30,000 Students.

The present study examined the predictors of information technology (IT) integration in secondary school mathematics lessons. The predictors pertained to IT resource availability in schools, school contextual/institutional variables, accountability pressure faced by schools, subject culture in mathematics, and mathematics teachers' pedagogical beliefs and practices. Data from 32,256 secondary school students from 2,519 schools in 16 developed economies who participated in the Program for International Student Assessment (PISA) 2012 were analyzed using hierarchical linear modeling (HLM). Results showed that after controlling for student-level (gender, prior academic achievement and socioeconomic status) and school-level (class size, number of mathematics teachers) variables, students in schools with more computers per student, with more IT resources, with higher levels of IT curricular expectations, with an explicit policy on the use of IT in mathematics, whose teachers believed in student-centered teaching-learning, and whose teachers provided more problem-solving activities in class reported higher levels of IT integration. On the other hand, students who studied in schools with more positive teacher-related school learning climate, and with more academically demanding parents reported lower levels of IT integration. Student-related school learning climate, principal leadership behaviors, schools' public posting of achievement data, tracking of school's achievement data by administrative authorities, and pedagogical and curricular differentiation in mathematics lessons were not related to levels of IT integration. Put together, the predictors explained a total of 15.90% of the school-level variance in levels of IT integration. In particular, school IT resource availability, and mathematics teachers' pedagogical beliefs and practices stood out as the most important determinants of IT integration in mathematics lessons.