Development of a flipped learning course to deliver and scale molecular variant evaluation education: A quality improvement initiative.

Over the past several decades, molecular genetic testing volumes have grown and testing has expanded from single-gene assays to multigene panels, exome sequencing, and genome sequencing. The number of molecular genetic variants that require manual interpretation has grown simultaneously, resulting in an increased demand for education on molecular variant evaluation (MVE). To meet this growing need, a team of genetic counselors and educational experts undertook a quality improvement (QI) initiative with the objectives of assessing, standardizing, and scaling access to MVE education, without increasing instructor time to deliver the education. Using the Six Sigma define-measure-analyze-improve-control (DMAIC) framework, a flipped learning course with a series of standardized online modules was developed to deliver MVE education in an enduring and accessible format for a diverse group of learners. Outcome measures included the number of online modules developed, the number of individual learners and unique learner groups accessing MVE education, and direct instruction time required to deliver MVE education. Countermeasures to ensure maintenance of educational quality included post-course learner satisfaction scores and performance on competency assessments. Both the total number of learners and the number of unique learner groups accessing MVE education increased, while instructor time required to deliver content per learner decreased. Learner satisfaction scores remained constant and performance on competency assessments improved. The QI initiative successfully scaled MVE education to a diverse group of learners without decreasing learner outcomes or satisfaction. The flipped learning format provides a scalable and flexible educational model for instructors and learners in a rapidly changing environment that often includes remote work and education.

Exploring educational transformations through the Innovative Flipped Learning Instruction Project Symposium.

The flipped classroom is an innovative pedagogy that shifts content delivery outside the classroom, utilizing in-class time for interactive learning. The preclass and in-class activities in this framework encourage individualized learning and collaborative problem-solving among students, fostering engagement. The Innovative Flipped Learning Instruction Project (IFLIP) conducted faculty development workshops over 4 years, guiding science, technology, engineering, and mathematics (STEM) faculty in integrating flipped teaching (FT) into their courses. The research aimed to assess its impact on pedagogical practices, explore its effectiveness, and provide a framework to implement FT across multiple institutions. It sought to evaluate the experiences of these educators throughout the transitional period of instructional change. In the fourth year of this project, a symposium was organized for IFLIP participants to share their experiences and findings concerning FT. This symposium helped promote collaboration among IFLIP participants and faculty interested in FT to disseminate participants' knowledge and experiences in implementing FT strategies. A survey conducted at the end of the symposium indicated that faculty participants with FT experience continued to embrace this pedagogy, and the new adopters expressed intentions to incorporate it into their courses. The survey revealed positive responses: 93% of respondents plan to integrate FT methods in future classes, 90% gained new information from the symposium and intend to implement it, and 91% are likely to recommend FT to colleagues. Ultimately, the symposium underscored the transformative impact of FT in empowering educators to deepen students' conceptual understanding, emphasizing the significance of this pedagogical approach in advancing the quality of education.NEW & NOTEWORTHY Flipped pedagogy shifts content delivery outside the classroom, emphasizing interactive learning during in-class time. The Innovative Flipped Learning Instruction Project (IFLIP) guided science, technology, engineering, and mathematics (STEM) faculty in integrating flipped teaching (FT), tracked experiences during this transition, and provided a framework for FT implementation. A fourth-year symposium fostered collaboration, revealing sustained enthusiasm for FT. The symposium underscored its transformative impact on deepening students' understanding, highlighting its significance in enhancing education quality.

Fostering clinical reasoning ability in preclinical students through an illness script worksheet approach in flipped learning: a quasi-experimental study.

BACKGROUND: The consensus that clinical reasoning should be explicitly addressed throughout medical training is increasing; however, studies on specific teaching methods, particularly, for preclinical students, are lacking. This study investigated the effects of an illness script worksheet approach in flipped learning on the development of clinical reasoning abilities in preclinical students. It also explored whether the impact of this intervention differed depending on clinical reasoning ability after dividing the students into high and low groups based on their pre-diagnostic thinking inventory (DTI) scores. METHODS: This study used a one-group pre-post test design and convenience sampling. Forty-two second-year medical students were invited to participate in this study. The course, "clinical reasoning method," was redesigned as an illness script worksheet approach in flipped learning. The course was an eight-week long program. The students met once or twice per week with a different professor each time and engaged with 15 clinical cases in small groups in one classroom. Each time, one professor facilitated seven groups in a single classroom. The effectiveness of the intervention was measured using DTI before and after the intervention. A learning experience survey was conducted with post-DTI assessment. RESULTS: Thirty-six students participated in the survey and their data were analyzed. The mean pre-DTI score was 170.4, and the mean post-DTI score was 185.2, indicating an 8.68% increase (p < .001). Significant differences were also found in both high and low groups between the pre- and post-DTI assessments. However, the low group improved much more than the high group and exhibited a significant increase in one of the DTI subscales as well. The overall average score on the learning experience survey was 3.11 out of 4. CONCLUSION: The findings indicated that the intervention was an effective instructional method for the development of clinical reasoning in preclinical students and was more beneficial for students with a low level of clinical reasoning ability. This study demonstrated that the intervention can be a feasible and scalable method to effectively and efficiently train clinical reasoning in preclinical students in a classroom.

COVID-19 Adaptations for Biomedical Teaching and Assessment Within the Undergraduate Dental Curriculum.

The COVID-19 pandemic has profoundly affected the provision of teaching and assessment on the undergraduate dental programme in many institutions worldwide, and for a prolonged period resulted in the cessation of face-to-face teaching. This resulted in significant changes in the way that didactic and preclinical skills have been taught and required novel thinking to overcome the issues that COVID-19 restrictions presented.Dentistry is a very practical subject and at this institution, the University of Glasgow Dental Hospital and School, we had to quickly develop new ways of teaching that allowed us to cover teaching and assessment of the required Intended Learning Outcomes. This chapter highlights some specific case studies of how adaptations were made to the undergraduate dental teaching program within our institution utilising technology and visualisation to promote this during this turbulent time. These included teaching of head and neck anatomy, teaching of pre-clinical skills in placement of local anaesthetic and dental extraction forceps, communication skills as well as describing a raft of modifications to our assessment programme.Many of these innovations, utilising blended learning methodologies with the use of visualisation, have been transferred into other areas of teaching within the curriculum and will replace older material as we transition out of the pandemic, undoubtedly significantly improving the student experience.

Flipped learning as an educational model in a cardiology residency program.

INTRODUCTION: Flipped learning (FL) is a model which allows students to adjust their study rhythm by taking advantage of class time to apply their knowledge. Although FL meets many of the needs of the traditional lecture-based model and the exclusively virtual model, its effectiveness in medical residency programs has not been thoroughly studied. Our study evaluates the efficacy of an FL model in a cardiology residency program based on the satisfaction and academic performance of the participants. METHOD: A prospective, observational, and descriptive study was conducted at Ignacio Chávez National Institute of Cardiology in Mexico City to evaluate the satisfaction and effectiveness of an FL model for acquiring competencies in electrocardiographic diagnosis among thirty-one first-year cardiology residents. The Advanced Electrocardiography Workshop and a virtual classroom were designed for the intervention. Four teachers taught the workshop and video classes, and ten medical specialists from the participants' areas of work performed evaluations of practical skills before and after the intervention. RESULTS: 75% of the participants rated the intervention as very favorable compared to the traditional and virtual models. The main advantages offered by the FL model were identified. An improvement of high statistical significance was observed in participants' academic performance after the intervention (P value < 0.001). CONCLUSION: The FL model has a high degree of acceptance among participants and teachers. Our study shows an improvement in academic performance after the intervention. Considering that the FL model is flexible and reproducible in other areas of medicine, it represents an excellent educational alternative that meets current needs.

Effectiveness of flipped classroom in pharmacy education - a meta-analysis.

BACKGROUND: Flipped classroom, blended with online and offline learning, was regarded as an effective learning approach in pharmacy education. This meta-analysis was to comprehensively compare the effectiveness of flipped classroom and traditional lecture-based approaches, attempting to generate a unified and firm conclusion of the effectiveness of flipped classroom in pharmacy education. METHODS: Data were collected from 7 databases, involving Cochrane Library, PubMed, Embase, ScienceDirect, Web of Science, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature Service System (SinoMed). The studies were included if they included objective evaluation of students' performance between groups of flipped classroom and traditional approaches. The standardized mean difference (SMD) with a corresponding 95% confidence interval (95% CI) was used as the outcomes for data pooling. RESULTS: A total of 22 studies (28 comparing groups) with 4379 participants were included in the meta-analysis. The risk of bias was relatively high. Results of the analysis revealed that flipped classroom presented significant advantages over traditional approaches in student performance improvement, with no evidence of publication bias. Through subgroup analysis, it showed better outcomes for flipped classrooms over traditional lectures for the other subgroups, including different performance, degree programs. CONCLUSIONS: Current evidence reveals that the flipped classroom approach in pharmacy education yields a statistical improvement in student learning compared with traditional methods. In the future, instructors should introduce more online technology into classroom and construct an interactive learning environment.

Measuring the Impact of Augmented Reality in Flipped Learning Mode on Critical Thinking, Learning Motivation, and Knowledge of Engineering Students.

Digital electronics is a fundamental subject for engineering students, and it enables the students to learn design-based approaches and solve complex engineering problems. Students learn about minimization techniques for reducing the hardware components and size of the circuit by solving complex Boolean equations. The Karnaugh map (K-map) is one such technique utilized in digital electronics to solve complex Boolean equations and design AND-OR-INVERT (AOI) logical diagrams. The K-map technique involves several steps to solve the Boolean expression, and students often find it difficult to follow the K-map process. In this study, an AR-based learning system was developed using Unity 3D and Vuforia SDK that aimed to teach the students about the step-wise operation of the K-map technique. An experimental study was conducted with 128 undergraduate engineering students to determine the impact of the AR learning system on the critical thinking skills, learning motivation, and knowledge gain of students. The students were divided into two groups: experimental group (N = 64) and control group (N = 64). The AR learning system was implemented in flipped learning mode and utilized to provide in-class activities during the learning. The experimental group students utilized the AR learning system for in-class activities whereas control group students performed in-class activities using the traditional approach. The experimental outcomes indicate that the use of AR technology has a significant positive impact on the critical thinking skills, learning motivation, and knowledge gain of students. The study also found that critical thinking skills and learning motivation have a significant positive correlation with the knowledge gain of students in the experimental group.

The flipped learning perception scale: A validity and reliability study.

This study aims to develop a scale to determine preservice science teachers' perceptions of flipped learning. The present study uses the survey design, a quantitative research method. For content validity, the authors created an item pool of 144 items based on the literature. After being checked by experts, the item pool dropped to 49 items for the five-point Likert-type draft scale. The current study has preferred cluster sampling due to generalization concerns. The accessible population of the study is the preservice science teachers in Türkiye's provinces of Kayseri, Nevsehir, Nigde, Kirsehir, and Konya. We administered the draft scale to 490 preservice science teachers, which is the recommended 10 times the number of items. We also performed explanatory and confirmatory factor analyses to check the scale's construct validity. We ultimately obtained a four-factor structure with 43 items that explain 49.2% of the variance in scores and found the correlation between the criterion and draft scales to be greater than .70, thus ensuring criterion validity. We calculated Cronbach's alpha and composite reliability coefficients to check the reliability of the scale and determined the reliability coefficients for both the overall scale and the sub-factors to be greater than 0.70. As a result, we have obtained a scale consisting of 43 items and four dimensions that explains 49.2% of the variance. This data collection tool can be used by researchers and lecturers to determine preservice teachers' perceptions toward flipped learning.

Trends and patterns in blended learning research (1965-2022).

Blended learning (BL) applications, which are defined as a combination of online and face-to-face education processes and created with the strongest aspects of various teaching approaches, have attracted increasing attention particularly in recent years with the effect of the pandemic. Although blended learning studies, which have a wide range of content and variety of applications in the literature, have been examined by content analysis in many scientific studies, bibliometric studies that provide a comprehensive review of studies on BL and reveal a general map of scientific studies are extremely limited. The purpose of this research is to conduct a systematic analysis of BL studies around the world and to reveal general research trends by bibliometric method. In the scope of the research, 4,059 publications searched in the Scopus database between the years 1965-2022 were analyzed by VOSviewer and Leximancer software; the publications were examined from aspects such as year, subject, fund, citation, journal, country, common word, etc. An analysis of the research results reveals that studies on BL have increased in number in the literature since 2006; it has been found that the fields of social sciences, computer, medicine and engineering come to the forefront in the categorization of publications by subject, and the USA, UK, China and Australia are the most cited countries. As revealed by the findings of common word analysis, the studies mostly focus on the use of technology during the pandemic, current trends in education and technology, online learning environment and learner characteristics, teaching approaches, social media, motivation and medical education. Furthermore, it is understood that the most common terms in abstracts-keywords and titles of the studies reflect the learning process, the learner, the classroom environment, the model adopted, the system designed and medical education.

The effect of the flipped learning approach designed with community of inquiry model to the development of students' critical thinking strategies and social, teaching and cognitive presences.

Considering the lack of interaction and feedback process of the pre-class component of the flipped learning approach, in this research this component was designed with the community of inquiry model and an e-learning environment was developed in line with the model's theoretical framework. By exposing its impacts on students' development of critical thinking skills and social, teaching and cognitive presences, this study aimed to determine the working and failing aspects of this learning approach. In this study, in which repeated measures design was used, the study group consisted of 35 undergraduate students studying at a state university. Scales were used to measure students' critical thinking strategies and their perceived presences, and the forum tool was used to collect student posts. The implementation process lasted for 15 weeks. Findings demonstrated that it was possible to eliminate the lack of the interaction and feedback processes, and to develop students' critical thinking strategies and their perceptions of teaching, social and cognitive presences, by designing the pre-class component of the flipped learning approach with the community of inquiry framework. Additionally, it was discovered that the critical thinking strategy had a positive and significant link with how the community of inquiry was perceived, and that this relationship accounted for 60% of the variance in the perception of community of inquiry. The study's conclusions are supported by recommendations for future research.

An investigation of the social influence processes of flipped class students: An application of the extension of the technology acceptance model.

Universities are increasingly incorporating flipped learning as an effective instructional approach. Given the popularity of flipped learning, numerous studies have examined the psychological aspects of students and learning achievement in flipped learning classes. However, little research has examined the social influence processes of students in flipped class. This study investigated the effects of social influence processes (i.e., subjective norm, image, and voluntariness) on students' perceived usefulness of and intention to register for flipped learning using the extension of technology acceptance model (TAM2). A total of 306 undergraduates who took flipped classes participated in this research. The primary research findings indicated that subjective norm influenced perceived usefulness and intention to register for flipped classes. However, image did not influence perceived usefulness or intention to register for flipped classes. Voluntariness affected perceived usefulness and influenced intention to register for flipped classes through perceived usefulness.

Retrospective study of online ligation student practice incorporating flipped learning into e-learning.

PURPOSE: Flipped learning has been applied in various fields, including medical professional education. E-learning is compatible with flipped learning; however, it is considered to be unsuitable for providing training on surgical techniques. In this study, we retrospectively examined the ligation performance of online students who underwent training with flipped learning incorporated into e-learning. METHODS: We conducted a retrospective study of the ligation practices of online students at the Department of General Surgery from March 2020 to June 2021. The subjects included 134 fourth- and fifth-year medical students from Gunma University School of Medicine. We conducted mid-term checks on the 8th day of practice and an examination on the 19th day. Two instructors independently evaluated and calculated scores using the original Global Rating Scale of Gunma University. We also conducted a questionnaire survey on the ligation practice of online students. RESULTS: The total average score of the three tasks was 12.4 for Instructor 1 and 12.0 for Instructor 2. All students had a passing score. The questionnaire survey showed that 70% of the students were trained in ligation at the time of the first evaluation. CONCLUSIONS: Our online training materials and training methods enabled the acquisition of ligation skills by students who had not previously received ligation training.

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.

The application of the spot the difference teaching method in clinical skills training for residents.

BACKGROUND: Clinical skill training (CST) is indispensable for first-year surgical residents. It can usually be carried out through video-based flipped learning (FL) within a web-based learning environment. However, we found that residents lack the process of reflection, blindly imitating results in losing interest and passion for learning in the traditional teaching pattern. The teaching method of "spot the difference" (SDTM), which is based on the fundamentals of the popular game of "spot the difference," is designed to improve students' participation and reflective learning during skill training. This study aimed to evaluate this novel educational model's short-term and long-term effectiveness for surgical residents in China. METHODS: First-year residents who required a three-month rotation in the head and neck surgery department were recruited to participate in a series of CSTs. They were randomized into SDTM and traditional FL (control) groups. Clinical skill performance was assessed with validated clinical skill scoring criteria. Evaluations were conducted by comparing the scores that contain departmental rotation skill examinations and the first China medical licensing examination (CMLE) performance on practical skills. In addition, two-way subjective evaluations were also implemented as a reference for the training results. Training effects were assessed using t tests, Mann-Whitney-Wilcoxon tests, chi-square tests, and Cohen' s effect size (d). The Cohen' s d value was considered to be small (<0.2), medium (0.2-0.8), or large (>0.8). RESULTS: The SDTM group was significantly superior to the control group in terms of after-department skill examination (t=2.179, p<0.05, d=0.5), taking medical history (t=2.665, p<0.05, d=0.59), and CMLE performance on practical skill (t=2.103, p<0.05, d=0.47). The SDTM members rated the curriculum more highly than the control on the items relating to interestingness and participation (p < 0.05) with large effect sizes (d >0.8). There were no significant differences between the two groups on clinical competence (t=0.819, p=0.415, d=0.18), the first-time pass rate for CMLE (χ2 =1.663, p=0.197, d=0.29), and short-term operational skills improvement (t=1.747, p=0.084, d=0.39). CONCLUSIONS: SDTM may be an effective method for enhancing residents' clinical skills, and the effect is significant both short- and long-term. The improvement effect seemed to be more significant in the peer-involved SDTM than training alone. However, despite positive objective results, SDTM still risks student learning burnout. TRIAL REGISTRATION: ISRCTN registry, ISRCTN10598469 , 02/04/2022，retrospectively registered.

Transforming postgraduate GP teaching through collaborative course design and peer-facilitated small-group, reflective learning.

Shropshire Vocational Training Scheme's (VTS) traditional structure of peer-delivered teaching had received poor feedback from trainees. There is good evidence in the literature for stakeholder engagement in training design and participation in small group learning and case discussion as a bedrock of GP learning in the VTS. We introduced three new initiatives to improve half-day release (HDR): 1. collaborative course design; 2. reflective, case-based learning with flipped learning resources; and 3. peer-facilitated, small groups. The aim was to marry trainees' desire for clinical context with the need to comprehensively cover the professional knowledge, skills and attitudes of the 'Being a GP' Royal College of General Practitioner's curriculum.The new collaborative model has improved feedback, facilitated high-level small group reflection and resulted in a smooth transition to virtual HDR during Covid-19. We now have a cohort of highly motivated facilitators, with the opportunity to develop leadership skills, and a bank of complex clinical cases developed to facilitate useful, trainee-led, case-based discussion.Our model is deliverable in other VTS areas and could enhance trainee experience of HDR. Future challenges will be maintaining facilitator training, quality control for cases and discussion and how to ensure our near-peer facilitators successfully become future leaders in primary care.

Exploring secondary school teachers' TPACK for video-based flipped learning: the role of pedagogical beliefs.

Video-based flipped learning (VFL) has become a popular form of flipped learning. However, teachers' technological pedagogical content knowledge (TPACK) for video-based flipped learning is still under-explored. A TPACK-VFL questionnaire for assessing teachers' TPACK for VFL was developed and validated with both EFA and CFA in this study to fill the research gap. After instrument development and validation, a total of 211 secondary school teachers' TPACK for VFL, their pedagogical beliefs, and the role of teacher pedagogical beliefs on their TPACK for VFL were explored in this study. The results showed that the secondary school teachers in this study generally expressed sufficient confidence in their TPACK for VFL. They tended to have strong learner-centered pedagogical beliefs and moderate teacher-centered pedagogical beliefs. Besides, compared with the senior high school teachers, the junior high school teachers showed significantly higher confidence in their technological pedagogical content knowledge (TPACK) for VFL (p < 0.05). This study also found that the teachers' learner-centered pedagogical belief was significantly correlated with their content knowledge (CK), pedagogical knowledge (PK), pedagogical content knowledge (PCK), technological content knowledge (TCK), and technological pedagogical knowledge (TPK) (p < 0.05). In contrast, their teacher-centered pedagogical belief was significantly correlated with their TCK, TPK, and TPACK (p < 0.05). Cluster analysis was conducted based on the teachers' pedagogical beliefs, which yielded three groups: the Learner-centered Group, the Double-emphasis Group, and the Neutral Group. A series of ANOVA confirmed that the three groups of teachers significantly differed in their CK, PK, PCK, and TPACK (p < 0.05), indicating that teachers' pedagogical beliefs played a role in their TPACK for VFL. A series of post hoc analyses further revealed that, in general, the teachers in the Double-emphasis Group (i.e., those teachers who held both strong learner-centered and teacher-centered pedagogical beliefs) showed better TPACK for VFL.

Use of active learning and simulation to teach pharmacy students order verification and patient education best practices with oral oncolytic therapies.

INTRODUCTION: The primary objective of this study was to describe the incorporation of the flipped classroom model and use of real-life oncology patients to facilitate student learning of oral oncolytic best safety practices and patient counseling. The secondary objective was to assess the impact of the flipped classroom learning activity on students' perceived confidence. METHODS: This study was a prospective, single center, flipped classroom learning activity and pre/post assessment survey administered to third year doctor of pharmacy students enrolled in the Oncology Pharmacotherapy didactic elective in 2016 and 2017. A pre/post survey was used to assess student's perceived confidence with oral oncolytic best practice competencies. RESULTS: Ten students participated in the flipped classroom learning activity and survey. Five students completed both the pre- and postsurvey. The overall change in student's mean scores for their confidence of oral oncolytic competencies improved significantly from 3 to 4.1 on a 6-point Likert Scale (p = 0.03) following the learning activity. Students perceived confidence in performing oral oncolytic order verification increased following the implementation of a flipped classroom learning activity and use of real-life cancer oncology patients. CONCLUSION: This study describes the development and implementation of a flipped classroom learning activity and use of real-life patients with cancer that can be implemented at other institutions of higher education in a didactic or experiential learning environment. Additionally, this study demonstrated a potential benefit in student learning.

Developing Dietetic Students' Confidence in Multicultural Communication through Flipped Learning.

Problem: In a Master of Dietetics program, cultural competence was originally taught with lectures of cultural food practices. Course evaluations reflected that students wanted more opportunities to practice multicultural communication skills whereas lecturers felt that students' personal inquiry of cultural competence could be strengthened. This study explores whether the combination of self-directed pre-class learning and in-class activities through flipped learning could address these instructional issues. Three research questions were examined: (1) How did dietetic students' perceived confidence in multicultural communication change before and after undergoing flipped learning? (2) Which aspects of cultural competence influenced students' confidence in multicultural communication before and after flipped learning? (3) Which aspects of cultural competence were students' cultural learning goals based upon after flipped learning? Intervention: The intervention began with an introductory lesson in which students attended a lecture on New Zealand's cultural landscape, self-assessed their cultural influences, and completed self-directed learning of cultural competence concepts. After this, students participated in two flipped learning lessons; the first lesson focused on cultural knowledge and the second on multicultural communication skills. For both lessons, students completed preparatory activities before engaging in small-group activities during the class sessions. Before and after the flipped learning lessons, students wrote online reflections about the reasons underlying their confidence in multicultural communication. Context: The intervention was carried out with 32 early dietetic students who were in their first semester of postgraduate studies and 31 students consented to study participation. The majority of study participants were female (n = 30, 97%), European or Asian (n = 28, 91%), and between 21-30 years old (n = 27, 87%). Impact: Pre and post module surveys submitted by 31 students showed that more of them reported being confident or very confident in multicultural communication after flipped learning. Reflections submitted by 31 students before flipped learning showed that their confidence in multicultural communication was based upon their cultural knowledge and cultural interaction experiences. Reflections submitted by 19 students after flipped learning indicated that they developed cultural skill which helped them become confident in multicultural communication. These students set goals to continue developing their cultural knowledge, engaging in cultural interaction, and optimizing opportunities for applying cultural skill during clinical practice. Lessons learned: The study results showed that flipped learning can be used for cultural learning. As compared to lectures, flipped learning can provide students with more authentic contexts to practice multicultural communication. These learning experiences model how students might continue to self-direct their cultural competence development throughout their professional practice.

Comparison of flipped learning and traditional lecture method for teaching digestive system diseases in undergraduate medicine: A prospective non-randomized controlled trial.

INTRODUCTION: This study examined the effects of a large-scale flipped learning (FL) approach in an undergraduate course of Digestive System Diseases. METHODS: This prospective non-randomized trial recruited 404 students over three academic years. In 2016, the course was taught entirely in a Traditional Lecture (TL) style, in 2017 half of the course (Medical topics) was replaced by FL while the remaining half (Surgical topics) was taught by TL and in 2018, the whole course was taught entirely by FL. Academic performance, class attendance and student's satisfaction surveys were compared between cohorts. RESULTS: Test scores were higher in the FL module (Medical) than in the TL module (Surgical) in the 2017 cohort but were not different when both components were taught entirely by TL (2016) or by FL (2018). Also, FL increased the probability of reaching superior grades (scores >7.0) and improved class attendance and students' satisfaction. CONCLUSION: The holistic FL model is more effective for teaching undergraduate clinical gastroenterology compared to traditional teaching methods and has a positive impact on classroom attendances.

Flipped classroom in the second decade of the Millenia: a Bibliometrics analysis with Lotka's law.

This paper aims to examine the current dynamics of the flipped classroom studies and to propose a direction for future research for the field. Using a bibliometric approach, we observe a sample of 1557 documents from the Scopus database to identify research activity on the flipped classroom. The keywords "flipped classroom" and "flipped learning" have been executed in the search query. We presented the earlier stage of research in the flipped classroom, the subsequent trends, publications status based on source title, country and institution and examined citations pattern of the publication. We also discuss the themes based on the occurrences and terms of the keywords, title and abstract of the documents. This paper also predicts the future study in the flipped classroom using Lotka's law. We found that the pattern distribution of the author's contribution fits with the law. We conclude by suggesting a few potential research directions on the flipped classroom. Research on flipped classroom focuses on approaches, strategies and effectiveness perceived by practitioners and learners with relatively less attention on author's contribution and the prediction on their future and sustainable contribution and networking in guaranteeing the survival and expansion of flipped classroom approach for the coming decades.