Concept and benefits of the Inverted Classroom method for a competency-based biochemistry course in the pre-clinical stage of a human medicine course of studies

Abstract

Background: Medical students often have a problem recognising the relevance of basic science subjects for their later professional work in the pre-clinical stage of their studies. This can lead to a lower motivation to learn biochemical content and dissatisfaction in the courses amongst the students. Alternative teaching methods such as the Inverted Classroom (IC) method can address this deficiency. The goal of this study was: to analyse the motivation and satisfaction of the students in a biochemistry seminar through the use of the e-learning-based IC method, to investigate the acceptance against the IC teaching method in biochemistry, and to compare the learning success achieved using the IC approach with that of a traditional course. We also investigated how a biochemistry course in the pre-clinical stage of a human medicine course of studies can be successfully organised according to the IC method. Furthermore, we examined the benefits of the IC method over conventional teaching formats. Method: The IC method was implemented in accordance with the guidelines of the GMA committee "New Media" [30] in a biochemistry seminar for two student IC intervention groups with 42 students. A part of the factual knowledge from the on-site phase in the form of teaching videos together with self-learning control tasks were provided online before the seminar for both IC intervention groups. Exporting content to the self-learning phase creates new free time in the on-site phase, during which the content can be critically considered and processed and additional competency-based learning objectives can be taught. Identical biochemistry teaching content was taught in parallel control groups (14 student groups with n=299 students), but no material was handed out beforehand for a self-learning phase. These students only received the materials after the on-site phase. Motivation and satisfaction as well as the acceptance for the teaching methods were recorded by questionnaires, the acquisition of knowledge by MC exams. Results: On a Likert scale from 1 (strongly disagree) to 6 (strongly agree), the students in the IC intervention groups could be seen to be much more motivated (5.53) than students in the control group (4.01). Students in the IC intervention groups also recognised the relevance of the learning content much more clearly (5.44) than students in the control group (4.01). Furthermore, the IC group also observed that additional competencies were trained in addition to the biochemistry content. In addition, the IC intervention group award the event a school grade of 1.53, the traditional control group a grade of 2.96. The teaching videos were rated very positively by both groups with an average school grade of 1.3 in each case. A qualitative analysis showed that the motivation and a positive attitude of the lecturers played a decisive role in the successful implementation of the IC method. Discussion and conclusion: Pre-clinical students display a high acceptance of the e-learning-based IC method. Teaching communication competencies in a biochemistry seminar was also rated very positively by the students. The quality of the teaching video and the motivation of the lecturers were shown to be a critical parameter for the successful performance of the IC method. What's more, the IC method can contribute to implementing a competence orientation in medical studies.

Keywords: Biochemistry; E-Learning; Inverted Classroom; Masterplan Medizin 2020; NKLM; competency-based training; human medicine.

Table 1. Summary of results from the evaluation of the overall course Integrated Seminar Module 6 – Pathobiochemistry II: ”From a gene to protein” of the Inverted Classroom group

Table 2. Results from the evaluations of the pilot teaching films

Figure 1. Comparison of the two teaching concepts

Left: Traditional teaching concept. Two on-site phases of four full clock hours each were held. A clinical case with corresponding questions and tasks was handed out in paper form in each of the 2 four-hour courses. After an around one-hour preparatory phase, the tasks were addressed jointly, for example in discussion groups or by student presentations. Tuition was mainly in the form of lecturer-centred instruction. In a subsequent online phase the students received on the one hand the preparatory materials of the IC group (i.e. after the seminar), and on the other the official evaluation sheet of the Medical Faculty in Ulm. The official biochemistry exam was held at the end of the semester. The on-site phase 0 was not carried out for the traditional teaching concept because 1. the traditional conditions were not to be changed, and 2. this was not necessary since the students did not have to be prepared for a self-learning phase. Right: Inverted Classroom teaching concept. The course was initiated by an e-mail inviting the students in the IC group to an on-site phase 0 with a brief explanation. A 45-minute introductory event (on-site phase 0) thus took place 1.5 weeks before on-site phase I. During this event, the students were presented with last year’s evaluation results for the integrated seminar as well as the goals of the new conception of the course. The organisational procedure for the seminar was then explained. What’s more, a formative, written and anonymised knowledge test was held with MC questions and case-based questions (see Attachment 1, Knowledge test). This was followed by self-learning phase I. The students were given exact work instructions for the self-learning phase. The students were asked to study a teaching film including self-learning control tasks in self-learning phase I. The complete group were told to watch a documentary film on Osteogenesis imperfecta. On-site phase I lasted for a total of four full clock hours (see Attacment 1). Osteogenesis imperfecta (OI) was discussed as a clinical symptom. Communication in a team was also trained in a group work phase and communication in an oral exam with feedback in an exam simulation (please refer to the Attachment 1 for exemplary work assignments from on-site phases I and II) in on-site phase I. Self-learning phase II was carried out similar to self-learning phase I, except that the students were allowed to watch two teaching films and two documentary films about Ehlers-Danlos syndrome and scurvy. On-site phase II was carried out similar to on-site phase I, whereby this unit concentrated on communication with peers and laymen (see Attachment 1). The knowledge test was held again at the end of the seminar and the evaluation sheet handed out for the course and teaching videos. In a subsequent online phase the students received the official evaluation sheet of the Medical Faculty in Ulm. An e-mail survey was carried out with the IC group. The official biochemistry exam was held at the end of the semester.

Figure 2. Evaluation results for the traditional versus Inverted Classroom group from the official evaluation sheet of the Medical Faculty in Ulm.

A-C The items were rated by the students on the basis of a Likert scale from 1 (strongly disagree) to 6 (strongly agree). A. Questions on the organisation, structure and design of the course. ***, p<0.05. B. Questions on the learning objectives and learning content of the course. ***, p<0.05. C. Questions on the commitment of the lecturers and the didactic implementation. ***, p<0.05. D. Vote on the need to optimise the course. Significantly fewer students from the IC group saw a need for optimisation in all fields compared to students from the traditional group. *, p=0.04; **, p=0.01; ***, p=0.001. See the Attachment 1 for individual values.

Figure 3. Results of the knowledge test

A. Results of the knowledge test held with the IC groups in the on-site phases 0 and II. The maximum number of points that could be achieved was 12. 37 students took part in the knowledge test in on-site phase 0 and 42 in on-site phase II. B-G. Classification of the questions from the knowledge test as purely biochemistry questions (B-D) and questions with a clinical relevance (E-G). Competency level 1 (factual knowledge) and 2 (reasoning knowledge and know-how) according to the NKLM as well as the types of questions are also shown. The Y-axis shows the maximum possible number of points for each questions. p-value, ** p=0.01; *** p=0.001; **** p=0.0001; n.s., not significant.