Flipped classroom combined with case-based learning is an effective teaching modality in nephrology clerkship

Abstract

Background: The flipped classroom (FC) is recognized as an effective teaching approaches by emphasizing on the development of high-order abilities; however, the implementation of FC has not been well explored in nephrology education. The present study aims to investigate the efficacy of FC in teaching nephrology via comparing with the traditional lecture-based teaching (LBT).

Methods: Sixty-two medical clerkship students at Zhejiang University School of Medicine were equally allocated into either LBT or FC group demographically matched. The glomerular diseases module was chosen for the teaching content. Students from the FC group were required to study the pre-class materials in annotated PPT format in advance. In the class, case-based learning (CBL) was employed, students encountered the related clinical cases and participated in the face-to -face discussion. Students from the LBT group attended a didactic lecture during the class. Quiz and questionnaires were performed to assess the efficacy of FC versus LBT.

Results: Participants from the FC group performed better in the quiz than those from the LBT group with higher total scores (78.06 ± 2.515 vs. 65.16 ± 3.209, mean ± SEM), particularly the scores of the case analysis-related questions (35.81 ± 1.657 vs. 27.42 ± 1.910, mean ± SEM). In the survey, more students considered FC beneficial to comprehension, critical thinking, patient management and team work as compared with LBT. Meanwhile, more participants agreed increased in-class pressure in FC than in LBT.

Conclusions: This study shows the positive impact of FC combined with CBL approach on nephrology education and provides an alternative pre-class and in-class format for the FC implementation.

Keywords: Flipped classroom; Medical Education; Nephrology; Traditional lecture-based teaching.

Fig. 1

Schematic demonstration of the process of teaching activities. In LBT model, students are exposed to new materials in class through lecture delivered by the instructor. In contrast, students in FC model are first exposed to the material prior to class through faculty-generated resources (annotated PPT files) and involved in active case-based learning during the class. LBT, traditional lecture-based teaching; FC, flipped classroom

Fig. 2

Comparison of students’ performance in the exam of Internal Medicine before the interventions. The students’ scores in the exam of Internal Medicine covering nephrology and other subjects such as cardiology, endocrinology, hematology, respiratory diseases and gastroenterology were assessed between the FC group and LBT group before the interventions. An independent samples t-test was used to compare the differences between these two groups. t = 0.3850 (df = 60), **p = 0.7016. Data were presented as mean ± SEM. NS: not significant. LBT, lecture-based teaching; FC, flipped classroom

Fig. 3

Comparison of students’ quiz scores between the FC group and LBT group after the classroom. Total, knowledge-related and case analysis-related questions were scored respectively. An independent samples t-test was used to compare the differences between the two groups. Data were presented as mean ± SEM. In total questions, t = 3.165 (df = 60), **p = 0.0024,; in knowledge-related questions, t = 1.795 (df = 60), p = 0.0776; in case analysis-related questions, t = 3.316 (df = 60), **p = 0.0016. NS: not significant. LBT, lecture-based teaching; FC, flipped classroom

Fig. 4

Comparison of students’ self-perceived competence and perspectives on the teaching modality experienced between the FC group and LBT group. Students’ answers to the survey questions were quantified using a three-point Likert scale (-1, disagree; 0, neutral; 1, agree). Data presented indicate the mean score ± SEM. *p < 0.05, **p < 0.01. ***p < 0.001. NS: not significant. LBT, lecture-based teaching; FC, flipped classroom