Effectiveness of Modified Flipped Classrooms Integrating Scenario-Based Questions, Multiple-Choice Question Assessments, and Mind Maps in Blood Physiology

Abstract

Background Conventional lectures in medical training may not always foster adequate comprehension and retention of complex physiological concepts. A modified flipped classroom integrating open-ended scenario-based questions (SBQs), multiple-choice questions (MCQs) assessments using an online response recording (ORR) system, and mind maps may enhance student comprehension, engagement, and knowledge retention. This study evaluates first-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students' perceptions of an integrated instructional module on blood physiology. Methods This cross-sectional study was conducted at the All India Institute of Medical Sciences, Raebareli, India, from November 2024 to February 2025, involving 96 first-year MBBS students. The instructional module consisted of 21 structured lectures that utilized a modified flipped classroom approach with pre-class study materials and in-class PowerPoint-based teaching (Microsoft Corp., Redmond, WA). This approach was integrated with mind map navigations, SBQ discussions, and MCQ assessments via Google Forms (Google LLC, Mountain View, CA). Student perceptions were assessed using a validated 14-item questionnaire categorized into three domains: handout quality, comprehension and retention, and satisfaction and engagement. Additionally, two questions assessed the consistency of handout review before classes and the preferred method among SBQs, MCQs, and mind maps for enhancing understanding and retention. Responses were recorded on a five-point Likert scale. Data analysis included descriptive statistics, principal component factor analysis for construct validity, and Cronbach's alpha for reliability assessment. Results Students highly appreciated the quality of structured handouts (4.57 ± 0.42). Students believed that integrating SBQ discussions, MCQs with ORR, and mind maps helped improve knowledge retention and comprehension (4.28 ± 0.44) in a satisfactory and engaging environment (4.49 ± 0.41). Most students acknowledged the benefits of these methods: 91% agreed that MCQs reinforced key concepts, 96% reported an improved understanding through SBQ discussions, and 92% found mind maps helpful for knowledge retention. Additionally, 72% preferred the combined approach of SBQs, MCQs with ORR, and mind maps for comprehension and retention. However, only 26% consistently reviewed the handouts before classes. Conclusion The modified flipped classroom model integrating SBQs, MCQs with ORR, and mind maps helped students comprehend blood physiology while maintaining engagement in lectures. This structured instructional module offers a feasible and effective strategy for enhancing comprehension and engagement in medical education, even with limited resources.

Keywords: active learning; blood physiology; comprehension; medical education; scenario-based questions; students.

Figure 1. Student's response to "Which method was most helpful in understanding and retaining blood physiology concepts?" They had to choose all that apply: MCQs, mind maps, SBQs, and none.

MCQ: multiple-choice question; SBQ: scenario-based question

Figure 2. Student's response to "Did you review the handouts before lectures?" The students had to choose from always, often, sometimes, rarely, and never.

Figure 3. Mind map for erythropoiesis

This is the original work of the first author created using the SimpleMind Pro trial version 2.4 for Windows.

Figure 4. Mind map for morphological classification of anemia

This is the original work of the first author created using the SimpleMind Pro trial version 2.4 for Windows.

Figure 5. Mind map for iron deficiency anemia

This is the original work of the first author created using the SimpleMind Pro trial version 2.4 for Windows.

Figure 6. Mind map for macrocytic anemia

This is the original work of the first author created using the SimpleMind Pro trial version 2.4 for Windows.

Figure 7. Mind map on leucocytes

This is the original work of the first author created using the SimpleMind Pro trial version 2.4 for Windows.

Figure 8. Mind map for few important causes of increase and decrease in granulocytes

This is the original work of the first author created using the SimpleMind Pro trial version 2.4 for Windows.

Figure 9. Mind map on innate immunity

This is the original work of the first author created using the SimpleMind Pro trial version 2.4 for Windows.

Figure 10. Mind map on acquired and cellular immunity

This is the original work of the first author created using the SimpleMind Pro trial version 2.4 for Windows.

Figure 11. Mind map for humoral immunity

This is the original work of the first author created using the SimpleMind Pro trial version 2.4 for Windows.

Figure 12. Mind map for hemostasis

This is the original work of the first author created using the SimpleMind Pro trial version 2.4 for Windows.

Figure 13. Mind map for blood groups

This is the original work of the first author created using the SimpleMind Pro trial version 2.4 for Windows.

Figure 14. Platelet adhesion and aggregation defects

This is the original work of the first author, created using Microsoft PowerPoint and Whiteboard for Windows.

Figure 15. Activation of T helper cell by antigen presenting cell

This is the original work of the first author, created using Microsoft PowerPoint and Whiteboard for Windows.