Friend or Foe? Flipped Classroom for Undergraduate Electrocardiogram Learning: a Randomized Controlled Study

Abstract

BackgroundInterpreting an electrocardiogram (ECG) is not only one of the most important parts of clinical diagnostics but also one of the most difficult topics to teach and learn. In order to enable medical students to master ECG interpretation skills in a limited teaching period, the flipped teaching method has been recommended by previous research to improve teaching effect on undergraduate ECG learning.MethodsA randomized controlled trial for ECG learning was conducted, involving 181 junior-year medical undergraduates using a flipped classroom as an experimental intervention, compared with Lecture-Based Learning (LBL) as a control group. All participants took an examination one week after the intervention by analysing 20 ECGs from actual clinical cases and submitting their ECG reports. A self-administered questionnaire was also used to evaluate the students’ attitudes, total learning time, and conditions under each teaching method.ResultsThe students in the experimental group scored significantly higher than the control group (8.72 ± 1.01 vs 8.03 ± 1.01, t = 4.549, P = 0.000) on ECG interpretation. The vast majority of the students in the flipped classroom group held positive attitudes toward the flipped classroom method and also supported LBL. There was no significant difference (4.07 ± 0.96 vs 4.16 ± 0.89, Z = − 0.948, P = 0.343) between the groups. Prior to class, the students in the flipped class group devoted significantly more time than those in the control group (42.33 ± 22.19 vs 30.55 ± 10.15, t = 4.586, P = 0.000), whereas after class, the time spent by the two groups were not significantly different (56.50 ± 46.80 vs 54.62 ± 31.77, t = 0.317, P = 0.752).ConclusionFlipped classroom teaching can improve medical students’ interest in learning and their self-learning abilities. It is an effective teaching model that needs to be further studied and promoted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-017-0881-8) contains supplementary material, which is available to authorized users.

Does the Flipped Classroom improve exam performance in medical education? A systematic review

“…120 articles were taken forward for abstract review, 94 articles were excluded (see figure 1). The remaining 26 articles went forward to full text review, of which 15 were excluded (nine failed to compare FC and DT, five provided inadequate objective test results, one using Chinese medicine) leaving eleven studies (Belfi, Bartolotta, Giambrone, Davi, & Min, 2017;Bonnes et al, 2017;Boysen-osborn et al, 2016;Connor et al, 2016;Evans et al, 2016;Gillispie, 2016;Heitz, Prusakowski, Willis, & Franck, 2015;Liebert et al, 2017;Morton & Colbert-getz, 2016;Rui et al, 2017) which were included in quantitative analysis.…”

“…Of a maximum score of twelve points, studies ranged from five to ten (appendix 1). One study (Bonnes et al, 2017) scored ten, four scored eight (Belfi et al, 2017;Boysen-osborn et al, 2016;Heitz et al, 2015;Rui et al, 2017), two scored seven (Connor et al, 2016;Gillispie, 2016) Baig, 2009) and one scored five (Evans et al, 2016). Whilst overall performance on study end point, unbiased assessment and clear aims were good, no studies undertook prospective power calculations and with the exception of two studies (Bonnes et al, 2017;Boysen-osborn et al, 2016), loss to follow up or failure to report total number of students completing examinations was high.…”

“…All studies assessed the teaching methods by examination scores; three studies used MCQ scores (Belfi et al, 2017;Connor et al, 2016;Heitz et al, 2015), one study used a pre and post course QI knowledge assessment tool (QIKAT) (Bonnes et al, 2017) and one study used an ECG interpretation examination (Rui et al, 2017). Four of the five studies demonstrated a clear, statistically significant, improvement in assessment scores for the FC groups over the DT (Belfi et al, 2017;Bonnes et al, 2017;Connor et al, 2016;Rui et al, 2017) with one study demonstrating no improvement for FC over DT (Heitz et al, 2015). Two of the studies used a crossover design with students experiencing both DT and FC conditions in an emergency medicine clerkship and radiology clerkship (Connor et al, 2016;Heitz et al, 2015).…”

“…Whilst overall performance on study end point, unbiased assessment and clear aims were good, no studies undertook prospective power calculations and with the exception of two studies (Bonnes et al, 2017;Boysen-osborn et al, 2016), loss to follow up or failure to report total number of students completing examinations was high. A prospective design was undertaken by six of the eleven studies (Belfi et al, 2017;Bonnes et al, 2017;Connor et al, 2016;Gillispie, 2016;Heitz et al, 2015;Rui et al, 2017).…”

Current problems with the prerequisites for flipped classroom teaching---a case study in a university in Northwest China

“…Some consider them a means to cater to every student's need because of the availability of repeated playing of the teaching content and the possibility of free interaction between students and teachers with the aid of modern communication platforms (Yin and Wu 2016). Some take them as a solution to the shortage of class time by allotting students teaching contents to study themselves in their spare time (Rui et al 2017). Others see an opportunity in them to improve teaching quality and cultivate students' innovativeness, teamwork, manipulative ability, etc., due to more interaction between students and between teachers and students (Chiang and Chen 2017).…”