Research Article: Facing the challenges in ophthalmology clerkship teaching: Is flipped classroom the answer?

Date Published: April 6, 2017

Publisher: Public Library of Science

Author(s): Ying Lin, Yi Zhu, Chuan Chen, Wei Wang, Tingting Chen, Tao Li, Yonghao Li, Bingqian Liu, Yu Lian, Lin Lu, Yuxian Zou, Yizhi Liu, Andreas Wedrich.


Recent reform of medical education highlights the growing concerns about the capability of the current educational model to equip medical school students with essential skills for future career development. In the field of ophthalmology, although many attempts have been made to address the problem of the decreasing teaching time and the increasing load of course content, a growing body of literature indicates the need to reform the current ophthalmology teaching strategies. Flipped classroom is a new pedagogical model in which students develop a basic understanding of the course materials before class, and use in-class time for learner-centered activities, such as group discussion and presentation. However, few studies have evaluated the effectiveness of the flipped classroom in ophthalmology education. This study, for the first time, assesses the use of flipped classroom in ophthalmology, specifically glaucoma and ocular trauma clerkship teaching. A total number of 44 international medical school students from diverse background were enrolled in this study, and randomly divided into two groups. One group took the flipped glaucoma classroom and lecture-based ocular trauma classroom, while the other group took the flipped ocular trauma classroom and lecture-based glaucoma classroom. In the traditional lecture-based classroom, students attended the didactic lecture and did the homework after class. In the flipped classroom, students were asked to watch the prerecorded lectures before the class, and use the class time for homework discussion. Both the teachers and students were asked to complete feedback questionnaires after the classroom. We found that the two groups did not show differences in the final exam scores. However, the flipped classroom helped students to develop skills in problem solving, creative thinking and team working. Also, compared to the lecture-based classroom, both teachers and students were more satisfied with the flipped classroom. Interestingly, students had a more positive attitude towards the flipped ocular trauma classroom than the flipped glaucoma classroom regarding the teaching process, the course materials, and the value of the classroom. Therefore, the flipped classroom model in ophthalmology teaching showed promise as an effective approach to promote active learning.

Partial Text

As our understanding of the pathophysiology of diseases keeps on expanding, and new treatment technology continuously emerges, the limitations of the traditional lecture-based teaching becomes obvious. First, the increasing load of course content and a decreasing teaching time due to the competing service demands pose a big challenge to the instructors[1]. Second, lecture-based teaching lacks efficiency, as previous studies show that the average attention span of the medical students during a lecture is only 10 to 20 minutes at the beginning[2]. Third, passive learning experience during the hour-long lecture inevitably bores students and deprives them from acquiring essential survival skills, such as critical thinking, problem solving and communication[3]. These growing concerns on the quality of medical education call for a reform of the traditional didactic teaching approach to better prepare students for their future career development.

The demographic distribution of the participants was presented in Table 2. A total of 44international students were enrolled. Twenty-two students participated in the flipped glaucoma classroom and lecture-based ocular trauma classroom. Twenty-two students participated in the flipped ocular trauma classroom and lecture-based glaucoma classroom. Students were from diverse countries including India, Sri Lanka, Nepal, Singapore, Thailand, Malaysia, Ghana, Mauritius, United Kingdom, United States and Canada. There were no statistical differences between gender (x2 = 0.093, P = 0.761), age (t = 1.568, P = 0.124), and place of residence (x2 = 0.093, P = 0.761). Most of them had been in China for 5 years, and were in the 5th year of medical school. None of the students withdrew from the classes, and all students completed the pre-class quiz and the final exam.

This study for the first time assessed the effectiveness of flipped classroom model in the ophthalmology clerkship teaching. Based on the questionnaire feedback, we found that the flipped classroom model is highly welcomed by the participating students and faculties. Possible explanations may include: (1) Flipped classroom model is stimulating. Students’ interest in learning is stimulated by the real clinical case and open questions assigned before the flipped classroom. In contrast to reading and memorizing lecture materials in the traditional class model, students in the flipped classroom feel strongly motivated to understand and master related knowledge in order to solve real clinical problems. This increased interest on both emotional and cognitive levels is beneficial for learning[19]. (2) Flipped classroom model is student-centered. In contrast to the traditional lecture-based classroom model where teachers are centered to deliver course materials and answer questions, in the flipped classroom model, students play multiple roles including organizers of their team, presenters to visually and orally express opinions, and communicators in questioning, answering and discussing among groups. In this student-driven, teacher-facilitated approach, students are encouraged to become both instructors and learners of each other, where students feel being valued more than where they do in the traditional lecture-based classroom. Also, in this student-centered learning environment, students could break the boundaries usually set in the traditional lecture-based classroom known as “learning goals” and “syllabus”. As a result, the increase in the freedom of personalized learning goals and learning means encourages students to learn more and therefore satisfies students’ learning motivation[20]. (3) Flipped classroom model is inclusive. One challenge of the traditional lecture-based teaching is the easy loss of audience concentration. On the contrary, in the flipped classroom, every student is encouraged to contribute in the team, to effectively present one’s own opinions, and to critically think and answer questions proposed by others. Although the degree of participation varies among the students, students are more likely to be attracted and tied in learning for a longer attention span. Also, the pre-recorded video lecture before the flipped classroom provides more flexibility for students to decide when, where, and how many times they want to learn the lectures in order to best fit their personal learning style. These features of flipped classroom maximize the inclusiveness of the class. (4) Flipped classroom model is active and playful. Instead of passively and quietly listening to the instructor in the lectured-based classroom, students in the flipped classroom actively participate in the learning process, where presenting, listening, questioning, answering, discussing or even debating combine to make more fun for students. Therefore, students are more satisfied with the learning experience in the flipped classroom. In summary, our study showed that flipped classroom approach is generally very welcomed by the medical school students. This suggests that flipped classroom model may be a direction of education reform in medical student ophthalmology clerkship training.




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