Using the Flipped Classroom to Bridge the Gap to Generation Y

INTRODUCTION

A generation is “a group of individuals belonging to a specific category at the same time.”¹ Their shared experiences greatly influence the way they process information. Academic medicine currently involves the coexistence of four generations—Traditionalists, Baby Boomers, Generation X, and Generation Y—and each generation has a unique teaching and learning style (Figure).^2,3 In the classroom, we often find the oldest generation (the physicians) instructing the youngest generation (the medical students), creating a generation gap. Because of the different teaching and learning styles associated with the generations, this gap can be an obstacle to both teaching and learning. The flipped classroom may be a way to bridge that gap.

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Figure.

Teaching and learning styles by generation. Adapted with permission from Moreno-Walton et al.³

The flipped classroom is a student-centered approach to learning that increases active learning for the student compared to the traditional classroom approach.⁴ In the flipped classroom model, students are first exposed to the learning material through didactics outside of the classroom, usually in the form of written material, voice-over lectures, or videos. During the formal teaching time, an instructor facilitates student-driven discussion of the material via case scenarios, allowing for complex problem solving, peer interaction, and a deep understanding of the concepts. A successful flipped classroom should have three goals: (1) allow the students to become critical thinkers, (2) fully engage students and instructors, and (3) stimulate the development of a deep understanding of the material.⁵

The flipped classroom model has components that can be appealing to all four generations in the academic environment. Traditionalists and Baby Boomers prefer the traditional classroom setting. In the flipped classroom model, didactic instruction, although it occurs outside classroom walls, is conducted in a traditional manner. Generation X students enjoy learning through high-tech videos and computer-aided instructions. Generation Y students are highly collaborative, thrive on technology, and benefit from group problem solving. In the flipped classroom, the background information is delivered in forms that appeal to Generation X. Group problem solving is the component of the flipped classroom that appeals to Generation Y. The flipped classroom has elements that can meet the needs of all generations and can be a bridge between generations, but does the flipped classroom model of instruction translate into better performance on examinations?

During the 2015 academic year, we decided to implement the flipped classroom in the obstetrics and gynecology clerkship for the Ochsner Clinical School in New Orleans, LA. Students enrolled in the Ochsner Clinical School are a part of a collaboration between the Ochsner Clinical School and the University of Queensland in Brisbane, Australia. Through this unique collaboration, students matriculate at the University of Queensland for the first and second years of medical school. They then spend their third and fourth years of medical school—the clinical years—at Ochsner Health System in New Orleans. In the years prior to 2015, students were taught in the traditional manner: lectures were presented by various clinical faculty in the Ochsner Clinical School. In an effort to veer away from the traditional lecture style of teaching, we decided to implement the flipped classroom to meet the needs of our students, most of whom belong to Generation Y, and to compare student performance before and after implementation.

RESULTS

During the 4 rotation blocks, a total of 70 students matriculated: Rotation 2 had 14 students in the traditional teaching group and 22 students in the flipped classroom group; Rotation 3 had 16 students in the traditional teaching group and 18 students in the flipped classroom group. As shown in Table 1, no statistical difference was observed in sex distribution or age between the comparison groups.

Results for the multiple-choice question examination are presented in Table 2. The average score for the obstetrics portion of the multiple-choice question examination in Rotation 2 for the traditional teaching group was 52% compared to 59% for the flipped classroom group, and this difference was statistically significant. The average score for the obstetrics portion of the multiple-choice question examination Rotation 3 for the traditional teaching group was 64% compared to 67% in the flipped classroom group, but this difference was not significant.

The average score for the gynecology portion of the multiple-choice question examination in Rotation 2 for the traditional teaching group was 58% compared to 68% for the flipped classroom group, and this difference was statistically significant. The average score for the gynecology portion of the multiple-choice question examination in Rotation 3 for the traditional teaching group was 75% compared to 65% for the flipped classroom group, and this difference was statistically significant.

Results for the OSCE are presented in Table 3. The average score for the obstetrics portion of the OSCE for Rotation 2 for the traditional teaching group was 74% compared to 82% for the flipped classroom group. In Rotation 3, the average score for the traditional teaching group was 70% compared to 82% for the flipped classroom group. Both comparisons were statistically significant.

The average score for the gynecology portion of the OSCE in Rotation 2 for the traditional teaching group was 71% compared to 84% for the flipped classroom group. In Rotation 3, the average score for the traditional teaching group was 67% compared to 81% for the flipped classroom group. Both comparisons were statistically significant.

DISCUSSION

When comparing the students taught by traditional methods to those taught in the flipped classroom model, we saw a statistically significant increase in test scores on the multiple-choice question examination in both the obstetrics and gynecology sections in Rotation 2. While the average score for the flipped classroom group increased in Rotation 3 on the obstetrics section of the multiple-choice question examination, the difference was not statistically significant. Unexpectedly, the average score on the gynecology portion of the multiple-choice question examination decreased among the flipped classroom group compared to the traditional teaching group, and this decrease was statistically significant.

For both the obstetrics and the gynecology portions of the OSCE, we saw statistically significant increases in the scores for the flipped classroom group in both Rotation 2 and Rotation 3 compared to the traditional teaching group.

With the exception of the gynecology portion of the multiple-choice question examination in Rotation 3, we saw improvement in all other scores after the implementation of the flipped classroom. We expected student performance on the OSCE to improve with the flipped classroom, as the scenarios for the problem-based learning sessions are very similar to the format of the oral OSCE. However, we did not just see improvement on the OSCE but also on the multiple-choice question examination, suggesting that students had better retention of the concepts taught during the rotation.

Our findings are similar to reports of implementation of the flipped classroom at other institutions. In a study conducted in an introductory physics class at the University of British Colombia, 538 students were divided into two large sections.⁷ One section received 3 hours of lecture from a highly experienced instructor, while the second section was taught by teaching assistants via problem-based learning. Students in both sections were administered the same test. The average score of the students taught by traditional methods was 41%, while the average score of the students taught by problem-based learning was 74%.

When we review the science of learning posed by Bransford and colleagues, we can understand why the flipped classroom works.⁸ Bransford et al state three fundamental findings regarding how teachers teach and how learners learn:

• 1. Engagement of students' preconceived ideas is necessary for understanding new concepts and information.

• 2. Students must have factual knowledge, understand concepts, and be able to retrieve and apply knowledge.

• 3. A metacognitive approach allows students to take control of their learning through self-monitoring.

The average attention span of a medical student is 15-20 minutes.⁹ The flipped classroom increases engagement compared to the traditional teaching method and also puts students in the driver's seat of their education. In addition to attaining factual knowledge through the traditional lecture format, students are able to immediately apply the knowledge. The higher-order critical thinking necessary in the application portion of the flipped classroom is needed in medical education. From a generational perspective, the flipped classroom incorporates the traditional teaching that Traditionalists and Baby Boomers are accustomed to, while creating interaction and using technology that Generation X and Generation Y need.

In our observation of the implementation of the flipped classroom, we did not evaluate the students' or teachers' satisfaction with the teaching. Other institutions that have implemented the flipped classroom have reported great satisfaction from the students.^7,10,11 While the flipped classroom incorporates elements to satisfy the teaching and learning styles of the Traditionalists through the Baby Boomers, it is a change in the way that they teach. Their satisfaction with the process should be evaluated.

We plan to continue using the flipped classroom in the discipline of obstetrics and gynecology. Because our implementation is rather recent, we have not had many students matriculate through this process. As we continue using the flipped classroom, we will continue to monitor student performance to ensure the trend in improved performance. If successful, this teaching method could be used across all disciplines in our clinical school, as well as in our residency programs. Future studies could determine if the application portion of the flipped classroom increases student confidence in patient interactions.

CONCLUSION

The flipped classroom is a feasible and useful alternative to the traditional classroom. It is a method that embraces Generation Y's need for active learning in a group setting while maintaining the traditional classroom method for introducing the didactic information. Active learning increases student engagement and can lead to improved retention of material as demonstrated on standard examinations.