Flipping the Classroom with Low-Fidelity Simulation

Lynne Massaro & Andrew Wolf

Background

Results of a Carnegie Foundation study (Benner, Sutphen, Leonard, & Day, 2010)

indicated that nursing education programs lack opportunities for students to apply

basic scientific theoretical knowledge in real life settings prior to program

completion. Current educational formats provide students with facts and concepts

to memorize without allowing opportunities for active engagement in synthesizing

or application. The authors recommend that nursing programs restructure

classroom environments to provide students practice in clinic-like experiences.

Results of a study by Deslauriers, Schelew, and Wieman (2011) compared a

flipped classroom to standard lecture delivery in 2 groups of an undergraduate

physics class. The students in the flipped classroom had improved test score

results with an effect size of 2.5%.

A randomized trial by Schroedl et al. (2012) evaluated the learning of clinical skills

in traditional lecture based education versus simulation for training residents prior

to MICU rotation. The simulation training resulted in significantly better results in

bedside tests of applied clinical skills such as respiratory mechanics, ventilator

management, and circulatory resuscitation.

Background

Flipping the classroom moves traditional lecture content to a structured

online learning environment. This opens up the classroom for face-to-face

active learning opportunities including problem sets, writing exercises, case

based learning, or simulation exercises.

Question for evaluation: Does the redesign of a traditional lecture based

course with structured online lessons and in-class low-fidelity simulation

increase satisfaction and impressions of learning effectiveness from

students and faculty?

Program Methods

Specific required online learning activities were completed outside of the classroom

prior to a three-hour active learning in-class session.

The face-to-face class began with a 10-minute lecture summarizing the key

concepts of management and treatment of the common complaint.

The in-class low-fidelity simulations of provider/patient interactions were designed

around the learning outcomes. One student enacted the role of patient while

another enacted the role of the nurse practitioner (NP). The NP completed a full

patient history and physical while other students provided guidance.

Students then worked in small groups to think through the presenting symptoms to

develop a list of differential diagnoses and a workup and treatment plan using

critical thinking and decision-making skills.

After completing their individual group work, the class debriefed in a large group

about the process of diagnosing and managing the patient.

Evaluation Methods

The quantitative data from student course evaluations was compared from

courses taught in 2011 and 2013. In 2011 the course was a traditional lecture

based course. In 2013, the classroom was “flipped” and included low-fidelity

simulation.

Qualitative data was collected from student course evaluations and emails in

2013 to determine themes on student satisfaction and impressions of learning

effectiveness.

Qualitative data was collected from a faculty debriefing about satisfaction and

impression of student learning.

Results

Student course evaluation data comparing a traditional lecture based classroom in 2011 with a “flipped” classroom in 2013.

Results

Student course evaluation data comparing a traditional lecture based classroom in 2011 with a “flipped” classroom in 2013.

Student Qualitative Data

Case Studies Improved Learning:

“I was wondering if we will be doing more examples of how to write a HPI's in

class, like we did the first few weeks?  I felt those were helping me become

more precise”

“…the case study discussions really help pull things together. I have learned

so much, yet feel not so stressed as in previous classes”

Pre-tests Helped Student Prepare for Low Fidelity Simulation:

“The pre and post test on line were wise. Case studies in class were helpful”

“ I loved the testing layout with pre-tests based on the reading and post-tests

based on the lectures. It forced me to stay on track with the material.

Appreciated Learning Opportunities:

“. . . thank you for the excellent semester of education. . . .This semester, by

far, has been superior to the rest in the Masters program.”

“Thanks so much I learned a great deal in the class”

“I am humbled and appreciative of my experiences this semester.”

“I just have to write and tell you how much I love your class! . . . I learned so

much . . . Just wanted to tell you both! (and no, I’m not trying to get extra

credits! . . . )”

Student Qualitative Data

Faculty Observations

Student attendance remained high throughout the entire semester.

Students were engaged and intrinsically motivated. They frequently

requested additional learning activities to support their academic and

professional goals.

Students appreciated the opportunity to practice role behaviors in a

non-threatening environment and expressed confidence in their skills in

patient evaluation and management using evidence-based treatment

plans.

Clinical papers demonstrated improved proficiency in applying scientific

and theoretical knowledge.

Students voiced decreased anxiety in role transition from RN to NP.

Recommendations for Practice

Provide well designed structured online lessons with outline, readings,

lecture materials, practice problems, and quizzes.

Low-tech works great. Simple text based lessons can be as effective as

multimedia.

Employ low-stakes pre-tests to provide formative assessment of

comprehension prior to face-to-face classes.

Online discussion is not always necessary in a course with rich face-to-face

interaction.

Use face-to-face courses for guided practice activities in which faculty and

peers can provide formative feedback and assistance.

Mini-lectures in a face-to-face class can provide an opportunity for students

to ask for clarification prior to starting practice activities.

References

Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call

for radical transformation. San Francisco, CA: Jossey-Bass.

Deslauriers, L., Schelew, E., & Wieman, C. (2011). Improved learning in a large-

enrollment physics class. Science, 332(6031), 862-864.

doi:10.1126/science.1201783

Schroedl, C. J., Corbridge, T. C., Cohen, E. R., Fakhran, S. S., Schimmel, D.,

McGaghie, W. C., & Wayne, D. B. (2012). Use of simulation-based education to

improve resident learning and patient care in the medical intensive care unit:

A randomized trial. Journal of Critical Care, 27(2), 219.e7-219.e13.

doi:10.1016/j.jcrc.2011.08.006