J Dulek Capstone

Running head: INTRODUCING THE FLIPPED CLASSROOM TO OTA EDUCATORS 1
A Flipped Course on the Flipped Model:
Introducing the Flipped Classroom to OTA Educators
Jennifer Dulek
Rocky Mountain University of Health Professions

INTRODUCING THE FLIPPED CLASSROOM TO OTA EDUCATORS 2
Table of Contents
Abstract……………………………………………………………………………………………3
Introduction………………………………………………………………………………………..4
The Flipped Classroom Model…………………………………………………………………….5
Definition and Development………………………………………………………………5
Use in Healthcare Education………………………………………………………………6
Theoretical Foundation……………………………………………………………………7
Evidence Supporting the Flipped Classroom Model……………………………………………...8
Educational Outcomes…………………………………………………………………….9
Healthcare-Related Outcomes…………………………………………………………...12
Student Satisfaction……………………………………………………………………...15
Faculty Experiences……………………………………………………………………...18
Summary of the Evidence………………………………………………………………..19
Implications for Occupational Therapy………………………………………………………….19
Centennial Vision and The Future of Occupational Therapy Education………………..19
Accreditation Standards………………………………………………………………….20
Educating Educators about the Flipped Model…………………………………………………..21
Instruction Utilizing the Flipped Model…………………………………………………22
Course Design……………………………………………………………………………23
Backward course design…………………………………………………………23
Course objectives……………………………………………………………...…23
Lesson development……………………………………………………………...24
Online lessons……………………………………………………………24
On-ground lessons……………………………………………………….27
Course Implementation…………………………………………………………………..28
Conclusion……………………………………………………………………………………….30
References………………………………………………………………………………………..31
Appendices……………………………………………………………………………………….38
Abstract
This paper details the development and implementation of a flipped course for occupational
therapy assistant (OTA) faculty detailing the use of the flipped classroom model with adult
learners. Evidence supporting the flipped classroom model is presented, as is research
supporting the introduction of the flipped model to educators using an online platform and face-
to-face learning activities. The constructivist learning approach is also described in its relation to
the instructional design of online lessons as well as active learning activities used in the
classroom setting within this model. The relevance to the future of the occupational therapy
profession and the implications for occupational therapy education are discussed, and
recommendations regarding occupational therapy instruction are included.
Keywords: occupational therapy education, teaching strategies, flipped classroom, adult
learners, active learning, constructivist approach, faculty development

A Flipped Course on the Flipped Model:
Introducing the Flipped Classroom to OTA Educators
In 1997, Ernest Boyer published an expanded definition of scholarship to go beyond the
traditional definition involving only pursuit of research. In this new definition, he suggested that
teaching be studied and examined more closely by those who engage in it, rather than taken for
granted as a routine function that does not warrant a professional’s focus and development
(Boyer, 1997). Indeed, my experience in academia has suggested that administrators and
program directors may assume that new faculty will know how best to teach by virtue of the
teaching they have done in clinical occupational therapy (OT) practice as well as their own
experiences as students in academic settings. However, this is often not the case, especially
given the recent introduction of teaching into today’s teaching practices. In order to pursue
scholarship in the area of teaching and learning (Boyer, 1997), OT educators must examine their
teaching practices and base teaching decisions on supporting evidence. They must also pursue
ongoing professional development activities that support best practices in education.
To meet these critical needs, this project involved creation of a continuing education
course for occupational therapy assistant (OTA) educators focused on a teaching model known
as the flipped classroom. As Assistant Program Director in an OTA program, I have
implemented this model in my own teaching, and would like to include it throughout our
program, as evidence suggests that this model may support student engagement and promote
active learning (McCallum, Schultz, Sellke, & Spartz, 2015). The purpose of this project was to
educate the rest of the OTA faculty about this model to support their use of it in their teaching.
This involved illustrating the benefits of the model according to available evidence, providing
active learning experiences that model and support faculty’s development of the necessary skills
for implementation, and assisting faculty in addressing barriers and concerns to implementation
utilizing supporting evidence and team problem-solving. Because there is some research that
suggests it (Ko & Rossen, 2010), I designed the continuing education course as a flipped course
in order to more effectively teach the model to faculty who will utilize the model in their own
teaching. This project involves several implications for OT, including support of the American
Occupational Therapy Association’s (AOTA) Centennial Vision (2007) and contributions to my
institution’s compliance with AOTA’s 2011 Accreditation Council for Occupational Therapy
Education (ACOTE) Standards and Interpretive Guide, which outlines the requirements of an
OTA educational program (AOTA, 2014).
The Flipped Classroom Model
Definition and Development
The flipped classroom model was first identified in 2007 by high school chemistry
teachers Bergmann and Sams (2012), who identified it as a way of incorporating active learning
and taking advantage of available technology for teaching. They describe the flipped classroom
as a method of instruction that moves what traditionally happens in the classroom to outside of
the classroom so that what traditionally happens outside the classroom can occur within the
classroom (Bergmann & Sams, 2012). The purpose of this “flip” is to move less-active teaching
strategies such as viewing a lecture to a student’s own time, as students do not require the
instructor’s assistance or influence for these learning activities (Bergmann & Sams, 2012). This
leaves class time for more active learning that involves interaction with peers and faculty, such
as discussion, lab activities, small group work, simulations, and case studies (Boucher,
Robertson, Wainner, & Sanders, 2013). These activities are considered more advanced in that
they require application of knowledge rather than simple memorization or understanding, so

students benefit from working with others and/or having access to their instructor while engaging
in this higher-order thinking (Boucher et al., 2013).
Because the flipped classroom approach continues to evolve and is considered to be a
model rather than a specific technique, there is a lack of consensus on exactly what is required
for a classroom to be considered flipped (Bishop & Verleger, 2013). According to Bishop and
Verlerger (2013), in order to be considered flipped, the instruction must involve both computer-
based individual instruction outside the classroom and interactive group learning within it.
These may include at-home computer-based tools such as podcasts, discussion boards, and
videos, and in-classroom active learning techniques such as case studies, team-based learning,
and other small group work. It is important to note that current research on the flipped classroom
often varies in which of these strategies is used and in what combination, which may impact the
outcomes being reported (Bishop & Verleger, 2013). For the purposes of this project, literature
was carefully examined to ensure that the authors’ definition of the flipped classroom model
involved computer-based instruction completed independently prior to classroom instruction
involving interactive lessons requiring higher-order thinking.
Use in Healthcare Education
The originators of the flipped model, Bergmann and Sams (2012), describe the use of the
model in elementary education, and recent literature has expanded on this to include adaptation
of college-level courses from the traditional to flipped model (Caufield, 2011; Clutterbuck &
Seamons, 2014). Recently, the flipped classroom model has begun gaining traction in health
professions education (Pierce & Fox, 2012). The physical therapy, nursing, and pharmacology
literature offer examples of this growth and describe how the model may help prepare students
for practice in a healthcare profession. Although this model has not yet been researched in OT
education, many of the outcomes cited within other healthcare-related studies apply to the
practice of OT as well, and several authors suggest that the flipped classroom model prepares
students for today’s healthcare environment (Boucher et al., 2013; Pierce & Fox, 2012). These
benefits will be discussed further in the section entitled “Evidence Supporting the Flipped
Classroom Model: Healthcare-Related Outcomes.”
Theoretical Foundation
Learning theory must be considered when developing online or blended courses and
lessons. In fact, Knowles, Holton, and Swanson (2015) argue that the design of instruction
involving the computer is just as important as it is in face-to-face instruction. It is generally
agreed that the blended model of online instruction supports a constructivist learning approach
(Bishop & Verleger, 2013; Davies, Dean, & Ball, 2013; Harrington, Bosch, Schoofs, Beel-Bates,
& Anderson, 2015). This approach, described by Lefoe in 1998, operates from the assumption
that learning is an active process, and that instruction involves supporting construction of
knowledge rather than communicating it.
According to Merriam and Bierema (2014), this theory defines learning as the
construction of meaning from experience and suggests that learning occurs in context and within
communities where learners share and learn from each other, such as in the active learning
activities occurring within the flipped classroom. It suggests that learning does not involve
simply acquiring knowledge, but instead involves construction, or a putting together of ideas and
facts (Lefoe, 1998). Instruction, therefore, is not just about giving students knowledge, but
giving them the opportunity to build their own understanding by providing resources and
opportunity (Lefoe, 1998).

Because constructivism involves the building of knowledge, the design of the learning
environment is crucial, as it can impact what is learned and how it is learned. Therefore, the
constructivist approach suggests that the environment must include tools and resources that allow
students to acquire understanding (Lefoe, 1998). It also must allow learners to work together, as
constructivism operates under the belief that learning is a social matter that requires the active
participation of the learner (Lefoe, 1998). In addition, because this approach involves
individuals not just taking in knowledge but engaging with it and utilizing it in dynamic ways,
there is a focus in constructivism on individual learners’ “unique interests, styles, motivations,
and capabilities” (Lefoe, 1998, p. 455). Because online lessons are considered part of the
learning environment, these concepts apply not only to lessons and activities presented in the
classroom, but within the online learning environment as well. The development of a rich, well-
designed blended, flipped course is consistent with this approach.
Knowledge of constructivism may assist instructors in understanding the theoretical
underpinnings of the flipped classroom as well as designing courses consistent with the flipped
model. For this reason, I designed the continuing education course with this theory in mind, and
also provided education to the OTA faculty on the constructivist approach. This will be
discussed further in the section describing the course design for the continuing education course.
Evidence Supporting the Flipped Classroom Model
Research supporting the flipped classroom model is still emerging, but there is growing
evidence supporting its use to improve learning outcomes, prepare students for healthcare
careers, increase student satisfaction and engagement, and improve instructor satisfaction.
Educational Outcomes
Studies comparing the learning outcomes of the flipped classroom versus a traditional
classroom have shown mixed but generally positive results. There are several studies indicating
that the flipped classroom may result in improved exam or course grades. For example, in a
level III (Oxford Centre for Evidence-Based Medicine [OCEBM], 2011) non-randomized cohort
study published in 2012, Pierce and Fox compared the exam scores for one module of a
pharmacotherapy course that had been flipped versus the previous cohort’s scores as part of a
traditional classroom. Utilizing a t-test to compare the average scores resulted in a p value of
0.024, showing a statistically significant difference in favor of the flipped classroom.
Another study demonstrated statistically significant and academically relevant
improvement in course grades when comparing the flipped classroom with a traditional
classroom. Misseldine, Fountain, Summers, and Gosselin (2013) conducted research with a
quasi-experimental design in two nursing courses offered consecutively. They calculated their
required sample size to be 159 participants, and included 589 in their study. Three approaches to
teaching were compared using a one-way analysis of variance with mean examination scores as
the dependent variable. These three approaches were: lecture only, lecture capture with
traditional lecture, and lecture capture with interactive teaching activities, which represents the
flipped classroom model. Mean scores for the flipped classroom group were 81.89, compared to
80.70 for the lecture capture group and 79.79 for the lecture only group. These results were
statistically significant, with a p value of 0.003 and 0.001 respectively. Although the change in
grade was small, authors indicate that it should be considered clinically significant, as the mean
grade change results in an additional 47 students passing the course.

Other studies have shown somewhat different outcomes, demonstrating no significant
difference in assignment or course grades as compared to the traditional classroom model. A
level II (OCEBM, 2011) randomized trial conducted by Harrington et al. (2015) involved 82
nursing students, and compared outcomes on all course assignments, including exams, quizzes,
and a paper, as well as the overall course grade for the students in the flipped classroom versus
those in the traditional classroom. Authors also examined the difference in group grades in
prerequisite classes and included it as a covariate to ensure that students’ scholastic capacity did
not influence outcomes of this study (Harrington et al., 2015). Results using a MANCOVA
indicated no statistically significant difference between the grades earned in the traditional and
flipped models, with small effect sizes on nearly all the calculations and all 95% confidence
intervals crossing zero (Harrington et al., 2015).
Another study, this one conducted by Li, Tsai, Tao, and Lorentz (2014), also suggested
that there was no significant difference in academic performance between students learning in a
flipped classroom and those learning using the traditional model. This research by Li et al.
(2014) is a Level III (OCEBM, 2011) study utilizing a quasi-experimental design to examine the
overall course scores earned by students in two nursing courses utilizing the two instructional
delivery methods. This study lacks rigor in several respects, including the fact that it is unclear
what assignments the course grades depended upon and how the teaching may have affected
these; researchers did not control for confounding variables such as previous experience with the
flipped classroom, and possible influences of demographics within the groups due to lack of
analysis to establish homogeneity between the two groups being studied; and the study design
offers only tentative results that cannot be confirmed without prospective randomized
experimental design. Results of the study indicate that within the course focusing on concrete
concepts there was a slight increase in mean course percentage following implementation of the
flipped model as compared to the traditional model; however, this result was not found to be
statistically significant (Li et al., 2014). Results for the course focusing on more application-
oriented learning showed a slight decrease in mean course grades as compared to the traditional
course, which also held no statistical significance (Li et al., 2014).
The studies by Harrington et al., (2015) and Li et al., (2014) both suggest that the flipped
method was equally effective for students learning as the traditional model, as they showed no
significant differences in learning outcomes between the two models. These findings could be
the result of poor study design, especially in the case of the study by Li et al. (2014), as there is
the likelihood of a Type II error (Portney & Watkins, 2009) due to the finding of no significant
difference in groups when in fact one exists. Therefore, it is possible that this research simply
does not provide strong enough evidence to support rejection of the null hypothesis, and in
reality the flipped classroom does provide improved learning outcomes as compared to the
traditional model. At minimum, no difference in grades demonstrates that this model can be just
as effective as the traditional model, which should not preclude instructors from its use.
Despite the obvious need to establish the effect of the flipped classroom on student
learning, there is currently limited objective outcome data available and most of it relies on lower
quality studies utilizing quasi-experimental design. In addition, available research is focused
primarily on exam scores as outcomes (Kowalski & Horner, 2015), which may not adequately
demonstrate the true benefits of this model. It is also important to note that most research
measures the effect of the model on only one module, exam, or assignment rather than on the
course as a whole, and those studies that do examine the overall course grades do not offer
adequate information regarding what these grades as based upon or how they are determined.
As reported above, the results of quantitative research examining the learning outcomes of the
flipped model remain inconclusive (Bishop & Verleger, 2013). However, it is important to keep
in mind that both quantitative and qualitative evidence that shows that both students and
instructors may benefit from the flipped classroom model in other important ways.
Healthcare-Related Outcomes
Recent literature suggests that the flipped classroom may improve clinical reasoning
among other skills relevant in today’s healthcare practice, such as problem-solving (Kowalski &
Horner, 2015), self-efficacy (Pierce & Fox, 2012), lifelong learning (Ireland et al., 2009),
autonomy (Ireland et al., 2009), technological competence (Costello et al., 2014), teamwork
(McLaughlin et al., 2014), and use of evidence-based practice (Cohn, Coster, & Kramer, 2014).
Although the research available supporting each of these positive outcomes is limited, initial
results seem to indicate that the flipped classroom may address many of the skills that have been
identified as important for successful clinical practice.
Clinical reasoning may be considered one of the most critical skills that students gain
from their healthcare education, and the available literature suggests that the flipped classroom
may positively influence its development. In their article describing a randomized control trial
comparing the flipped classroom to the traditional classroom model, Missildine et al. (2013)
reason that the flipped classroom allows students more face-to-face time with their instructors
while engaging in activities required higher-order synthesis and application of knowledge. They
suggest that it is this higher-order thinking that contributes to clinical reasoning (Missildine et
al., 2013). Students who are able to engage with their instructors in this way, who can observe
their instructors applying clinical reasoning, and who can engage in discussion with their
instructors about the thinking process receive much more opportunity to develop clinical
reasoning than those who are passive observers in a lecture (Missildine et al., 2013). Costello et
al. (2014) take this reasoning a step further and identify the evidence that supports the
development of clinical reasoning through problem-based learning and patient simulation.
Because these teaching techniques are typically used within the flipped classroom, the belief is
that the flipped classroom offers the opportunity to develop clinical reasoning as well (Costello
et al., 2014). While these lines of reasoning certainly seem feasible, Harrington et al. (2015)
suggest that clinical reasoning should be examined as an outcome in future research, as the
evidence available so far is promising but inconclusive.
In addition to using clinical reasoning, the ability to solve problems, which includes
asking for help when it is necessary, is important for most students, but especially for those who
will soon provide life-impacting care for others such as OT students. An article by Kowalski and
Horner (2015) does not include a research study but instead relies on the authors’ anecdotal
teaching experiences with nursing students to suggest that by allowing students to prepare online
at home before engaging in hands-on practice such as simulations, instructors utilizing the
flipped model teach students to problem-solve and ask for help. They suggest that the flipped
classroom, much more so than the traditional lecture-based classroom, puts students in the
position to develop these critical skills (Kowalski & Horner, 2015).
Self-efficacy is another important skill for successful OT practice, and there is also
evidence supporting the flipped model’s development of it in students. Pierce and Fox (2012)
used a survey with reliability measuring 0.83 to determine students’ perceptions of the flipped
classroom using an evidence-based active learning strategy known as process-oriented guided
inquiring learning. They found that 83% of their students agreed that the model improved their
self-efficacy (Pierce & Fox, 2012). Although this question was directed toward only their
perceived efficacy with items on the final exam, it is reasonable to assume that those are also
items they might encounter in healthcare practice, as these students are studying pharmacology.
Other important outcomes for future healthcare professionals include autonomy and
lifelong learning, the ability to use technology in everyday practice, the ability to engage in
successful collaboration with team members, and the ability to utilize evidence in making
clinical decisions. Ireland et al. (2009) suggest that blended learning may increase autonomy and
lifelong learning, and Costello et al. (2014) shared that utilizing technology in healthcare
education may enhance the technological competence of students and better prepare them for the
workplace. McLaughlin et al. (2014) surveyed students in their own pre-med courses and found
that students felt that their skills in working with and contributing to a team had improved as a
result of their flipped classroom experience, and Cohn, Coster, and Kramer (2014) demonstrated
improved evidence-based reasoning in their master’s level occupational therapy students in a
flipped classroom. Although this research was not designed to examine the flipped classroom
itself, their teaching model included it, and this, along with a structured series of evidence-based
assignments, showed improvement in their students’ understanding and acceptance of evidence-
based practices (Cohn et al., 2014).
In summary, although more research is needed, there is some evidence to suggest that the
flipped classroom may improve clinical reasoning among other important skills. In addition,
there is evidence that the flipped model addresses many of the skills that have been identified as
important for successful clinical practice. These are skills that are important to build in students
in healthcare fields, many of which cannot easily be taught. The structure and demands of the
flipped classroom seem to support their growth and development, and this is likely why the use
of the flipped classroom in healthcare education is growing.

Student Satisfaction
Despite the fact that outcome data regarding student learning in the flipped model is
inconclusive, and much of the literature suggesting that this model develops important
healthcare-related skills does not rely on research but instead on anecdotal evidence, there is a
growing body of both quantitative and qualitative research that shows that student perceptions of
the model are generally positive. In addition, the available research suggesting that students are
not satisfied with the model has not specifically identified the reasons for this dissatisfaction, and
has not been correlated with student learning.
Student satisfaction has been researched primarily via qualitative studies focusing on
student perceptions of the flipped classroom model. Two such studies were conducted by
McCallum, Schultz, Sellke, and Spartz in 2015 and Strayer in 2007. Although somewhat limited
in its trustworthiness, the well-designed study by McCallum et al. (2015) includes evidence to
support the authors’ theory that the flipped model engages students more with the material,
peers, and faculty as compared to the traditional model. This theory is supported by findings
from sixty participants in a phenomenological design involving six focus group interviews aimed
at exploring students’ experiences with the flipped classroom, especially their perception of its
usefulness, impact on learning, and engagement with faculty and peers (McCallum et al., 2015).
Authors assert that overall, their data suggests that students view the flipped classroom approach
as supportive to student academic success, and data within each of the three themes being
explored (academic involvement, peer involvement, and engagement with faculty) support this
conclusion (McCallum et al., 2015). With regard to engagement with the academic materials,
students identified that online lectures supported note-taking strategies and allowed them to
organize and improve their notes (McCallum et al., 2015). They also suggested that because
they had viewed materials online before class, they felt more prepared and engaged during
classroom sessions (McCallum et al., 2015). This includes coming to class with background
knowledge, specific questions, and the ability to engage with and apply pre-class lessons during
classroom activities (McCallum et al., 2015). When considering peer-to-peer involvement,
students cited the ability to work with others on class projects, engage with peers to solve
problems, and share knowledge within the online and classroom settings as benefits of the
flipped model (McCallum et al., 2015). Lastly, students within the study by McCallum et al.
(2015) identified faculty members who utilize the flipped model as more approachable and
accessible than traditional courses, which in turn led to their perception that faculty have
increased insight into students’ knowledge and personal learning needs. Students also reported
feeling more comfortable contacting faculty outside of class (McCallum et al., 2015). Based on
these findings, McCallum et al. (2015) conclude that the flipped classroom model fosters student
involvement by increasing student time and energy focused on learning activities.
The study done by Strayer (2007) was similarly well-designed and focused on student
perception of the flipped model. In this study, which used a grounded theory qualitative analysis
and involved 49 participants, 26 of whom were in a traditional course and 23 of whom were in a
flipped classroom, researchers identified three areas as contributing to student interactions in the
classroom; these were homework dynamics, and in-class dynamics (Strayer, 2007). With regard
to the types of activity used within the classroom, students expressed frustration with the flipped
model in that that did not know what kind of activity to expect, but also described adapting their
learning strategies and saw the benefits of helping each other learn (Strayer, 2007). Strayer
(2007) found similarities between the homework dynamics of the flipped and traditional models
in that students expressed concern about keeping up with homework, though the flipped model
meant that many put off their homework and tried to complete it all at once.
Different from the qualitative research conducted by McCallum et al. (2015), Strayer
(2007) identified several issues about the flipped classroom that students did not appreciate.
These include the fact that because the online work was provided by a publisher rather than the
instructor himself, students were faced with the challenge of making a connection between the
online and in-class work (Strayer, 2007). The author points out that this could be beneficial if
time was allowed for students to make these connections and strengthen their conceptual
understanding, but acknowledges that this course did not allow for that to happen and students in
the flipped classroom were at a disadvantage (Strayer, 2007). It is also important to note that not
all flipped courses utilize such online resources, meaning that this difficulty is not inherent in the
model itself, but rather in this particular instructor-chosen aspect of the course design. In
addition, Strayer (2007) also reports students reported this the in-class dynamics of a flipped
classroom as being negative, as they identified themselves as very active in the classroom, but
reported conflicted feelings about the expectation that they attend and engaged.
Other authors have also identified similar student concerns in their research. For
example, in a Level III (OCEBM, 2011) quasi-experimental design with no control group,
Jamaludin and Osman (2014) examined 24 students’ responses to questions regarding their
behavioral engagement, agentic engagement, cognitive engagement, and emotional engagement
when involved in a classroom designed around the flipped model. The mean scores for
emotional engagement were highest, followed by behavioral engagement, cognitive engagement,
and agentic engagement (Jamaludin & Osman, 2014). They suggest that students do not feel as
agentically engaged due to the fact that it was their first experience in a flipped classroom and
they do not fully contribute their own learning material to the class (Jamaludin & Osman, 2014).
Although this study has several significant limitations, its results are similar to those found by
Missildine et al. (2013) in a study aiming to measure the effectiveness of the flipped classroom
model on the academic success and satisfaction levels of nursing students. Despite the authors’
hypothesis that the flipped classroom model would result in higher student satisfaction scores
than the traditional classroom or lecture plus lecture capture technology, the results of a 16-item,
4-point Likert scale questionnaire indicated that students were significantly less satisfied with the
flipped classroom model than the other conditions (Missildine et al., 2013). Missidline et al.
(2013) suggest that this may be due to the fact that the flipped classroom typically requires more
work and self-discipline, and removes the opportunity for possible social support. It is important
to note that the literature includes research countering these results (Lindeman et al., 2015;
O’Flaherty & Laws, 2014) as well as several possible and well-researched solutions to these
barriers (Kowalski & Horner, 2015; Missildine et al., 2013; Schwartz, 2014). Additionally,
many authors suggest that student satisfaction does not correlate with student learning (Kowalski
& Horner, 2015; Missildine et al., 2013), indicating that while important, these results must be
considered in light of other more relevant outcomes associated with use of this model.
Faculty Experiences
Faculty experiences with the flipped classroom model seem to be represented less within
the literature, but are just as important in its implementation. Two studies examining faculty
views and experiences, both of which involved only small groups of faculty, indicated that
faculty appreciate the fact that this model allows them to assess students’ learning via informal
methods as they work with students in the classroom, so that they may adjust their approaches if
learning objectives are not being met (McLaughlin, Gharkholonarehe, Khanova, Deyo, &
Rodgers, 2015; Roehl, Reddy, & Shannon, 2013). In addition, this research indicated that
instructors experience increased job satisfaction and decreased preparation time for flipped
classes once the initial online material has been recorded (McLaughlin et al., 2015). Another
relevant study indicates that instructors appreciate that the model addresses concerns regarding
time constraints and student motivation common in teaching (Boucher, Robertson, Wainner, &
Sanders, 2013).
Summary of the Evidence
Given the growing amount of evidence suggesting that the flipped classroom may
improve students’ educational outcomes, prepare them for healthcare careers, increase student
satisfaction and engagement, and improve instructor satisfaction, use of this model in education
seems timely, appropriate, and beneficial. Although it is important to note that much of this
evidence is only preliminary, and none of these outcomes are yet supported by higher-level
quality research or meta-analysis, there are early indications that this model may benefit both
students and instructors’ teaching and learning outcomes and experiences, and pursuit of
additional research and personal observations are warranted.
Implications for Occupational Therapy
This project addresses two critical and timely needs within the OT profession; that is, the
charge set forth by the AOTA in its 2007 Centennial Vision, as well as the educational
requirements for OTA programs outlined in AOTA’s 2011 Accreditation Council for
Occupational Therapy Education (ACOTE) Standards and Interpretive Guide (2014).
Centennial Vision and The Future of Occupational Therapy Education
The AOTA’s Centennial Vision calls for OT practitioners and educators to contribute to
the quality and future of the profession (AOTA, 2007). This document suggests that
occupational therapy educators build the capacity of the profession to fulfill its mission via
several specific actions, including developing a diverse workforce and preparing OT
practitioners for 21st century practice (AOTA, 2007). This project involves training OTA faculty
who will then use the knowledge they gain to provide quality education to our diverse student
population. Instruction provided via the flipped model may support 21st century practice in that
it prepares students to perform better in activities requiring problem solving, clinical reasoning,
and use of evidence-based practice (Boucher et al., 2013).
Related to the AOTA’s Centennial Vision (2007) is the organization’s Ad Hoc
Committee that was convened in 2013 to discuss the future of occupational therapy education.
The document that resulted from these meetings, entitled The Future of Occupational Therapy
Education, identifies several needs within occupational therapy education, including the need to
develop scholarship and research in education (AOTA, 2013). Among the committee’s
recommendations regarding this need were to identify signature pedagogy for occupational
therapy education and to evaluate innovative methods of education (AOTA, 2013). This project
attempts to address this need by exploring pedagogy and identifying innovative and effective
methods of occupational therapy instruction.
Accreditation Standards
In addition to the Centennial Vision (AOTA, 2007), OT education is guided by the
AOTA’s 2011 Accreditation Council for Occupational Therapy Education (ACOTE) Standards
and Interpretive Guide, which outlines the requirements of an OTA educational program
(AOTA, 2014). These requirements include the need for occupational therapy programs to
prepare students to be lifelong learners who are willing and able to remain current with best
practices in the field, and to effectively communicate with others (AOTA, 2014). The flipped
classroom model supports these requirements by addressing and enhancing students’ abilities to
express themselves in writing, pursue independent thought and research, and build internal
motivation for learning (Roehl, Ready, & Shannon, 2013). Specific ACOTE accreditation
standards outline a requirement that the program director be committed to strategies for
professional development, and that faculty have knowledge of the program’s content delivery
method and be trained and skilled to use distance education methodologies (AOTA, 2014). By
pursuing this knowledge as Assistant Program Director and sharing it with my colleagues, this
project supports professional development and ensures compliance with these ACOTE standards.
Educating Educators about the Flipped Model
In keeping with the evidence suggesting that flipped classroom is an effective model for
teaching, and in an effort to expose instructors to the model as a potential tool for their own use,
I created a flipped professional education course for my OTA colleagues to teach the flipped
model of instruction. The flipped model allowed me to maximize the use of instruction time by
combining pre-class online instruction with a more active on-ground classroom experience.
Within this 4-hour continuing education course, two hours of the instruction occurred online with
screen capture lectures and other activities, and the remaining two hours occurred face-to-face in
the classroom, where students engaged in active learning activities to promote application and
higher-order skills. In designing the course, I considered the available evidence supporting use
of this method to provide continuing education, utilized constructivist learning theory to create
engaging, learner-centered instruction for adults, and relied on existing literature to support the
decisions I made regarding implementation of the model in practice.

Instruction Utilizing the Flipped Model
The teaching and education literature appears to lack significant focus on how the flipped
model may be best taught to educators, though Ko and Rossen (2010) indicate that at least some
part of training for faculty who teach in online or blended models should be conducted online.
Additionally, authors McGowan, Balmer, and Chappell (2014) provide an example of this in an
article detailing a flipped continuing education course they developed for nurse educators. This
model seems consistent with Rogers’ (2003) diffusion of innovation theory in which “near
peers” (Edwards et al., 2014) who have adopted new approaches and have experimented with
technology provide peer education and support to other faculty members.
Despite the lack of clear direction regarding how educators be instructed regarding such
teaching models and methodologies, there is some information in the literature regarding
faculty’s exposure to new teaching technology. In an article detailing how new physical
education teachers may learn to adopt technology in their teaching, Kristi Roth (2014) argues
that faculty require training and support, and suggests that exposure to this technology may
increase faculty curiosity and decrease fear. The author offers the challenge to faculty to try one
new tool within their teaching each term or semester, so they are not overwhelmed or confused
by its implementation (Roth, 2014). I designed this course with these suggestions in mind, with
the goal that OTA faculty experience the use of technology in their own flipped classroom
experience as well as experiment with technological tools in the active learning portion of the
course in order to decrease fear and increase their understanding of its benefits and ease of
implementation.
Course Design
To design this course, I relied upon knowledge of backward course design (Wiggins &
McTighe, 2011) to establish learning objectives and then develop online and face-to-face active
learning activities.
Backward course design. To design this flipped continuing education course, I relied
on the backward design model outlined by Wiggins and McTighe in 2011. This model suggests
that course design begin with clearly defined learning outcomes that will function as evidence
that learning has occurred (Wiggins & McTighe, 2011). From there, specific lessons may be
developed within this context (Wiggins & McTighe, 2011). This results in more clearly defined
course objectives, appropriate assessments, and more focused teaching than typical planning
(Wiggins & McTighe, 2011).
After reviewing the literature and other available material on the flipped classroom
model, I identified six main topics that instructors should be able to understand and utilize when
implementing this model. These topics are: an overview of the flipped classroom model,
introduction to adult learning theories and constructivism, evidence for use of the flipped model
in healthcare education, online teaching strategies and technology tools, active learning activities
for the flipped classroom, and preparing to implement the model. For each of these six topics, I
developed two course objectives.
Course objectives. Bloom’s taxonomy (Bloom & Krathwohl, 1956) outlines learning
goals within the cognitive domain, and Anderson and Krathwohl’s 2001 revision provides
language for writing specific and measurable course goals in the affective and psychomotor
domains. This taxonomy is based on the concept that learning processes occur in lesser and
greater levels of abstraction and complexity, with lower levels of learning focused on students
remembering and understanding, and higher-order thinking occurring when students analyze,
evaluate, and create (Anderson & Krathwohl, 2001). Utilizing these documents as a reference,
along with the knowledge that within the flipped classroom model, online materials should
address more basic levels such as knowledge retention while classroom activities are the ideal
place to address higher-order thinking involving analysis, synthesis, and evaluation (Missildine
et al., 2013), I wrote my own course objectives. For each of the six topics I identified, I wrote a
lower-level objective to be met during the online portion of the lesson, and a higher-level
objective to be met during the on-ground application portion of the course. These objectives can
be found within the course syllabus located in Appendix A.
Lesson development. Backward course design (Wiggins & McTighe, 2011) suggests
that teaching strategies and lessons are best developed with learning outcomes in mind.
Therefore, for each of the six topics I had identified for the course, I designed one online lesson
using the lower-level learning objective, and one on-ground lesson focused on the higher-level
learning objective.
Online lessons. To start the process of building the online portion of this course, I first
required access to a learning management system (LMS), sometimes considered to be a “virtual
classroom” (Young, Celli, Denault, & Roque, 2015, p. 114). An LMS offers instructors and
students space to post reading and lectures, post and accept assignments, and interact with each
other (Young et al., 2015). I obtained permission from my institution’s instructional support
team to use Blackboard, our school’s LMS, which meant that the OTA faculty not only had
convenient access to their course materials, they also had the opportunity to experience the
system from a student perspective, offering potentially useful observations and suggestions for
implementation in future courses that they teach.

In beginning to design the online learning environment in the LMS, I considered the
constructivist approach. This learning theory suggests that online lessons are considered part of
the learning environment, and therefore should include tools and resources to support student
learning, as well as the opportunity for formal and informal interaction with peers and instructors
(Lefoe, 1998). For this reason, I created a course overview script and video (see Appendix B),
designed an interactive course glossary (see Appendix C), and created and posted handouts for
note-taking for each of the online lectures that students were assigned. I posted these within the
LMS, and also built a course orientation discussion board as well as included an email tool in
order to support student communication, consistent with Dixson’s (2010) suggestion that
students be given multiple opportunities to communicate within an online environment. In
addition, I created a course assignment checklist to ensure that course participants understood the
expectations for the online portion of the course, and I posted this within the LMS (see Appendix
D).
In determining how best to provide online lecture materials, I found that Jokinen and
Mikkonen (2013) suggest that it is important to not rely solely on reading assignments for
students who are learning at a distance, whether via the blended or flipped models. In addition,
Missildine et al. (2013) identify screen capture lecture as being the most common means of
online instruction. The literature suggests creating one recording per topic with brief segments
covering no more than ten to twenty minutes; in fact, Kowalski and Horner (2015) found that
very long videos result in lower student satisfaction. Smith and McDonald (2013) also suggest
that an instructor include an introduction and summary each screencasts, and use a headset with a
microphone to ensure recording quality. In addition, they recommend that an instructor prepare
a script and be sure to speak slowly, repeat important information, and define terms that students
may not already know (Smith & McDonald, 2013).
In accordance with this literature, I created six brief screencasts using Microsoft
PowerPoint (Microsoft PowerPoint for Mac 2011, Version 14.5.5) slides. Each screencast varies
in length from 6:44 to 14:55 and focuses on only one topic at a time. They each incorporate only
one learning objective, include an introduction and summary, rely on a script, and were recorded
using a headset and microphone. The PowerPoint slides and scripts for all six lessons can be
found in Appendix E, and links to each of the recorded screencasts are located within the lesson
plans of Appendix F. Consistent with the recommendations from Jokinen and Mikkonen (2013)
regarding reading assignments, I selected brief articles to supplement some of the online lectures,
but made them recommended rather than required. These articles can be found in Appendices G,
H, I, and J.
In addition to utilizing an LMS and creating online lecture, the literature describing best
practice in online teaching also highlights the importance of engaging students during and after
online content (Kanuka, Rourke, & Laflamme, 2007). This may be done via optional and
required learning activities and course assignments. I chose to provide optional, non-graded
learning activities such as those described by Li et al. (2014), which allow for fun, repetition, and
reinforcement of new concepts and terms while also allowing students to check for
understanding. For each of the six topics covered online, I used SoftChalk (2015) software to
create an interactive game. These games include drag-and-drop, matching, and crossword puzzle
activities; details and links to these activities can be found in the lesson plans of Appendix F. In
addition to these optional activities, I also created required assessment activities within the LMS,
utilizing discussion boards, blogs, and wikis as well as an online dropbox for a graded
assignment. Use of these tools is supported by the evidence (Dixson, 2010; Erardi & Hartmann,
2008; Flood, 2012; Goldman, Cohen, & Sheahan, 2008), and each was designed with the
corresponding lesson’s specific learning objectives in mind. Details about each of these
assignments can be found within Appendix F. To ensure that participants understood the
expectations for each assignment, I included assignment guidelines and an embedded rubric for
all online assignments, which can be found in Appendix K.
On-ground lessons. In order to prepare high-quality on-ground lessons, I again relied
first on the higher-order objectives I had written for each lesson topic as well as on several
learner-centered strategies relevant to the flipped classroom model. These strategies are meant to
encourage participants to engage in “a different kind of learning” (Weimer, 2013, p. 125),
meaning that in the classroom instructors should engage students in activities that require basic
knowledge of course concepts as well as challenge them to achieve more complex learning.
Because the classroom provides participants with support from peers and instructors, this is an
ideal place for such challenges to occur.
I created one on-ground activity for each topic addressed online, resulting in six on-
ground activities. Activities were chosen based on the evidence supporting them, although it is
important to note that although active learning techniques have been researched extensively
(Jokinen & Mikkonen, 2013; McDonald & Smith, 2013), it remains unclear which, if any, result
in improved outcomes within the flipped classroom model (Roehl et al., 2013). The primary
goal of each on-ground activity was to allow students to integrate new information into their
existing understanding (Barkley, Major, & Cross, 2014), and to eliminate “the illusion of
understanding” (Svinicki & McKeachie, 2014, p. 192) that can occur when concepts are only
superficially addressed. Within the on-ground session, I incorporated a classroom assessment

technique known as think-pair-share (Angelo & Cross, 1993), offering participants the chance to
partner with peers to exchange responses to a discussion question before sharing them with the
rest of the group; engaged them in several small group activities requiring hands-on problem-
solving and real-world application of information (Svincki & McKeachie, 2014); and provided a
microlecture (McLaughlin et al., 2014) to review and reinforce the topic of learning theories
before proceeding with an application-based learning activity. All on-ground lessons are
detailed within the lesson plan located in Appendix F, including the corresponding worksheets
and handouts. The time allotted for each varied from ten to twenty minutes to allow completion
of all six during the 2-hour session. This was also planned to allow participants to fully engage
in the activities without losing interest or becoming distracted.
To assist myself and course participants in the implementation of these on-ground
lessons, I created and followed a basic PowerPoint presentation (Appendix L), which also
includes the microlecture I presented, and I provided participants with a handout of these slides
on which to take notes. I created an on-ground material list to ensure that I was prepared with
the necessary materials and equipment (see Appendix M), and provided all necessary worksheets
and handouts to participants throughout the on-ground session. Refer to Appendix F, where
these worksheets and handouts are embedded within the corresponding lesson plans, and
Appendices N and O for the two journal articles that participants used in Lesson 3.
Course Implementation
Once the course was designed, OTA faculty were invited to participate. The course was
announced via a flyer that was distributed to OTA faculty (see Appendix P). When a faculty
member confirmed interest, I provided them with a course packet, which included the syllabus
(Appendix A), course assignment checklist (Appendix D), note-taking handouts for all online
lessons, and copies of the four articles for recommended reading (Appendices G through J),
which were verified by the institution librarian as being available for distribution to members of
the faculty.
The course was designed to require two hours of online learning over two weeks, and two
hours of activities during attendance at the on-ground face-to-face session. The two weeks of
online time began on October 15, 2015, so on that day I sent an e-mail announcement to all
enrolled participants welcoming them to the course and outlining the course expectations. I set
up the course in the LMS to require participants to complete the pre-course rating scale
(Appendix Q) prior to accessing the online materials, so I explained this step to the faculty in the
e-mail so they were alerted. This rating scale was designed to examine participants’ preparation,
perceived importance, and confidence levels in implementing the flipped classroom in their own
teaching, and was administered again as a post-rating scale at the conclusion of the on-ground
session.
Throughout the two weeks of online activity, I was active in responding to participant
posts on the course discussion board and blogs, and I graded all completed assignments. As the
on-ground session drew closer, I sent a reminder e-mail to participants encouraging them to
complete the online lessons and detailing what would happen in the on-ground session. On
October 29, 2015, participants convened to engage in the on-ground lessons. Please refer to
Appendix R for my post-course reflection. At the conclusion of the course, OTA faculty
completed a course evaluation, located in Appendix S. Other materials used throughout the
process of project development are located in Appendices T, U, V, W, and X.

Conclusion
Faculty education on methods such as the flipped classroom are crucial to meet the
AOTA’s Centennial Vision (2007) as well as the accreditation standards set forth for OTA
programs. This faculty education program, which itself employed the methods being taught,
provided a unique, evidence-based approach for the OTA program at my institution and will
serve instructors well in their experiences designing and teaching courses. There is growing
evidence that the flipped classroom can improve outcomes as well as student and faculty
satisfaction, and this project has put this evidence into the hands and minds of those poised to
employ it in everyday practice. It is important that as instructors work to implement this model
they examine the evidence supporting the decisions they make. Doing so will provide the active,
learner-centered education that will best prepare OTA students for future practice.
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Appendix A
Flipping Your OTA Course Syllabus

Appendix B
Course Overview Script
Hello, and welcome to this continuing education course entitled Flipping Your OTA
Classroom. This is Jeni and I will be your instructor for this course.
This course is designed as a flipped course on the flipped classroom, meaning that you
will experience all the aspects of the flipped classroom that you will learn throughout the course.
I’ve designed the course to help you gain knowledge and apply that knowledge, but also to
reflect on your own experiences as a student in a flipped class. This will help you decide what
might work in your own classroom, and how you might utilize tools or modify techniques to
support your students’ learning.
I’d like to begin this course overview with an introduction to the course syllabus. Since
this is a flipped classroom, we won’t be together in class until two weeks from now, meaning
that you will be on your own to be sure that you engage in the learning activities laid out for you
in Blackboard. It is important that you understand what is expected of you and how you will
meet those expectations.
The first thing to note on the syllabus is that you will have between October 15 and
October 28 to complete your online work, which will add up to about 2 hours overall. We will
then come together for our on-ground session on Thursday, October 29 at 2:30 PM, and will be
together for 2 hours.
The next thing to note on the syllabus is my contact information, which I know you
already have. I think it’s important to point out to students, though, who aren’t always familiar
with Blackboard’s email system or may not have access to Blackboard when they are trying to
contact instructors.
Moving though the syllabus now, you will see the course description, relationship to
curricular design, and relationship to curricular threads. I will leave it to you to read more
completely, but I want to point out that this course will provide you with the evidence supporting
the use of the flipped model and will expose you to the technologies and strategies typically used
within the model. It is designed for instructors who have limited knowledge of or familiarity
with the flipped model, but who want to explore its use in their student instruction. As a
reminder, student-centered learning is one of our curricular threads, and this suggests that
students benefit most from active, experiential learning. As you will experience in this course,
the flipped model incorporates active learning into the teaching-learning process and will allow
you to foster student-centered learning in your own classroom.
In the suggested articles section of the syllabus, you will find 4 short articles I
recommend you take a look at. They correspond with certain lessons included in this course and
are listed within the course schedule. These articles are available to you via ProQuest, accessible
through ACC’s library tab. Because you have this access, and I have confirmed with our
librarian that you have the right to access these materials as an ACC instructor, I have also
attached them within the Blackboard lessons and provided printed copies in your course handout
packets. I’ve also recommended a book, which I will have available for you to examine when
we are together in the classroom. This book does not specifically address how to flip a
classroom, but makes a strong argument for doing so and includes several interesting and
relevant suggestions to improve student learning in this model.
Access to ACC’s library via Blackboard recently changed, so I direct you to the Online
Information section of your syllabus for information regarding how to access the databases. This
will be required in Lesson 3 when we address evidence supporting use of the flipped classroom
model in healthcare education.
Next you will find the course objectives, and there are 12 of them for this course. You
will see once you start watching the online lectures that there are two objectives for each of the
six lessons in this course; one of these we will cover in the online lecture, and one we will cover
in the on-ground portion of the course. I’ve written these objectives to be consistent with the
flipped model approach. That is, the objectives for the online portion address basic knowledge
and understanding, and the objectives for the on-ground portion address higher-order analysis
and synthesis of information.
Next, we move on to the Evaluation Methods portion of the syllabus. I want to start by
explaining that you will not receive a grade for this course, nor will you receive continuing
education credits. I’ve included the evaluation methods section and points for assignments, as
well as rubrics for your online assignments, simply so that you can experience the online
feedback mechanisms built into Blackboard. This may help you determine how and where you
provide feedback to your own students. Within this course you will be asked to complete one
online assignment for nearly every lesson, with the exception of lessons 4 and 5 when you will
complete one joint assignment. These assignments are geared toward assessing your knowledge
of the material covered in the online lecture, and I’ve set them up so that you will experience a
variety of types of online activities, including a discussion board, a blog, a wiki, and an
assignment. In class, you will complete several application-oriented activities as well.
The final page of the syllabus gives you some additional information about the flipped
model structure of the course, reading assignments, and online expectations. Since I’ve already
covered that in this screencast, I won’t go over it again, but know it’s there should you need to
refer back to it.
The course schedule is the final, and probably most important, part of the syllabus. You
will see that I’ve split up this course into six mini-lessons, to allow you to work your way
through the online material in pieces rather than having to devote two hours non-stop to your
online learning. Each lesson has an online lecture, optional check your understanding activity,
and required online assignment. As you watch the lectures, you will have the opportunity to take
notes on the handouts provided, and can replay pieces to review the material. After you have
completed your learning activities, please do the online assignment. I will mention here that I’ve
set due dates within Blackboard for your online assignments, and have spread them out
throughout the two week online period of the course. I did this so that you can experience how
Blackboard alerts students of assignments and how the calendar tool works in the system. Please
know that you will not be penalized if you miss due dates, and are welcome to work through the
assignments at your own pace. If the intermittent reminders and scheduled dates assist you to
engage and avoid procrastination in engaging with the material, then by all means feel free to use
them to guide you, but don’t feel like they are required.
The last thing I want to say about the course schedule has to do with the scheduling of
online and on-ground activities. As you know, if this were a typical course, students would
complete just one lesson or topic before arriving to class for application and reinforcement, then
would go home and move on to the next topic. The difference between that and this course is
that you will work through the online portion of all six lessons prior to coming to class, where
we will cover all six lessons with hands-on activities. The concept is the same, but the set up is
slightly different from how our students experience the flow of a flipped class.
With that, we reach the end of this course overview. I hope that this has been a helpful
orientation for you, and that this course meets your learning needs and interests. You will
complete a course evaluation at the conclusion of the on-ground session, so please note any
constructive or positive feedback along the way so that you can share it then.
To begin the course, you will need to complete the Pre-Course Rating Scale. This is
anonymous, and takes the place of a course pre-test. The idea behind the rating scale is that it
will allow me to get an idea about your readiness and interest in implementing the flipped model
in your own classrooms. I have it set so that you cannot access course materials until you have
submitted your rating scale, so be sure to do that in order to get started.
Thanks for watching, and again, thanks for being part of this course. I look forward to
our time together online and in the classroom. Happy learning!

Appendix C
Course Glossary
Asynchronous learning: Online education involving several students that does not happen
simultaneously, meaning that students can access it when they are able and do not need to
coordinate with peers or instructor (Svinicki & McKeachie, 2014).
Synchronous learning: Online education involving several students where all involved students
must be online at the same time in order to interact (Svinicki & McKeachie, 2014).
Screencast: An online recording of what is on a user’s computer screen. Also known as screen
capture.
Pedagogy: the theory and practice of education and teaching (Knowles, Holton, & Swanson,
2015).
Andragogy: the theory and practice of educating and teaching adult learners (Knowles, Holton,
& Swanson, 2015).
Blended learning/course: Instruction or course that involves both an online and an on-ground
component. Same as hybrid learning/course.
Hybrid learning/course: Instruction or course that involves both an online and an on-ground
component. Same as blended learning/course.
Appendix D
Course Assignment Checklist
The following are assignments to be completed within the “Flipping Your OTA Classroom”
course:
Online Assignments:
□ Lesson 1 Discussion Board (5 points)
□ Lesson 2 Wiki (5 points)
□ Lesson 3 Blog (5 points)
□ Lesson 4/5 Analysis of Teaching Methods Worksheet (20 points)
□ Lesson 6 Discussion Board (5 points)
On-Ground Assignments:
□ Lesson Worksheet (10 points)
□ Online Lesson Creation (20 points)
□ Learning Activity Worksheet (10 points)
□ Individual Plan Worksheet (20 points)

Appendix E
Online Lecture Slides

Appendix F
Lesson Plans
Lesson 1: Flipped Classroom Model
Introduction
In this lesson, you will be introduced to the flipped classroom model as a pedagogical method
combining the recent technological movement with group-based interactive learning activities in
the classroom (Bishop & Verleger, 2013). You will examine what the recent literature identifies
as likely benefits and outcomes of using the model, and will begin to explore how this model
might benefit your teaching.
Learning Objectives
Online: Define the “flipped model” utilizing descriptions from current literature, including listing
its benefits and expected educational outcomes.
On-ground: Justify use of the flipped model within your own classroom through knowledge of its
benefits and expected educational outcomes.
Suggested Reading
See Appendix G.
Part I. Benefits and strategies. The Journal of Continuing Education in Nursing, 44(10),
437-438.
Online Lecture
Flipped Classroom Model video:
https://www.youtube.com/watch?v=FnGZcQffkE&feature=youtu.be&hd=1
Online Assignment
Discussion Board: Define the “flipped model” based on the descriptions from current literature
available in your reading and online lectures. Do this in 30 words or less. Then list one benefit
and one expected educational outcome of utilizing this model.
Online Learning Activity

Sorting Game: https://www.softchalkcloud.com/lesson/serve/QUsS2fpwKm1LYn/html
Topic: Flipped versus Traditional Classroom
Directions: Click the card deck to view a card. Drag the card from the bottom to the correct
category.
Flipped Classroom:
• is considered more student-centered
• usually includes recorded lectures
• offers more face-to-face time with instructor and peers
• includes active learning activities in the classroom

• is considered an “expansion of the curriculum”
• grounded in constructivist learning theory
• works well for busy learners
• promotes higher-order thinking
Traditional Classroom:
• involves homework done independently
• relies on lecture within the classroom
• offers a standard approach to teaching
• presents the instructor as the expert
On-Ground Preview
In class, we will discuss the use of the flipped model in your own classroom. Please come to
class ready to share your views on this model and how it might benefit your teaching.
On-Ground Learning Activity

Discussion: See on-ground PowerPoint for discussion questions.
Lesson 2: Adult Learning Theories
Introduction
This lesson examines adult learning theories with a focus on the constructivist approach.
Constructivism provides a theoretical foundation for justifying the flipped classroom and guides
instructors in designing in-class activities.
Learning Objectives
Online: Describe the constructivist approach and its relationship to the flipped classroom.
On-ground: Generate a brief outline of an online and on-ground occupational therapy lesson
utilizing the constructivist approach.
Suggested Reading
None
Online Lecture
Adult Learning Theories video:
https://www.youtube.com/watch?v=VfeOSidqDCg&feature=youtu.be&hd=1
Online Assignment
Wiki: Describe the constructivist approach and its relationship to the flipped classroom.
Your Role: Begin, edit, or update the wiki with your own contributions to the definition and
description of the constructivist approach. Be sure that the resulting description includes several
ways that the constructivist approach relates to the flipped classroom model. You will be graded
on your individual contributions to the class wiki.

Crossword Puzzle: https://www.softchalkcloud.com/lesson/serve/Qed8ZI36wO1p4i/html
Topic: Constructivism
Directions: Solve the crossword puzzle.
Clues:
• Constructivism emphasizes design of the learning ENVIRONMENT.
• Constructivists believe that learning results from social INTERACTION.
• The flipped classroom focuses on building knowledge rather than on its
TRANSMISSION.
• The theory that involves believe that adults create knowledge. (CONSTRUCTIVISM)
• The study of adult learning. (ANDRAGOGY)
On-Ground Preview
In class, you will apply what you have learned about the constructivist approach to create a brief
lesson plan consisting of online and on-ground material. This will set the stage for future class
activities that will build on this outline and allow you to create a lesson plan using the flipped
model.

Constructivist Lesson Planning Worksheet
Topic addressed by this lesson:
Previous Traditional Lesson Plan New Constructivist Lesson Plan

Before class: Before class:
During class: During class:
After class: After class:
Lesson 3: Evidence for Use of the Flipped Model in Healthcare Education
Introduction
In this lesson, you will further explore the available evidence for use of the flipped classroom
model. This exploration will focus specifically on healthcare education and how the flipped
model can prepare students for practice in today’s healthcare environment.
Learning Objectives
Online: Identify current research trends and findings related to use of the flipped model in
healthcare education.
On-ground: Appraise evidence related to the flipped model in order to formulate 2 reasonable
goals for use of the model in your own classroom.
Suggested Reading
None
Online Lecture
Evidence for the Use of the Flipped Model in Healthcare Education video:
https://www.softchalkcloud.com/lesson/serve/Qed8ZI36wO1p4i/html
Online Assignment
Blog: Use the library resources to search for an article that examines the flipped classroom
model in healthcare education. Review it, attach it to your post, and identify one outcome of
using the model demonstrated within the study. State how you think a similar outcome would be
useful to prepare your students for future occupational therapy practice.

Identification Activity: https://www.softchalkcloud.com/lesson/serve/75w8ptoHUj0aIB/html
Topic: Abilities developed by the flipped model
Directions: Select the correct items. Click the bottom right arrow to go to the next set. Click the
checkmark (available on the last set) to submit all your answers.
• Evidence-based practice*
• Problem-solving*
• Independent learning
• Clinical reasoning*
• Research
• Autonomy*
• Therapeutic use of self
• Lifelong learning*
• Technological competence*
• Self-efficacy*
• Teamwork*
• Documentation*
On-Ground Preview
In our on-ground lesson, you will work with your peers to review several articles on the flipped
model in healthcare education. Together you will create a list of expectations for the flipped
classroom, and individually you will identify which of these are appropriate goals for your own
flipped class.

Research exploration: See on-ground PowerPoint for details and directions.
Materials:
Boucher, B., Roberson, E., Wainner, R., & Sanders, B. (2013). “Flipping” Texas State
Education, 76(10), 1-5.
Lesson 4: Online Strategies for Blended Learning
Introduction
In this lesson we will focus on the online portion of the flipped instruction, with a goal of you
becoming more comfortable with the technology that is available to deliver your online lessons.
You will explore several options and begin to apply this knowledge to develop a lesson utilizing
teaching technology that is new to you.
Learning Objectives
Online: Explain the use of at least 2 methods for providing online instruction (such as screen
capture, discussion boards, and blogs) and note at least one benefit and one drawback of each
method.
On-ground: Construct a short online lesson utilizing at least one new technological teaching tool.
Suggested Reading
See Appendix H.
Part II. Making podcasts and videos. The Journal of Continuing Education in Nursing,
44(11), 486-487.
Online Lecture
Online Strategies for Blended Learning video:
https://www.youtube.com/watch?v=VAeh3QizMOA&feature=youtu.be&hd=1
Online Assignment
Begin the Analysis of Teaching Methods worksheet with information about online strategies.
Analysis of Teaching Methods Worksheet: Online Lessons 4 and 5
Select 2 online instruction methods and 2 on-ground active learning activities that are commonly
used in the flipped classroom model. Label the left column with these methods and complete
the table with information on a benefit and drawback of each identified method.
Teaching Method 1 Benefit of the Teaching Method 1 Drawback of the Teaching

Method
Online method:
Online method:
On-Ground method:
On-Ground method:

Word Search: https://www.softchalkcloud.com/lesson/serve/Dd3k4GmJnQ9X8v/html
Topic: Online Learning Terminology
Directions: Click and drag to highlight a found word from the list. Click word for hint.
Word List:
• wiki
• screen capture
• podcast
• discussion
• Camtasia
• games
• blog
• Jing
• Blackboard
• YouTube
• Moodle
• SoftChalk
• Edpuzzle
On-Ground Preview
In class, you will engage in hands-on learning with your peers to develop skills utilizing a new
technology tool. You will utilize these skills to begin to develop a basic lesson relevant to your
teaching.

Online Lesson Creation Worksheet
Spend a few minutes exploring at least two of the tools available to you in the classroom today.
First, you will write some brief notes on two of these tools, then you will select one of them to
begin creating an online lesson.
Tool Exploration:
1. Tool explored: _________________________________________________________
a. What you did with it:
b. What you like about it:
c. What (if anything) do you need to practice/learn more about to use it:
d. How it could help in your teaching:
2. Tool explored: _________________________________________________________
a. What you did with it:

b. What you like about it:
c. What (if anything) do you need to practice/learn more about to use it:
d. How it could help in your teaching:
Lesson Creation:
1. Tool selected: _________________________________________________________
a. What you created with it:
b. How you will use this lesson in your teaching:
c. How you will use this tool more in your teaching:
Technology Tools Handout
The following technology-based tools may be useful to you as you create online lessons, ask
students to interact with each other to complete learning activities, and engage with students in a
more active classroom environment.
Screen capture: This software allows you to record what you see on your computer screen,
with or without voiceover narration.
• Jing: https://www.techsmith.com/jing.html
• Screencast-o-matic: http://www.screencast-o-matic.com/
• Camtasia: https://www.techsmith.com/camtasia.html
Lesson creation: These websites allow you to build online lessons including text, games, and
videos. You can either place a link in your Learning Management System (LSM) or can embed
them in the LMS.
• Wikispaces: http://www.wikispaces.com/
• TedEd: http://ed.ted.com/
• SoftChalk: http://softchalk.com/
Blackboard tools: These tools are located within Blackboard and offer a variety of learning
activities for students. You can find them in the “Course Tools” section of the Control Panel
(bottom left of your screen).
• Wikis
• Blogs
• Surveys
• Glossary
Other: This list include a variety of other instructional tools useful in and out of the classroom.
• Poll Everywhere: https://www.polleverywhere.com/
This site lets you create live polls that students respond to anonymously via phone, tablet,
or computer.
• Edmodo: https://www.edmodo.com/
This site allows you to create an online classroom and/or connect with other online
educators.
• Khan Academy: https://www.khanacademy.org/
This page offers a wide variety of free online educational resources and courses.
• Google Hangout: https://hangouts.google.com/
This site offers a way to video, call, or chat online with others for free. It can be useful
for student collaboration.
• Google Docs: https://www.google.com/docs/about/
This site allows users to create and edit documents online, and to collaborate and share
these documents with others.
• Bitstrips: https://www.bitstrips.com/create/comic/
This website lets students create online comic strips depicting anything you assign. It can
be useful for assignments involving stories and timelines.
• Survey Monkey: https://www.surveymonkey.com/
This page allows users to create, administer, and interpret surveys and survey data.
Either students or instructors can use it to create a means of offering anonymous
feedback.
Lesson 5: Active Learning Activities for the Classroom
Introduction
This lesson focuses on activities that support learning in the on-ground portion of the flipped
classroom. You will examine several types of activities commonly used in the flipped model and
begin to apply this knowledge to one of your classroom lessons.
Learning Objectives
Online: Describe at least 2 active learning activities for use in the flipped classroom (such as
small group work, quizzes, case studies, and simulations) and note at least one benefit and one
drawback of each method.
On-ground: Adapt an on-ground learning activity utilized currently to incorporate active learning
strategies.
Suggested Reading
None
Online Lecture
Active Learning Activities for the Classroom video:
https://www.youtube.com/watch?v=uCgdtX0v72M&feature=youtu.be&hd=1
Online Assignment
Assignment: Please complete the Analysis of Teaching Methods worksheet by filling in the table
with information regarding the use of various online and on-ground teaching methods. (See
Lesson 4 above: Analysis of Teaching Methods worksheet)

Flashcards: https://www.softchalkcloud.com/lesson/serve/6b4f2MgsyvZWjr/html
Topic: Active Learning Terminology
Directions: Click ‘Show’ to see the hidden portion.
Term list:
• Clickers: A classroom response system allowing anonymous response to questions
assessing knowledge or opinions.
• Retention: The goal of learner-centered strategies such as active learning activities.
• Quiz: Start with a brief one of these to assess students’ knowledge before beginning
activities.
• Discussions: The use of open-ended questions to improve students’ observation,

communication, and clinical reasoning.
• Microlectures: Brief 1-3 minute lectures incorporated during or between activities to
reinforce student learning.
• Classroom Assessment Techniques: Means of formative assessment within the active
learning classroom.
• Case studies: Real or hypothetical situations that allow students to address skills such as
critical thinking, ethics, and reflection.
• Entry tickets: Paperwork that students complete and submit upon walking into the
classroom to allow the instructor to assess student preparation.
• Observation skills: Ability of the instructor to recognize and provide what students need
to reinforce their learning.
• Active learning: The term for activities requiring generalization, interaction with peers,
and articulation of rationale.
On-Ground Preview
In class, you will have the opportunity to work with your peers to adapt an on-ground learning
activity. You will work to ensure that this learning activity incorporates the active learning
strategies that you have learned in this lesson.

Active Learning Activities Worksheet
Look through the books that are available to you as well as the presentation for this lesson and
any other online resources to which you have access. Find one active learning activity you could
use in your on-ground time with students. Write about it below.
1. Activity name:
_________________________________________________________________
Source:
2. Details of the activity (do not copy directly from your source, but instead work to
incorporate any changes you would make to the activity and/or specific directions you
will give your students):
3. Considerations in carrying out this activity (such as space demands, staffing needs,
supply needs, etc.):

4. Instructor role during this activity:
5. Expectations of students during this activity:
6. How you can make expectations of students clear:
7. How this activity could benefit your students’ learning:
Lesson Title Lesson 6: Implementing the Flipped Model
Introduction
In this lesson, you will focus on how you might implement the flipped model into your own
classroom. You will do this by examining student and instructor concerns regarding this model
and researching possible strategies to address these concerns.
Learning Objectives
Online: Predict at least 1 common student concern and 1 common instructor concern regarding
the flipped classroom, and identify at least 1 strategy to address each identified concern.
On-ground: Propose an individualized plan to incorporate knowledge, skills, and appreciation
for the flipped classroom into your own teaching in the next year.
Suggested Reading
See Appendices I and J.
477-478.
Morin, K.H. (2014). Editorial: Fostering student accountability for learning. Journal of
Online Lecture
Implementing the Flipped model video:

https://www.youtube.com/watch?v=TSdyVqkyIc&feature=youtu.be&hd=1
Online Assignment
Discussion Board: Relying on what you have learned within this course and your experiences in
the classroom, identify at least one concern that you expect your students would have about the
flipped classroom model and one strategy you could use to address this concern. Then identify
one concern that you have about implementing the model and one strategy you can use to
address this concern.

Matching Pairs: https://www.softchalkcloud.com/lesson/serve/bHU54eFx8Vitqn/html
Topic: Barriers and Solutions in Implementation
Directions: Select the matching pairs. Click the bottom right arrow to go to the next set.
Barrier-Solution pairs:
• Students are nervous, Explain model in the beginning
• Time burden to prepare, Put in time up-front
• Requires more work by students, Realize it increases learning
• Disconnect between materials, Organize assignments
• Can’t ask questions online, Allow question period in class
• Students don’t work ahead, Give quizzes
On-Ground Preview
In class, you will complete a personalized plan that will allow you to begin apply what you have
learned in this course. You will have the chance to share this plan with your classmates and will
obtain feedback and suggestions regarding this plan from your classmates and instructor.

Individual Implementation Plan Worksheet
Please complete the following prompts as a written plan for your implementation of the flipped
classroom model in your own teaching. Note that you do not need to make a plan to implement
the model fully into all of your lessons, but instead are encouraged to start with a reasonable first
step and evaluate its outcomes before proceeding further. You are free to decide what seems
right for you and your students in its implementation.
1. What outcomes do you hope to accomplish by implementing a flipped lesson or course?
2. What seems reasonable to you as a goal in implementing the flipped model? (Consider
flipping one lesson or module, developing your online lectures, or learning more about
available technology.)
3. Write out your response to #2 in goal format, being sure to include a timeframe:
a. Long Term Goal:
b. Short Term Objective #1:
c. Short Term Objective #2:
d. Short Term Objective #3:
4. What resources will you need to implement this plan?
5. What support will you need to implement this plan?
6. List at least 2 anticipated possible barriers and a solution for each:
a. Barrier and Solution #1:
b. Barrier and Solution #2:
7. What is the first step you will take toward your goal?
Useful Resources for the Flipped Classroom Handout
Angelo, T.A., & Cross, K.P. (1993). Classroom assessment techniques: A handbook for
college teachers (2nd ed.). San Francisco, CA: Jossey-Bass.
This classic handbook offers descriptions of fifty classroom assessment techniques that will help
instructors gauge student learning in an active and practical manner. It details step-by-step
procedures for each of the techniques and explains how to implement these in a systematic way
to measure learning and inform future teaching. These techniques are useful in the flipped
classroom as both active learning activities and also as formative assessment of student learning.
Barkley, E.F., Major, C.H., & Cross, K.P. (2014). Collaborative learning techniques: A
handbook for college faculty. San Francisco, CA: Jossey-Bass.
This handbook includes descriptions of thirty-five assignments for use with pairs or groups of
students. These activities allow for engagement and active learning, and require students to
collaborate as they learn. Because the flipped classroom relies on active learning and
collaboration, these activities are well-suited for implementation during on-ground lessons.
Bergmann, J., & Sams, A. (2012). Flip your classroom: Reach every student in every class every
day. Eugene, OR: International Society for Technology in Education.
This book offers a quick and easy overview of the flipped model as it was developed by Jonathan
Bergmann and Aaron Sams, two high-school chemistry teachers who began using the model in
2007. They detail its development and the lessons they learned as they refined it. This is a
helpful overview of the model and offers practical tips for implementing and refining it in your
own teaching.
Bowen, J.A. (2012). Teaching naked: How moving technology out of your college classroom
will improve student learning. San Francisco, CA: Jossey-Bass.
Although not specifically about the flipped classroom, this book offers a strong argument for
using technology outside of the classroom to allow for quality face-to-face instruction in the
classroom. The author cites evidence supporting this model and makes his own case for
changing education to better address the evolving needs of students as technology also continues
to evolve. He offers a strong argument for increasing active learning with instructor support in
the classroom so that higher education is not overtaken by solely online educational offerings.
Knowles, M.S., Holton, E.F., & Swanson, R.A. (2015). The adult learner: The definitive classic
in adult education and human resource development (8th edition). New York, NY:
Routledge.
This book describes the adult learner and outlines learning theories relevant to teaching adults,
including the constructivist approach. It is a useful resource to better understand the learning
needs of students in a flipped college course.
Lowenstein, N., & Halloran, P. (2015). Case studies through the health care continuum: A
workbook for the occupational therapy student (2nd ed.). Thorofare, NJ: Slack Inc.
This workbook is designed for occupational therapy students and includes many extensive case
studies from multiple practice settings and client populations. These may be useful in designing
realistic activities for students to complete during on-ground lessons.
Michaelsen, L.K., Parmelee, D.X., McMahon, K.K., & Levine, R.E. (Eds.). (2008). Team-
based learning for health professions education. Sterling, VA: Stylus Publishing, LLC.
This book details the use of team-based learning in health-related education. Team-based
learning is a specific collaborative technique that may be utilized within the flipped classroom,
as it requires students to complete some learning outside the classroom, then come to class
prepared to work together to solve specific problems. This book offers information regarding the
specific procedures and suggestions for implementing team-based learning in your classroom.
Svinicki, M.D., & McKeachie, W.J. (2014). McKeachie’s teaching tips: Strategies, research,
and theory for college and university teachers (14th ed.). Belmont, CA: Wadsworth.
This book offers evidence-based approaches to many teaching situations, including using
technology in teaching, conducting online discussions, and other useful tools and tricks of the
trade. Much of it is relevant to teaching in any context, but the chapters on technology and
group-based learning are particularly useful in the flipped classroom.
Appendix G
Suggested Reading: Online Article 1
Part I. benefits and strategies. The Journal of Continuing Education in Nursing, 44(10),
437-438.
teaching tips
Associate Editors: Diane M. Billings, EdD, RN, FAAN
Karren Kowalski, PhD, RN, NEA-BC, FAAN
Authors: Katie McDonald, MS, and Charlene M. Smith, DNS, MSEd, WHNP, RN-BC, CNE
The Flipped Classroom for Professional Development:

Part I. Benefits and Strategies
(p. 13). They further described the ing collaborative activities, and group
flipped classroom as offering students discussions on content.
abstract a personalized, individualized educa-
Individualizing the educational en- tion. This is done by providing learning BENEFITS
counter is supported by flipping the resources to address the varied learn- Many of the key benefits of flipping
classroom experience. This column of- ing needs of students and transitioning the classroom identified by Bergmann
fers an overview and describes the ben- classroom time to engage students in and Sams (2012) that apply to high
efits of flipping the classroom. Part II the application of content, formatively school students also apply to adult
will explore the practicalities and peda- assess student progress, and work indi- learners in the professional develop-
gogy of lecture capture using podcasts vidually or with groups of students as ment setting. This model puts more
and videos, a technology strategy used needed. The fundamental principles of onus on learners to actively learn and
in flipping the classroom. the model are not complicated, but the individualizes the experience so stu-
J Contin Educ Nurs 2013;44(10):437- opportunities created by the small ad- dents learn what is pertinent to them
438. justments around when certain instruc- and their learning needs. Providing ed-
tional activities occur significantly alter ucation to nurses in a classroom setting
the type of learning that is possible. is challenging, given their varied shifts
T he flipped classroom is a grow-

ing movement in both K-12 and
higher education that forces educators
Although the term may be rela-
tively new, many of the underly-
ing principles and techniques often
and often limited access to educational
resources. Flipped classes work well
for learners who are extremely busy,
to rethink the learning environment used in a flipped class, including ac- as videos can be viewed at a conve-
and how best to use precious class time tive learning, self-directed inquiry, nient time. All that is typically neces-
with learners. The term “flipped class- student-centered instruction, and sary to view video recordings is an
room” was coined by two high school constructivist learning theory, have Internet connection; thus, this can be
chemistry teachers from Colorado, been thoroughly researched and used done from work, home, or mobile de-
Jonathan Bergmann and Aaron Sams successfully in a variety of educa- vice and while traveling. Although ac-
(2012), who began flipping courses in tional formats for years (Bergmann cess to the videos is convenient, nurses
2007. The flipped classroom model has & Sams, 2012). The flipped classroom should be encouraged to view all or-
since spread to many other teachers, has a unique approach, combining ganization-mandated training materi-
professors, and professional develop- these same learning strategies with als during paid work hours to address
ment educators nationwide. Bergmann increasingly available technologies any specific labor laws. These videos
and Sams (2012) defined the flipped used to create short video lectures also help learners who are struggling
classroom as “that which is tradition- (e.g., podcasts or vodcasts). Hence, with a concept because they can stop,
ally done in class is now done at home, more time is allowed in the face-to- pause, and replay them as many times
and that which is traditionally done as face classroom setting for applica- as needed. Prerecording essential con-
homework is now completed in class” tion-level teaching strategies, engag- tent topics also provides a greater level
of transparency and specificity into
Ms. McDonald is Educational Technologist, St. John Fisher College, Rochester, New York. Dr. what content is being delivered to stu-
Smith is Professor, Wegman’s School of Nursing, St. John Fisher College, Rochester; Research Coor- dents; thus, a higher level of consis-
dinator, University of Rochester Medical Center: Highland Hospital, Rochester; and Clinical Nurse tency exists across multiple instructors
Specialist, University of Rochester Medical Center: Strong Memorial Hospital, Rochester, New York. involved in the delivery of professional
The authors have disclosed no potential conflicts of interest, financial or otherwise. development sessions.
Address correspondence to Katie McDonald, MS, 3690 East Avenue, Rochester, NY 14618. Bergmann and Sams (2012) also
E-mail: kmcdonald@sjfc.edu. defined the term “flipped mastery
doi:10.3928/00220124-20130925-19 classroom.” This is an extension of the
The Journal of Continuing Education in Nursing · Vol 44, No 10, 2013 437
flipped classroom where all students ing learner progress. Educators in a lecture and assigning homework to
move through content at their own flipped classroom have a less promi- students. Educators can then use the
pace to meet the requirements for the nent role than traditional lecturers, classroom more efficiently as a means
learning objectives. This strategy uses but must possess critical competen- to assess student understanding of the
the techniques and tools implemented cies in assessing students and facili- prior learning and elevate the learn-
in the flipped classroom, but mastery tating class sessions. ing experience to application activities
learning does not require all students such as case studies, problem-based
to watch video content or complete TECHNOLOGICAL STRATEGIES learning, or simulation. In the profes-
other instructional activities on the A variety of resources can be used sional development setting, a flipped
same schedule to prepare for group to create video materials for the flipped classroom can deploy content elicited
class activities that are offered at a classroom. It is becoming easier to from subject matter experts, clinical
specific time. Each learner progresses create high-quality video recordings grand rounds, safety alerts, new prod-
through the content in a self-paced with commonly available software uct demonstrations, consumer health
manner and may complete the neces- programs and devices such as tab- education, and professional continu-
sary requirements at different time lets, smartphones, and video cameras. ing education in a way that maximizes
frames. This model provides unique Many computers now include web- the learning experience in the class-
advantages for the professional devel- cams and microphones that can be used room. The flipped classroom sup-
opment arena, where greater levels of to create prerecorded instructional ma- ports adult learning processes through
flexibility and scheduling are valued by terial. Educators should also repurpose self-directed inquiry with students
learners with other time commitments existing instructional material for use controlling the timing and direction
and varied schedules. with the flipped classroom. Recorded of learning (Russell, 2006). This allows
Hamdan, McKnight, McKnight, conference presentations or workshop adult learners to construct knowledge
and Arfstrom (2013) identified four sessions could be used in a flipped in the classroom based on the shared
pillars that are essential for educators classroom. Learners are asked to view real-world experiences the collabora-
seeking to implement either the flipped the recording on their own time prior tive group can bring to the classroom
classroom or the flipped mastery class- to a live interactive session where the experience.
room into their courses: topics are discussed in detail in a group.
● Flexible learning environments, with Additionally, professional webinar ses- SUMMARY
students selecting when and where sions are often recorded and could be The flipped classroom has the po-
they view video lectures and class- repurposed. Webinars may be internal tential to increase access to and provide
room time becoming more collabor- presentations that were not available to greater efficiencies for individualized
ative, active, and engaging compared all learners in an organization, or ex- delivery of instruction. The student-
to typical in-class lectures. ternal sessions that showcase outside centered approach allows learners
● A shift in the learning culture, experts who could not travel to spe- to master content as the director of
“where in-class time is meant for cific locations to deliver sessions live. their learning and educators to deploy
exploring topics in greater depth and A wide variety of materials exist on the teaching strategies in the classroom
creating richer learning opportuni- web that are useful to share with learn- that facilitate active learning.
ties” (Hamdan et al., 2013, p. 5), thus ers as a primer to a forthcoming class-
focusing on student- versus teacher- room topic. Although many educators REFERENCES
directed instruction. begin employing the flipped classroom Bergmann, J., & Sams, A. (2012). Flip your class-
● The use of intentional content and by creating their own video materials, room: Reach every student in every class ev-
ery day. Eugene, OR: International Society
active methods of instruction se- existing resources freely available on a for Technology in Education.
lected by instructors to maximize given topic that are of equal or better Hamdan, N., McKnight, P., McKnight, K., &
both the out of class time, when in- quality should be considered, saving Arfstrom, K. M. (2013). The flipped learn-
structional materials can be viewed time and money. ing model: A white paper based on the lit-
erature review titled “A review of flipped
as many times as needed, and the in- In the nursing professional devel-
learning.” Retrieved from http://fln.
class time, when students can benefit opment setting, the flipped classroom schoolwires.net/cms/lib07/VA01923112/
from the expertise of instructors and can provide nursing staff 24/7 access Centricity/Domain/41/WhitePaper_
peers as they work to apply their to consistent instructional content FlippedLearning.pdf
learning to real-world situations. prior to the in-class session. Bergmann Russell, S. S. (2006). An overview of adult-
learning processes. Urologic Nursing,
● Professional educators who are and Sams (2012) described this model
26(5), 349-352.
skilled at observing and monitor- as more efficient than delivering a
438 Copyright © SLACK Incorporated

Appendix H
Part II. making podcasts and videos. The Journal of Continuing Education in Nursing,
44(11), 486-487.
teaching tips
Associate Editors: Diane M. Billings, EdD, RN, FAAN
Karren Kowalski, PhD, RN, NEA-BC, FAAN
Authors: Charlene M. Smith, DNS, MSEd, WHNP, RN-BC, CNE; and Katie McDonald, MS
The Flipped Classroom for Professional Development:

Part II. Making Podcasts and Videos
cast/vodcast files are downloaded to varied learning styles/preferences,

abstract play on a computer or mobile device. creation of a connection with the edu-
As described in Part I, podcasts and Screencast or lecture capture software cator, and repetitive access to absorb
videos are educational technologies that captures the output on a com- new material (Billings & Phillips, 2008;
used to flip the classroom. This col- puter screen, audio, or video is used Long & Edwards, 2010). In academia,
umn describes the technology options to create the spectrum of multimedia students use podcasts and videos cap-
for creating podcasts and videos and files typically included in a podcast or turing lecture material to review dif-
offers tips on developing podcasts vodcast. ficult concepts, study for tests, engage
and videos. The use of podcasts and videos in reflective learning, and review con-
J Contin Educ Nurs 2013;44(11):486- available online has become a pertinent tent for better understanding (Brittain,
487. teaching strategy. These technologies Glowacki, Van Ittersum, & Johnson,
are used as teaching strategies in the 2006). In the practice setting, educa-
flipped classroom (Bergmann & Sams, tors use podcasts and videos for similar
P odcasts, a form of lecture capture,

are technological and pedagogi-
cal phenomena that exploded on the
2012). Podcasts and videos capture lec-
ture material so that students can re-
view “lectures” prior to class to focus
reasons to provide nurses with a viable
pedagogical option to access instruc-
tional content.
scene in September 2004 (Campbell, the classroom experience on collab-
2005). In a May 2010 survey, the Pew orative application activities. Online TECHNOLOGY OPTIONS
Internet & American Life Project re- distribution of podcasts and videos is As technologies to create and share
ported 21% of adults (18 years and used to bring content to students who podcast or video content have in-
older) had downloaded a podcast are unable to attend a program, capture creased and become less expensive or
(Zickuhr, 2010). subject matter expert presentations, free to anyone with Internet access,
“Podcast” is defined as “a package deliver information-dense orientation educators have begun using these tools
of multimedia files that can be down- content, deploy marketing content, to create high-quality instructional
loaded from the Internet and played and distribute in-service or continuing materials.
on a computer or a mobile device” education programs to nurses working Camtasia (www.techsmith.com/
(Oxford University Press, 2013). A off-site or varied shifts. camtasia.html), often used to cre-
podcast is a download of an audio file; Advantages of lecture capture in- ate podcasts, allows instructors to
an enhanced podcast includes addi- clude access to material on-demand, record anything on their computer
tional multimedia such as audio plus mobile access of content, quick dis- screen, including presentations,
images or presentation slides. Adding semination and updates of content, documents, PDFs, and websites.
a video component to a podcast is re- distribution to a wide audience, con- This software also allows audio re-
ferred to as a vodcast or vidcast. Pod- sistency of content, ability to address cording. Jing (www.techsmith.com/
jing.html), a free version of the soft-
Dr. Smith is Professor, Wegman’s School of Nursing, St. John Fisher College, Rochester; Re- ware without much of the additional
search Coordinator, University of Rochester Medical Center: Highland Hospital, Rochester; and functionality Camtasia offers, is use-
Clinical Nurse Specialist, University of Rochester Medical Center: Strong Memorial Hospital, ful for recording screen captures.
Rochester, New York. Ms. McDonald is Educational Technologist, St. John Fisher College, Roch- Use of a headset with microphone
ester, New York. and a webcam if needed for video
The authors have disclosed no potential conflicts of interest, financial or otherwise. capture is recommended for these
Address correspondence to Charlene M. Smith, DNS, MSEd, WHNP, RN-BC, CNE, 3690 types of recordings. Webcams and
East Avenue, Rochester, NY 14618. E-mail: cmsmith@sjfc.edu. internal microphones are often part
doi:10.3928/00220124-20131025-93 of many computers. A Wacom tab-

let (www.wacom.com/en/products/ updating and editing easier. Capture material (Green, Pinder-Grover, &
pen-tablets) may be necessary for software that has editing capability Millunchick, 2012). Receiving content
annotating documents or capturing saves time. through online prerecorded materials
handwritten diagrams or formulas ● Select content topics that are reus- may be new to adult students. Edu-
as part of podcast or video materi- able for multiple purposes (e.g., for cators need to discuss with them the
als. Given the popularity of mobile formal training events or as sup- format of the materials, why it was se-
devices and apps, an iPad or other portive instructional materials). lected, and how it will positively trans-
tablet device can be used. ShowMe, ● Prepare a script before recording form the learning experience.
Educreations, Explain Everything, to create a shorter recording. For
ScreenChomp, and Knowmia Teach, a more natural recording, do not SUMMARY
apps for creating these types of re- follow the script word for word. A variety of technology strategies
cordings, offer similar functionality, Having two presenters when cre- are accessible to educators for peda-
including use of the tablet as a white- ating a podcast or capturing a real gogical application. Podcasts, vodcasts,
board with pen, highlighters, color, class presentation when vodcasting and videos can support the flipped
incorporation of photos as objects or videoing can make the dialogue classroom and the self-directed, stu-
to annotate, and recording of audio and experience realistic for student-centered approach adult learners
from the built-in microphone. dents. value. Capturing lectures as podcasts,
Once created, recorded podcasts ● Provide a clear introduction as to vodcasts, and videos is applicable for
or videos must be shared in an eas- the purpose of the presentation and many professional development activi-
ily accessible place. Many of the tools a summary at the end reviewing ob- ties in nursing and other learning envi-
available to create podcasts or videos jectives and key points. ronments.
provide built-in options to publish and ● Avoid auditory distractions and
share them, including Camtasia and ensure microphone and audio qual- REFERENCES
Jing. Most of the iPad apps have built- ity. Position the camera to capture Bergmann, J., & Sams, A. (2012). Flip your
classroom: Reach every student in every
in options to share podcasts and videos the visual field but avoid distracting
class every day. Eugene, OR: International
created using specific apps. If a built-in backgrounds and clothing and ex- Society for Technology in Education.
option is unavailable, YouTube (http:// cessive movement. Billings, D., & Phillips, J. (2008). Technology in
youtube.com) or Vimeo (https:// ● Anticipate students’ needs. Speak nursing education: Use today’s tools to pro-
vimeo.com) can be used to easily share slowly, avoid filler words, and re- mote learning and enhance patient safety
[Webinar]. Marblehead, MA: Hcpro.
materials with students. Educators peat and define new words or key
Brittain, S., Glowacki, R., Van Ittersum, J., &
may choose to use institution-specific concepts (Masie, 2007). Johnson, L. (2006). Podcasting lectures:
websites or technologies that keep ● Consider adding both formative Formative evaluation strategies helped
content private to share podcasts or and summative assessments with identify a solution to a learning dilemma.
videos with students (e.g., podcasts instructional materials. These can Educause Quarterly, 29(3), 24-31.
Campbell, G. (2005). There’s something in the
and videos created by educators can be validate if students viewed the ma-
air: Podcasting in education. EDUCAUSE
posted within a learning management terials and assess how well the con- Review, 40(6), 32-47.
system and embedded as components tent is understood. If students are to Green, K. R., Pinder-Grover, T., & Millunch-
of larger learning activities). apply the material provided, offer ick, J. M. (2012). Impact of screencast
clear instructions and imbed home- technology: Connecting the perception of
usefulness and the reality of performance.
TIPS FOR LECTURE CAPTURE work to ensure they review the total
Journal of Engineering Education, 101(4),
Tips to consider when creating pod- podcast or video. 717-737.
casts or videos for students include: Prepare students by reviewing the Long, S. R., & Edwards, P. B. (2010). Podcast-
● Avoid losing the audience’s atten- purpose and pedagogical value of using: Making waves in millennial education.
tion. Create materials that are short- ing the technology. Students must un- Journal for Nurses in Staff Development,
er than typical face-to-face presenta- derstand the reasons podcast or video 26(3), 96-101.
Masie, E. (2007). Podcasting for learning. Chief
tions, aiming for final recordings of materials were created and acknowl- Learning Officer, 6(7), 16.
10- to 20-minute segments. A series edge their value as a learning resource. Oxford University Press. (2013). Oxford
of shorter podcasts or videos, instead Students who perceive the value of reference. Retrieved from www.oxford
of one longer presentation, may be podcast recordings and report a deeper reference.com/view/10.1093/oi/authority.
20110803100332964
needed if content cannot be covered. understanding of content as a result of
Zickuhr, K. (2010, December 16). Generations
● Create one recording per topic. watching them subsequently demon- 2010. Retrieved from http://pewinternet.
Chunking content makes content strate more proficiency with course org/Reports/2010/Generations-2010.aspx
Appendix I
477-478.
administrative angles
Associate Editors: Pamela S. Dickerson, PhD, RN-BC, FAAN
Barbara G. Lubejko, MS, RN
Authors: Brian S. McGowan, PhD; Jann T. Balmer, PhD, RN; and Kathy Chappell, PhD, RN
Flipping the Classroom: A Data-Driven Model

for Nursing Education
learners prior to attending a live Center (ANCC) Annual Sympo-

abstract classroom experience. Learners ex- sium on Continuing Nursing Edu-
Structured, blended learning plore this content at their own pace cation. The goals of the project were
models have been developed to help to improve their overall understand- to maximize learning opportunities
participants more actively engage in ing of the subject matter and maxi- in a 1-day conference, expose nurse
learning experiences, as opposed mize learning opportunities in the educators to the flipped classroom
to traditional didactic sessions. A live experience (Klegeris & Hurren, model as a potential tool for their
flipped classroom model allows 2011). Keys to the flipped classroom own use, and to expand the number
learners to build on self-directed model are ensuring that: of contact hours by combining pre-
online prework in an interactive and ● Prework is prepared and com- work with classroom experience.
collaborative learning laboratory. pleted in ways that support learn-
J Contin Educ Nurs. 2014;45(11):477- ing and better inform educational PLANNING AND
478. planners. IMPLEMENTATION
● Learning data from the prework For this project, prework in-
is effectively gathered, explored, cluded a series of videos created to
A dults come to the learning

environment with different
learning preferences, expertise, and ●
and leveraged to support the live
experience.
The live classroom experience
introduce the science of continuing
education. In all, 11 videos rang-
ing in length from 6 to 11 minutes
experience, creating significant chal- creates a learning laboratory that were produced. Learners were given
lenges for educators. Educational fosters dialogue among learners access to the e-learning environment
research recently has explored in- and facilitators, providing oppor- 1 month before the symposium.
novative approaches to addressing tunities for integrating context During that month, they received
these challenges. One model that has into the application of content. weekly notifications to encourage
gained significant traction in the past To better understand the appli- participation.
few years is the flipped classroom cability of this model to support To enable planners and facilita-
(McLaughlin et al., 2014). nursing education, a flipped class- tors to capture data about learning
In a flipped classroom, content room model was chosen for the 2014 and engagement in the prework,
and learning tasks are assigned to American Nurses Credentialing an innovative e-learning technol-
ogy, the ArcheViewerSM (McGowan,
2014), was used. This novel technol-
Dr. McGowan is Chief Learning Officer, ArcheMedX, Charlottesville; Dr. Balmer is ogy creates an immersive and engag-
Director, Continuing Medical Education, University of Virginia School of Medicine, Charlot- ing online learning environment by
tesville, Virginia; and Dr. Chappell is Vice President, Accreditation Program and Institute for allowing educators to define distinct
Credentialing Research, American Nurses Credentialing Center, Silver Spring, Maryland. learning moments, build a search-
The authors have disclosed no potential conflicts of interest, financial or otherwise. able library of related resources, and
Dr. Dickerson is a commissioner and Ms. Lubejko is an appraiser with the ANCC’s Commis- highlight these resources and engage
sion on Accreditation. Views expressed by them or their guest authors are their own and are not learners at predefined moments. In
representative of the Commission, except as specifically noted. addition, within the learning envi-
Address correspondence to Brian S. McGowan, PhD, Chief Learning Officer, ArcheMedX, ronment, learners have the ability
313 2nd Street SE, Suite 207, Charlottesville, VA 22902; e-mail: brian@archemedx.com. to take notes, set reminders, search
doi:10.3928/00220124-20141027-11 through related resources, and ask
questions of faculty. For example, completed more than 95% of each ● Learners participating in a flipped
leading up to the live symposium, video started. learning experience perceive them-
102 learners took 178 notes, set In aggregate, 47% of learners said selves as being more prepared to
408 reminders, and searched through they were comfortable with the indi- participate and engage in live or
a library of nearly 100 collated and vidual topics before beginning each classroom-style learning.
related resources. video lesson (n = 431). After comple- ● Four weeks of weekly notifica-
Analysis of the use of these tion of each video, 55% of learners tions seemed sufficient to drive
learning actions helped facilitators stated that they were more confident high levels of participation,
prepare the live classroom experi- with the topic or were ready to make although many participants noted
ence to complement the prework. changes in their practice (n = 358). that they waited until the final
Anticipated questions and areas of Before the online lessons began, 96 hours to ensure the content
concern were identified, and facili- there was tremendous variation in was fresh in their minds.
tators were able to focus on critical confidence levels across the top- ● Although not all learners will
learning opportunities for attend- ics, ranging from greater than 90% participate in prework, with clear
ees. Case studies at the live session comfort with adult learning theory and effective communication, a
enabled learners to apply informa- to less than 15% comfort with the more structured and engaging
tion from the prelearning experi- implementation sciences. Follow- online learning experience, and
ence. An audience response system ing the online lessons, although sufficient incentives (such as addi-
was used during the live session to some variation persisted, there was tional continuing education cred-
collect additional assessment data far greater homogeneity in terms of its), it is possible to surpass 80%
and validate learners’ level of un- comfort with the topics. participation.
derstanding of the topics addressed Finally, across all ArcheViewer- ● Connecting the flipped video
in the prework. powered prework, 11% of learn- series to the final planning of the
ers stated that they were ready to onsite symposium appears to be
WHAT WAS LEARNED change their practice related to one a critical success factor. How-
The flipped classroom model of the topics presented. This com- ever, this seems to depend largely
and novel e-learning technology mitment was made prior to arriving on access to timely and accurate
provided an overall learning expe- at the live symposium and therefore learning analytics (such as those
rience where outcome data and can be seen as a clear predisposition provided within the ArcheViewer
learner engagement allowed plan- for change. e-learning technology), permit-
ners to refine and focus structured At the symposium, 76% of re- ting planners and faculty to cre-
scenarios for application of the spondents claimed that by viewing ate a more rewarding live learning
content. This educational design the online series, they were better experience.
incorporated both the individual- prepared to engage with sympo-
ized learning experience and group sium faculty and to be more active REFERENCES
learning dynamics. learners. In addition, the majority Klegeris, A., & Hurren, H. (2011). Impact of
problem-based learning in a large class-
Of the 124 participants who at- of respondents felt that the flipped
room setting: Student perception and
tended the live session, 82% par- classroom model was an effective problem-solving skills. Advances in Physi-
ticipated in the online video series educational strategy. ology Education, 35, 408-415.
prior to attending the live sympo- McGowan, B.S. (2014, February 12). How great
sium. Of those who participated, SUMMARY is the impact of ArcheMedX-powered edu-
cation? [Web log message]. Retrieved from
74% self-reported watching more A flipped classroom educational
http://www.archemedx.com/blog/great-
than 10 videos in the 11-part series. design was used to educate and sup- impact-archemedx-powered-education
This high level of participation was port nurses in conjunction with the McLaughlin, J.E., Roth, M.T., Glatt, D.M.,
encouraging because 73% of respon- 2014 ANCC Annual Symposium Gharkholonarehe, N., Davidson, C.A.,
dents acknowledged that this was on Continuing Nursing Educa- Griffin, L.M., . . . Mumper, R.J. (2014).
The flipped classroom: A course rede-
their first flipped classroom learning tion. Although this project was not
sign to foster learning and engagement
experience. Completion rates for designed to be statistically rigorous, in a health professions school. Academic
the videos were greater than 85% several conservative conclusions can Medicine, 89, 236-243.
on average, and the average viewer be drawn:

Appendix J
Morin, K.H. (2014). Editorial: Fostering student accountability for learning. Journal of
Editorial
Fostering Student Accountability

for Learning
H
ow often have you said to or different type of learning experience— prepare responses to all questions, as
heard a faculty colleague say, “I one that requires students to be actively they do not know which questions will
want to use teaching strategies engaged in their learning—can be help- be asked. The challenge for faculty is to
such as the flipped classroom or collab- ful in proactively addressing potential generate questions that will prompt stu-
orative learning that engages students resistance to change. Thus, faculty may dents to think critically about the material
in their learning, but how do I hold stu- wish to share their evidence for its use, or reading that has been provided. A roll
dents accountable for coming to class along with highlighting the desired out- of the dice also can be used to determine
prepared?” One certainly can hear the come; that is, “the application, analysis, which student or group will be called on
frustration in this question. Recent pub- and synthesis of course content…rather to answer a question, thereby preventing
lications (Benner, Sutphen, Leonard, than rote memorization” (Hawks, 2014, any indication of not being fair. Finally,
& Day, 2010; McLaughlin et al., 2014) p. 267). Given that having students ac- explicitly stating the consequences at
reinforced that educators need to change tively engaged in their learning calls for the beginning of the course for students
how they have approached teaching. considerable collaboration, faculty may not being prepared and then adhering to
Thus, faculty are challenged to imple- wish to spend some time initially helping those consequences later can enhance
ment strategies that will engage students students learn how to collaborate (White, student preparation.
in their learning. Changing teaching style 2011), as well as emphasizing the critical Although these strategies may
requires a paradigmatic shift in how fac- role that teamwork plays in health care. enhance student preparation, it is equally
ulty approach learning to one that invites Student preparation and participa- important that faculty devote sufficient
students to work collaboratively to learn tion also can be enhanced by having time to creating meaningful pre-class
not only the required knowledge but also explicit and appropriate methods of as- work. Doing so may require consider-
the skills that will assist them when cop- sessment, based on individual and group ably more time and effort than required
ing with complex clinical issues encoun- efforts. For example, McLaughlin et al. for traditional approaches to classroom
tered in clinical practice. Meeting the (2014) indicated they used quizzes, stu- design. Both Hawks (2014) and Stiles
challenge with success requires prepara- dent presentations, and examinations to (2006) indicated that a comprehensive
tion on the part of the faculty, as well as evaluate student achievement of learning plan for pre-class and in-class activities,
the student, and calls for support from outcomes. Stiles (2006) provided several whether face-to-face or online, must be
those in administrative positions not only examples of peer evaluation forms that in place prior to undertaking strategies
relative to teaching strategies but also to can be used to evaluate student contribu- such as the flipped classroom and collab-
the provision of new resources, such as tion to group work, as well as an example orative learning, as most of faculty’s time
technology and flexible facilities. of how to grade individual performance in-class will be spent on interacting with
How can faculty be proactive in ad- while accounting for the student’s group students, precluding time to “plan activi-
dressing the possibility that students may participation. Because quizzes are fre- ties on a week-to-week basis” (Hawks,
not do the necessary pre-work to en- quently used at the beginning of class, 2014, p. 268). McLaughlin et al. (2014)
able them to participate in both face-to- faculty may wish to introduce some ran- reported that “In 2012, faculty needed
face and online class activities? Success domness to their administration. Gooblar 127% more time to prepare the flipped
is enhanced when faculty, as a whole, (2014) provided examples of how a roll classroom than they needed in 2011
endorse the use of student-centered learn- of dice can be used to determine whether to prepare the traditional classroom”
ing activities. However, not having all a quiz is given, what readings will be tested (p. 239). However, those authors antici-
faculty embrace these strategies does not for, and what specific questions will be pated that less time would be required,
preclude the individual faculty member answered. Using such a strategy requires as materials could be reused after be-
from implementing them. Hawks (2014) that students are provided with the ques- ing developed. Lage, Platt, and Treglia
suggested that preparing students for a tions before the class period and that they (2000) reported that it took approxi-
Journal of Nursing Education • Vol. 53, No. 10, 2014 547

EDITORIAL
mately 4 hours to develop and record and engagement in their own learning is to-come-to-class-prepared-try-rolling-the-
dice
each video presentation. essential to their development as lifelong
Hawks, S.J. (2014). The flipped classroom: Now
Finally, fostering student accountabil- learners. Thus, faculty must change the or never? AANA Journal, 82, 264-269.
ity for learning requires not only faculty focus from learning to pass the examina- Lage, M.J., Platt, G.J., & Treglia, M. (2000).
to be supportive of each other but also tion to learning to learn. Given the com- Inverting the classroom: A gateway to cre-
for academic administrators be support- plexity and uncertainty of health care, ating an inclusive learning environment.
The Journal of Economic Education, 31,
ive of these efforts. Nothing is more dis- nurse educators have the responsibility to 30-43.
couraging to faculty who are attempting structure learning experiences and teach McLaughlin, J.E., Roth, M.T., Glatt, D.M.,
to implement new strategies than to have in ways that foster student responsibility Gharkholonarehe, N., Davidson, C.A.,
their colleagues not be supportive of their and ownership of their learning, in part- Griffin, L.M, . . . Mumper, R.J. (2014).
The flipped classroom: A course rede-
efforts. Faculty’s willingness to invest nership with faculty and their peers so
sign to foster learning and engagement
considerable time and energy, their will- that students are prepared to continue to in a health professions school. Academic
ingness to incur student rancor conse- be active learners after they graduate and Medicine, 89, 236-243. doi:10.1097/
quent to introducing class activities that enter clinical practice. ACM.0000000000000086
require student participation, and their Stiles, A.S. (2006). Cooperative learning: En-
hancing individual learning through positive
persistence in continuing these practices References group process. Annual Review of Nursing
all play a significant role in fostering Benner, P., Sutphen, M., Leonard, V., & Day, L. Education, 4, 129-159.
student engagement in their learning. (2010). Educating nurses: A call for radical White, R. (2011). A sociocultural understanding
Given the complexities of health care, transformation. San Francisco, CA: Jossey- of mediated learning, peer cooperation and
Bass emotional well-being. Emotional and Behav-
not addressing student accountability for
Critz, C.M., & Knight, D. (2013). Using the ioral Difficulties, 16, 15-33.
learning does little to prepare the next flipped classroom in graduate nursing
generation of nurses to meet the health education. Nurse Educator, 38, 210-213. Karen H. Morin, DSN, RN, FAAN, ANEF
care needs of society and negates the doi:10.1097/NNE.0b013e3182a0e56a Associate Editor
impact that nurse educators can have. Gooblar, D. (2014, March 5). Want students to The author has disclosed no potential conflicts
come to class prepared? Try rolling the dice.
Although certain foundational content Pedagogy Unbound. Retrieved from https://
of interest, financial or otherwise.
is necessary, assuring student readiness chroniclevitae.com/news/368-want-students- doi:10.3928/01484834-20140922-10

Appendix K
Online Assignment Guidelines and Rubric
Discussion Board
Original Post: Your original post must relate to the lesson’s topic and cite your reading and
other applicable course material. In addition, you must answer all questions listed in the given
prompt.
Peer Responses: You are required to respond to at least one peer’s post for full credit. This
must be a thoughtful response, additional information, or question. This post must be at least 3
sentences in length, and must not be a simple agreement with the original post. Saying something
similar to “Good job” or “Interesting post” is not sufficient; please comment directly on whether
or not you agree with your peer, the quality of his/her response—and WHY, or ask a question to
promote further discussion.
Active Participation: One of your instructors will be active within the Discussion Board to guide
and promote discussion. He/she may pose new questions throughout the thread. Be on the
lookout for this and prepare to respond to these new questions or ways of looking at things. For
this reason, plan to log into the Discussion Board several times throughout the week and not just
when you intend to post. This will maximize your learning and allow you to actively participate.
APA Citations: Please be sure to cite the suggested reading and additional resources in APA
style.
Due Dates: You will not be given credit for late posts or peer responses.
Grading: Be sure to follow the grading rubric to ensure that you comply will all expectations.
(5 points possible)
0 points 1 point 2 points

Content of Original Post (2 No original post or does Does not fully address Fully addresses prompt,
points) not directly relate to prompt or reflect assigned reflects assigned material.
prompt or material. material, but demonstrates
some understanding.
Content of Peer Response No peer response or offers Response is adequate but Response is substantial
(2 points) simple agreement or may lack some and thorough, supported
disagreement with no thoroughness or factual with factual information.
support. support.
Writing Mechanics and Significant spelling or Minor to no spelling or
Compliance with grammatical errors, no grammatical errors,
Directions (1 point) citations as directed. includes citations when
necessary.
Blog
Blog Entry: Your entry must relate to the lesson’s topic and cite your reading and other
applicable course material. In addition, you must answer all questions listed in the given prompt.
style.
Due Dates: You will not be given credit for late entries.
(5 points possible per entry)

Content of Blog Entry No blog entry or does Does not fully address Fully addresses
(2 points) not directly relate to prompt or reflect prompt, reflects
prompt or material. assigned material, but assigned material.
demonstrates some
understanding.
Use of Resources (2 Does not use or reflect Demonstrates fair use Demonstrates
points) outside resources. of library and/or web- excellent use of
based resources to library and web-based
support assertions. resources to support
assertions.
Writing Mechanics Significant spelling or Minor to no spelling
and Compliance with grammatical errors, or grammatical errors,
Directions (1 point) no citations as includes citations
directed. when necessary.
Wiki Contribution
Wiki Contributions: Your contributions to the class wiki must relate to the lesson’s topic and
cite your reading and other applicable course material. They should further the class’s
understanding of the material and improve what has already been written.
style.
Due Dates: You will not be given credit for late contributions.
(5 points possible)

Content of No contributions or Does not fully address Fully addresses
Contributions (2 does not directly prompt or reflect prompt, reflects
points) relate to prompt or assigned material, but assigned material.
material. demonstrates some
understanding.
Quality of No contributions or Contributions Contributions

Contributions (2 contributions decrease somewhat improve substantially improve
points) the quality of the understanding and/or understanding and
information or writing quality of writing in quality of writing in
in the shared wiki. the shared wiki. the shared wiki.
Writing Mechanics Significant spelling or Minor to no spelling
and Compliance with grammatical errors, or grammatical errors,
Directions (1 point) no citations as includes citations
directed. when necessary.
Appendix L
On-Ground Lesson Presentation

Appendix M
On-Ground Lesson Material List
Handouts for On-ground Session

The following items will be provided to students in the on-ground session:
• On-ground Lesson note outline
• Constructivist Lesson Planning worksheet
• Online Lesson Creation worksheet
• Technology Tools handout
• Active Learning Activities worksheet
• Individual Implementation Plan worksheet
• Course Evaluation form
• Post-Course Rating Scale form
• Useful Resources for the Flipped Classroom handout
Materials for On-ground Session

The following materials will be available to students in the on-ground session:
• Poster board and marker
• Books:
Angelo, T.A., & Cross, K.P. (1993). Classroom assessment techniques:
A handbook for college teachers (2nd ed.). San Francisco, CA:
Jossey-Bass.
Barkley, E.F., Major, C.H., & Cross, K.P. (2014). Collaborative learning
techniques: A handbook for college faculty. San Francisco, CA:
Jossey-Bass.
Bowen, J.A. (2012). Teaching naked: How moving technology out of your
college classroom will improve student learning. San Francisco, CA: Jossey-
Bass.
• Articles:
Boucher, B., Roberson, E., Wainner, R., & Sanders, B. (2013). “Flipping” Texas
State University’s physical therapist musculoskeletal curriculum: Implementation
of a hybrid learning model. Journal of Physical Therapy Education, 27(3), 72-77.
Pierce, R., & Fox, J. (2012). Vodcasts and active-learning exercises in a “flipped
classroom” model of a renal pharmacotherapy module. American Journal of
Pharmaceutical Education, 76(10), 1-5.
• Headsets
• Laptops
o SoftChalk
o Internet browser
o Blackboard
Appendix N
Article 1 for On-Ground Lesson 3
Boucher, B., Roberson, E., Wainner, R., & Sanders, B. (2013). “Flipping” Texas State

————————————-—-—-- METHOD/MODEL PRESENTATION ---—-————————————
“Flipping” Texas State University’s Physical

Therapist Musculoskeletal Curriculum:
Implementation of a Hybrid Learning Model
Brenda Boucher, PT, PhD, CHT, OCS, FAAOMPT, Eric Robertson, PT, DPT, OCS, FAAOMPT,
Rob Wainner, PT, PhD, OCS, ECS, FAAOMPT, and Barbara Sanders, PT, PhD, SCS, FAPTA
Therapy Association (APTA) Vision 2020,2

Background and Purpose. Although Outcomes. Student response to a web-
in which physical therapy will be provided
our vision of physical therapist prac- based survey indicated overall satisfaction
by physical therapists who are doctors of
tice has changed considerably for future with the usefulness and effectiveness of
physical therapy, recognized by consumers
generations, methods of teaching have the recorded lecture format and the in-
and other health care professionals as the
not reflected a similar transformation. structors. Faculty response was positive
practitioners of choice to whom consumers
Additionally, students of today have an and overall class outcomes were improved
have direct access for the diagnosis of, inter-
inherent comfort level with technology. from traditional delivery.
The “flipped” classroom is an approach ventions for, and prevention of impairments,
Discussion and Conclusion. The model
designed to meet the distinctive set of activity limitations, participation restrictions,
presented in this paper describes the im-
expectations and requirements faced by and environmental barriers related to move-
plementation and evolution of a “flipped”
physical therapist educators. The purpose ment, function, and health.2
classroom to teach musculoskeletal con-
of this paper is to describe the methods tent to first-year physical therapist stu- Physical therapist educators also are
and outcomes of a blended learning ap- dents. Student response indicated that challenged to educate students in the face
proach—using the “flipped” classroom the model was useful and effective, while of limited resources and an ever-increasing
model—when delivering musculoskeletal qualitative feedback suggested means for demand to produce high-quality education
content to first-year physical therapist stu- improvement. to support a predicted increased demand
dents. Key Words: “Flipped” classroom, Instruc- for skilled health providers. Technology-
Method/Model Description and Evalu- tional technology, Musculoskeletal cur- enhanced instruction has been suggested by
ation. In this “flipped” classroom model, riculum. colleges and universities as a method to ex-
students view lectures prior to class, leav- tend limited resources, enhance educational
ing class time for instructors to engage quality, and engage students in manners that
students with critical content clarification may be more in line with their values and life
BACKGROUND AND PURPOSE
and valuable clinical reasoning as well as circumstances.3,4
Physical therapist educators are challenged
active learning activities (eg, psychomotor To reconcile the challenge faced by physi-
to make the best use of classroom time as
skills lab). cal therapist educators to convey knowledge,
they transition novice, first-year students
into competent clinicians who are prepared skills, and clinical decision-making abilities
Brenda Boucher is a clinical assistant professor with respect to the manner in which students
in the Department of Physical Therapy at Texas to face challenges associated with a busy
and sophisticated health care environment. of today best learn is a difficult if not daunting
State University, 601 University Drive, San Mar-
These challenges are not unique to physical task. One approach that is gaining popularity
cos, TX 78666. Please address all correspondence
to Brenda Boucher (bb10@txstate.edu). therapist education and exist in medicine and in many disciplines across the country is the
Eric Robertson is an assistant professor in the other health-related fields that seek to maxi- “flipped” classroom.5-8 The flipped classroom
Department of Physical Therapy at Texas State mize value within the unyielding constraint employs a learning strategy that takes activi-
University, San Marcos, TX. of time.1 Physical therapy is an applied pro- ties that traditionally occur inside the class-
Rob Wainner is an associate professor in the fession in which students are expected not room and places them outside the classroom,
Department of Physical Therapy at Texas State only to master the acquisition of theory and while those activities that normally take place
University, San Marcos, TX. knowledge, but they are required to dem- outside of class are given primary focus for
Barbara Sanders is a professor in and chair of onstrate proficiency with skills, techniques, time spent in class.5,6,9,10
the Department of Physical Therapy, and an as- and, most importantly—clinical reasoning. Using the flipped model, technology
sociate dean in the College of Health Professions (eg, web streaming, downloadable media
By graduation, students need to have dem-
at Texas State University, San Marcos, TX.
onstrated an entry-level comprehension of files, podcasts) is used to deliver less-active
This study met criteria and was granted status of events—such as listening to lectures and ac-
didactic content, confidence with evaluative
exemption by the Texas State University Internal
and manual skills, fluency in communica- cessing links to resources—outside of class
Review Board.
tion, and assuredness in clinical reasoning. time. Class time is then left for discussion,
The authors declare no conflict of interest.
Physical therapist educators are charged with laboratory, or other active-learning events.11
Received June 6, 2012, and accepted December
preparing students to enter the profession During class, students have direct interaction
12, 2012.
in accordance with the American Physical with faculty and are engaged with in-depth
72 Journal of Physical Therapy Education Vol 27, No 3, Fall 2013

learning activities that are guided by the in- are provided with regard to its development rich presentations using a web-based appli-
structor.5 The flipped classroom model re- from the spring semester 2009 to the spring cation, highlighted articles correlating to key
moves the less-active learning activities from semester of 2012 (inclusive of four different questions from prep sheets, and/or patient
the classroom and draws more active-learn- cohorts of students). The implementation of cases presented either in selected fashion or
ing experiences into the classroom.5 It should the integrated model in the classroom is also in their entirety.
be emphasized here that those using such an described. In-class lab. Lab was typically conducted
approach agree that technology and recorded for every scheduled block of instruction and
media are not the solution; rather, the man- The “Flipped” Classroom Model: constituted the majority of scheduled class
ner in which they are used and integrated Essential Components time (2-3 hours). Critical content clarification
into an overall approach make them poten- Out-of-class viewing of recorded lectures. and valuable clinical reasoning discussion
tially effective.12 This model of instruction All scheduled lectures for the course were took place during lab sessions. A structured,
represents a novel approach for faculty, which prerecorded in a digital format by faculty progressive approach to content pedagogy
has been described as moving the instructor responsible for teaching the musculoskeletal was used when introducing psychomotor
away from the role of “sage on the stage” and curriculum. Beginning in 2012, we also in- lab content. First, individual tests and mea-
toward acting as “the guide on the side.”13 corporated digital lecture content prepared sures of the physical examination considered
Instructions in using a modified learning ap- by faculty from several other collaborating critical for all patients and ones that students
proach such as the flipped classroom model programs. Recorded lectures were uploaded must perform were listed on an examination
have been described in other medical and to a central server where students could ac- “Precis,’” which was created for each region of
health science settings with variable but posi- cess streaming content via the web. The lec- study (eg, spine, lower extremity, upper ex-
tive results.14-16 tures were stored on Texas State University’s tremity). These tests and measures were dem-
The flipped classroom provides valuable Sakai-based learning management system onstrated, practiced, and incorporated into
faculty “face time” to students, which can be (LMS) called Teaching, Research, and Col- existing and subsequent lab practice sessions,
used to define and refine concepts, compe- laboration System (TRACS). The TRACS sys- with the expectation that students would
tence, and critical-thinking abilities.11 This tem enabled students to access the recorded achieve a level of psychomotor functional
classroom model is well-suited to meet the lectures without having to download large proficiency. Peer-learning was used during
5 ideal learning standards proposed by Fore- files and also served as a storage point for all this time as students were provided opportu-
arm8: (1) customize learning to the specific the course resources. The most recent semes- nities to give their partners feedback privately
needs of the individual, (2) provide immedi- ter included lectures recorded by collaborat- when working in pairs as well as publically
ate feedback, (3) create a constructive learning subject matter experts as well. Assigned when a group of students were demonstrat-
ing environment, (4) motivate students to lecture topics were listed in the course calen- ing a procedure to the class. As students
perform beyond externally imposed require- dar and were required to be viewed prior to gained proficiency, they were challenged to
ments, and (5) build enduring conceptual the class period in which they were due. As- integrate the items of the examination Precis’
structures.8 Constructing an appropriate mix sociated lecture handouts in the Adobe© PDF into a comprehensive regional examination
of technical, theoretical, and practical learn- file format were made available for each lec- performed by position (stand, sit, supine, and
ing opportunities can create an environment ture and could be downloaded from TRACS. prone) and to incorporate information from
useful in achieving intended instructional Out-of-class readings as preparation for the lecture material to augment their hypoth-
objectives such as these. class interaction. Faculty developed “prep” esis generation. A similar approach was used
The purpose of this paper is to describe the sheets for selected lectures, which included when providing instruction related to inter-
methods and outcomes of a blended learning reference citations for key articles (required vention as well as role-playing responses to
approach—using the flipped classroom mod- readings) and 3-5 questions related to the re- patient case scenarios.
el—when delivering musculoskeletal content corded lecture and/or key articles. The goals In-class problem solving and clinical reason-
to first-year physical therapist students. of the prep sheets were to help the students ing. Two activities were identified as vital to
prepare to contribute and facilitate class in- the students’ development of problem-solving
METHODS/MODEL DESCRIPTION teraction and discussion and were, therefore, ability and clinical reasoning: formative, mini
AND EVALUATION a strongly encouraged aspect of the lecture lab exams (FMLEs) and practice patient cas-
format. es. FMLEs were used to test content and per-
History of Instructional Models In-class review and discussion. The chal- formance and were typically conducted at the
The musculoskeletal curriculum at Texas lenge for this component was covering key beginning of the class period or immediately
State University historically has been deliv- content items for which the students would following the review and discussion session.
ered in 3 blocks of instruction using a body be responsible for without devolving into a Each FMLE included at minimum 1 question
region (ie, spine, lower extremity, upper ex- repeat of the lecture and squelching discus- related to lecture content, 1 technique dem-
tremity) approach. Lectures and labs were sion. The ability of faculty to provide an ap- onstration, and 1 question related to clinical
delivered in class using traditional learn- propriate debriefing (versus repeating) of a reasoning. During each class session, 2-3 stu-
ing models. The move to a DPT program in lecture gradually improved over the course of dents were selected, at random, to perform
2008 provided an opportunity to incorporate time for all 3 instructors. No single method an FMLE. Each FMLE performance was fol-
electronic-learning (e-learning) models into was found to work best, and each instruc- lowed with immediate constructive feedback,
the curriculum. Thus, plans developed to im- tor adapted to methods that were optimal first from students and then by the instructor,
plement a blended learning approach in the for their teaching style and the content be- on strengths of performance and recommen-
musculoskeletal course series. ing taught. These methods included open dations for improvement. Instructor written
The essential components of the flipped floor for student questions, instructor-seeded feedback was e-mailed to students addressing
classroom approach and blended learning questions with open discussion, summary specific strengths and weaknesses with grade
model are described below. Key comments presentations highlighting key slides, media assignment within 24 hours.
Vol 27, No 3, Fall 2013 Journal of Physical Therapy Education 73

Practice cases and case-based problem solv- jection, and recorded content. In addition, the development of prep sheets, fine-tuning
ing. Practice cases were used after examina- an overhead camera system was installed to the overall lecture length, and strategies for
tion and intervention techniques, including provide detailed visualization of lab activities debriefing lectures in class.
manual therapy and therapeutic exercise, and demonstration. The video system was an Class met twice weekly and was con-
were introduced. Practice cases were con- integral factor in mitigating the challenge of a ducted in two, 4-hour blocks of instruction.
structed to provide students the essential large student-to-faculty ratio. Although the format evolved over time, the
elements needed when practicing physical first 30 minutes has been used to conduct
therapy using an evidence-based philosophy. Model Implementation FMLEs, followed by 30-90 minutes of lecture
Each case included the following standard- The Texas State University Doctor of Physical content review using a variety of approaches
ized forms: medical screening, patient subjec- Therapy program incorporates a “spiral” cur- (eg, Socratic probing, discussion of prep sheet
tive report, pain diagram, and patient health riculum design, with a regional approach for questions, highlighting key lecture points,
outcome measure. Students teamed up into the musculoskeletal component, ie, students clarifying content and student understand-
patient/clinician pairs. A short debrief (5-10 enter the program studies in the summer ing, answering questions). The remainder of
minutes) followed the evaluation compo- and start the musculoskeletal curriculum class time was dedicated to psychomotor lab
nent of the practice case in order to answer in the spring semester of the first year. The activities, which included the introduction,
questions and clarify understanding. Student musculoskeletal curriculum is divided into demonstration, and practice of examination
clinicians were instructed to prepare an in- 3 regions (spine, lower extremity, and upper and intervention skills and manual therapy
formal write-up, prior to the next class, with extremity), and 1 region is taught each semes- techniques. In addition, the first 5-10 min-
a plan of care for first visit intervention and ter (spring, summer, and fall) so that each co- utes of the first class of the week included a
treatment progression through 6 treatment hort completes the musculoskeletal sequence purposeful, affective intervention consisting
sessions, depending on the particulars of the of the curriculum within a 12-month period. of inspirational, motivational, or professional
patient case. The spring semester of 2012 began the behavior content that was delivered using
Evidence-based practice (EBP) topic assign- fourth iteration of the model and represented YouTube videos and other publically available
ment. The purpose of the EBP assignment a fully integrated flipped classroom approach. multimedia content.
project was to have students explore selected The principle changes made were multiple The initial class session in the musculosk-
topics not covered in detail by the faculty in and varied: the proportion of streamed con- eletal curriculum was critical to the students’
the course to determine current best evidence tent; collaborative development of content success in the entire course series in that, in
and clinical integration related to those topics by subject matter experts; restructured class- addition to reviewing the expected profes-
and to facilitate peer-teaching and learning. time to compensate students for time spent sional behaviors, the initial class period was
Examples included topics such as postero- outside of class (eg, viewing lectures to avoid dedicated to orienting the students to the
lateral corner instability of the knee, lower artificially adding credit hours to a course); flipped/blended learning model, describing
extremity injuries in dancers, low back pain a structured approach to lecture debriefing, key aspects to having a successful experi-
and pregnancy, and calcific tendonitis for the which included guidelines and standardized ence, and setting course and instructor ex-
shoulder. Small groups were assigned indi- format, lab design, introduction of FMLEs, pectations. We emphasized the importance
vidual topics. The deliverables consisted of an and learning aides in the form of prep sheets; of viewing lectures prior to class, completing
oral 10-minute presentation in class; comple- and handout material posted on the LMS. directed readings, being an active participant,
tion of a 1-page clinical management guide, Prep sheets were short, 1-page summaries and practicing psychomotor skills covered in
which included key elements related to etiol- of lecture topics that included key questions the previous class periods.
ogy, prognosis, harm, key diagnostic and in- to be answered by the students after viewing a
terventional information; and a bottom-line lecture and required readings. Table 1 chron- OUTCOMES
summary. Edited presentations were then ologically outlines the principal changes The students in Texas State University’s Doc-
posted on the web as a department resource made to key components of the model from tor of Physical Therapy (DPT) program who
to alumni and the general public. 2009 to 2012 (4 cohorts). It should be noted participated in the flipped classroom model
Technology tool. Key technologic compo- that over the course of the 4-year implemen- ranged in age from 21-42 years. The students
nents that facilitated the delivery of the mus- tation, adjustments and decisions were made primarily presented to the program with a
culoskeletal curriculum existed in 2 main through review of subjective comments on bachelor’s degree, with less than 10% having
areas: preclass technology and in-class tech- course evaluations, in-class interviews with a graduate degree. Course grade averages and
nology. In the preclass area, faculty became students, and faculty input at the end of each average scores on practical examinations re-
proficient in screen capture technology and semester. This process allowed for items like mained consistent over time. Of note, during
scripting audio recordings to record lectures
prior to class. These lectures were developed Table 1. Key Component: Out-of-Class Viewing of Recorded Lectures
in a manner that allowed viewing on smart-
phones and other mobile devices and were Average length
Percent of Use of subject Compensated
stored on a central server. Students accessed Year of recordings
lectures recorded matter experts class time
the recorded lectures via the university’s LMS (minutes)
(TRACS), inline with other course content.
2009 20% 50 no no
In-class technology included access to
several key tools, which allowed a smooth 2010 45% 45 no no
interplay between recorded resources and
2011 80% 35 no yes
live discussion. A “smart” classroom station
allowed instructors to seamlessly switch be- 2012 100% 25 yes yes
tween lecture material, videos, overhead pro-

the most recent course year, the year with full Table 2. Survey Responses
implementation of the flipped curriculum in
place, no students failed a practical examina- Response: Mode, Mean (with 5 being “Very Effective”
tion during the course of the musculoskeletal Survey Items:
or “Strongly Agree”)
series. This was considered noteworthy, as it
was an atypical experience. Practical exami- What was your overall
nations in the musculoskeletal curriculum at impression of the effectiveness
4, 4.15
Texas State University are graded by clinician of the recorded lectures used
in this course?
examiners external to the program, and this
result can be regarded as an external valida-
tion of student performance. Question: How useful were
the Q&A/discussion sessions to 5, 4.5
debrief the lecture content?
Faculty Response to Model
Overall, faculty response to the flipped model
Question: How valuable was
was extremely positive. Faculty met weekly the fact that the lectures were
during the course of the implementation and 5, 4.5
delivered by subject matter
excerpts from discussions revealed several experts in the field?
main themes important to faculty, including
workload, lecture debrief, lab performance, Question: How effective were
and overall satisfaction. Faculty reported a the subject matter experts
4, 4.2
who delivered the recorded
reduced workload with respect to class prepa-
lectures?
ration. Since lecture prep occurred well ahead
of class time due to the prerecording process, Question: What is the overall
preparation during the busy semesters was value of having the ability to
5, 4.2
reduced. Faculty also reported that class dis- listen to the lectures outside
cussions during the debriefing of each lec- of class?
ture were efficient and reflected strong, prior
preparation by the students. Faculty reported The duration of each of the
that they were better able to hold integrative recorded lectures was an 3, 3.0
discussions during this time, using patient appropriate length of time.
examples and higher-level clinical reasoning,
since students were not receiving the infor- The additional lab time
mation for the first time during class. Faculty created by listening to lectures
experienced more time in class to devote to ahead of time allowed for
5, 4.4
adequate preparation for
lab performance and felt that the students’
formative, mini lab exams, and
also benefitted from the extra time. Finally, practical exams.
faculty reported an overall increase in job
satisfaction
Student Survey Outcome Qualitative Component Observation of how long they were. Really enjoyed
A web-based survey, developed using Google and Assessments this class!
Forms, was administered to students, follow- Fifty-eight percent of students opted to add
ing the 2012 iteration of the spine content— voluntary comments on the survey. Several Some lectures were way too long to sit
the first course in the musculoskeletal series. themes related to challenges of content deliv- through and be able to stop them and
The survey consisted of 10 questions and an take notes as needed. A 20-minute lec-
ery were noted in the comments section:
ture turns into a 1-2 hour task with note
option for voluntary comments. Eight ques- • Length of Lectures: While students did not taking, so a 45-minute lecture takes far
tions were in a 5-point Likert scale format feel that the overall work outside of class too long.
and 2 were yes/no questions. The response was excessive, many reported that lectures
rate for the survey was 100% (38 students). over 30 minutes reduced their satisfac- • Organization of Content: Several students
Questions were asked about the recorded tion, as notetaking could often dramati- felt that the logistics of navigating the LMS
lecture format, including questions about cally increase the time spent viewing a to access content was subpar and could be
overall effectiveness, use, ease of navigation, lecture. Example comments reflecting this improved by ensuring accuracy between
duration, and the value of outside subject concern included the following 2 com- the names of lectures on the schedule and
matter experts contributing to the lecture se- the actual lecture title. Overall, many felt
ments:
ries (Table 2). the course contained “too many docu-
Additionally, 2 yes/no questions were ments.”
The recorded lectures were extremely
asked. Thirty-seven percent of students re- • Effectiveness of the Instructors: Several
helpful …. I did appreciate that we
ported repeated listening of the lectures after had extra time to learn skills in class. students reported reduced satisfaction
their due date as part of their preparation I would just suggest that the lectures in their comments when lectures were
for examinations in the course, and 26% of don’t go any longer than 30 minutes. delivered by instructors with “monotone
students reported accessing the content on a The 40-minute and greater lectures voices” or when it felt like they were hav-
smartphone or other mobile device. were very hard to learn from because ing “slides read to them.”

• Technology Limitations: Many students either the classroom time or the level of stu- improved, as was the case in practical exam
expressed frustration with not being giv- dent preparation to engage in a higher-level, performance. This indicates that the flipped
en PowerPoint files, as had become the student-centered approach to learning. method may be able to produce equivalent
mode of delivery for lecture content in The other components of our approach outcomes with improved student and faculty
the curriculum. In addition to watching could be considered either supporting ele- satisfaction.
the movie file for each lecture on the LMS, ments or activities that flowed from the re- The technology resources used in craft-
students were given handouts for each lec- corded lectures. The advanced preparation ing this approach primarily included free and
ture in PDF format. This effectively forced of updated lectures allowed for the develop- commercially available resources for devel-
the students to devise new ways of taking ment and collection of test-bank items. In oping lecture presentations and performing
notes on lectures. While this seemed to be addition, it held instructors accountable for screen recordings. Many universities offering
a small problem to the faculty, it seemed recorded lecture content, as students could professional physical therapist education pro-
to cause the students significant stress. easily identify errata by referencing the lec- grams also offer some form of content man-
One student made a summative comment tures. Advanced student preparation enabled agement or learning management system.
that seemed to capture all of these themes: the ability to restructure class time, employ Therefore, the feasibility and generalizability
interactive teaching approaches, administer of this approach is high, given that adequate
The method used to organize content was in-class assessment, and provide immediate planning and staff time be allotted to allow
too complicated. The inability to take notes feedback. Time was available to introduce for the up-front workload of recording all of
on the lecture handout online was frustrat- a semester’s lectures prior to that semester.
detailed patient case scenarios, and students
ing. Many of the lectures could have been
were found to be much better prepared to en- The technology learning curve for recording
shorter. Having slides read to me doesn’t
help me stay interested in the subject mat-
gage in higher-level clinical reasoning when screen captures is slightly above simple web
ter. I did appreciate having experts as lec- working through these cases. Supporting navigation or lecture design; however, not so
turers. The FMLEs were tough but made me collaterals helped to reinforce content and high that it is an unachievable task for most
stay on top of my studying. The hands-on included formatted debriefing guides, high- physical therapist educators. Moreover, this
lab time was awesome. The instructors were lighted required readings, prep sheets, and flipped approach need not be limited to mus-
great. I enjoyed the class. supplementary handout material. In addi- culoskeletal curriculum, as it benefits poten-
tion, we found it integral to provide students tially extend across the entire span of physical
DISCUSSION with an overview of the pedagogy of the therapist education.
The musculoskeletal curriculum at Texas flipped classroom rationale and to set course Reflecting on our experience with the
State University employed a flipped class- expectations up-front. flipped classroom approach, Christensen’s11
room approach to instruction, implemented Student response to a web-based survey statement is worth noting: “With the rise of
over a 4-year time period. The structural dy- provided valuable information on the lecture online education, the future of learning will
namics of the approach have been outlined component of the curriculum. Student survey be a student-paced culture as opposed to our
and overall positive response to the instruc- responses indicated that several components current forms of custodial education, which
tional methods described. Recorded lectures were considered key value items: the delivery are teacher-based.”(p7) The incorporation of
are the central element of the flipped class- of content by subject matter experts; time online technologies with classroom activi-
room approach and provide leverage in a spent in question-and-answer debriefing ses- ties and overall pedagogy is rapidly emerging
number of ways, which have been more fully sions; additional lab time for preparation and and has many facets and components ripe for
described by others.1,7,10,17-19 These online testing; and the ability to listen to the lectures investigation. However, in our opinion, the
lectures—viewed at the students’ own pace— outside of class. Given these responses, it was more pressing needs for entry-level physical
replaced the traditional monologue lecture interesting to note that both the effective- therapist programs are additional descrip-
and allowed students to assimilate content ness of the recorded lectures and instructor tions and outcome reports in order to better
and gain more in-depth learning and under- delivery received lower ratings; however, identify and prioritize future research efforts.
standing during time spent in the classroom. this could be attributed to the student com-
The 3 main advantages to having all lec- ments indicating a low tolerance for lectures CONCLUSION
tures recorded and viewed by students prior that exceeded 30 minutes and for instructors Implementation of the blended/flipped class-
to class were the ability to: (1) spend more whose recorded lectures were characterized room approach for instruction in the mus-
time in dialogue and interaction with stu- by a monotone voice and limited inflection. culoskeletal curriculum of first-year physical
dents to clarify content; (2) use time savings Surprisingly, only 37% of students reported therapist students produced positive feed-
to delve into content at a more in-depth level; repeated listening of the lectures as a tool back from both students and faculty. Further-
and (3) spend more time teaching psycho- for studying for exams. Not surprising was more, the blended model produced improved
motor skills, while concomitantly engaging the low percentage of students that accessed learning outcomes as measured by course
in clinical reasoning and decision making. content on mobile devices, given that lecture grades, student surveys, and faculty response.
This approach also provided both time and content was not specifically developed and Student feedback indicated that the approach
a basis for integrating a Socratic teaching ap- formatted for mobile platforms. was received positively as a whole, although
proach, eliciting student-generated questions Faculty response to the flipped classroom the length and delivery of recorded lectures
and assessing student proficiency by way of approach was uniformly positive, with overall were a concern. In conclusion, the findings
oral quizzing and FMLEs. Students’ profi- improved satisfaction with work and student associated with teaching musculoskeletal
ciency was assessed by way of oral quizzing performance perceived. This has important content to first-year physical therapist stu-
and FMLEs in every class session and served implications for others considering using this dents using the flipped classroom approach
the purpose of providing students with regu- approach. Likewise, overall class outcomes support further exploration; specifically, the
lar and timely feedback on their progress. in terms of course grades and course evalu- development and assessment of competency-
A traditional lecture model seldom allows ations remained either unchanged or slightly based outcomes are recommended to deter-

mine the true value and impact of a flipped 6. Lage MJ, Platt G, Treglia, M. Inverting the 13. Frand J. The information-age mindset: changes
classroom model in physical therapist educa- classroom: a gateway to creating an inclu- in students and implications for higher educa-
tion. sive learning environment. J Economic Educ. tion. EDUCAUSE Review. 2000;September/
2000;31(1):30-43. October:15-24.
7. Lage MJ, Platt G. The internet and the inverted 14. Carbonaro M, King S, Taylor E, Satzinger F,
REFERENCES
classroom. J Economic Educ. 2000;31(1):11. Snart F, Drummond J. Integration of e-learn-
1. Prober CG, Heath C. Lecture halls without lec- ing technologies in an interprofessional health
tures: a proposal for medical education. N Engl 8. Foreman J. Next-generation educational tech-
science course. Med Teach. 2008;30(1):25-33.
J Med. 2012;366(18):1657-1659. nology versus the lecture. EDUCAUSE Review.
2003;July/August:12-22. 15. Evgeniou E, Loizou P. The theoretical base of
2. American Physical Therapy Association. Vi- e-learning and its role in surgical education. J
9. Knewton Inc. Blended learning: a disruptive
sion 2020. http://www.apta.org/vision2020/. Surg Educ. 2012;69(5):665-669.
innovation. http://www.knewton.com/blend-
Accessed May 15, 2012. 16. Sherman H, Comer L, Putnam L, Freeman
ed-learning/. Accessed June 23, 2011.
3. Mathur S, Stanton S, Reid WD. Canadian H. Blended versus lecture learning: outcomes
10. Petrinjak L. Blending traditional and online for staff development. J Nurs in Staff Dev.
physical therapists’ interest in web-based and
learning. NSTA Webnews Digest: NSTA Re- 2012;28(4):186-190.
computer-assisted continuing education. Phys
ports. http://www.nsta.org/publications/news/ 17. Sams A, Bergmann J. Flipping the classroom.
Ther. 2005;85(3):226-237.
story.aspx?id=58149. Accessed August 5, 2013. Educ Horizons. 2011;90(1):5-7.
4. Nkenke E, Vairaktaris E, Bauersachs A, et al.
11. Meyers CB. Clayton Christensen: why online 18. Sams A, Bergmann J. Flipped classroom offers
Acceptance of technology-enhanced learning
learning is ready for disruption now. http:// new learning paths. Electronic Educ Report.
for a theoretical radiological science course: a
thenextweb.com/insider/2011/11/13/clayton- 2011;18(23):1-3.
randomized controlled trial. BMC Med Educ.
christensen-why-online-education-is-ready- 19. Berrett, D. How “flipping” the classroom can
2012;12:18.
for-disruption-now/?awesm=tnw.to_1Bos4. improve the traditional lecture. The Chronicle
5. Gannod GC, Burge JE, Helmick MT. Technical Accessed December 19, 2011. of Higher Educ. http://chronicle.com/article/
report: using the inverted classroom to teach
12. Tucker B. The flipped curriculum. Educ Next. How-Flipping-the-Classroom/130857/. Ac-
software engineering. Software Engineering.
2012;12(1):82-83. cessed February 19, 2012.
2008:777-786.

Appendix O
Article 2 for On-Ground Lesson 3
Education, 76(10), 1-5.

American Journal of Pharmaceutical Education 2012; 76 (10) Article 196.
INSTRUCTIONAL DESIGN AND ASSESSMENT

Vodcasts and Active-Learning Exercises in a “Flipped Classroom” Model
of a Renal Pharmacotherapy Module
Richard Pierce, EdD, and Jeremy Fox, PharmD
Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, VA
Submitted June 4, 2012; accepted July 30, 2012; published December 12, 2012.
Objective. To implement a “flipped classroom” model for a renal pharmacotherapy topic module and
assess the impact on pharmacy students’ performance and attitudes.
Design. Students viewed vodcasts (video podcasts) of lectures prior to the scheduled class and then
discussed interactive cases of patients with end-stage renal disease in class. A process-oriented guided
inquiry learning (POGIL) activity was developed and implemented that complemented, summarized,
and allowed for application of the material contained in the previously viewed lectures.
Assessment. Students’ performance on the final examination significantly improved compared to
performance of students the previous year who completed the same module in a traditional classroom
setting. Students’ opinions of the POGIL activity and the flipped classroom instructional model were
mostly positive.
Conclusion. Implementing a flipped classroom model to teach a renal pharmacotherapy module
resulted in improved student performance and favorable student perceptions about the instructional
approach. Some of the factors that may have contributed to students’ improved scores included: student
mediated contact with the course material prior to classes, benchmark and formative assessments
administered during the module, and the interactive class activities.
Keywords: active learning, process-oriented guided inquiry learning, instructional design, pharmacotherapy,
renal therapeutics
INTRODUCTON model has transformed teaching practice by changing

The challenge for educators in every discipline is for traditional roles and increasing interaction between the
them to transition from being dispensers of facts to being instructor and students during class. In the flipped class-
architects of learning activities. Critical in this process is room, the responsibility and ownership of learning is
designing experiences that facilitate students developing transferred from the teacher to the students through par-
into active learners rather than passive receptacles of in- ticipation in interactive activities.
formation. While large-group lecture continues to be a sta- The empirical support for active learning, generally
ple of medical education, advances in video and audio defined as any instructional method that engages students
technology; the exponential growth of available quality in the learning process, is extensive.2 Health professions
online content, such as Coursera and The Kahn Academy; continue to grapple with the format and the extent to
and developments in cognitive science combine to chal- which they should include active learning, despite a grow-
lenge traditional notions of teaching and learning. The ing body of evidence for its efficacy. The Accreditation
“flipped classroom” instructional model was developed Council for Pharmacy Education (ACPE) requires the
by Jonathan Bergmann and Aaron Sams in 2007 to pro- inclusion of active-learning strategies. 3 Gleason and
vide instruction to secondary students who were missing colleagues provided a comprehensive overview of ac-
class and therefore missing instruction.1 In the flipped tive-learning strategies in pharmacy education and a
class model, what used to be class work (namely, the well-articulated rationale for adopting these strategies.4
instructor-led lecture and student note taking) is done While many programs use technology to electronically
prior to class, while what used to be homework (typically, capture lectures and thus shift the time and space in which
assigned problems) is done in the scheduled class. The teaching and learning may occur, there is little empirical
Corresponding Author: Richard Pierce, EdD, Shenandoah evidence concerning the use or efficacy of these flipped
University, 104 Keswick Court, Winchester, VA 22601. Tel: 304- classroom projects as a tool to improve student perfor-
376-6073. E-mail: rpierce@su.edu mance in pharmacy education. In this project, faculty at
1
the Shenandoah University’s Bernard J. Dunn School of attention placed on the effects of pharmacodynamic and
Pharmacy address the ACPE’s requirement for including pharmacokinetic properties of medications, was the focus
active-learning practices by integrating instructional ap- of the course.
proaches that are typically associated with the flipped The class of 2012 included 71 pharmacy students of
classroom model. The goal of this project was to assess which 30 (42%) were male and 41 (57%) were female.
the impact of the flipped classroom instructional model The educational background of participants included
on pharmacy student performance and perceptions. Flip- students with: 1 to 2 years of undergraduate education
ping the classroom requires a reconsideration of student (6 [8%]), associates degrees (8 [11%]), 31 years of un-
and faculty interaction because traditional lectures are con- dergraduate education (14 [20%]), bachelor’s degrees
ducted through videos outside of scheduled classes. In (42 [58%]), and master’s degrees (1 [1%]). To assess
this project, a process-oriented guided inquiry learning the development of student knowledge using the flipped
(POGIL) activity was used to actively engage students to classroom instructional model, in 2012, a pretest was ad-
develop critical thinking and problem solving. The POGIL ministered on the first day of the renal module. The pretest
instructional strategy has been endorsed by the National was constructed with an emphasis on the learning outcomes
Science Foundation after 2 decades of showing positive of the module, namely case-based clinical dosing vignettes
results in undergraduate basic science courses.5,6 The infor patients with end-stage renal disease. The pretest con-
vestigators hypothesized that the flipped classroom instruc- sisted of 17 items, of which 9 (53%) were application-
tional model would improve student test performance and level, case-based multiple-choice questions and 8 (47%)
student perceptions of the renal module. The research ques- were knowledge-level multiple-choice questions. Eleven
tions included: did the flipped classroom instructional (65%) of the 17 multi-choice questions had 4 possible
model impact student performance, and did the flipped response options and 6 (35%) had 5 possible responses.
classroom instructional model impact student perceptions Of the 23 hours of course material delivered in 2012,
of the renal module? 4 hours of lecture content in the form of vodcasts related to
dialysis therapy were provided for the students to review
DESIGN prior to the in-class activity. The vodcasts were assigned
A design experiment was selected as the guiding on the first day of the module immediately after the pre-
methodology of this study. The term was introduced in test. The vodcasts were course lectures that were origi-
1992 as a method to conduct formative research and refine nally performed live in spring 2011 and made available
educational designs based on principles derived from for viewing on iTunes U platform (Apple Computer,
prior research.7 Design experiments are set in the messy Cupertino, CA). Lectures are recorded in a voiceover sli-
situations that characterize real-life learning; in order to deshow format using Camtasia Relay (Techsmith, Lansing,
avoid the distortions of laboratory experiments and there- Michigan). In spring 2012, the same lectures, originally
fore constitute a means of addressing the complexity that recorded in spring 2011, were assigned, after the pretest,
is a hallmark of educational settings.8 This investigation to be viewed prior to the in-class activity. The POGIL ac-
examined the impact of active-learning strategies, in tivity was conducted during the next scheduled class, which
a renal pharmacotherapy module within the Integrated integrated information from the 4 vodcasts.
Pharmaceutical Care and Science (ICARE) series. The The POGIL activity consisted of 2 patient cases. The
Institutional Review Board of Shenandoah University ap- first case was a progressive patient case that required the
proved the project in April 2012. students to make multiple interventions for a single pa-
The renal pharmacotherapy module occurred in an tient as he transitioned from acute continuous renal re-
8-week pharmacy integrated therapeutics course that met placement therapy to chronic intermittent hemodialysis
twice weekly for 2 hours. In 2011 the total contact hours therapy. The second case involved a patient presenting
excluding assessments were 23 hours of lecture, a case symptoms of toxic ingestion of alcohol and required the
discussion, and a scheduled 1-hour review period prior to students to determine if renal replacement was necessary
the final examination. Module material was organized or if pharmacological therapy alone was adequate. At the
into 4 topics which included an introduction to renal conclusion of these cases, the students spent 90 minutes
and electrolyte disorders, acute kidney injury, chronic actively involved in simulated patient care, which in-
kidney disease, and dialysis. The course presented phar- cluded assessment of the patient’s renal function, drug
macy students with the pathophysiology of common renal dosing in renal replacement therapy, pharmacokinetic
diseases, renal replacement strategies, associated complica- calculations, in-depth discussion of the processes and
tions, and electrolyte and acid-base disorders. Therapeutic components that affect medication dosing, and discussion
management of patients with renal disease, with specific of methanol toxicology and the associated therapies.
2
All of the objectives from the vodcast lectures were range 5 43-100) final examinations. A t test assuming
covered during the activity through the completion of equal variance conducted to analyze differences in student
a series of calculations, or through student-centered dis- performance found significant differences between the
cussion of topics. The POGIL activity was conducted at renal questions on the 2011 and 2012 final examinations,
the application level of Bloom’s taxonomy of learning p 5 0.024.
domains as students were required to combine patient-
specific data and drug information to design a treatment Student Evaluations
regimen for the patient.9 The instructor-led activity guided Student’s perceptions of the flipped classroom ex-
students from one scenario to the next, interjecting salient perience also were determined. A 10-question survey in-
contextual information that connected lecture content and strument was administered using a 5-point Likert scale
lesson objectives to the clinical settings. Attendance for (strongly disagree, disagree, neutral, agree, strongly agree).
the spring module for 2012 was 100%, with 71 students The survey instrument investigated 2 domains of student
attending all scheduled classes. During the POGIL activity, perceptions: attitudes about the POGIL activity and per-
students were randomly called upon to confirm their an- ceptions about the flipped class instructional model. The
swers to the series of clinical questions and calculations. survey instrument was administered online using Survey
The structure of the activity mirrored the knowledge and Monkey (Palo Alto, CA) and was available for a 13-day
skills that were required on the formative assessments, the period between the posttest and the final examination.
course final examination, and the national board immedi- The survey response rate was 73.0%. Survey items for
ately after the POGIL activity, during the last class prior to agreement (strongly agree and agree) and disagreement
the final examination. (strongly disagree and disagree) were combined for
Another metric of student progress was a compari- reporting. Students’ responses to 5 items addressing
son of student performance on the 2011 and 2012 final student perceptions of the POGIL lecture yielded a
examination questions that related to the renal module. Cronbach alpha measure of reliability equal to 0.82.
The same instructor conducted the same lectures in 2011 Responses to 5 items addressing perceptions about the
and 2012 and the identical final examination questions flipped classroom instructional model yielded a slightly
were used in spring 2011 and spring 2012. The final ex- larger reliability ( a 5 0.83).
amination included 16 multiple-choice questions from Students’ perceptions about the POGIL activity
the renal module, of which 8 (50%) questions had 4 pos- (Table 1) were mostly favorable. The majority (96.0%)
sible response options and 8 (50%) questions had 5 pos- of the 52 survey respondents agreed or strongly agreed
sible responses. that viewing the prerecorded lectures prior to class was
important, and that active student participation was re-
EVALUATION AND ASSESSMENT quired in the POGIL activity. Most students (76%) also
Student performance on the renal pharmacotherapy agreed that the extent to which the instructor required
module delivered using the flipped classroom model was student participation in the POGIL activity was impor-
assessed by a pretest/posttest design and by group com- tant. Ninety percent of the students agreed that the in-
parisons. Assessments were administered electronically structor made meaningful connections between the
using a secure browser in a proctored setting. Question- topics in the prerecorded lecture and the class activities.
mark (Perception, Norwalk, CT) was selected for the cre- Seventy-six percent agreed that viewing prerecorded lec-
ation, delivery, and analysis of assessments. Data were tures was essential to successfully participating in the
further analyzed using SPSS, version 19 (IBM, Armonk, POGIL activity.
New York). Students’ perceptions about the flipped classroom
Descriptive statistics for the formative assessments instructional model were also mostly favorable. Eighty
in 2012 included the pretest (33.5 6 11.6 [mean 6 SD], percent of students agreed that the model improved their
range 0-59) and the posttest (79.2 6 10.6, range 53-100). self-efficacy to address the topics on the final examina-
A paired t test yielded significant differences for student tion. Seventy-eight percent of students agreed that being
performance in 2012 between pretest and posttest, p , able to view the lectures prior to class was important.
0.001. No pretest and posttest information was available Seventy-nine percent also agreed that increased faculty-
for 2011. A between-group comparison was conducted student interaction was desirable. Seventy-five percent
for student performance on the 16 renal ICARE final ex- felt the flipped classroom model was dissimilar to the
amination questions, between 2011 and 2012. Summed teaching model used in other pharmacy courses (n539,
scores were computed and yielded descriptive statistics 75.0%), and 62.0% expressed a desire for more instructors
for the 2011 (77.7 6 4.7, range 43-100) and 2012 (81.6 6 4.4, to use the flipped classroom model.
3
Table 1. Pharmacy Students’ Perceptions About the Use of Process Oriented Guided Interactive Lecture and a Flipped Classroom
Model to Teach a Renal Pharmacotherapy Module (N 5 52)
Strongly Disagree/Strongly
Agree/Agree Neutral Disagree
Viewing the lecture before scheduled class prepared me 50 (96) 1 (2) 1 (2)
for the class activity.
I did not view the lecture before class although I was 2 (4) 0 50 (96)
supposed to.
Viewing the pre-recorded lecture was essential to 40 (76) 6 (12) 6 (12)
successfully participating in the class activity.
The instructor made meaningful connections between the 47 (90) 4 (8) 1 (2)
topics in the pre-recorded lecture and the class activity.
The flipped classroom model was similar to other classes 3 (6) 10 (19) 39 (75)
in the Bernard J. Dunn School of Pharmacy.
I enjoyed being able to view the lecture prior to schedule 41 (78) 5 (10) 6 (12)
class as opposed to live class lecture.
The instructor required student participation in the in-class 50 (96) 1 (2) 1 (2)
activity.
I am confident about my ability to address these topics 42 (80) 5 (10) 5 (10)
on the final examination.
I want more interaction between students and faculty 41 (79) 8 (15) 3 (6)
members in class.
I wish more instructors used the “flipped classroom” model. 32 (62) 13 (25) 7 (13)
DISCUSSION model. Students expressed a consistently high preference

The flipped classroom instructional model for a renal for the flipped classroom instructional model relative to the
pharmacotherapy module replaced instructor-dominated traditional instructor-led lecture model. Future studies may
lectures, during which students traditionally took notes with provide additional insight into the impact of the flipped
highly interactive student-instructor activities. The design classroom on improved student performance and attitudes
of this project included repeated exposure to the content as the instructional model becomes more widely adopted
at the application level through a series of assessments in- in practice and the novelty of the approach abates. This
cluding a pretest, a class activity, a posttest, and a final flipped classroom project supports the notion that the qual-
examination. Scheduled lecture time was devoted primarily ity, not necessarily the quantity, of student-teacher interac-
to assessing student knowledge and developing student tion is a compelling force in improving student performance.
knowledge through activities. Prerecorded lectures, the pri- Additionally, this project supports a growing body of edu-
mary purpose of which is the transmission of information, cational research concerning how people learn and develop-
were viewed independently by students prior to class. Ac- ments in modern cognitive science by affirming students’
tive learning, through the POGIL activity, increased oppor- proclivity for active learning, and by demonstrating the ef-
tunities for students to apply knowledge to clinical case ficacy of active learning using the flipped classroom model
scenarios in class. Fostering critical thinking and problem to improve student outcomes.10-12
solving through formative assessments and participation in A limitation of this study was the scope of the in-
the POGIL activity was effective in preparing students for tervention. Expanding the intervention to other modules
the final examination format and content. Student perfor- or other courses, where appropriate, may provide addi-
mance on the 16 final examination questions relating to the tional evidence. Another limitation of the study was the
renal module significantly improved from 2011 to 2012. modest although significant improvements in student
While we believe that the improvement in student perfor- performance.
mance was the result of repeated exposure to the concepts
through the pretest, the POGIL activity, and the posttest, SUMMARY
further research is needed to discern if the improvement in The flipped classroom model is gaining recognition
student scores in 2012 was an anomaly. in a wide variety of academic settings as an approach
Pharmacy students recognized the convenience and to promote student-centered, active learning. This study
pedagogical benefits of the flipped classroom instructional detailed how using prerecorded lectures, or vodcasts,
4
engendered a more active, student-centered lecture style. 4. Gleason BL, Peeters MJ, Resman-Targoff BH, et al. An active-
The implementation of the flipped class in this study ac- learning strategies primer for achieving ability-based educational
outcomes. Am J Pharm Educ. 2011;75(9):Article 186.
companied improved student performance and generated
5. Eberlein T, Kampmeier J, Minderhout V, et al. Pedagogies of
positive student attitudes towards the experience. Further engagement in science: a comparison of PBL, POGIL, and PLTL.
research is needed to continue the investigation into the Biochem Mol Bio Educ. 2008;36(4):262-273.
efficacy of the flipped class. 6. Brown S. A process-oriented guided inquiry approach to teaching
medicinal chemistry. Am J Pharm Educ. 2010;74(7):Article 121.
7. Collins A, Joseph D, Bielaczyc K. Design research: theoretical
REFERENCES and methodological issue. J Learn Sci. 2004;13(1):15-42.
1. Bergmann J, Sams A. Flip Your Classroom. Reach Every Student 8. Cobb P, Confrey J, diSessa A, et al. Design experiments in
in Every Class Every Day. Washington, DC: International Society for educational research. Educ Res. 2003;32(1):9-13.
Technology in Education; 2012. 9. Bloom BS, ed. Taxonomy of Educational Objectives, Handbook
2. Bonwell CC, Eison AJ. Active Learning: Creating Excitement in I: The Cognitive Domain. New York, NY: McKay; 1956.
the Classroom. ASHE-ERIC Higher Education Report No. 1. 10. Gardner S. Preparing for the Nexters. Am J Pharm Educ. 2006;
Washington, DC: George Washington University Press; 1991. 70(4):Article 1.
3. Accreditation Council for Pharmacy Education. Accreditation 11. Litzenger T, Lattuca L, Hadgraft R, et al. Engineering education
standards and guidelines for the professional program in pharmacy and the development of expertise. J Eng Educ. 2011;100(1):123-150.
leading to the doctor of pharmacy degree. http://www.acpe-accredit. 12. Olds B, Johri A. Situated engineering learning: bridging
org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006. engineering education research and the learning sciences. J Eng
pdf. Accessed July 10, 2012. Educ. 2011;100(1):151-185.
5
Appendix P
Course Flyer
Y O U A R E I N VI T E D TO A T T E N D
Flipping Your OTA Classroom

Flipping Your OTA Classroom
A continuing education
opportunity to learn to
apply the flipped
classroom model.
This course aims to educate faculty in the use of the flipped classroom
model. It includes evidence for the use of the model and is designed to
promote faculty’s knowledge, skills, and acceptance of the flipped
classroom to support students’ OT education. The course is presented
A ME R I CA N C A R E E R
C OL L E GE OT A utilizing a flipped model, and incorporates many of the technologies and
P R O GR A M strategies that students will learn about within the course; this allows
participants to incorporate and evaluate their own learning experiences into
1200 North Magnolia Avenue
their future student instruction.
Room 212
Anaheim, California92801 This course was created as part of a Capstone Project for the Post-Professional Doctor of Occupational
Therapy program at Rocky Mountain University of Health Professions.
Instructor: Jeni Dulek, OTR/L

Phone: 714 763 9129
E-mail:
jdulek@americancareercollege.edu
Appendix Q
Pre- and Post-Course Rating Scales
Flipping Your OTA Course Pre-Course Rating Scale
Before you begin this course, please rate your agreement with the following statements. You
will complete the same rating following your completion of the course.
1. Your PREPARATION to implement the flipped classroom model in your own teaching:
1 2 3 4 5
Not at all prepared Moderately prepared Extremely prepared
2. Your perceived level of IMPORTANCE in implementing the flipped classroom model in

your own teaching:
1 2 3 4 5
Not at all important Moderately important Extremely important
3. Your CONFIDENCE in implementing the flipped classroom model in your own

teaching:
1 2 3 4 5
Not at all confident Moderately confident Extremely confident
Flipping Your OTA Course Post-Course Rating Scale
After you have completed this course, please rate your agreement with the following statements.
1. Your PREPARATION to implement the flipped classroom model in your own teaching:
1 2 3 4 5
Not at all prepared Moderately prepared Extremely prepared
2. Your perceived level of IMPORTANCE in implementing the flipped classroom model in

your own teaching:
1 2 3 4 5
Not at all important Moderately important Extremely important
3. Your CONFIDENCE in implementing the flipped classroom model in your own

teaching:
1 2 3 4 5
Not at all confident Moderately confident Extremely confident
Appendix R
Post-Course Reflection
The day I began my first full-time teaching position over one and a half years ago, my
new director tore a sheet of paper from her notebook, wrote the word “flipped” horizontally
across it, and handed it back to me. “Google this,” she said. “The flipped classroom. That’s
what we’re going to use” (M. Hartgraves, personal communication, March 17, 2013). That
director moved on from the position three months later, before I had the chance to see her
implement the model in her own teaching, and before I was able to develop my own flipped
course. Despite the fact that a new director took her place months later and did not necessarily
seem as enthusiastic or knowledgeable about the model as the first had been, the idea stuck with
me. I had indeed researched it on that first day, and I was intrigued. I designed my first course
using the model with very little reference to available literature, and continued using the model
throughout my teaching with a good understanding of its practice but not necessarily of the
theory and evidence behind it. As I designed this professional development course on the model
for my peers, and relied on research throughout, I realized how powerful this evidence-based
model can be.
As I researched and taught my colleagues about the flipped model in this project, I was
pleased to realize that some of the practices I had developed out of necessity in my own teaching
are actually supported by the literature. Practices such as making short online lectures versus
longer ones, requiring brief graded assignments online to reinforce learning, and incorporating
microlectures into on-ground classes were familiar to me already, and have been proven to work
in the flipped model. I easily implemented these into the design of this professional development
course as both a way of incorporating evidence into practice and of illustrating to my peers the
use of these practices.
Other practices within the flipped classroom model were new to me, but important that I
also incorporate into this course. For example, I created an online glossary for participants as a
way of providing additional support and resources in the online learning environment. I also
used blogs and wikis as assignments for the first time with the goal of becoming more familiar
with these assessment and learning tools. This project offered me the opportunity to explore new
evidence-based strategies I might use in the future with my own students, just as my peers might
use them as well.
The concept of presenting this course to my colleagues while utilizing the flipped model
made me somewhat nervous, as I anticipated some of the difficulties I have encountered with
students in the flipped model. Just as I suspected, two of the four on-ground participants did not
complete the online learning ahead of attendance. Rather than providing a required graded
activity at the beginning of the on-ground session, instead I incorporated discussion throughout
the session about how they could handle such a situation in their own classrooms. This was
helpful because it allowed them to identify the real-life reasons that students may not complete
their online work, so suggestions about how it be handled were less paternalistic and
disciplinarian than might have occurred without the first-hand experience.
I was pleased to learn that many of the participants were interested in implementing the
model in their own classrooms, rating it as “very important” on the pre-course rating scale. Still,
prior to the class, they had low ratings with regard to “preparation” and “confidence,” and
therefore were not ready to begin using it in practice. It was satisfying to see that the 4-hour
course influenced that readiness, even in the students who did not complete the online lessons.
Both of those students reported that they intended to review the online portion at some point in
the near future, though the learning analytics indicate that neither has done so since that date.
Another aspect of the project that I found to be rewarding was the fact that participants
used the on-ground time to talk realistically—but enthusiastically—about implementing the
model into their own teaching in the near future. During the lesson where participants created an
online lesson or activity, they prepared specific items with specific courses and lessons in mind.
During the lesson when I asked them to develop an on-ground activity, they excitedly used the
resources I made available to find certain activities that would meet their teaching needs. This
helped me see how useful it is to present such information in a professional, organized, and
motivating manner.
I am extremely pleased with how the course proceeded and what may come of it in the
future for our program. I am interested in exploring with our administration if this course might
be used with other programs at our institution as well, as they have a goal of developing more
blended programs that could benefit from use of this model. I am hopeful that the use of this
model will continue to grow, and that the evidence supporting it will expand to include higher-
level studies and more specific details that we can continue to incorporate into our teaching.
Appendix S
Course Evaluation
Thank you for participating in this course. I welcome your feedback.
Course Content
Poor Fair Satisfactory Good Excellent

Knowledge/skill before the
course
Knowledge/skill at conclusion of
the course
Relevance of content for my job
responsibilities
Relevance of assignments and
activities for my everyday use of
the content
What was the most useful topic covered within this course? Why is it useful to you?
Learning Materials and Environment

Content and organization of
online presentations
Content and organization of on-
ground presentations
The use of technology to support
my learning
Navigation and use of online
environment
Organization and set up of on-
ground environment
Productive use of online time
Productive use of on-ground time
What did you find most helpful about the way the course materials were presented in this course
(either online or on-ground)?
Course Instructor

Clarity of online presentations
Clarity of on-ground
presentations
Instructor’s involvement in online
portion of the course
Feedback I received for my online
work
Responsiveness of instructor in
online environment
Instructor’s preparation,
organization, and timeliness in
on-ground course
Instructor’s knowledge of content
Instructor’s ability to respond to
questions
Instructor’s ability to engage all
students in on-ground activities
What could the instructor have done to improve your learning experience?
Please rate your overall impression of the course:
1 2 3 4 5 6 7 8 9 10
Poor Fair Good Excellent
Would you attend another presentation/course by this instructor?
________ Yes ________ No
Is there anything else you would like to share? Please do so here.

Appendix T
HR-213 Form
Appendix U
Search History
Project: Educating the Educators to Flip: Introducing the Flipped Classroom Model to OTA
Educators
Clinical Question in PICO Format [Note – PIO is acceptable, simply insert N/A at C]:
P (population/problem): adult OTA (healthcare) students
I (intervention): flipped classroom model
C (comparison): traditional classroom lecture
O (outcome): student learning outcomes
Clinical Question in Sentence Format:
For adult occupational therapy assistant (healthcare) students, will the flipped classroom model
result in improved learning outcomes as compared to traditional classroom lecture?
Search Strategy
DATABASES/Websites [Must report on 3 ONLY Databases]:

CINAHL ** PubMed ** Ebsco OVID Cochrane Library OT Seeker
www.guidelines.gov ** List Other(s): ProQuest
Duplicates removed
Database Yields Hits Obtained Keywords
[# of initial [# after [# of articles ]
hits] limits]
“adult learners” and “flipped
ProQuest 27 19 7 classroom”
“flipped classroom” and

ProQuest 119 12 4 “occupational therapy”
“flipped classroom” and

ProQuest 113 59 18 “learning outcomes”
“flipped classroom” and “health

PubMed 15 8 6 education”
“flipped classroom” and “adult

Ebsco 165 5 3 learning”
Appendix V
Evidence Tables
APA Citation:
McCallum, S., Schultz, J., Sellke, K., & Spartz, J. (2015). An examination of the flipped
classroom approach on college student academic involvement. International Journal of
Teaching and Learning in Higher Education, 27(1), 42-55.
Research Problem and Purpose:

Student involvement theory suggests that there are certain behaviors and processes that support
student development, including engagement with course material, faculty, and peers. Because
the flipped classroom approach is relatively new to the college level, little is known about the
level of student engagement in these areas in a flipped college classroom. This study aims to
examine the academic involvement of students engaged in a flipped college course via focus
group interviews.
Study Participants:
Number: 60 participants
Describe Sampling: Researchers recruited 60 of the 71 students registered in three flipped
undergraduate courses (2 math courses and 1 business management course) to participate in the
study. Students had completed 15 of 16 weeks of the courses. 47% were male and 53% were
female, and participants represented a mix of majors, college experience, and nationalities.
Study Design & Data Collection Methods:
Theoretical Framework of Researcher(s):
Authors rely heavily on the student involvement theory within their research, suggesting that
instructors may design more effective learning environments by understanding student
involvement. They assert that student involvement includes many components and may be
influenced by how instructors engage students, which in turn may contribute positively to student
academic success and persistence. The authors base their research on the theory that because the
flipped classroom model involves out-of-classroom preparation as well as more active learning
activities and faculty/peer engagement in the classroom, these factors may influence student
involvement and therefore increase academic success and persistence.
Study Design:
This study uses a phenomenological design, in that it seeks to explore the experiences of the
students in a flipped college course.
Data Collection Methods:
Authors conducted six focus group interviews to explore students’ experiences with the flipped
classroom, especially their perception of its usefulness, impact on learning, and engagement with
faculty and peers. Students were randomly assigned to a focus group to allow for a mix of
students in each group. Written and verbal consent were obtained, and interviews lasted
approximately 30 minutes.
Analysis:
Four researchers examined transcripts of student responses from the focus groups and
independently identified themes from these responses. During analysis, they considered
concepts of academic involvement, including engagement with the course material, faculty, and
peers. After independently coding the responses, researchers discussed their interpretation of
responses and reached 100% agreement on theme coding.
Results & Conclusion (max 400 words):
Authors assert that overall, data suggests that students view the flipped classroom approach as
supportive to student academic success. Data within each of the three themes being explored
(academic involvement, peer involvement, and engagement with faculty) support this
conclusion.
With regard to engagement with the academic materials, students identified that online lectures
supported note taking strategies and allowed them to organize and improve their notes. They
also suggested that because they had viewed materials online before class, they felt more
prepared and engaged during classroom sessions. This includes coming to class with
background knowledge, specific questions, and the ability to engage with and apply pre-class
lessons during classroom activities.
When considering peer-to-peer involvement, students cited the ability to work with others on
class projects, engage with peers to solve problems, and share knowledge within the online and
classroom settings.
Lastly, students identified faculty members who utilize the flipped model as more approachable
and accessible than traditional courses, which in turn led to their perception that faculty have
increased insight into students’ knowledge and personal learning needs. Students also reported
feeling more comfortable contacting faculty outside of class.
Based on these findings, the authors conclude that the flipped classroom model fosters student
involvement by increasing student time and energy focused on learning activities. They assert
that this study considers how students become involved in a flipped classroom and suggest that
by addressing specific techniques within the flipped model, its effectiveness may increase. In the
section of the article addressing implications, authors suggest that students are concerned about
the self-discipline required by the flipped model, and offer suggestions regarding how faculty
may address this. They also raise the issue of how to engage Generation Y students who may
desire teamwork and fun in their learning, and suggest that they flipped model may meet these
learning needs.
Trustworthiness & Limitations of the Study –report information published by author(s)
and those you, the reader , perceive (max 400 words):
Authors identify two primary limitations to their study: its exploratory nature and the
generalizability of their findings, though both of these would be expected of a study of this kind.
Although they identify the exploratory nature of the study as a limitation, they do not elaborate
further on this assertion and instead go on to suggest future research opportunities based on their
preliminary research findings; I do not necessarily agree that this is a limitation because the
study was meant to be preliminary and it met those expectations. In describing generalizability
as a limitation, they explain that their study sample, three undergraduate courses at the same
institution, may not fully represent other students’ experiences in other classes or at other
institutions. They also identify the fact that their sample came from only one semester and from
small classrooms. Neither of these is a significant limitation, as it is generally accepted that a
qualitative study will not be generalizable.
In reviewing the study, several other limitations are evident. The first of these involves the
transferability of the data. Although researchers describe some demographics of their sample,
they do not include any details about the institution where their research took place. Because
they focused on students at only one institution, details about its location, resources, faculty, and
student demographics would have been useful to the reader to better understand the context of
the study. Details regarding the sample’s mean age and previous experience with the flipped
classroom model would also serve to better inform the reader regarding the context and
transferability of study data.
In addition, authors make no mention of methods used to ensure the confirmability and
credibility of their study. Techniques such as peer debriefing of the interviewers and member
checking were not mentioned, which leads to a conclusion that they were not utilized. The
article includes no description of the researchers’ backgrounds, or if the authors conducted the
interviews or if other interviewers were involved, leading to uncertainty regarding researcher
bias. Triangulation of data by utilizing another data collection method or involving students at
other institutions would also have served to strengthen the trustworthiness of this study.
Application of the Study to My Capstone Project- given the limitations noted above,
explain the rationale for using the study in your project, and explain how the study will
inform the capstone project. (max 350 words):
Although exploratory in nature, and somewhat limited in its trustworthiness, this article provides
a structured view of many concepts commonly believed or observed but not yet thoroughly
researched regarding the flipped model. I have found a lot of research that demonstrates that the
flipped model results in improved student engagement, but there has been little information
regarding how or why this occurs. Through the use of this qualitative research, the authors have
built evidence to support their theory that this is because the flipped model engages students
more with the material, peers, and faculty as compared to the traditional model. This is relevant
to my project because it not only supports the use of the flipped model, it suggests that
instructors must be aware of each of these three components when designing their courses and
lessons. I will use this evidence as I teach OTA faculty about the components of the flipped
model as well as evidence supporting its use.
APA Citation:
251.
*Note that this is a mixed-methods study that involves both qualitative and quantitative data.
The qualitative components are limited and would not constitute a complete or well-designed
qualitative study, as they are primarily gleaned from brief interviews with two instructors. I have
appraised only the qualitative components of the study here, and appraise the quantitative
components in the following table.
In the qualitative component of this study, researchers examined faculty members’ views of
student complaints and their solutions when implemented the blended (flipped classroom) model.
Their overall goal of the study was to investigate whether the blended model adopted within
undergraduate nursing programs could achieve the same if not better academic results as the
traditional classroom model.
Study Participants:
Number: Two instructors
Describe Sampling: For the qualitative portion of this study, researchers interviewed the two
instructors who taught nursing courses that had been converted from the traditional model in one
semester to the flipped model in the next semester. This was a convenience sample based upon
the fact that they taught the courses that included the students who were the subjects of the
quantitative research portion of the study.
The theoretical framework of the researchers is not identified directly. However, they describe
the setting of the study as a private four-year university specializing in healthcare education, and
share that all current nursing courses utilize the blended/flipped classroom model. The authors’
role in the adoption of this model is unclear, but the listing of author affiliations in the article
suggests that the last two authors are the instructors who were interviewed for the article. This
seems to indicate that they have experience with the flipped classroom model and have
encountered some of the obstacles mentioned in implementing it.
Study Design:
Although not identified as such, this research appears to be a phenomenological study, as it seeks
to determine participants’ experiences with the implementation of the flipped classroom.
Authors state that they interviewed the instructors regarding their perception of the adoption of
the flipped classroom model. This is the only information provided regarding qualitative data
collection.
Analysis:
Details of the qualitative analysis are limited. The authors describe the themes that emerged from
the interviews but not how they arrived at these themes.
The qualitative results of this study indicate that instructors experienced student reluctance to
view lectures and other course materials online prior to classroom instruction. Instructors were
faced with challenges relating to how best to engage and motivate students in the online portion
of instruction, and each responded differently. One gave students additional information about
the model and the expectation of the program regarding blended learning, and the other
implemented short quizzes at the beginning of each classroom session to improve student
preparation.
Authors conclude that although students may initially resist taking responsibility for their
learning in the online portion of the flipped classroom, strategies such as pop quizzes may
motivate students to comply with pre-class expectations.
and those you, the reader, perceive (max 400 words):
The authors do not identify limitations of the qualitative portion of the study, although many
exist. It is evident to the reader that the qualitative research lacks credibility, dependability, and
confirmability. Regarding credibility, the study lacks random sampling of interviewees and does
not identify a systematic approach to the interviews. In fact, it is unclear if the participants were
interviewed together or separately. In addition, the interviewers backgrounds and roles in the
study are unclear, and data analysis methods are not described. No peer review or member
checks were employed in this research, and only one data collection method (interview) was
used.
The study’s dependability is limited by the fact that the interview and data collection methods
were not described and therefore not able to be repeated, and the study lacks confirmability
because there is no description of researchers’ beliefs or identification of the study’s
shortcomings.
Despite this study’s clear limitations in study design and analysis, it is one of the few studies I
have located that includes instructors’ perceptions of the flipped classroom model. I think this is
an important aspect of model adoption to address in my project, as I will be attempting to
persuade my colleagues to adopt this model in their own courses. A description of barriers that
faculty have encountered and perceived is necessary, as is the presentation of possible solutions
supported by the evidence. This article identifies reasonable instructor concerns and suggests
that pop quizzes may assist instructors in facilitating student involvement with online materials.
I will present this as a possible solution to concerns likely to be raised by my colleagues, and will
use this article to open discussion of their own concerns regarding student engagement.
APA Citation:
251.
*Note that this is a mixed-methods study that involves both qualitative and quantitative data. I
have appraised only the quantitative components of the study here.
Research Question: (Phrase it as one or more alternative hypothesis(es))
The authors hypothesize that the blended (flipped classroom) model will yield the same, if not
better, academic results (grades) as compared with the traditional classroom model in students
enrolled in an undergraduate nursing program.
Study Design & Level of Study per CEBM Levels of evidence (LOE)(2011):
This study involves retrospective analysis of student grades for 2 nursing courses conducted first
in the traditional classroom method and then the next semester utilizing a flipped classroom
model. Researchers examined the course outcomes for both courses to determine if there were
differences in student learning between the two instruction models. This makes this a Level 3
quasi-experimental study relying on retrospective data.
Subjects:
Number:
In course 1, there were 66 students in the traditional course and 69 in the blended course. In
course 2, there were 65 students in the traditional course and 68 in the blended course. It is
unclear if the authors calculated an a priori power analysis to determine necessary sample size,
but it appears that these numbers simply came from the convenience sample of students the
authors had available to them.
Inclusion criteria:
Because this is a retrospective study, researchers did not designate inclusion criteria prior to
study inception. They included data from all students enrolled in NRSG110 and NRSG111 in
the fall of 2008 and spring 2009. These courses were conducted by two instructors at a private,
four-year university in the United States.
Exclusion criteria:
No specific exclusion criteria were utilized. All student data from the two courses over two
semesters were included.
Measurement:
Independent variable (s) for experimental and quasi-experimental studies (Intervention):
The independent variable was the instructional delivery method; this included two levels:
traditional (face to face) instruction and blended (flipped classroom) model.
Dependent variable (s):
The dependent variable was the students’ academic achievement.
Outcome measures utilized:
Researchers examined the final percentage grades for the courses to measure outcomes. They
report that the instructors used the same tests during both semesters in order to determine course
grades, but no details about the content or format of these tests are given. No other outcome
measure was used.
Results & Conclusions of the Study- Report any statistically and/or clinically significant
results and explain your rationale (max 400 words):

Authors used an independent t-test to determine if there was any statistical significance between
the grades students earned in the traditional classroom versus the flipped classroom. Results for
the course focusing on concrete concepts indicated a slight increase in mean course percentage
following implementation of the flipped model as compared to the traditional model; this result
was not found to be statistically significant. Results for the course focusing on more application-
oriented learning showed a slight decrease in mean course grades as compared to the traditional
classroom; this too held no statistical significance. Authors concluded that students in a flipped
classroom perform at the same level as students in a traditional model, but note that blended
learning may offer students more of an advantage in courses relying on factual and conceptual
knowledge rather than application. They suggest that this may be because the online component
of the flipped classroom allows for simple repetition, which may increase students’ ability to
memorize information.
Study Limitations- report both those published by the author(s) and those you , the reader,
perceive (max 400 words):
Authors identify their study design as the biggest limitation of the study, as it offers only
tentative results than cannot be confirmed without a prospective randomized experimental
design.
In addition, the study lacks demographic data on study participants, which might include student
gender, age, previous education, technological comfort/experience, and typical academic
performance. This information would strengthen the study’s design and ability to be
generalized. Related to this is the fact that no analysis of the two study groups was done to
determine homogeneity between them. Because of this, the groups cannot be assumed to be
similar in demographics and the outcomes cannot be assumed to be derived solely from the
intervention but rather may have been a result of other confounding variables not taken into
account by the researchers.
The authors also note that the experience with blended learning was the students’ first such
experience, and suggest that their motivation and achievement may have been impacted by the
novelty of this approach. It is unclear how they know this, because it is possible that students
had previous experiences with the flipped classroom at other institutions or in other courses
within other academic programs. While it is possible that they are correct in their reporting that
this is the students’ first such experience, they do not describe how they gathered this
information from students whose grades were examined retrospectively, and it seems unlikely
that none of the approximately 120 subjects involved in the flipped courses had never been
involved in one previously.
Additionally, the study is limited by a focus only on grades as an outcome. These grades appear
to be measured solely on exams, which may not adequately capture student learning, especially
in relation to application of knowledge. It is possible that the flipped model improves students’
ability to apply information but that this outcome was not measured accurately and therefore not
represented in the students’ final course grades. An additional outcome measure, perhaps a lab
assessment or other application-based measure, could more adequately capture such an outcome,
although it would confound the results of this particular study.
Application of Study to My Capstone Project- given the limitations noted above, explain
the rationale for using the study in your project, and explain how the study will inform the
capstone project. (max 350 words):
This study is similar to many other quantitative studies I have encountered in the literature in that
it does not utilize a prospective experimental design and therefore is a lower level of evidence
than would be ideal. This seems related to the fact that the flipped model is still fairly new and
many studies rely on researchers’ personal experiences or access to retrospective data.
Therefore, I must take into account the limitations of this study when utilizing it within my
project.
Despite this, this study focuses on healthcare education and offers a reasonably-sized sample of
participants. That it focuses only on grades as a learning measure means that it offers evidence
to administrators, faculty, and students that students’ grades will not be affected by such a
dramatic shift in instructional design when moving from a traditional to flipped classroom
model. I will use this when teaching faculty about the evidence supporting use of the flipped
classroom in healthcare education.
APA Citation:
*Note that this article documents a mixed-methods study involving both quantitative and
qualitative data. I have appraised only the qualitative research component here.
This article seeks to explore the learning environment of both a flipped classroom and a
traditional classroom to determine students’ views of their learning experiences. The author
identifies his research question as “How does the learning environment of an inverted [flipped]
introductory statistics classroom compare with the learning environment of a more traditional
lecture-homework introduction to the statistics classroom?” (Strayer, 2012, p. 172).
Study Participants:
Number: 26 students who participated were in the traditional course and 23 were in the
flipped course, for a total of 49 participants.
Describe Sampling:
Participants were all students in two different introductory statistics classrooms at an American
university. Typical students at this university are middle class white Americans from the
Midwest. There were equal numbers of participants by gender, and a majority of students in
both sections were in their first or second years of study. A variety of majors were represented
within the participant pool.
The author identifies that the outcome measure used in the quantitative aspects of this research
follows Moos’ framework for describing human social environments, and thus his research also
relies on these theories. Within this framework, there are three domains that influence human
environments: relationships, personal growth, and system maintenance and change. The author
does not elaborate on how this framework directly influenced his research.
Study Design:
This research uses a grounded theory qualitative analysis. The author’s goal was to learn more
about students’ perceptions of the traditional and flipped models to inform teaching practice and
identify ways to structure productive classroom learning.
Four researchers participated in data collection, which included observations and field notes,
recordings of class sessions, and a reflective teacher journal. Three researchers also conducted
individual and focus group interviews.
Analysis:
Researchers first used open coding on the qualitative data, which included 115 codes. They then
organized the data, generated themes, and tested hypotheses through additional coding and
memo writing, which resulted in several major categories. The author then reviewed the data
again, reflected on possible connections, and built dimensional ranges for each property
observed. This resulted in three main areas being identified as contributors to how students
interact with the material, peers, and faculty in the classroom.

The three areas identified as contributing to student interactions in the classroom are: types of
activity, homework dynamics, and in-class dynamics. With regard to the types of activity used
within the classroom, students expressed frustration with the flipped model in that that did not
know what kind of activity to expect, but also described adapting their learning strategies and
saw the benefits of helping each other learn. In the traditional classroom, students appreciated
having a set structure to class activities.
The study found similarities between the homework dynamics of the flipped and traditional
models. Students expressed concern about keeping up with homework, though the flipped model
meant that many put off their homework and tried to complete it all at once. In addition, because
the online work was provided by a publisher rather than the instructor himself, students were also
faced with the challenge of making a connection between the online and in-class work. The
author points out that this could be beneficial if time was allowed for students to make these
connections and strengthen their conceptual understanding, but acknowledges that this course did
not allow for that to happen and students in the flipped classroom were at a disadvantage.
The findings regarding in-class dynamics are complex and relate mostly to the loose atmosphere
that the instructor brings to the class. In the flipped classroom, students reported this as being
negative, but in the traditional classroom, students focused on this as a positive. The students in
the flipped classroom identified themselves as very active in the classroom, but reported
conflicted feelings about the expectation that they attend and engaged.
and those you, the reader , perceive (max 400 words):
Throughout the article, the author describes many procedures used to establish trustworthiness.
To establish credibility, he included several researchers other than himself, was previously
familiar with the institution, courses, and students, and used several sources and methods of data
collection. To establish transferability, he included details about the student demographics and
institution, as well as about his data collection methods. In establishing dependability, the author
shares reflections on the process and his conclusions, and shares specific details of what occurred
in the field, including some interview transcripts.
The author identifies several major limitations in the study, all of which could affect credibility.
The first author-identified limitation is the fact that he was both the instructor and a researcher in
his classrooms. He also identifies concern about students not sharing criticisms because of the
possibility of these influencing their grades in the course. Lastly, the author suggests that the
fact that students were not randomly assigned to either course limits the generalizability of the
data and conclusions.
The author established transferability and dependability well, but did not do the same with
confirmability. The study lacks member checking or peer review, and makes no mention of an
audit trail. These procedures would all allow the reader to feel certain that the author was
objective in his reporting.
This article applies my capstone in that it raises several likely student concerns or complaints
about the flipped model. Although the author does not provide individual suggestions for each
of the student concerns identified within the study, he mentions several that may be useful,
including providing instructor-produced online lessons, assist students in anticipating what is to
come in the flipped classroom, and consider using the flipped model for more advanced rather
than introductory courses. These are all practical suggestions that will be useful to suggest to
instructors as we discuss the application of this model to our own classrooms.
Additionally, this article highlights several benefits of the flipped classroom for students,
including the fact that students become more aware of their own learning processes, have
increased opportunities to integrate and apply information, and can benefit from each others’
learning. These will be important to discuss and include in my presentation on evidence
supporting the flipped model.
APA Citation:
*Note that this article documents a mixed-methods study involving both quantitative and
qualitative data. I have appraised only the quantitative research component here.
Research Question: (Phrase it as one or more alternative hypothesis(es))
Both the qualitative and quantitative elements of this study were designed to answer the question
“How does the learning environment of an inverted [flipped] introductory statistics classroom
compare with the learning environment of a more traditional lecture-homework introduction to
statistics classroom?” (p. 172) The author does not specify his hypothesis, but his literature
review suggests that he expects that when structured well, the blended classroom will be
preferred over the traditional classroom.
Study Design & Level of Study per CEBM Levels of evidence (LOE)(2011):
This study is a level III quasi-experimental study that involves two groups: students who took the
flipped course, and students who took the traditional course. These courses occurred
concurrently, but students were not randomly assigned. At the same point in the semester in both
courses, students completed the College and University Classroom Environment Inventory
(CUCEI) to assess their perceptions of their given learning environment.
Subjects:
Number: 27 students in the traditional classroom and 23 students in the flipped classroom
participated, for a total of 50 participants. This was a convenience sample and a power analysis
was not conducted prior to participant recruitment.
Inclusion criteria: The author does not describe specific inclusion criteria except that students
must be enrolled in the corresponding statistics course.
Exclusion criteria: The author does not describe specific exclusion criteria. Students who
completed the inventory must have not dropped the course by the time it was administered.
Measurement:
Independent variable (s) for experimental and quasi-experimental studies (Intervention):
The independent variable being examined is type of classroom instruction—either flipped or
traditional.
Dependent variable (s): The dependent variable is student perception of the learning
environment.
Outcome measures utilized: The College and University Classroom Environment Inventory
(CUCEI) was used to measure student perception. This tool’s internal reliability has been
established as “quite acceptable in multiple studies” (p. 175), with Cronbach’s alpha coefficients
for the seven scales ranging from 0.70 to 0.90. Students completed the CUCEI twice to reflect
their actual and preferred classroom environments.
Results & Conclusions of the Study- Report any statistically and/or clinically significant
results and explain your rationale (max 400 words):
Due to the multidimensional nature of the data, the author used a paired design, repeated
MANOVA to pair actual and preferred answers for each scale. This yielded significant results,
which then led to use of paired and independent t tests. The results generally indicated that their
actual learning environments (whether traditional or flipped) did not measure up to their
preferred environments. Between the (actual) traditional and flipped classrooms, there were
significant differences on the survey for Innovation, Task Orientation, and Cooperation
subscales. The author discusses this result in light of the qualitative data from the study, and
describes how it was reinforced through the interviews with students. The Task Orientation
subscale differences indicate that students found the flipped classroom to be unpredictable and
difficult to adjust to, though the author argues that this is not necessarily a negative thing.
Study Limitations- report both those published by the author(s) and those you , the reader,
perceive (max 400 words):
The author identifies several limitations relevant to the quantitative portion of the study,
including the fact that he was both teacher and researcher, and that students were not randomly
assigned to either the flipped or traditional classroom. The reader also identifies that the author’s
argument that low task orientation is not necessarily a negative thing highlights a possible
incongruence between his teaching beliefs and the outcome measure he used in this study. The
CUCEI was selected to measure student perceptions on several aspects of the classroom, and if it
is indeed a valid measure, should indicate low scores on items that can or should be improved.
His disagreement with the data it provided suggests that this may not have been the proper
outcome measure for use with this study.
Application of Study to My Capstone Project- given the limitations noted above, explain
the rationale for using the study in your project, and explain how the study will inform the
capstone project. (max 350 words):
This study offers some useful insight into student perceptions of the flipped classroom as they
relate to both the traditional classroom as well as a perceive ideal classroom. Through the use of
a quantitative survey process and outcome measure, the author is able to identify specific items
that students do and do not like about this model. While he was able to use this information to
ask specific questions in the qualitative portion of the study, it can also be useful for instructors
to understand so that they can make observations and adjustments regarding student satisfaction
within their own classrooms when using the flipped model.
Appendix W
Critically Appraised Paper
Critical Review Form – Quantitative Studies

©Law, M., Stewart, D., Pollock, N., Letts, L. Bosch, J., & Westmorland, M.
McMaster University
- Adapted Word Version Used with Permission –
The EB Group would like to thank Dr. Craig Scanlan, University of Medicine and Dentistry of
NJ, for providing this Word version of the quantitative review form.
Instructions: Use tab or arrow keys to move between fields, mouse or spacebar to check/uncheck boxes.
CITATION Provide the full citation for this article in APA format:
Missildine, K., Fountain, R., Summers, L., & Gosselin, K. (2013). Flipping
the classroom to improve student performance and satisfaction.
Journal of Nursing Education, 52(10), 597-599.
STUDY PURPOSE Outline the purpose of the study. How does the study apply to your research
question?
Was the purpose This study aimed to measure the effectiveness of the flipped classroom
stated clearly? model on the academic success and satisfaction levels of nursing students at
the Bachelor’s level. The authors hypothesized that students’ exam scores
X Yes would be higher in the flipped classroom than in the traditional classroom or
No the traditional classroom with lecture capture. They also hypothesized that
the flipped classroom model would result in higher student satisfaction scores
than either of the other methods studied.
LITERATURE Describe the justification of the need for this study:
The authors describe the concept and use of lecture capture at length,
Was relevant background including literature identifying the challenges of using this method for both
literature reviewed? students and instructors. They explain that lecture capture has received
Yes “mixed reviews” (p. 588) and they seek to measure the effects of lecture
X No capture and other activities on nursing students’ learning and subjective
experience.
This literature review is limited in that it does not cite or describe any
available evidence addressing the flipped classroom model, although the
flipped classroom is the focus of their study. While lecture capture is one
method used within the flipped classroom, the flipped model incorporates
many other methods such as active learning activities, that are not adequately
addressed within this article. It would be more appropriate for the authors to
discuss the evidence that addresses the benefits of the flipped classroom
model, rather than just the drawbacks of using lecture capture.
DESIGN Describe the study design. Was the design appropriate for the study question?
(e.g., for knowledge level about this issue, outcomes, ethical issues, etc.):
Randomized (RCT) The study involves examination of data from three consecutive semesters of
X cohort nursing classes (cohorts). The first semester involved teaching with lecture
single case design only, the second involved lecture only plus lecture capture, and the final
before and after semester utilized the flipped classroom approach, resulting in three levels of
case-control the variable. Researchers examined students’ exam grades throughout each
cross-sectional semester and also conducted surveys regarding student satisfaction with the
case study teaching method.
The cohort design seems appropriate in that it appears that these courses
would have been taught using these methods regardless of the study.
Therefore it did not require randomization or disruption of the students’
education in order for the study to take place, which is an ethical approach to
the situation and students’ learning needs. Researchers used a convenience
sample to measure real students’ real-world educational experiences, and this
seems appropriate. In addition, most of the available literature examining the
flipped classroom also utilizes this design and is consistent with the
knowledge level about this model.
Specify any biases that may have been operating and the direction of their
influence on the results:
The article specifies that the authors are all involved directly in nursing
education, either as deans, professors, or instructors. It is unclear if this
research was conducted at the institutions where they teach, or possibly even
within their own courses, which could have affected the study outcomes,
especially regarding student satisfaction because it is more subjective than
exam grades.
SAMPLE Sampling (who; characteristics; how many; how was sampling done?) If
more than one group, was there similarity between the groups?:
N =589 Researchers recruited a convenience sample of 589 students over the three
Was the sample described semesters from the courses being examined. They include some details about
in detail? the sample as a whole, including the fact that it was 75% Caucasian and 81%
X Yes female; they also include mean age, average hours worked outside of classes,
No and number of credit hours they were enrolled in. However, they do not
provide a detailed description of each of the three groups separately, making
Was sample size it impossible to know if there were differences in the groups’ demographics
justified? that might have accounted for a difference in outcomes. In addition,
X Yes differences in other variables not addressed within the study, such as comfort
No with technology or previous GPA, could account for a difference in outcomes
N/A as well. Had the authors acknowledged and accounted for these variables,
the study would be strengthened.
The authors justify the sample size with an a priori analysis of power for one-
way ANOVA for three groups, which came out to be 159 participants. Their
sample size was much larger at 589.
Describe ethics procedures. Was informed consent obtained?:

Authors state that the study was approved by the institutional review board,
but do not include any other details about ethical procedures including
informed consent. It is unclear if all exam scores were included in the study
or if students were allowed to opt out of including their scores in the results.
OUTCOMES Specify the frequency of outcome measurement (i.e., pre, post, follow-up):
The outcomes (grades and satisfaction levels) were measured post-
Were the outcome intervention.
measures reliable? Outcome areas: List measures used.:
X Yes Grades on exams Course exams (no details about
No question type or consistency of exam
Not addressed questions between semesters are
Student satisfaction included)
Were the outcome
measures valid? Faculty-developed satisfaction
Yes questionnaire with 16 items on a 4-
No point Likert scale
X Not addressed
INTERVENTION Provide a short description of the intervention (focus, who delivered it, how
often, setting). Could the intervention be replicated in practice?
Intervention was Researchers examined the outcomes following three separate courses that
described in detail? used three different teaching methods. The first involved lecture only (as in
Yes the traditional classroom model), the second involved lecture plus lecture
X No capture (meaning that students received the traditional lecture in the
Not addressed classroom but access to videos repeating the lecture when at home), and the
last involved what they called “lecture capture plus innovation” (p. 588).
Contamination was This final intervention is described as including at-home videos (lecture
avoided? capture) as well as in-class simulation, case study, games, and “other
Yes exercises” (p. 588), and is defined as the flipped classroom. Similar to the
No descriptions in other research on the flipped classroom model that lack a
X Not addressed clear definition of the intervention, this description does not specify what
N/A these “other” exercises are or what activities were implemented at what
frequency. In addition, the article does not specify how long classes were,
Cointervention was the number of credit hours, the topics covered, details about the educational
avoided? institution, or a description of the course assignments.
Yes
No The researchers’ description of the intervention also does not include any
Not addressed information about who taught the courses, or if they were taught by the same
X N/A instructor from one semester to the next, which could influence students’
grades and satisfaction as much as the model itself. They make reference to
the infrastructure (classroom availability and high-speed Internet access), but
do not include enough details on these topics to make it relevant or useful to
the reader. Lastly, they do not include the student-faculty ratios of the
courses. For all of these reasons, this intervention could not be replicated in
practice.
RESULTS What were the results? Were they statistically significant (i.e., p < 0.05)? If
not statistically significant, was study big enough to show an important
Results were reported in difference if it should occur? If there were multiple outcomes, was that taken
terms of statistical into account for the statistical analysis?
significance? Regarding student grades, the flipped classroom group scored higher than the
X Yes lecture plus lecture capture group with a significance value of p<0.003, and
No better than the lecture only group with a significance value of p<0.001. The
N/A mean differences were small, with just two points between the lowest and
Not addressed highest scoring groups, but the results were statistically and clinically
significant. These results were obtained using a one-way ANOVA to
Were the analysis measure the differences between the three samples.
method(s) appropriate?
X Yes To analyze the student satisfaction rating scores (n=445), the researchers
No used a Kruksal-Wallis test because there were three samples and they were
Not addressed not normally distributed. The results of this test showed significant results in
favor of both the lecture only and lecture plus lecture capture groups as
compared to the flipped classroom group. Lecture only versus flipped
classroom resulted in a p value of p,0.001, with the flipped classroom
students being significantly less satisfied than the lecture only group.
Comparison of lecture plus lecture capture versus flipped classroom also
resulted in p < 0.001 with the flipped classroom students significantly less
satisfied.
Clinical importance was What was the clinical importance of the results? Were differences between
reported? groups clinically meaningful? (if applicable)
X Yes The authors report that the difference in grades between the flipped
No classroom and the traditional classroom resulted in 47 more students passing
Not addressed the class. This seems important enough to consider beyond simply looking
at statistical significance.
Authors do not report any specific data on student satisfaction beyond the
results that show that students were less satisfied with the flipped classroom
model than the other two models in the study. In their discussion of the
results, they suggest that these results are likely due to students’ loss of social
support with the flipped classroom. It is unclear how they came to this
conclusion, or if there is evidence that decreased satisfaction may lead to
dropouts, lower grades, or any other relevant outcomes.
Drop-outs were reported? Did any participants drop out from the study? Why? (Were reasons given and
Yes were drop-outs handled appropriately?)
X No It is likely that students did drop out of either the study or the nursing
program during the study, but drop outs are not reported, and it is unclear
how this was handled.
CONCLUSIONS AND What did the study conclude? What are the implications of these results for
IMPLICATIONS practice? What were the main limitations or biases in the study?
The study concluded that the flipped classroom may improve learning
Conclusions were outcomes but that students may not approve of such changes to the teaching
appropriate given study methods. Authors suggest that faculty should be attentive to how they
methods and results implement the flipped classroom model and ensure that students have the
X Yes necessary social support and structured opportunities to ask questions. This
No knowledge may help instructors choose and plan to implement the model in
their own classrooms as it allows them to anticipate potential students
concerns and be proactive in addressing them.
The limitations of this study, which the authors themselves identify, include
the fact that nothing within the courses or classrooms was controlled for,
leaving it difficult for the reader to confidently conclude that the outcomes
were based solely on the flipped classroom intervention. More attention to
issues such as classroom ratios, teaching styles, and student access to the
Internet, would have served to strengthen this study. In addition, a
comparison of the demographics of the student groups would help readers
interpret and apply the results to their own classrooms.
Appendix X
Article to Accompany Critically Appraised Paper
Missildine, K., Fountain, R., Summers, L., & Gosselin, K. (2013). Flipping the classroom to improve
student performance and satisfaction. Journal of Nursing Education, 52(10), 597-599.

Research Brief
Flipping the Classroom to Improve Student Performance

and Satisfaction
Kathy Missildine, PhD, RN, CNE; Rebecca Fountain, PhD, RN; Lynn Summers, MSN, RN;
and Kevin Gosselin, PhD
D
ABSTRACT espite the easing of the nursing shortage, Buerhaus, Au-
This study aimed to determine the effects of a flipped erbach, and Stalger (2009) cautioned that the need for
classroom (i.e., reversal of time allotment for lecture and nurses will worsen to critical proportions as the econ-
homework) and innovative learning activities on academic omy recovers. The student attrition rate may be viewed as one
success and the satisfaction of nursing students. A quasi- reason for the nursing shortage. Students lost through attrition
experimental design was used to compare three approaches have met admission requirements and have successfully com-
to learning: traditional lecture only (LO), lecture and lecture pleted rigorous prerequisite courses but were unable to complete
capture back-up (LLC), and the flipped classroom approach the nursing curriculum due to a variety of factors. Previous stud-
of lecture capture with innovative classroom activities (LCI). ies by Walker et al. (2011) have focused on methods to increase
Examination scores were higher for the flipped classroom student retention, including an examination of student preadmis-
LCI group (M = 81.89, SD = 5.02) than for both the LLC group sion characteristics and the use of innovative teaching protocols.
(M = 80.70, SD = 4.25), p = 0.003, and the LO group (M = The current study expanded those efforts to improve the success
79.79, SD = 4.51), p < 0.001. Students were less satisfied with of currently enrolled students by using a flipped classroom ap-
the flipped classroom method than with either of the other proach, coupled with innovative teaching techniques.
methods (p < 0.001). Blending new teaching technologies The purpose of the current study was to determine the effects
with interactive classroom activities can result in improved of the flipped classroom approach using innovative teaching
learning but not necessarily improved student satisfaction. methods on the academic success of baccalaureate nursing stu-
[J Nurs Educ. 2013;52(10):597-599.] dents in two adult health nursing courses, as measured by exami-
nation averages and student satisfaction. Three different teach-
ing modalities were used: traditional lecture only (LO), lecture
capture as an adjunct to traditional lecture (LLC), and lecture
capture with interactive teaching activities (flipped classroom;
LCI). The flipped classroom using lecture capture in this study
was a teaching approach in which lecture content was electroni-
cally recorded through lecture capture software, and classroom
time was used in a variety of active learning activities designed
to increase student engagement. The hypotheses were:
Received: March 1, 2013 ● The LCI (flipped classroom) method of teaching will result
Accepted: April 3, 2013 in a higher course examination average for Adult Health I students
Posted Online: September 19, 2013 and Adult Health II students than the LLC and LO methods.
Dr. Missildine is Assistant Dean of Graduate Studies, and Dr. Gosselin ● The LCI method will result in higher student satisfaction
is Assistant Dean of Research, College of Nursing, Texas A&M Health Sci- scores than the LLC and the LO methods.
ence Center, Bryan; Dr. Fountain is Assistant Professor, and Ms. Summers
is Clinical Instructor, College of Nursing, The University of Texas at Tyler, Background and Significance
Tyler, Texas. A recent call for radical transformation in nursing education
The authors received financial support from The University of Texas at challenges educators to design learning experiences that will re-
Tyler through the J. Burns Brown Fellowship award. sult in graduates prepared to practice in a changing health care
The authors have disclosed no potential conflicts of interest, financial environment (Benner, Sutphen, Leonard, & Day, 2010). Those
or otherwise. authors identified a significant gap between nursing practice and
Address correspondence to Kathy Missildine, PhD, RN, CNE, Assistant educational preparation and recommended these paradigm shifts:
Dean of Graduate Studies, College of Nursing, Texas A&M Health Science teaching in context, teaching for a sense of salience, integrated
Center, 8447 State Highway 47, Bryan, TX 77807; e-mail: katemissi@yahoo. clinical reasoning, and an emphasis on professional formation.
com. High- and low-fidelity simulation, social media, role-play,
doi:10.3928/01484834-20130919-03 problem-based learning, case analysis, and service-learning can

RESEARCH BRIEF
provide integrative learning experiences to meet these challenges Buchner, 2007). A convenience sample of 589 students was re-
and replace the usual classroom lecture. Faculty members have cruited for the study over a period of three semesters. A majority
not fully realized the potential of these methods and are often of the participants were White (75%) and female (81%), with
reluctant to abandon the lecture approach. Likewise, students are a mean age of 24.32 (SD = 6.71) years. Participants worked an
dependent on the lecture method because it is familiar, comfort- average of 13.6 hours (SD = 10.62) per week and were enrolled
able, and instructor centered, requiring little active student par- in 14.1 credit hours (SD = 1.67).
ticipation (Fitzgerald, 2008). To effectively integrate innovative Three approaches to teaching Adult Health nursing were
instructional strategies, it may be necessary to supplement lecture used: (a) lecture only (LO) (fall 2009), classroom lectures by
with new methods, rather than to completely replace lecture. faculty and via interactive television; (b) lecture plus lecture
The flipped classroom is a hybrid approach to learning, using capture (LLC) (spring 2010), classroom lecture format plus
technology to move the classroom lecture to “homework” status lecture capture backup; and (c) lecture capture plus innova-
and using face-to-face classroom time for interactive learning. tion (LCI) (fall 2010) using the flipped classroom approach, in
This approach in higher education usually involves faculty de- which there were no classroom lectures. Lectures captured the
velopment of a video-recorded lecture (lecture capture) that is prior semester were made available to students, with updates to
made available to students for viewing outside of the classroom. the content as needed. Prior to the beginning of the final semes-
Classroom time is spent in discussion, clarification, exercises, ter of the study, faculty on all campuses met in course groups
or other learning activities to enhance application of knowledge and planned the flipped activities. Simulation case studies,
(Ronchetti, 2010). This approach was first used in the 1990s games, and other exercises were implemented independently by
(Mazur, 1997) in elementary and secondary education and was faculty on each campus. Interactive television was used only
referred to as the “classroom flip” by Baker (2000, p. 9), who for guest lectures during the semester. Comparable examina-
also coined the “guide on the side” as compared to the “sage on tion items on test metrics were used from semester to semester
the stage,” which is now the mantra of those who espouse this to ensure consistency. Course examination averages for each
method of teaching (Frydenberg, 2013). student were determined. Satisfaction data were gathered using
The lecture capture method of content delivery may assist a 16-item, faculty-developed questionnaire scored on a 4-point
in achieving the goal of lecture enhancement and supplementa- Likert-type scale, with higher scores indicating greater satisfac-
tion. Lecture capture is a software system that automatically tion. The internal reliability for the 16-item questionnaire was
records audio and video media that is then automatically made assessed using Cronbach’s coefficient alpha. Cronbach’s alpha
available for student viewing and download to personal MP3 was 0.98, indicating good internal consistency across the sam-
devices or through applications available for smart phones. ple. All statistical analyses were conducted using SPSS® ver-
Recordings can be edited into segments to allow for shorter, sion 18 software. The level of significance was set at p = 0.05
focused study sessions. Challenges for students in the use of (two-tailed).
lecture capture include effective time management, lack of so-
cial interaction with faculty and other students, and lack of op- Results and Discussion
portunity to ask questions. Faculty members are challenged to The first research hypothesis was designed to examine dif-
maintain classroom attendance by engaging students when lec- ferences among three educational delivery methods (LO, LLC,
tures are offered electronically (Rogers & Cordell, 2011). and LCI) on mean examination scores. A one-way analysis of
Lecture capture as an adjunct to classroom presentation has variance (ANOVA) demonstrated significant differences ac-
received mixed reviews. Low-achieving students (Veeramani & cording to the method of teaching, F(2,586) = 10.69, p ! 0.001,
Bradley, 2008) and those for whom English is a second lan- "² = 0.032. Average examination scores were significantly
guage (Shaw & Molnar, 2011) prefer courses that offer lecture higher for the students in the LCI group (M = 81.89, SD = 5.02)
capture backup. The impact of the substitution of lecture cap- than students in both the LLC group (M = 80.70, SD = 4.25, p =
ture for traditional lecture on performance is largely unknown. 0.003) and LO group (M = 79.79, SD = 4.51, p ! 0.001) in both
The current study contributes to nursing education by measur- courses. The change in mean grade was small but reflects an ad-
ing the effects of the use of lecture capture and innovative learn- ditional 47 students achieving passing grades over the course of
ing activities in the flipped classroom on the academic success the study. The results of these tests support the first hypothesis.
of baccalaureate nursing students. The second aim of the study was to assess the differences in
student satisfaction scores across the three educational delivery
Method methods. The satisfaction survey, completed by 445 students
A quasi-experimental design was used in two adult health (75.55% response rate), was faculty developed and therefore
courses that are offered consecutively in semesters two and lacked validity data; this is a limitation of the study. As the satis-
three of the nursing curriculum. The study was approved by faction data were not normally distributed, a Kruskal-Wallis test
the institutional review board. Sixteen master’s-prepared fac- was conducted to determine whether satisfaction scores were
ulty members teach the two courses via interactive television higher for the LCI groups, compared with the LLC and LO
on three campuses. An a priori analysis of power for a one-way groups. The result of the test was significant #² (2, n = 445) =
ANOVA for three groups (conditions) using a power of 0.80, 66.10, p ! 0.001, indicating a difference in satisfaction across
moderate effect size of 0.25 and alpha of 0.05 resulted in a re- the three delivery methods. Follow-up tests to examine the LO
quired sample size of 159, or 53 participants for each course and LCI group satisfaction mean scores were significant but
and condition (LO, LLC, and LCI) (Faul, Erdfelder, Lang, & not in the expected direction, z = –6.37, p ! 0.001, r = 0.36.

RESEARCH BRIEF
The LCI students (n = 186) had an average satisfaction rank of would enhance interpretation of results, reducing student frus-
131.18, whereas the LO students (n = 130) had an average rank tration related to access and technology. The following research
of 197.59, indicating that the LCI students were significantly questions could be considered in future studies:
less satisfied than the LO group. Comparison of LCI and LLC ● What is the result of using social media resources for stu-
(n = 129) group satisfaction mean scores was significant but dent support on satisfaction and course grades when using the
also not in the expected direction, z = –7.17, p ! 0.001, r = flipped classroom approach?
0.40. The LCI students had an average rank of 127.39, whereas ● What ratio of lecture classes to innovative application
the LLC students had an average rank of 202.14, indicating that classes results in best student learning and improved situated
the LCI students were also less satisfied than students in the cognition in the clinical practice setting?
LLC group. A final test to examine differences in satisfaction ● Is there a difference in course grades and student satis-
scores across the LO and LLC group found no significant re- faction with use of different approaches to teaching? In other
sults, z = –1.25, p = 0.21. These findings contradict the second words, do different teaching methods have differing results; for
research hypothesis; students were more satisfied with the LO example, are games as effective as simulation?
and LLC methods than the LCI flipped classroom approach. ● Which teaching methods are more effective in teaching
Thus the second hypothesis was rejected. Students reported that specific types of content or developing specific types of think-
the LCI approach required more work, and they did not seem to ing; for example, how best to teach pharmacological content, to
perceive the value of interactive learning approaches. However, stimulate the development of salience or use of creative thinking?
as Benner et al. (2010) noted, student satisfaction may not be a ● What are the most effective methods to ensure student
good indicator of learning. preparation for the interactive sessions?
The advantage of these approaches is best seen in the con- Blending teaching technologies, the flipped classroom and
text of the four changes for nursing education recommended interactive classroom activities can result in improved learning;
by Benner et al. (2010). Using the LCI flipped classroom ap- however, faculty will need to refine implementation techniques
proach, small groups of students were engaged in case studies, to gain students’ approval of these new approaches.
simulation, and other learning activities that enabled applica-
tion of theoretical information to clinical practice. The faculty References
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2010, p. 82) to develop clinical judgment. Students linked class- agement tools to become the guide on the side. Paper presented at the
room and clinical learning to enable the integration of theory International Conference on College Teaching and Learning, Jackson-
ville, FL.
and clinical practice. By using lecture capture and working
Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses:
with small in-class groups of students, faculty are better able A call for radical transformation. Stanford, CA: Jossey-Bass.
to model and engage students in clinical reasoning, reflection, Buerhaus, P.I., Auerbach, D.I., & Stalger, D.O. (2009). The recent surge in
application of relevant research findings, and clinical imagina- nurse employment: Causes and implications. Health Affairs, 28, w657-
tion. These approaches further the formation of the student as a w668. doi:10.1377/hlthaff.28.4.w657
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A
professional nurse. flexible statistical power analysis program for the social, behavioral,
and biomedical sciences. Behavior Research Methods, 39, 175-191.
Limitations Fitzgerald, K. (2008). Instructional methods and settings. In S.B. Bastable
The study was limited by problems of infrastructure, includ- (Ed.), Nurse as educator: Principles of teaching and learning for nurs-
ing practice (pp. 429-472). Sudbury, MA: Jones and Bartlett.
ing classroom availability and limited access to high-speed In-
Frydenberg, M. (2013, January 24). The flipped classroom: It’s got to be done
ternet by rural students. Innovative teaching methods were de- right. Huff Post College. Retrieved from http://www.huffingtonpost.com/
veloped by faculty using a guide common to the two courses, mark-frydenberg/the-flipped-classroom-its_b_2300988.html
but inevitable variations in faculty approach may have affected Mazur, E. (1997). Peer instruction: A user’s manual. Upper Saddle River,
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Running head: INTRODUCING THE FLIPPED CLASSROOM TO OTA EDUCATORS 1

A Flipped Course on the Flipped Model:

Introducing the Flipped Classroom to OTA Educators

Rocky Mountain University of Health Professions

learners. Evidence supporting the flipped classroom model is presented, as is research

recommendations regarding occupational therapy instruction are included.

Keywords: occupational therapy education, teaching strategies, flipped classroom, adult

learners, active learning, constructivist approach, faculty development

A Flipped Course on the Flipped Model:

Introducing the Flipped Classroom to OTA Educators

In 1997, Ernest Boyer published an expanded definition of scholarship to go beyond the

ongoing professional development activities that support best practices in education.

as the flipped classroom. As Assistant Program Director in an OTA program, I have

Occupational Therapy Association’s (AOTA) Centennial Vision (2007) and contributions to my

OTA educational program (AOTA, 2014).

The Flipped Classroom Model

Definition and Development

they require application of knowledge rather than simple memorization or understanding, so

in this higher-order thinking (Boucher et al., 2013).

Because the flipped classroom approach continues to evolve and is considered to be a

involved computer-based instruction completed independently prior to classroom instruction

involving interactive lessons requiring higher-order thinking.

Use in Healthcare Education

Classroom Model: Healthcare-Related Outcomes.”

involving the computer is just as important as it is in face-to-face instruction. It is generally

knowledge rather than communicating it.

opportunity (Lefoe, 1998).

there is a focus in constructivism on individual learners’ “unique interests, styles, motivations,

designed blended, flipped course is consistent with this approach.

Knowledge of constructivism may assist instructors in understanding the theoretical

Evidence Supporting the Flipped Classroom Model

0.024, showing a statistically significant difference in favor of the flipped classroom.

Another study demonstrated statistically significant and academically relevant

grade change results in an additional 47 students passing the course.

Other studies have shown somewhat different outcomes, demonstrating no significant

difference in assignment or course grades as compared to the traditional classroom model. A

intervals crossing zero (Harrington et al., 2015).

course, which also held no statistical significance (Li et al., 2014).

quality studies utilizing quasi-experimental design. In addition, available research is focused

identified as important for successful clinical practice.

development of clinical reasoning through problem-based learning and patient simulation.

evidence available so far is promising but inconclusive.

position to develop these critical skills (Kowalski & Horner, 2015).

classroom using an evidence-based active learning strategy known as process-oriented guided

improved evidence-based reasoning in their master’s level occupational therapy students in a

assignments, showed improvement in their students’ understanding and acceptance of evidence-

based practices (Cohn et al., 2014).

of the flipped classroom in healthcare education is growing.

has not been correlated with student learning.

classroom activities (McCallum et al., 2015). When considering peer-to-peer involvement,

involvement by increasing student time and energy focused on learning activities.

behavioral engagement, agentic engagement, cognitive engagement, and emotional engagement

emotional engagement were highest, followed by behavioral engagement, cognitive engagement,

Summary of the Evidence

additional research and personal observations are warranted.

Implications for Occupational Therapy

Occupational Therapy Education (ACOTE) Standards and Interpretive Guide (2014).

Centennial Vision and The Future of Occupational Therapy Education

several specific actions, including developing a diverse workforce and preparing OT

and use of evidence-based practice (Boucher et al., 2013).

Related to the AOTA’s Centennial Vision (2007) is the organization’s Ad Hoc

methods of occupational therapy instruction.

In addition to the Centennial Vision (AOTA, 2007), OT education is guided by the