A Mixed Methods Study on the Effect of Flipping the Undergraduate Medical Classroom

The flipped classroom model is increasingly being adopted in healthcare education, despite the fact that recent systematic reviews in the nursing and medical education literature suggest that this method of instructional design is not inherently better or worse than the traditional classroom. In this study, we used a sequential, explanatory mixed methods design to assess the impact of flipping the hepatology classroom for preclinical medical students. Compared to students in the traditional classroom, students in the flipped classroom had significantly lower mean (SD) ratings of their learning experiences (3.48 (1.10) vs. 4.50 (0.72), p < 0.001, d = 1.10), but better performance on the hepatology content of the end-of-course examination (78.0% (11.7%) vs. 74.2 (15.1%), respectively, p < 0.01, d = 0.3). Based upon our qualitative data analyses, we propose that the flipped classroom induced a change in the learning process of students by requiring increased preparation for classroom learning and promoting greater learner autonomy, which resulted in better retention of learned material, but reduced enjoyment of the learning experience. This dissonance in outcomes is captured in the words of one flipped classroom student: “ . . . I hated it while I was learning it, but boy did I remember it . . . ”. Based upon our dissonant outcomes and the inconsistent findings in the literature, we feel that there is still equipoise regarding the effectiveness of the flipped classroom, and further studies are needed to describe ways of making the flipped classroom a more effective (±more enjoyable) learning experience.