Effects of a quasi-experimental study of using flipped classroom approach to teach evidence-based medicine to medical technology students

Huang et al. BMC Medical Education (2020) 20:31 https://doi.org/10.1186/s12909-020-1946-7 RESEARCH ARTICLE Open Access Effects of a quasi-experimental study of using flipped classroom approach to teach evidence-based medicine to medical technology students Hsien-Li Huang1,2†, Chia-Pei Chou3, Steve Leu4, Huey-Ling You1,5, Mao-Meng Tiao6 and Chih-Hung Chen2,7*† Abstract Background: Flipped classroom is known to improve learning efficiency and to develop one’s ability to apply highlevel knowledge. To investigate the effect of flipped classroom approach on teaching evidence-based medicine to medical technology students, we conducted a tailor-made six flipped classroom based EBM courses for medical technology students. Methods: This study adopted a qusai-experimental design with 62 medical technology interns as the research object. Students in the experimental group attended the flipped classroom course, while students in the control group attended the traditional course. The learning outcomes were evaluated by Fresno test in both groups. Furthermore, to understand student’s perceptions on the flipped classroom approach, students in the experimental group were required to fill in a satisfaction survey and answer some open-ended questions. Results: The Fresno test scores of the experimental group were significantly higher than that of the control group. From the results of the satisfaction survey, we know that students were satisfied with this course format. Students claimed that the flipped classroom approach could improve their learning efficiency and the interactions with teacher could help them to think more deeply. Conclusions: To conclude, most students showed positive attitudes and views on flipped classroom strategy. Moreover, students’ questions were solved more effectively during class resulting in an improvement of effectiveness of evidence-based medicine trainings. Keywords: Quasi-experiment, Evidence-based medicine, eBook, Flipped classroom, Fresno test, Medical technology Background Evidence-based medicine (EBM) is a combined knowledge of clinical problems, patient’s values, research evidences and clinical experiences [1]. In 2003, the Institute of Medicine (IOM) has published an article, health professions education: A bridge to Quality, in which 5 core competencies in reconstruction of medical professional education * Correspondence: † Hsien-Li Huang and Chih-Hung Chen contributed equally to this work. 2 Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung, Taiwan 7 Divisions of General Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Road, Niaosong District, Kaohsiung 83301, Taiwan Full list of author information is available at the end of the article are presented. The 5 core competencies include patient-centered care, medical team operation, EBM training, quality promotion and information system application [2]. As EBM supports the acquisition of evidence in an accurate, clear and knowledgeable way, the implementation of EBM in clinical practice will provide a guideline for selection of the most appropriate patient care based on the best available evidence [3, 4]. Solving clinical problems by applying EBM techniques is the main emphasis in Western medical practice, therefore, all medical staffs in a patient-centered cross-disciplinary medical care team should acquire EBM skill [5]. © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Huang et al. BMC Medical Education (2020) 20:31 Studies suggested that it is necessary to provide EBM trainings to medical technologists allowing them to develop problem-solving skills and to integrate knowledge for other medical staffs as inspection consultation or interpretative comments [6]. Currently, several hospitals in Taiwan, the Taiwan Evidence-Based Medicine Association, and the Taiwan Society of Laboratory Medicine are offering EBM courses to medical technologists. The main difficulties in teaching EBM to medical technologists are that most of the courses are traditional lecturestyle teaching and there is a limited amount of literature focused on laboratory diagnostics in the medical databases. However, a systematic review of EBM teaching suggests that using a single teaching method can strengthen only theoretical knowledge [7]. When EBM is combined with clinical case practicing as a blended-learning model, a considerable improvement in knowledge, skill acquaintance, and learning attitude is observed [8]. With the rapid development of the Internet, the learning style of learners has been changed. Moreover, teaching is no longer limited by time and location. Thus, teachers are able to utilize varies teaching modes and appropriate methods. For a long period of time, teacher is the center of the teaching style of medical education, in which giving a lecture to a group of learner is the main way of teaching [9]. The teaching content mainly consists of knowledge learning and concept understating. Learners have to attend lectures and study in class. And a large number of repeated exercises and tests are required to enhance learners’ competence of understanding [10]. In this teaching model, there is often a lack of interactions between teachers and learners. Learner often does not actively think leading to poor development of his or her cognitive ability [11]. Flipped classroom, an emerging wave in teaching, is considered as a variant of blended-learning model [12]. Instead of providing traditional in-class lectures, the concept of flipped classroom teaching is to teach the basic concept online and to trigger discussion, problem solving and extended thinking during class [13]. As student-centered learning is the core of flipped classroom teaching, the main task of the teacher is to discuss concepts and constructs with students, but not to give lectures. The success of the flipped classroom is mainly due to the increasing convenience of the Internet network that enables motivated students to learn independently through an online teaching platform [14]. Students who learn from the flipped classroom model are more focused during learning. Both their critical thinking skills and their learning attitude are improved [15]. Furthermore, students who are responsible for their own learning activity become active learners [16, 17]. Through peer feedb (...truncated)