Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction

Original article. Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Vol. 10, n.º 1; p. 14-31, January 2024. https://doi.org/10.17979/sportis.2024.10.1.9956 14 Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction Evaluación de la asimilación de contenidos en la metodología de investigación en salud: un estudio comparativo de la conferencia y la instrucción en el aula invertida Javier Pecci1; Wanessa Onetti Onetti2; Horacio Sánchez-Trigo1 1 Department of Physical Education and Sport, University of Seville, Seville, Spain 2International University of Rioja. Spain. Corresponding author: Javier Pecci E-mail: [email protected] Cronograma editorial: Artículo recibido 03/10/2023 Aceptado: 07/11/2023 Publicado: 01/01/2024 https://doi.org/10.17979/sportis.2024.10.1.9956 Para citar este artículo utilice la siguiente referencia: Pecci, J.; Onetti, W.; Sánchez-Trigo, H. (2024). Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Sportis Sci J, 10 (1), 14-31 https://doi.org/10.17979/sportis.2024.10.1.9956 Contribución autores: Introducción: JP, WOO; Metodología: JP, HST; Resultados: JP, WOO, HST; Discusión: JP, WOO, HST; Conclusión: JP, HST. Financiación: El estudio no obtuvo financiación. Conflicto de interés: Los autores declaran no tener ningun tipo de conflito Aspectos éticos: El estudio declara los aspectos éticos. Abstract Virtual education has evolved significantly, driven by the integration of Information and Communication Technology (ICT) resources, particularly during the COVID-19 pandemic. Health Sciences, with their practical components, present unique challenges in virtual education, including maintaining student engagement. This study aimed to compare the effectiveness of the flipped learning methodology with and without in-class content reinforcement in a virtual classroom for previously assimilated materials within Health Sciences. The study involved students in a Kinesiology program using the Blackboard Learn platform. Two groups were established: one completing a Original article. Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Vol. 10, n.º 1; p. 14-31, January 2024. https://doi.org/10.17979/sportis.2024.10.1.9956 15 questionnaire at the beginning of the virtual class (FLI group) and the other at the end following a content reinforcement session (FLI+TRA group). While no statistically significant score differences were found between the two groups, the FLI+TRA group showed higher pass rates and improved average scores, indicating practical benefits. These results suggest that combining flipped learning with traditional in-class instruction can enhance content assimilation in virtual education, fostering increased student engagement and participation. However, further research is needed to explore the full implications and adaptability of this approach. In conclusion, this study highlights the potential of the FLI+TRA approach to improve learning outcomes in complex subjects like Epistemology and Research Methodology within Health Sciences. As virtual education continues to evolve, educators should consider this hybrid teaching model as a valuable tool to provide a more holistic and effective learning experience. Keywords: flipped learning; traditional classroom; virtual learning; health sciences; kinesiology. Resumen La educación virtual ha evolucionado significativamente, impulsada por la integración de recursos de Tecnologías de la Información y Comunicación (TIC), especialmente durante la pandemia de COVID-19. Las Ciencias de la Salud, con sus componentes prácticos, presentan desafíos únicos en la educación virtual, incluida la retención del interés de los estudiantes. Este estudio tuvo como objetivo comparar la efectividad de la metodología de aprendizaje invertido (flipped learning) con y sin refuerzo de contenido en clase en un aula virtual para materiales previamente asimilados en Ciencias de la Salud. El estudio involucró a estudiantes de un programa de Kinesiología utilizando la plataforma Blackboard Learn. Se establecieron dos grupos: uno completando un cuestionario al comienzo de la clase virtual (grupo FLI) y otro al final después de una sesión de refuerzo de contenido en clase (grupo FLI+TRA). Aunque no se encontraron diferencias estadísticamente significativas en las puntuaciones entre los dos grupos, el grupo FLI+TRA mostró tasas de aprobación más altas y puntajes promedio mejorados, lo que indica beneficios prácticos. Estos resultados sugieren que la combinación de aprendizaje invertido con instrucción tradicional en clase puede mejorar la asimilación de contenido en la educación virtual, fomentando un mayor compromiso y participación de los estudiantes. Sin embargo, se necesita más investigación para explorar las implicaciones y la adaptabilidad completas de este enfoque. En conclusión, este estudio resalta el potencial del enfoque FLI+TRA para mejorar los resultados de aprendizaje en materias complejas como Epistemología y Metodología de Investigación en Ciencias de la Salud. A medida que la educación virtual continúa evolucionando, los educadores deben considerar este modelo de enseñanza híbrido como una herramienta valiosa para proporcionar una experiencia de aprendizaje más holística y efectiva. Palabras clave: aprendizaje invertido; aula tradicional; aprendizaje virtual; ciencias de la salud; kinesiología. Original article. Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Vol. 10, n.º 1; p. 14-31, January 2024. https://doi.org/10.17979/sportis.2024.10.1.9956 16 Introduction Virtual education, defined as instruction or learning when teachers and students are separated by time, space, or both (Dung, 2020), is experiencing a significant transformation. The utilization of new technologies and Information and Communication Technology (ICT) resources, including video conferencing, streaming, and mobile applications, is at the core of virtual teaching. The emergence of virtual teaching platforms like Blackboard Learn and integrated streaming services such as Blackboard Collaborate Ultra has played a pivotal role in bolstering virtual education, particularly during the COVID-19 pandemic (Al-khresheh, 2021), and this trend continues today (Hill, 2019; Raza et al., 2022). In this line, many educational centers such as universities has perceived the COVID-19 pandemic as an opportunity to mix presential and virtual environments, making the learning process more dynamic (Kurbakova et al., 2020). Nonetheless, virtual education requires to the teachers specific skills, knowledge, strategies and attitudes to adapt the content to the non-presential classroom (Spante et al., 2018). In any case, teaching methodology employed in traditional classrooms could be adapted to the virtual mode, but it could be a challenge for teachers (Torres Martin et al., 2021). Nonetheless, it is important to highlight that Blackboard Learn could present several limitations, especially those related to student monitoring and individualization of teaching, that could make difficult establishing alternative teaching methodologies. In addition, difficulties of the students with low resources such as poor internet connections may turn this platform into a means of discrimination, especially in pandemic situations in which no alternatives could be offered. Comparing with its competitors such as Google Classrooms, Blackboard Collaborate offers an integration with Blackboard Learn, thus offering more resources, discussion forums, etc. A great disadvantage is its costs, but they are usually covered by the university, so the students have not to pay for its use. Virtual education has demonstrated its efficacy in the learning process of Health Science students (Almarzooq et al., 2020). This is noteworthy as Health Sciences often require hands-on practical components, which can pose challenges to the teachinglearning process when delivered virtually, unlike disciplines such as Social Sciences Original article. Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Vol. 10, n.º 1; p. 14-31, January 2024. https://doi.org/10.17979/sportis.2024.10.1.9956 17 (Calderón, 2002). Despite the adoption of commonly used online teaching tools like Blackboard Collaborate Ultra, maintaining student engagement and motivation remains a persistent challenge for educators (Beluce & Oliveira, 2015; Huang et al., 2019). Traditionally, the delivery of content by instructors with the expectation that students will assimilate it has been the predominant approach (Morell, 2004). However, a shift towards methodologies promoting student autonomy and active participation has gained popularity, especially in higher education where students possess the maturity to engage effectively with alternative methods (Hernández et al., 2020; Labrador & Andreu, 2008). In this line, flipped learning is an alternative methodology which consists on recording in-class activities to convey a course: Students watch the video before the class and use the class time to solve complex concepts, answer questions, and students are encouraged to learn actively as well as create bonds with daily lives (Hwang et al., 2015)). Nonetheless, flipped learning could also be applied with alternative material such as books, PDF of the syllabus to study, etc. In the university context, the flipped learning or flipped classroom methodology has gained popularity for its ability to foster student autonomy and enhance the teaching-learning process (Al-Samarraie et al., 2020). Flipped learning allocates classroom time to practical or engaging activities such as discussions and projects (Bergmann & Sams, 2012). This approach has demonstrated its potential to enrich teaching and learning processes, integrate concepts, redefine the roles of educators and students, enhance participation and communication, utilize ICT resources, improve academic performance, and boost the interest of university students (Flores et al., 2016). Previous research has established the effectiveness of this approach (i.e., flipped learning) in virtual university contexts and especially in Health Sciences. A study conducted by Halasa et al. (2020) demonstrated that flipped classroom is more effective in assimilating nursing contents than traditional classrooms. In addition, a systematic review conducted by Banks & Kay (2022) showed the effectiveness of flipped classrooms in 16 included studies, concluding that flipped learning could be effective in producing positive changes in academic performance, enhancing student satisfaction and self-efficacy linked to well-designed curriculum. In addition, a study conducted by Original article. Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Vol. 10, n.º 1; p. 14-31, January 2024. https://doi.org/10.17979/sportis.2024.10.1.9956 18 Pozo-Sanchez et al. (2019) showed that students perceive and could assimilate better the contents using flipped learning in superior education (e.g., university), whereas during the childhoold this methodology could not be very valuable. Nonetheless, it is necessary to check if flipped learning learning could be improved with a traditional reinforcement. In light of these developments, this study aimed to compare the effectiveness of the flipped learning methodology without in-class content reinforcement against the same methodology with content reinforcement in the virtual classroom for previously assimilated materials. This investigation seeks to shed light on the evolving landscape of virtual education, its applicability in Health Sciences, and the role of pedagogical methodologies in content assimilation. Methods Experimental Design The current study was conducted within the curriculum of the "Epistemology and Research Methodology" course, a part of the Kinesiology program at the University Andrés Bello (Santiago, Chile). This course was part of the first semester of the second year. Teaching for this course was a collaborative effort, with 70% of instruction delivered by faculty from the University Andrés Bello and the remaining 30% by faculty from the University Europea de Madrid. The portion of the course conducted by the University Europea de Madrid (the focus of this study) was entirely online, utilizing the Blackboard Learn platform. The instructional methodology employed within the course was the flipped learning approach, where students received detailed PDF documents containing the study material. This material was organized into two units, each comprising several topics (seven topics for the first unit and eleven topics for the second unit). An schematic approach of the study design is shown in Figure 1. Original article. Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Vol. 10, n.º 1; p. 14-31, January 2024. https://doi.org/10.17979/sportis.2024.10.1.9956 19 Figure 1. Experimental approach of the study Assessment within the University Europea de Madrid segment of the course consisted of three graded activities and a final exam. Prior to each graded task and the final exam, a virtual class session was conducted by faculty from the University Europea de Madrid. These sessions aimed to address student queries and engage in activities aligned with the flipped learning methodology. The present study aimed to evaluate, using a 10-question questionnaire in 5 minutes, whether students had correctly assimilated the course content. Specifically, the questionnaire assessed topics including "Randomized Clinical Study," "Scientific Articles," "Article Structure," "Scientific Article Writing," and "Journal Quality." This questionnaire corresponded to the third graded activity, and students were already familiar with this assessment method. Two student groups were established within the course. One group completed the questionnaire at the beginning of the virtual class (FLI group), while the other group completed the questionnaire at the end of the class following a reinforcement session covering the content of the topics taught through traditional methodology (FLI+TRA group). The present study followed a quasiexperimental design, since no randomization of the groups was made. Randomization was not possible due to the groups conformed by the university, according to the schedule needs of the students. Nonetheless, the content was the same for both groups (i.e., same PDFs). Consequently, the professor could not influence the results due to different explanations of the contents in the FLI+TRA group or the FLI group. In Original article. Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Vol. 10, n.º 1; p. 14-31, January 2024. https://doi.org/10.17979/sportis.2024.10.1.9956 20 addition, it is important to highlight that one class (i.e., FLI) followed the other one (i.e., FLI+TRA), thus not allowing students to communicate from one class to another. Figure 1 illustrates the schematic representation of the experimental design. Participants Each group comprised ten students, totaling twenty participants. In the FLI+TRA group, class participation was at 100%, while in the FLI group, participation stood at 70%. The age of the participants ranged from 19 to 24 years, with twelve male and five female students. All participants were enrolled in the Kinesiology program at the University Andrés Bello, registered for the "Epistemology and Research Methodology" course, and received instruction from the University Europea de Madrid, as previously outlined. This course served as their initial exposure to research methodology content, ensuring that no group had previously undertaken the course with a higher level of knowledge. Procedure A 10-question online questionnaire was administered either at the beginning of the virtual class (FLI) or at the end of the virtual class following a review session (FLI+TRA). The virtual class sessions were conducted using the Blackboard Collaborate Ultra platform. The questionnaire was administered via Google Forms, with automated scoring. Each of the ten questions had four answer options, with one correct response, except for one question with two correct options. Pre-Questionnaire Virtual Class (FLI+TRA) The virtual theoretical class preceding the questionnaire in the FLI+TRA group consisted of two parts. The first twenty minutes were dedicated to addressing student queries regarding the content they had previously studied through the provided PDF documents, which extensively covered the assessable content from each topic. Subsequently, a sixty-minute session was devoted to reviewing all theoretical content through a lecture by the instructor. Throughout the class, students were encouraged to reflect on the topic content through questions and were required to provide examples for Original article. Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Vol. 10, n.º 1; p. 14-31, January 2024. https://doi.org/10.17979/sportis.2024.10.1.9956 21 each assessable content item from the topics. Following this, ten minutes were allocated for the administration of the questionnaire. The entire class duration was ninety minutes. It was explicitly communicated that the questionnaire would not contribute to their course grade but was intended as a simulation for the final exam. Post-Questionnaire Virtual Class (FLI) The virtual theoretical class following the questionnaire in the FLI group spanned eighty minutes (following the initial ten minutes allotted for the questionnaire). During this session, each questionnaire item was revisited, with explanations provided for the correctness or incorrectness of possible answer choices. This dynamic approach addressed student queries and further clarified the topic content. Similar to the FLI+TRA group, it was emphasized that the questionnaire would not impact their course grades but was intended to serve as an exam simulation. The complete ad-hoc questionnaire designed for the intervention is shown in Appendix 1. Statistical Analysis A descriptive analysis was performed on the scores of each group, with scores reported as mean ± standard deviation. Additionally, the percentage of students passing (i.e., scores equal to or exceeding 5) within each group was reported. A simple analysis of variance (ANOVA) was conducted between the two groups. Statistical analysis was performed using the Jamovi software (The Jamovi project, 2019, Version 2.3.18), with significance set at α < 0.05. Results Results obtained by the students in the ad-hoc designed questionnaire ranged from 0 to 10 points. Scoring obtained by FLI+TRA group was 6.3 ± 2.15 points, whereas FLI group obtained 5 ± 2.67. ANOVA showed no statistically significant differences between groups (p = 0.341). The approval rate in the FLI+TRA group was 80%, whereas the approval rate in the FL group was 57.14%. Therefore, despite the absence of statistically significant differences, FLI+TRA group obtained a mean score Original article. Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Vol. 10, n.º 1; p. 14-31, January 2024. https://doi.org/10.17979/sportis.2024.10.1.9956 22 1.3 points higher than FLI group, with a 22.86% higher approval rate, thus representing a substantial and relevant difference. Results are summarized in Figure 2. Figure 2. Questionnaire results in flipped learning in addition to traditional explanation (FLI+TRA) group and flipped learning (FLI) group (A) and approval rates (B). FLI+TRA showed higher mean scores and approval rates in the results of the test when compared to FLI. Discussion The utilization of the flipped learning methodology has proven effective in ensuring that the average student passes a test even when encountering the content for the first time. However, providing a small in-class reinforcement after students have autonomously assimilated the content can increase the number of passing grades and elevate the average scores for the same test. Although no statistically significant differences were found in the ANOVA test, the grades are substantially better in the FLI+TRA (flipped learning with traditional instruction) group, showing a higher pass rate. This could be attributed to the small sample size used in the study, which can significantly affect the ability to detect significant differences (Cohen, 1992). However, virtual teaching to large numbers of students does not seem to be a very effective strategy (Rubio Hernández & Olivo-Franco, 2020). Additionally, international teaching, especially in this format for the first time for students, can also be a limiting factor. Original article. Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Vol. 10, n.º 1; p. 14-31, January 2024. https://doi.org/10.17979/sportis.2024.10.1.9956 29 Applied Research in Higher Education, 14(4), 1603-1622. https://doi.org/10.1108/JARHE-02-2021-0054 Rubio Hernández, F. J., & Olivo-Franco, J. L. (2020). Dificultades del profesorado en sus funciones docentes y posibles soluciones. Un estudio descriptivo actualizado. Ciencia y Educación, 4(2), 7-25. https://doi.org/10.22206/cyed.2020.v4i2.pp7-25 Spante, M., Hashemi, S. S., Lundin, M., & Algers, A. (2018). Digital competence and digital literacy in higher education research: Systematic review of concept use. Cogent Education, 5(1), 1519143. https://doi.org/10.1080/2331186X.2018.1519143 Tabera Galván, M. V., Álvarez Comino, M. J., Hernando Jerez, A., & Rubio Alonso, M. (2015). Percepción de los estudiantes universitarios de Ciencias de la Salud sobre las actitudes de los docentes y su influencia en el clima de aprendizaje. Revista Complutense de Educación. https://doi.org/10.5209/rev_RCED.2015.v26.n2.43028 Torres Martín, C., Acal, C., El Homrani, M., & Mingorance Estrada, Á. C. (2021). Impact on the virtual learning environment due to COVID- 19. Sustainability, 13(2), 582. https://doi.org/10.3390/su13020582 Yean, L. S. (2019). Promoting active learning and independent learning among primary school students using flipped classroom. International Journal of Education, 4(30), 324-341. Original article. Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Vol. 10, n.º 1; p. 14-31, January 2024. https://doi.org/10.17979/sportis.2024.10.1.9956 30 APPENDIX 1. AD-HOC QUESTIONNAIRE ELABORATED TO ASSESS THE CONTENTS ASSIMILATION 1. What does phase 2 of a randomized clinical trial correspond to? a. First phase in patients (100-300) b. It is tested on healthy subjects (20-50) c. Efficacy and safety are evaluated, in addition to establishing the correct therapeutic dose d. Long-term adverse effects are evaluated (pharmacovigilance) 2. The dependent variable is the one that... a. Define the intervention b. They are intrinsic to the patient c. Determine treatment results d. They make up the variables necessary to define the descriptive table of the sample. 3. An unambiguous way to identify an author who has common names and surnames, and therefore can be confused with other authors with similar names, is... a. Attaching the PROSPERO profile of each author to the article b. Attaching the ORCID profile of each author to the article c. Attaching the Google Scholar profile of each author to the article d. Attaching the PRISMA profile of each author to the article 4. Meta-analyses… a. They present information from various studies in a qualitative way b. They are written by experts c. They present the information in frequency tables d. They bring together information from various investigations in a quantitative way 5. Regarding exclusion criteria in systematic reviews: a. If one or more of these criteria are met, the study will not be considered b. If two or more of these criteria are met, the study will not be considered c. If three or more of these criteria are met, the study will not be considered d. All exclusion criteria must be met for a study to not be considered 6. When a scientific article is submitted for review, the following possibilities exist: a. Rejection or acceptance of the article b. Rejection, major review, medium review and acceptance c. Rejection, major review, minor review and acceptance d. Rejection, major review, medium review, minor review and acceptance 7. Systematic reviews generally follow the guideline: a. CONSORT Original article. Assessing Content Assimilation in Health Research Methodology: A Comparative Study of Lecture and Flipped Classroom Instruction. Vol. 10, n.º 1; p. 14-31, January 2024. https://doi.org/10.17979/sportis.2024.10.1.9956 31 b. CARE c. PRISMA d. PROSPERO e. QUOROM 8. The most used impact indexes are: a. FECYT ranking and Eigenfactor b. Google Scholar Metrics and Dialnet index c. JCR and SJR journal rankings d. JIR and SNIPE journal rankings 9. In Health Sciences, most of the articles are of the type: a. Qualitative b. Quantitative 10. Scientific research tables would be presented in: a. At the end of the methodology section, when we have already described in detail what has been done b. In the results section, as a synthesis of these c. Following the figures, to show with exact numbers what has been shown in a more visual way previously d. In the discussion of the results, in the part where reference is made to what appears in the table to comment on it in this section