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Equivalent Performance of Exam Items Associated with Case-Based Learning, Flipped Classroom, and Lecture in a Pre-clerkship Medical Curriculum

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Abstract

The purpose of our study was to determine if knowledge acquisition, as measured by exam item performance, differed for active or passive learning activities in our medical curriculum. Additionally, we looked for differences in exam item performance in one second-year course that varies the method of an active learning activity, case-based collaborative learning (CBCL). Finally, we assessed whether item performance was impacted when small group activities were conducted online due to the COVID-19 pandemic. Exam item difficulty values were collected for several years of lectures, flipped classroom, and CBCL. Statistical analysis and modeling of data were performed to identify differences in difficulty of exam items that assess content delivered by different learning activities. Our analysis revealed no differences in difficulty of exam items that assess content delivered by different learning activities. Similarly, we determined that varying the execution of CBCL in one course did not impact exam item performance. Finally, moving CBCL small group sessions online did not impact exam item difficulty. However, we did detect a minor reduction in overall exam scores for the period of online instruction. Our results indicate that knowledge acquisition, as assessed by our multiple-choice summative exams, was equivalent regardless of learning activity modality.

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References

  1. Boulet JR, Durning SJ. What we measure … and what we should measure in medical education. Med Educ. 2019;53(1):86–94.

    Article  Google Scholar 

  2. Lombardi D, et al. The curious construct of active learning. Psychological Science in the Public Interest. 2021;22(1):8–43.

    Article  Google Scholar 

  3. Richardson V. Constructivist pedagogy. Teach Coll Rec. 2003;105(9):1623–40.

    Article  Google Scholar 

  4. Hazel SJ, et al. Team-based learning increases active engagement and enhances development of teamwork and communication skills in a first-year course for veterinary and animal science undergraduates. J Vet Med Educ. 2013;40(4):333–41.

    Article  Google Scholar 

  5. Huitt TW, Killins A, Brooks WS. Team-based learning in the gross anatomy laboratory improves academic performance and students’ attitudes toward teamwork. Anat Sci Educ. 2015;8(2):95–103.

    Article  Google Scholar 

  6. Medina MS, Castleberry AN, Persky AM. Strategies for improving learner metacognition in health professional education. Am J Pharm Educ. 2017;81(4):78.

    Article  Google Scholar 

  7. Rezaee R, Mosalanejad L. The effects of case-based team learning on students’ learning, self regulation and self direction. Glob J Health Sci. 2015;7(4):295–306.

    Article  Google Scholar 

  8. Slieman TA, Camarata T. Case-based group learning using concept maps to achieve multiple educational objectives and behavioral outcomes. J Med Educ Curric Dev. 2019;6:2382120519872510.

    Article  Google Scholar 

  9. Arain SA, et al. Perceived effectiveness of learning methods among preclinical medical students - role of personality and changes over time. Pak J Med Sci. 2021;37(7):1854–9.

    Google Scholar 

  10. Donkin R, Rasmussen R. Student perception and the effectiveness of Kahoot!: a scoping review in histology, anatomy, and medical education. Anat Sci Educ. 2021;14(5):572–85.

    Article  Google Scholar 

  11. Kazory A, Zaidi Z. Team-based learning activities for first-year medical students: perception of the learners. South Med J. 2018;111(9):525–9.

    Article  Google Scholar 

  12. Ramnanan CJ, Pound LD. Advances in medical education and practice: student perceptions of the flipped classroom. Adv Med Educ Pract. 2017;8:63–73.

    Article  Google Scholar 

  13. Walling A, et al. Medical student perspectives of active learning: a focus group study. Teach Learn Med. 2017;29(2):173–80.

    Article  Google Scholar 

  14. Wang B, Abdul Khader A. Medical student and tutor perceptions on active learning strategies. Med Educ Online. 2019;24(1):1650565.

  15. Betihavas V, et al. The evidence for ‘flipping out’: a systematic review of the flipped classroom in nursing education. Nurse Educ Today. 2016;38:15–21.

    Article  Google Scholar 

  16. Chen KS, et al. Academic outcomes of flipped classroom learning: a meta-analysis. Med Educ. 2018;25(52):910–24.

    Article  Google Scholar 

  17. Cheng L, Ritzhaupt AD, Antonenko P. Effects of the flipped classroom instructional strategy on students’ learning outcomes: a meta-analysis. Etr&D-Educational Technology Research and Development. 2019;67(4):793–824.

    Article  Google Scholar 

  18. Street S, et al. The flipped classroom improved medical student performance and satisfaction in a pre-clinical physiology course. Med Sci Educ. 2015;25:35–43.

    Article  Google Scholar 

  19. Van Vliet EA, Winnips JC, Brouwer N. Flipped-class pedagogy enhances student metacognition and collaborative-learning strategies in higher education but effect does not persist. CBE Life Sci Educ. 2015;14(3):1–10.

    Google Scholar 

  20. Fatmi M, et al. The effectiveness of team-based learning on learning outcomes in health professions education: BEME Guide No. 30. Med Teach. 2013;35(12):e1608–24.

  21. Joshi T, et al. Team-based learning among health care professionals: a systematic review. Cureus. 2022;14(1):e21252.

    Google Scholar 

  22. Koles PG, et al. The impact of team-based learning on medical students’ academic performance. Acad Med. 2010;85(11):1739–45.

    Article  Google Scholar 

  23. Trullas JC, et al. Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review. BMC Med Educ. 2022;22(1):104.

    Article  Google Scholar 

  24. Neville AJ. Problem-based learning and medical education forty years on. A review of its effects on knowledge and clinical performance. Med Princ Pract. 2009;18(1):1–9.

  25. Sayyah M, et al. Use of a problem-based learning teaching model for undergraduate medical and nursing education: a systematic review and meta-analysis. Adv Med Educ Pract. 2017;8:691–700.

    Article  Google Scholar 

  26. Zaveri N, et al. Changes to an active learning curriculum in osteopathic medical education: effects on exam outcomes and board scores. Med Sci Educ. 2019;29(1):215–22.

    Article  Google Scholar 

  27. Bonaminio GA, et al. The University of Kansas School of Medicine. Acad Med. 2020;95(9S A snapshot of medical student education in the United States and Canada: reports from 145 schools):S184–S7.

  28. Pourshanazari AA, et al. Comparing the long-term retention of a physiology course for medical students with the traditional and problem-based learning. Adv Health Sci Educ Theory Pract. 2013;18(1):91–7.

    Article  Google Scholar 

  29. Ozgonul L, Alimoglu MK. Comparison of lecture and team-based learning in medical ethics education. Nurs Ethics. 2019;26(3):903–13.

    Article  Google Scholar 

  30. MacDougall C. A novel teaching tool combined with active-learning to teach antimicrobial spectrum activity. Am J Pharm Educ. 2017;81(2):25.

    Article  Google Scholar 

  31. Shatto B, L’Ecuyer K, Quinn J. Retention of content utilizing a flipped classroom approach. Nurs Educ Perspect. 2017;38(4):206–8.

    Article  Google Scholar 

  32. Cevik AA, et al. Team-based learning improves knowledge and retention in an emergency medicine clerkship. Int J Emerg Med. 2019;12(1):6.

    Article  Google Scholar 

  33. Wang X, et al. Teaching health assessment symptomatology using a flipped classroom combined with scenario simulation. J Nurs Educ. 2020;59(8):448–52.

    Article  Google Scholar 

  34. Ballouk R, et al. Medical students’ self-regulation of learning in a blended learning environment: a systematic scoping review. Med Educ Online. 2022;27(1):2029336.

    Article  Google Scholar 

  35. Ahmady S, et al. Distance learning strategies in medical education during COVID-19: a systematic review. J Educ Health Promot. 2021;10:421.

    Google Scholar 

  36. Althwanay A, et al. Medical education, pre- and post-pandemic era: a review article. Cureus. 2020;12(10):e10775.

    Google Scholar 

  37. Dedeilia A, et al. Medical and surgical education challenges and innovations in the COVID-19 era: a systematic review. In Vivo. 2020;34(3 Suppl):1603–11.

    Article  Google Scholar 

  38. Ishak A, et al. Virtual pathology education in medical schools worldwide during the COVID-19 pandemic: advantages, challenges faced, and perspectives. Diagnostics. 2022;12:1578. https://doi.org/10.3390/diagnostics12071578.

    Article  Google Scholar 

  39. Stojan J, et al. Online learning developments in undergraduate medical education in response to the COVID-19 pandemic: a BEME systematic review: BEME Guide No. 69. Med Teach. 2022;44(2):109–129.

  40. Ballen CJ, et al. Enhancing diversity in undergraduate science: self-efficacy drives performance gains with active learning. CBE Life Sci Educ. 2017;16(4):1–16.

    Article  Google Scholar 

  41. Theobald EJ, et al. Active learning narrows achievement gaps for underrepresented students in undergraduate science, technology, engineering, and math. Proc Natl Acad Sci U S A. 2020;117(12):6476–83.

    Article  Google Scholar 

  42. Collins CM, Carrasco GA, Lopez OJ. Participation in active learning correlates to higher female performance in a pipeline course for underrepresented students in medicine. Med Sci Educ. 2019;29(4):1175–8.

    Article  Google Scholar 

  43. Behling KC, et al. Team-based learning in a pipeline course in medical microbiology for under-represented student populations in medicine improves learning of microbiology concepts. J Microbiol Biol Educ. 2016;17(3):370–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Population Health, University of Kansas School of Medicine, KS, 66160, Kansas City, USA

    Dorothy Hughes

  2. Department of Surgery, University of Kansas School of Medicine, KS, 66160, Kansas City, USA

    Sarah A. Keim

  3. Department of Biochemistry and Molecular Biology, University of Kansas School of Medicine, KS, 66160, Kansas City, USA

    Joseph D. Fontes

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  1. Dorothy Hughes
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  2. Sarah A. Keim
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  3. Joseph D. Fontes
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Correspondence to Joseph D. Fontes.

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The study utilized only deidentified data in secondary analysis and our study was undertaken as quality improvement and was judged by the University of Kansas Medical Center Institutional Review Board not to require full IRB review.

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The authors declare no competing interests.

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Hughes, D., Keim, S.A. & Fontes, J.D. Equivalent Performance of Exam Items Associated with Case-Based Learning, Flipped Classroom, and Lecture in a Pre-clerkship Medical Curriculum. Med.Sci.Educ. 33, 1109–1115 (2023). https://doi.org/10.1007/s40670-023-01842-8

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