Gubbiyappa KS
Barua A
Das B
Vasudeva Murthy C R
Baloch HZ
Engaging tools
pedagogical model
» Materials and Me...
» Discussion
Effectiveness of flipped classroom with Poll Everywhere as a teaching-learning method for pharmacy students
Kumar Shiva Gubbiyappa1, Ankur Barua2, Biswadeep Das3, CR Vasudeva Murthy4, Hasnain Zafar Baloch5
1 Department of Life Sciences, School of Pharmacy, International Medical University, 57000 Kuala Lumpur, Malaysia
2 Department of Community Medicine, International Medical University, 57000 Kuala Lumpur, Malaysia
3 Department of Pharmacology, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
4 Department of Pathology, International Medical University, 57000 Kuala Lumpur, Malaysia
5 Department of e-Learning Resources, International Medical University, 57000 Kuala Lumpur, Malaysia
Date of Acceptance 12-Oct-2016
Kumar Shiva Gubbiyappa
Department of Life Sciences, School of Pharmacy, International Medical University, 57000 Kuala Lumpur
Objectives: Flipped classroom (FC) is a pedagogical model to engage students in learning process by replacing the didactic lectures. Using technology, lectures are moved out of the classroom and delivered online as means to provide interaction and collaboration. Poll Everywhere is an audience response system (ARS) which can be used in an FC to make the activities more interesting, engaging, and interactive. This study aims to study the perception of undergraduate pharmacy students on FC activity using Poll Everywhere ARS and to study the effectiveness of FC activity as a teaching-learning tool for delivering complementary medicine module in the undergraduate pharmacy program.
Materials and Methods: In this nonrandomized trial on interrupted time series study, flipped class was conducted on group of 112 students of bachelor of pharmacy semester V. The topic selected was popular herbal remedies of the complementary medicine module. Flipped class was conducted with audio and video presentation in the form of a quiz using ten one-best-answer type of multiple-choice questions covering the learning objectives. Audience response was captured using web-based interaction with Poll Everywhere. Feedback was obtained from participants at the end of FC activity and debriefing was done.
Results: Randomly selected 112 complete responses were included in the final analysis. There were 47 (42%) male and 65 (58%) female respondents. The overall Cronbach's alpha of feedback questionnaire was 0.912. The central tendencies and dispersions of items in the questionnaire indicated the effectiveness of FC. The low or middle achievers of quiz session (pretest) during the FC activity were three times (95% confidence interval [CI] = 1.1–8.9) at the risk of providing neutral or negative feedback than high achievers (P = 0.040). Those who gave neutral or negative feedback on FC activity were 3.9 times (95% CI = 1.3–11.8) at the risk of becoming low or middle achievers during the end of semester examination (P = 0.013). The multivariate analysis of "Agree" or "Disagree" and "Agree" or "Strongly Agree" was statistically significant.
Conclusion: This study provides insight on how the pharmacy students learn and develop their cognitive functions. The results revealed that the FC activity with Poll Everywhere is an effective teaching-learning method.
Key message:
Flipped classes (FC) drive active learning among the participants, resulting in better performance in students. FC for pharmacy students enabled instructors to engage the learners and helpthem towards self-directed learning. FC supported the fact that the quality (not necessarily the quantity) of student-teacher interaction was a compelling force in improving student performance.
Keywords: Engaging tools, flipped classroom, Poll Everywhere, pedagogical model
Gubbiyappa KS, Barua A, Das B, Vasudeva Murthy C R, Baloch HZ. Effectiveness of flipped classroom with Poll Everywhere as a teaching-learning method for pharmacy students. Indian J Pharmacol 2016;48, Suppl S1:41-6
Gubbiyappa KS, Barua A, Das B, Vasudeva Murthy C R, Baloch HZ. Effectiveness of flipped classroom with Poll Everywhere as a teaching-learning method for pharmacy students. Indian J Pharmacol [serial online] 2016 [cited 2023 Jan 29];48, Suppl S1:41-6. Available from: https://www.ijp-online.com/text.asp?2016/48/7/41/193313
There is sufficient documented evidence in the literature on student concentration that concentration of students begins to falter after (10–15) min[1] and hence, maintaining student attention during didactic lectures is a significantly difficult challenge.[2],[3] Flipped classes represent a type of blended learning where the instructor develops content such as videos for students to watch outside the live classroom and then class time is channelized toward the application of the concepts imbibed invoking active learning methods, which results in higher student achievement.[4],[5],[6] This methodology may be considered as the backward classroom and reverse instruction. In a flipped class, students study the topic independently and then spend the class time-solving problems, applying the underlying concepts to case studies, or doing practical application activities. Instructors take on the role of tutor or coach or facilitator to help students in areas where they have trouble in the application of concepts.[7] Flipped classes enable instructors to spend extended time with students and facilitate them toward creation of higher level application projects[8] which culminates in increased learning,[9] active learning exercises, for example, quizzes, teamwork, debates, self-reflective, and case studies that prompt students engagement and reflection encourage them to explore attitudes and values while facilitating them motivation to acquire knowledge and related skills.[10]
Poll Everywhere is an audience response system (ARS). It is also termed as a personal response system or in education circles, as a student polling system (clickers). Research published over the last decade indicates that classroom use of an ARS can have a significant, positive impact on student learning.[5]
In this study, the researchers intended to determine whether a combination of flipped classroom (FC) activity and Poll Everywhere were successful in engaging attention, facilitating participation, and learning among undergraduate pharmacy students for delivering the complementary medicine module in a university setting.
» Materials and Methods
The complementary medicine module under the bachelor of pharmacy program for semester V students was designed to provide background knowledge on natural herbal products.
This was a nonrandomized trial in the form of an interrupted time series study.
This study was conducted for 4 months from July 1, 2013, to November 30, 2013.
All the undergraduate students of pharmacy from semester V, who gave informed written consent to participate in this study, were included.
Eligible students, who were absent on the day of the FC activity, were excluded from this study. Incomplete quiz or feedback questionnaires were excluded from the final analysis.
In this study, all the 156 undergraduate students of pharmacy from semester V, who were present on the day of intervention, were exposed to FC activity and were subjected to a quiz and an immediate feedback questionnaire.
Sample Size Estimation
The sample size was estimated for finite population with the help of statistical package Epi Info version 5. 0 for Windows and Statistical Package for Social Sciences version 17.0 and verified using the following formula:
Here, the confidence level was taken as 95%.
t = normal deviate corresponding to the required confidence interval (CI).
Here, it was 1.96 for 95% CI.
p = proportion of positive feedback was expected to be at least 50%.
q = (100 − p).
d = Absolute precision of the estimate was set at 5%.
N = total eligible population for this study comprised 156 undergraduate students of pharmacy from semester V, who were present on the day of the FC activity.
Hence, the minimum sample size was determined to be 112.
Sampling Method
Simple random sampling method was used to select the study sample.
Study Instruments
The "Poll Everywhere" is web-based software for analyzing instant poll responses from the audience using smart devices such as smartphone, tablet, computers, or laptops. It is an interactive ARS which can be employed in an FC activity. The instructor can assess the responses of the participants instantly during an interactive session and provide valuable feedback on the spot to the respondents. Ten quiz questions, covering the learning outcomes of the FC activity, were included in this "Poll Everywhere" software for capturing participant responses.
A feedback questionnaire on the FC activity was adapted from a validated questionnaire developed by Pierce and Fox during 2012.[5] This questionnaire was modified and revalidated during the pilot study appropriately to suit the needs. The final feedback questionnaire captured and analyzed stated to the following items:
Were the prereading materials (i-Lecture/others) available on e-Learning portal before the FC activity?
Was adequate time provided for going through the prereading materials (i-Lecture/additional references etc.) before the FC activity?
Did you find the prereading materials relevant for the FC activity?
Were the classroom arrangements (positioning of the chairs for group activity, audio-visual facilities, etc.) conducive for the FC activity?
Did the activities during FC session increase your understanding of the key concepts?
Did the FC session inspire you to pursue further learning for the module?
Should there be more lectures conducted in the FC mode?
Was the instructor able to engage the students in the FC activity?
Was the instructor able to provide clarification to the concerned students on difficult concepts during the FC activity?
Was the instructor was able to elaborate on i-Lectures and prereading materials during the FC activity.
Data Collection Procedure
Four i-Lectures and prereading materials in connection to the learning outcomes of FC activity were made available in the e-Learning portal for access to the students 2 weeks prior the FC activity. All the learning outcomes from the FC activity were created from the four designated i-Lectures and prereading materials.
The FC activity was undertaken for 50 min in the form of an instructor-created quiz format with ten questions. Some audio and video clips were incorporated as indirect cues to the quiz questions. These were in acceptance to the learning outcomes of the FC activity. A minimum of two one-best-answer (OBA) questions was selected from each of the four lectures that were converted into an FC activity. Each of the questions had five options with one correct answer. The real-time evaluation of quiz (pretest) during FC activity through "Poll Everywhere" was conducted using these ten OBA questions.
The instructor revealed one quiz question during the FC on "Poll Everywhere" at a time and requested the participants to select their one best response from the given five options provided. One minute was allocated for the participants to register their responses online at "Poll Everywhere" through their smart devices. After all the responses were captured, the poll froze and the poll-result were displayed on the screen. Since the quiz was conducted before any discussion, the poll responses were considered as pretest in this study. The instructor discussed each of the options in brief and engaged the participants in debate for the next 3 min. The students were guided by the instructor to identify the correct answer for each quiz question only after evaluating all the five options. This procedure was repeated for all the ten quiz questions. Five minutes were allocated for poll and discussion on each quiz question during the FC activity. Hence, it was possible to conduct the entire FC activity within 50 min. Since the answer for each quiz question was revealed at the end of discussion, an immediate posttest on the same questions was not deemed necessary.
A feedback questionnaire was administered to the participants for 10 min after the FC activity. This was followed up with a debriefing session for 5 min.
The effectiveness of the FC activity was evaluated in the form of eight problem-solving exercises (two from each i-Lecture) during a formative assessment which was conducted 8 weeks after the FC activity. Since this was a formative assessment, the data generated was not included in the final analysis. The appropriate contents of the complementary medicine module were reinforced after this assessment.
The effectiveness of FC activity was analyzed by comparing the performance of participants on the end of semester examination questions related to the FC activity versus the initial quiz result captured by the "Poll Everywhere." The summative end of semester examination was conducted 6 weeks after the formative assessment. It included ten OBA questions from the complementary medicine module encompassing the FC activity. There were five "K-type" questions among these. All the questions were vetted by the pharmacy experts to ensure that difficulty levels were matched with the quiz questions administered during the FC activity.
Approval for the present study was obtained from the Institutional Ethics Committee and the Department of Life Sciences, School of Pharmacy at the International Medical University, Kuala Lumpur, Malaysia.
The data collected were tabulated and analyzed using the Epi Info version 5.0 for Windows and Statistical Package for Social Sciences version 17.0 (SPSS Inc., 233 South Wacker Drive, 11th Floor Chicago, IL 60606-6412). The results were expressed in terms of proportion, median, and interquartile range (IQR). Chi-square test and McNemar's test were applied for comparison purposes among categorical (binomial) variables. The strengths of association were calculated using the odds ratio (OR), relative risk, and their 95% CIs. Although three observations were made, only the performance in the quiz session of FC activity (pretest result) was compared with the end of semester examination (posttest result). Multiple logistic regression analysis was conducted to study the independent effect of each variable over the outcome. In this study, a P < 0.05 was considered statistically significant.
In the present study, randomly selected complete responses from 112 undergraduate pharmacy students of semester V were included for the final analysis. There were 47 (42%) male and 65 (58%) female respondents in this sample.
[Table 1] describes the intra-observer reliability for individual items in feedback questionnaire. The overall intra-observer reliability from Cronbach's alpha was found to be 0.852. The intra-observer reliability ranged between 0.755 and 0.845 for item deletion in Cronbach's alpha analysis. Since none of the Cronbach's alpha values exceeded 0.852 in item deletion.
Table 1: Intra-observer reliability for individual items in feedback questionnaire
[Table 2] describes the central tendencies and dispersions of responses on individual items in feedback questionnaire. The analysis revealed that majority agreed (three) or strongly agreed (four) on the following items: (a) i-Lectures and prereading materials were available on e-Learning portal before the FC activity, (b) i-Lectures and prereading materials were relevant for the FC activity, (c) physical arrangements were conducive for FC activity, (d) FC activity had increased the understanding of topics and pursue further learning for the module, (e) instructor was able to actively engage the students during the FC activity, (f) instructor was able to provide clarification on difficult concepts, and (g) instructor was able to expand on the i-Lectures and prereading materials. However, the central tendency was found to be three (agree) with IQR ranging between two (neutral) and four (strongly agree) for adequate time spent by the students on i-Lectures and prereading materials. The results indicated that most of items were favoring the flipped classroom activity which was considered as an effective teaching-learning tool by the participants and majority recommended that more lectures should be conducted in the FC mode.
Table 2: Central tendencies and dispersions of responses on individual items in feedback questionnaire
[Table 3] describes the proportion of individual responses on feedback questionnaire. It explains the perceptions of participants regarding the FC activity. Although all the students agreed that i-Lectures and prereading materials were available on e-Learning portal before the FC activity, only 55% among them reported that they had spent significant time in going through i-Lectures and prereading materials. Eighty-eight percent of the students agreed that physical arrangements were conducive for FC activity.
Table 3: Proportion of individual responses on feedback questionnaire
[Table 4] shows the univariate analysis of the association between FC quiz result (pretest) and feedback. It was revealed that majority of the low/middle achievers of the FC quiz result (63.6%) provided the neutral/negative feedback on FC activity as compared to the high achievers (36.4%). This difference was found to be statistically significant (0.040). The unadjusted OR was found to be 3.0 with 95% CI ranging between 1.1 and 8.9. These findings clearly indicated that those who performed low in the quiz (pretest) during the FC activity were 3 times more at the risk of providing neutral or negative feedback.
Table 4: Univariate analysis: Association between flipped classroom quiz result and feedback
[Table 5] shows the univariate analysis of association between feedback and end of semester examination result (posttest). It was revealed that majority of those who gave neutral/negative feedback on FC activity (45.5%) became low/middle achievers during the end of semester examination as compared to those gave positive feedback (17.8). This difference was found to be statistically significant (0.013). The unadjusted OR was found to be 3.9 with 95% CI ranging between 1.3 and 11.8. These findings clearly indicated that those who gave neutral/negative feedback on FC activity were 3.9 times at the risk of becoming low/middle achievers during the end of semester examination.
Table 5: Univariate analysis: Association between feedback and end of semester examination result
[Table 6] reveals the multivariate analysis of responses on "Agree" or "Disagree" for feedback items. A statistically significant difference of responses was observed for the following items: (a) classroom arrangements (positioning of the chairs for group activity, audio-visual facilities etc.) were conducive for the FC activity, (b) FC session inspired me to pursue further learning for the module, and (c) instructor was able to provide clarification on difficult concepts during the FC activity.
Table 6: Multivariate analysis: Responses on agree or disagree for items Q2, Q4, Q6 and Q9
Flipped classes enable instructors to engage the participants and help the stakeholders toward self-directed learning. It also facilitates them toward critical thinking[8] which will result in better understanding of the subject by promoting active learning.[9] The scheduled lecture time was used primarily for assessing student knowledge and fostering active learning through activities in the form of an interactive quiz session.[4],[12] Four prerecorded i-Lectures and prereading materials were viewed independently by students before the FC activity. These activities were expected to drive active learning among the participants, resulting in better performance, and culminating in higher achievements.[4],[12]
The studies by Pierce and Fox, Gardner,[13] Litzenger et al.,[14] and Olds and Johri[15] also reported that the pharmacy students expressed a consistently high preference for the FC instructional model relative to the traditional instructor-led lecture model. They recognized the convenience and pedagogical benefits of the FC instructional model. They demonstrated the efficacy of active learning using the FC model to improve student outcomes. It was observed that the FC supported the fact that the quality (not necessarily the quantity) of student-teacher interaction was a compelling force in improving student performance.[13],[14],[15]
In this study, participation in FC activity, in combination with (ARS) Poll Everywhere fostered critical thinking among the participants. It had created new experience for participants to engage in active learning and to apply their knowledge in problem-solving scenario during the formative assessment. It was also effective in preparing the students for final summative examination.
Due to feasibility and time constraints, both the quiz and feedback questionnaire had to be restricted to ten questions. The generalizability of this study is restricted as it was conducted only in one discipline and at one center.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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