Flip or Flop: Do Students Thrive in a Flipped Classroom?
Authors: Carpenter Kelsey A. , Williams James M. , Ferrigno Christopher 
Published: April 2020

IntroductionWhile the traditional gross anatomy course contains a didactic component using live in‐person lectures, there is a recent push for using a flipped classroom by incorporating online pre‐recorded videos (PRV) and having learners apply the video content during in‐class activities. Here we highlight a full‐body gross anatomy course using a flipped classroom approach by including PRV to introduce anatomy mixed with an in‐person group discussion. The purpose of this study is to determine the effect of introducing PRV and in‐class discussions in a clinically‐focused gross anatomy course on student exam performance and the quantitative and qualitative course evaluations.MethodsIn this retrospective study to elucidate the effect of a flipped classroom on student performance in a full‐body gross anatomy course, we compared test scores of two consecutive student cohorts at Rush University enrolled in an intensive, single semester clinically‐focused gross anatomy course for physician assistant (PA) students. In 2018, learners attended 3 in‐class lectures per week over 14 weeks. Each one‐hour lecture was followed by a 3‐hour dissection. Course content was distributed over 5 blocks, each ending in a written multiple choice exam and timed‐station practical exam.In 2019, the didactic portion of course content was delivered in a PRV. Learners watched PRV prior to class then convened to participate in small group, active learning activities for 1 hour followed by a 3‐hour dissection. The 2018 live lectures and 2019 PRV and classroom facilitation were provided by the same faculty members (JMW and CF).Student written and practical exam performance by cohort for each of the 5 block exams were compared as well as the aggregated test performance by year. Quantitative course evaluations were also compared by year.ResultsEach student cohort in the 2018 and 2019 gross anatomy course included 30 learners. The average length of PRV provided in 2019 was 35.0 (± 10.8) minutes. The average practical and written scores for each block in 2018 and 2019 are shown in Table
1. The learners in the 2019 cohort achieved 4% higher on their practical scores and 1.2% higher on their written exam scores when compared to learners who received in‐class lectures alone (2018). When grouping all 5 exams and comparing 2018 scores and 2019 scores using student t‐tests, learners in the flipped classroom (2019) scored significantly higher on the practical exams than the students who received traditional lectures (2018) (p<0.001). There was no significant difference in written exam scores (p=0.251).When asked to rate the overall class at the end of the semester, learners who experienced the flipped classroom (2019) rated the course at 4.9/5, while learners who experienced a traditional curriculum (2018) rated the course at 4.5.DiscussionThe results from this study suggest that students in a flipped classroom setting achieved higher practical exam scores but not higher written exam scores during a clinicallyfocused gross anatomy course. The results also suggest that students who experienced the flipped‐classroom approach held the course in higher regard than the students who experienced traditional lectures.
Average written and practical block exam scores, standard deviations, and corresponding p‐values for the 2018 and 2019 cohorts. Course evaluation scores provided for both cohorts.

Written 2018

Written 2019

Practical 2018

Practical 2019

Average

STD

Average

STD

p‐value

Average

STD

Average

STD

p‐value

Back and Thorax

88.9

9.4

87.8

9.8

0.67

90.6

6.8

93.2

6.1

0.12

Abdomen and Pelvis

87.7

9.8

90.4

7.3

0.23

88.3

9.6

90.2

6.7

0.38

Upper Limb

83.5

11.5

89.3

8.8

0.03

87.7

9.2

93.1

5.2

0.01

Lower Limb

93.9

6.2

91.9

7.4

0.27

88.3

8.6

96.5

4.0

<0.001

Head and Neck

86.8

10.0

87.4

8.2

0.82

89.1

8.5

91.1

5.9

0.29

All Blocks Combined

88.1

9.4

89.4

8.3

0.33

88.6

8.5

92.8

5.6

<0.001

Course Evaluation

2018

2019

Score

4.5

4.9