Chen Kuo-Su, Monrouxe Lynn, Lu Yi-Hsuan, Jenq Chang-Chyi, Chang Yeu-Jhy, Chang Yu-Che, Chai Pony Yee-Chee
Department of Nephrology, Chang Gung Memorial Hospital, Keelung branch, Keelung, Taiwan.
Chang Gung Medical Education Research Center (CG-MERC), Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
Med Educ. 2018 Jun 25;52(9):910-24. doi: 10.1111/medu.13616.
The flipped classroom (FC), reversing lecture and homework elements of a course, is popular in medical education. The FC uses technology-enhanced pre-class learning to transmit knowledge, incorporating in-class interaction to enhance higher cognitive learning. However, the FC model is expensive and research on its effectiveness remains inconclusive. The aim of this study was to compare the efficacy of the FC model over traditional lecture-based (LB) learning by meta-analysis.
We systematically searched MEDLINE, PubMed, ERIC, CINAHL, EMBASE, reference lists and Association for Medical Education in Europe (AMEE) conference books. Controlled trials comparing academic outcomes between the FC and LB approaches in higher education were considered eligible. The main findings were pooled using a random-effects model when appropriate.
Forty-six studies (9026 participants) were included, comprising four randomised controlled trials (RCTs), 19 quasi-experimental studies and 23 cohort studies. Study populations were health science (n = 32) and non health science (n = 14) students. The risk of bias was high (36/37 articles). Meta-analyses revealed that the FC had significantly better outcomes than the LB method in examination scores (post-intervention and pre-post change) and course grades, but not in objective structured clinical examination scores. Subgroup analyses showed the advantage of the FC was not observed in RCTs, non-USA countries, nursing and other health science disciplines and earlier publication years (2013 and 2014). Cumulative analysis and meta-regression suggested a tendency for progressively better outcomes by year. Outcome assessments rarely focused on behaviour change.
The FC method is associated with greater academic achievement than the LB approach for higher-level learning outcomes, which has become more obvious in recent years. However, results should be interpreted with caution because of the high methodological diversity, statistical heterogeneity and risk of bias in the studies used. Future studies should have high methodological rigour, a standardised FC format and utilise assessment tools evaluating higher cognitive learning and behaviour change to further examine differences between FC and LB learning.
翻转课堂（FC）将课程中的讲座和作业环节进行了颠倒，在医学教育中很受欢迎。翻转课堂利用技术增强的课前学习来传授知识，并通过课堂互动来促进更高层次的认知学习。然而，翻转课堂模式成本高昂，其有效性的研究尚无定论。本研究旨在通过荟萃分析比较翻转课堂模式与传统讲座式（LB）学习的效果。
我们系统检索了MEDLINE、PubMed、ERIC、CINAHL、EMBASE、参考文献列表以及欧洲医学教育协会（AMEE）会议书籍。比较高等教育中翻转课堂和讲座式方法学术成果的对照试验被视为合格。在适当情况下，主要研究结果采用随机效应模型进行汇总。
纳入了46项研究（9026名参与者），包括4项随机对照试验（RCT）、19项准实验研究和23项队列研究。研究对象为健康科学专业学生（n = 32）和非健康科学专业学生（n = 14）。偏倚风险较高（36/37篇文章）。荟萃分析显示，在考试成绩（干预后和前后变化）和课程成绩方面，翻转课堂的效果显著优于讲座式方法，但在客观结构化临床考试成绩方面并非如此。亚组分析表明，在随机对照试验、非美国国家、护理和其他健康科学学科以及较早的出版年份（2013年和2014年）中未观察到翻转课堂的优势。累积分析和荟萃回归表明，逐年来看有效果逐渐更好的趋势。结果评估很少关注行为变化。
对于更高层次的学习成果，翻转课堂方法比讲座式方法能带来更大的学术成就，近年来这一点变得更加明显。然而，由于所用研究方法的高度多样性、统计异质性和偏倚风险，对结果的解释应谨慎。未来的研究应具有高度的方法严谨性、标准化的翻转课堂形式，并使用评估更高认知学习和行为变化的评估工具，以进一步研究翻转课堂和讲座式学习之间的差异。
