Most of the early studies related to the flipped format occurred in academia. For example, Zainuddin and Halili (2016) reviewed 20 research-based articles regarding the flipped classroom from 2013 to 2015 in varied fields of study ranging from science and math to humanities. Overall results indicated the flipped classroom positively contributed to leaner achievement and engagement. Challenges such as student and faculty adaptation were mentioned, as well as concerns regarding the quality and design of online content. Similarly, Presti (2016) performed an integrative review of 13 research articles regarding the flipped classroom in nursing education from 2010 to 2015. The reviewed studies included undergraduate, graduate-level, and doctoral courses. The research designs were varied and focused on different variables, such as improved test scores, responses to survey questions, and participant satisfaction. Overall, results were mixed, with only one study demonstrating a statistical significance in improving examination scores. Thus, Presti (2016) limited their conclusion to suggest that the flipped classroom may improve learner engagement.
The Flipped Format in Workplace Learning
Flipping the classroom may seem to be more easily fit into the academic setting, rather than the workplace. However, Nederveld and Berge (2015) performed a review of the literature for examples of how the format had been used in the workplace. Prework included video lectures, interactive videos with knowledge checks, and online modules. Active learning in the classroom included problem-based learning, concept exploration, meaning-making activities, and collaborative learning. Benefits were identified as having more class time to apply knowledge, higher level learning, support to diverse learners, and increased resources. The authors suggested additional potential benefits could include reduced travel costs, improved outcomes, and improved return on investment. Nederveld and Berg (2015) also identified challenges with the flipped classroom, such as the need for instructors to learn new skills, unprepared students, and varied learner access to technology.
The Flipped Format to Educate Nursing Professionals
McDonald and Smith (2013) recommended use of the flipped classroom for nursing professional development and indicated the flipped format could provide nursing staff on all shifts with “access to consistent instructional content prior to in-class sessions” (p. 438). Several examples regarding use of the format with practicing nurses have been published. Although most articles are anecdotal (rather than research based), they provide insight as to how educators have used the flipped format for orientation, ongoing education activities, and workshops.
An early example of the flipped classroom occurred in a nurse internship program for new neonatal intensive care nurses (Pilcher, 2011). In an effort to increase learner engagement and vary learning strategies, new nurses were assigned prework for several of the topics, with live class time being used for application. For example, for the topic of neonatal ventilation, the nurse interns completed three online modules prior to class, which consisted primarily of reading material with pictures. Afterwards, they spent time in the unit with a respiratory therapist for hands-on experience with the different types of ventilators. Live class time was used for interpreting blood gases and solving case examples in which learners anticipated what ventilator changes might be needed (Pilcher, 2011). Although results were not compared to prior nonflipped results, preceptors reported the new graduate nurses who participated in this learning format demonstrated a better understanding of neonatal ventilation and blood gases than prior groups who had lecture for this content. The primary challenge that arose was logistical (rather than educational). According to the Fair Labor Standards Act, nonexempt employees should be compensated for off-the-clock work. This includes required training, such as self-study work. To address this, the average time to complete the modules was calculated to determine the amount of time to pay the nurse interns for the time they spent completing the prework.
More recently, Bishop and Wackler (2017) described using the flipped format, along with increased interactivity and simulation, to improve engagement of Generation Y nurses attending a nurse residency program. The authors reported learner satisfaction, improved confidence, and retention of content. Similarly, McPherson and Talbot (2018) described use of the flipped classroom for orientation and skills fairs for acute care nurses. Content was provided through use of online modules, with builtin real-time remediation, followed by a skills fair with hands-on demonstration. The authors reported a savings of $28,737 during the first 2 years after the flipped format was initiated. They also reported unexpected results related to increased staffing flexibility and staff reporting that the learning “added value that was not previously present” (McPherson & Talbot, 2018, p. E2).
For ongoing education, Costanzo, Ehrhardt, and Gormly (2013) described a blended flipped dysrhythmia course for new nurses. Prework included online content, which allowed nurses to spend as much time as they needed to complete modules. The live class was used for problem-solving activities. Costanzo et al. (2013) reported that the nurses successfully completed the course in a shorter time frame than with the prior traditional model, with an estimated annual savings of $40,000. Similarly, Johnson (2016) described the flipped classroom format as a strategy for promoting professional development through journal clubs. Interested participants were notified regarding specific articles to read before attending a class. The class time was then spent with participants discussing how to incorporate evidence into their practice.
Butlar, Pilcher, Flanagan, and Haley (2017) described use of the flipped classroom in a workshop for 104 nurse educators. The purpose of the workshop was to advance the skills and practices of nurse educators, as well as to model the flipped format. Prework included reading materials, brief lectures with voice-over narration, online modules, spreadsheets, FAQ sheets, an electronic book, and Word® documents designed as just-in-time resources. The live session included participant application of content learned. Participants worked in small groups to solve a multifaceted case study that incorporated all the topics from the prework. A facilitator presented the case study to each group and assisted participants with staying on track. Participants reported overall satisfaction, with some indicating excitement regarding the flipped format and the learning that had occurred. A challenge was described related to technology firewalls at some of the participant's facilities, which blocked access to some of the prework content (such as YouTube videos and content developed using Prezi®).
The flipped format can also be used for advanced training. For example, Zwerneman, Tolentino, and Pilcher (2019) described changing from a traditional lecture-based format to the flipped classroom, along with a problem-based learning strategy, to provide training for new clinical leaders. Prework included reading materials, hint sheets, how-to videos, and online modules. During the class time, participants worked in small groups to solve six multifaceted case studies focused on “realistic and complex problems that participants would likely face in their new leadership roles” (p. 31). The class time was facilitated by subject matter experts who had undergone training regarding how to facilitate learning using the flipped format. Although initial cost of module and resource development was significant, the authors reported that the costs were offset by a decrease in the number of actual classroom days and a decrease in commuter hours per person, resulting in an estimated annual salary savings of $18,240. Participants reported increased perceived competence when performing common management tasks, such as reading finance reports and applying content to practice.