Journal of Nursing Education

Major Article 

Flipping the Statistics Classroom in Nursing Education

Todd A. Schwartz, DrPH

Abstract

Flipped classrooms are so named because they substitute the traditional lecture that commonly encompasses the entire class period with active learning techniques, such as small-group work. The lectures are delivered instead by using an alternative mode—video recordings—that are made available for viewing online outside the class period. Due to this inverted approach, students are engaged with the course material during the class period, rather than participating only passively. This flipped approach is gaining popularity in many areas of education due to its enhancement of student learning and represents an opportunity for utilization by instructors of statistics courses in nursing education. This article presents the author’s recent experiences with flipping a statistics course for nursing students in a PhD program, including practical considerations and student outcomes and reaction. This transformative experience deepened the level of student learning in a way that may not have occurred using a traditional format. [J Nurs Educ. 2014;53(4):199–206.]

Dr. Schwartz is Research Assistant Professor, Department of Biostatistics, Gillings School of Global Public Health, and School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Todd A. Schwartz, DrPH, Research Assistant Professor, Department of Biostatistics, Gillings School of Global Public Health, and School of Nursing, University of North Carolina at Chapel Hill, 2010 Carrington Hall, CB#7460, Chapel Hill, NC 27599-7460; e-mail: Todd_Schwartz@unc.edu.

Received: May 31, 2013
Accepted: November 20, 2013
Posted Online: March 25, 2014

Abstract

Flipped classrooms are so named because they substitute the traditional lecture that commonly encompasses the entire class period with active learning techniques, such as small-group work. The lectures are delivered instead by using an alternative mode—video recordings—that are made available for viewing online outside the class period. Due to this inverted approach, students are engaged with the course material during the class period, rather than participating only passively. This flipped approach is gaining popularity in many areas of education due to its enhancement of student learning and represents an opportunity for utilization by instructors of statistics courses in nursing education. This article presents the author’s recent experiences with flipping a statistics course for nursing students in a PhD program, including practical considerations and student outcomes and reaction. This transformative experience deepened the level of student learning in a way that may not have occurred using a traditional format. [J Nurs Educ. 2014;53(4):199–206.]

Dr. Schwartz is Research Assistant Professor, Department of Biostatistics, Gillings School of Global Public Health, and School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Todd A. Schwartz, DrPH, Research Assistant Professor, Department of Biostatistics, Gillings School of Global Public Health, and School of Nursing, University of North Carolina at Chapel Hill, 2010 Carrington Hall, CB#7460, Chapel Hill, NC 27599-7460; e-mail: Todd_Schwartz@unc.edu.

Received: May 31, 2013
Accepted: November 20, 2013
Posted Online: March 25, 2014

The concept of a “flipped” classroom has been recently gaining much attention from educators (Bergmann & Sams, 2012; Foertsch, Moses, Strikwerda, & Litzkow, 2002; Lage, Platt, & Treglia, 2000; McLaughlin et al., 2013; McLaughlin et al., 2014). Its practice has been on the increase, not only in K-12 education (Roscorla, 2011) but in the community college and university settings as well (Dove, 2013). Traditionally, information is conveyed from the instructor to the students by means of formal lecture as the primary activity during the class period. Students passively receive the course material through the lectures, and material may then be reinforced through exercises that are assigned as homework. The key idea behind the flipped approach is to reverse the nature and timing of these activities, so that the lecture is made available outside the class period; therefore, class time is freed up for hands-on activities that are focused on training students about how to apply the lecture material.

If the majority of the class period can be utilized for purposes other than lecture, a world of possibilities opens up for teaching and learning. Because contemporary technology is available to instructors, this inverted format can be implemented in a relatively simple and inexpensive way. Lectures can be pre-recorded for students to view at their convenience prior to the class period; thus, the class time can then be used less for imparting basic information and more for engaging the students in a variety of activities that allow the instructor to interact with the students as they practice and apply the material.

The flipped approach incorporates aspects of collaborative and active learning, so that an instructor using the approach is sometimes referred to as a “guide on the side” rather than the “sage on the stage” (King, 1993, p. 30). Others have performed extensive literature reviews on the evidence supporting the advantages of active learning (Kuh, Kinzie, Buckley, Bridges, & Hayek, 2006; McKeachie, Pintrich, Lin, Smith, & Sharma, 1990; Prince, 2004). Bonwell and Eison (1991) provided an overview of active learning techniques, including short demonstrations, classroom discussions, mini-lectures, and peer teaching.

Many authors have espoused active learning in the field of nursing (Huff, 1997), as well as in a variety of specific aspects of nursing education, including clinical methods (Glendon & Ulrich, 1992; Hoke & Robbins, 2005), graduate-level education (Critz & Knight, 2013), and nursing research (Goodfellow, 1995).

The adoption of active learning techniques results in many learning advantages (Carini, Kuh, & Klein, 2006; Deslauriers, Schelew, & Wieman, 2011), such as learning that is emphasized through doing rather than through listening. This is particularly relevant for statistics education because, although rich datasets are now freely available through many sources, students require additional skills in analyzing and synthesizing such datasets, while also being engaged in higher levels of evaluation and critical thinking. The flipped classroom provides an ideal setting in which to progressively transition students through increasingly complex levels of the cognitive domain of Bloom’s revised taxonomy (i.e., applying, analyzing, evaluating, and creating; Anderson et al., 2000).

Of importance, a distinction exists between a flipped course and an online course. An online course may deliver its content via mechanisms similar to a face-to-face course, but it does not have the same classroom component as a flipped classroom. The flipped classroom thoroughly integrates the prerecorded lectures with regular weekly classroom attendance where activities occur in a face-to-face setting. The flipped course involves student preparation outside of class, engagement in activities and subsequent discussion during class, and reinforcement of concepts outside of class via homework; this process is repeated during each week of the course.

One key element of the flipped approach is that the primary responsibility for learning is explicitly shifted from the instructor to the student. Because lecture is transferred from inside the classroom to outside the formal class period, students must view the lectures on their own time. Students must regard this task with high priority, focus, and attention at a level as high as the attendance of lectures in a traditional class format. If students do not properly attend to the flipped, prerecorded lectures, they will not have the requisite background to fully engage in the classroom activities, which are intended to build on the foundation provided by those lectures. The class period is not used for repetition of the prerecorded lecture but rather is utilized to extend those concepts in ways highly relevant to the students’ training.

Context

The specific context for this experience in teaching a flipped course is a sequence of two required statistics courses (3 credit hours each) for nursing students in a research-based Doctor of Philosophy (PhD) program, typically taken in each of their first 2 years of the curriculum. The material of the two courses focuses on the methods of linear regression and analysis of variance (ANOVA), respectively. The course objectives emphasize the mainstream utilization of these statistical methods, rather than delving deeply into details, proofs, and esoteric topics. Conceptual underpinnings of these statistical methods are covered, rather than formulaic details.

Annual enrollment in these courses is approximately 12 students who have a broad range of statistical backgrounds, as well as varying lengths of time since their last statistics course. These students display a wide range of attitudes toward statistics, although some tend to experience statistics anxiety, which is a common phenomenon among graduate students (Williams, 2013). The class period is 3 consecutive hours and meets once per week. Before flipping this classroom, course time consisted primarily of in-class lecture, although a limited amount of class activities were periodically introduced to help students engage with the material on a deeper level. One example of such activity is a hands-on exercise demonstrating ANOVA by using M&M® candies (Schwartz, 2013). The classroom is configured with rows of long tables with portable chairs so that students could flexibly reconfigure their seating arrangements for either individual or small-group work.

The author’s philosophy involves ensuring that all students comprehend each essential course concept before proceeding to the next topic. Furthermore, these two statistics courses involve sequential and cumulative learning of technical material, so mastery of each topic is critical for understanding the next. If a student cannot maintain pace with the course, he or she may not be able to recover in time to catch up by the end of the semester. The author has taught these courses for several years and has encountered several persistent challenges, which mainly seemed to be due to the heterogeneity of the students’ statistical backgrounds. Notably, it was consistently difficult to cover the full complement of course material. One frequently encountered scenario involves a student asking a question two thirds of the way through a lecture, revealing a lack of understanding of a fundamental concept that was covered much earlier in the same lecture. The student could be asked to postpone his or her question until it could be addressed after class—resulting in the student (and others who had the same question) likely being lost for the reminder of the class period and not having gained any meaningful learning for most of the class—or the class could circle back to the point of confusion and resume the lecture from there, losing precious class time for those students who were successfully following the lecture to that point. The latter approach was generally adopted, although the author knew it would be more desirable to accommodate both groups of students—those who were struggling to maintain pace, as well as those who were ready to move to the next topic.

Given the context, this PhD program was preparing for a significantly streamlined revision of its curriculum. This author offered to revise the required statistics sequence from two 3-credit courses into a single 4-credit course. This new course would maintain the single weekly class period of 3 hours, but would include an additional 1-hour computer laboratory. Given the aforementioned struggle to fit the necessary content material into each semester, how could the course possibly achieve this restructuring in a way that would be satisfactory to all involved parties? The adopted solution lay with the flipped classroom, a concept the author had not previously implemented.

The author believed the flipped statistics classroom would work on many levels and that it could enhance the students’ learning experience. Using this model, an instructor could exert control over the amount of material covered each week, rather than being constrained by the timing and nature of the questions students might ask. Because the students were not listening to live lectures, the lecturer would not pause for questions. When the lectures were made available to the students, they would be able to view them according to their level of understanding; if a student understood the material perfectly, then he or she could choose to view it only once. However, if a student had difficulty comprehending some material, he or she could watch and rewatch that lecture (or the relevant portions thereof) as many times as was needed to gain the level of comprehension necessary to be prepared for the next class period’s activities.

The American Statistical Association’s (ASA, 2012) Guidelines for Assessment and Instruction in Statistics Education (GAISE) presented six recommendations for statistical education (Table 1), all of which fit nicely into this flipped course. The guidelines reflect current best practices in the statistics classroom, including all degree levels of the nursing curriculum (Hayat, 2014). These recommendations are highlighted in the sections that follow.

Summary of GAISE Recommendations for Statistical Education

Table 1:

Summary of GAISE Recommendations for Statistical Education

Approach and Practical Considerations

Video Recordings

The video-recorded lectures are a crucial piece of the flipped classroom. Instructors may find an existing library of such lectures, particularly as this model gains traction in the field of education, but it is likely that such lectures will not be precisely tailored to their courses. Creating the recordings is a time-intensive activity but ideally will prove to be a time saver in the long run, as those recordings can potentially be reused year after year. The author was able to convert his existing lecture notes into video-recorded lectures. Other instructors may find different approaches that work best for them; some may wish to script the audio portion word-for-word, whereas others may be more comfortable making off-the-cuff remarks from very basic lecture notes.

Rather than one long weekly lecture, creating a series of video recordings for each week’s topic was ideal. The lengths of these recordings may need to vary according to the material being covered, but shorter recordings—approximately 10- to 15-minutes’ duration—tended to provide better results. Different topics permitted this to varying degrees. For example, some topics need sufficient development and explanation, so one would not want to break them into multiple, shorter sessions. Interestingly, when asked for feedback on this aspect of the course, some students liked the shorter segments, whereas others preferred longer video recordings.

One may also provide students with links to alternative pre-existing recordings, such as those produced by the Khan Academy (available for free at http://www.khanacademy.org) or others easily found online. Although students may not be required to view these, the alternative recordings can provide a different approach or perspective to which students might better relate; the drawback is that there will inevitably be different notation, nuances, and jargon from those used in the course, which students may not have the sophistication to be able to translate successfully across those differences.

Hardware and Software

The video recordings include a technical side, in terms of both computer hardware and software, so it is best to consult with the information technology department at one’s institution, when possible. A tablet personal computer was used, which is a laptop computer with a screen that can capture handwriting via a stylus. Alternatives to this configuration include an external tablet peripheral device with a USB connection to a computer or an iPad® (or other tablet device) with the user’s preferred application. A USB microphone can be used to record the simultaneous audio, although the computer’s built-in microphone may provide sufficient quality. Video recordings for the statistics course included the video capture of the author’s computer screen with the real-time audio overlay of his voice; however, there was no need for video capture of his face. The video started with the computer screen appearing like a blank whiteboard, with the author’s handwriting displayed on the screen as it was written with the stylus. Freely available, open-source software is available, such as Sankoré ( http://open-sankore.org/), which serves as a virtual whiteboard. Other software options are summarized in Table 2.

Selected Software Resources for Video Recordings

Table 2:

Selected Software Resources for Video Recordings

Finally, software is needed to record and integrate the video and audio portions, as well as to perform some basic editing functions. The Echo360® (n.d.) product was available for this purpose at the author’s institution, but such software may already be included as part of one’s operating system (e.g., Movie Maker® in Microsoft® Windows). The recordings should be saved in a format that can be accessed by the students through their Web browsers (e.g., YouTube video) or downloaded as a podcast (e.g., MP4 file). Depending on the hardware and software already accessible at one’s institution, converting to a flipped classroom may cost little to nothing at all.

Some software packages, such as Microsoft® Word and PowerPoint, have built-in capabilities to capture stylus input. These features can be useful in the event that one has lecture notes that are already in a presentation format. For example, video recordings can be produced using existing PowerPoint slides as the basis, and the slides (with additional optional written notations) can be displayed, along with the instructor’s spoken lecture.

An online course management system, such as Blackboard (n.d.) or Sakai (n.d.), is suitable to make the links to the video recordings available to the students. Given the wide scope in nature of the course activities, the course management system can be utilized as a method for helping the students to organize the material and informing them how the lectures and various activities cohere. Common file name stems (e.g., class01…) were used to reflect the common video recordings, in-class activities, homework problem sets, and computer code that applied to a specific topic.

Active Learning

One recommendation of the GAISE report (ASA, 2012; Table 1) is to “foster active learning in the classroom” (p. 4). An essential component of the flipped course that is time intensive in its initial offering is the design of appropriate active learning exercises to be used during the class period. These can and should include a combination of types of activities because the chance of engaging each student with the material at the intended level and critical time spent on-task will be maximized by using a variety of approaches. These can include individual-based activities (such as quizzes or the think-pair-share approach), small-group exercises, case studies, reviewing and critiquing published articles, and working through the entire data analysis process using statistical software (e.g., beginning with a disorganized dataset and proceeding through to statistical analysis and interpretation of findings). This allows for emphasis on conceptual understanding and not merely statistical mechanics, as per the GAISE recommendations (ASA, 2012). A key to approaching these activities is to begin with the end in mind: what should the students ultimately learn about a particular topic during this class period? Activities can then be designed to bridge the gap in the students’ lack of understanding to the necessary level of comprehension. By alternating among individual activities, small-group work, and whole-class discussions, an instructor can engage each student and provide opportunities for him or her to determine what topics he or she has mastered and which topics still present gaps in understanding.

Students appeared to learn material more deeply when there were multiple points of contact for learning—first the prerecorded lecture, then the in-class active learning techniques, followed by related homework assignments. This approach also stands a greater chance of presenting material in at least one way that will fit with each student’s learning preferences. The in-class activities should be consistent with all six recommendations of the GAISE report (ASA, 2012; Table 1).

In particular, the GAISE report (ASA, 2012) recommends that statistical courses emphasize statistical literacy and develop statistical thinking, and the in-class, small-group activities were ideal for accomplishing this goal. When assigning work to the students in small groups, often using real data, the classroom became dynamic. Without the need to lecture, the author was free to circulate around the classroom to interact with the students, which allowed him to identify precisely where students were having difficulty with the material. This accelerated the learning process because problems with statistical literacy and thinking could be diagnosed and remedied during class, rather than discovering such gaps after the students had attempted their homework, requiring the need to address deficiencies during the following class period. The author was able to tailor his response to a specific group’s needs, rather than requiring the entire class to reduce its pace. Because all the required material had already been covered prior to the class period, the author was no longer constrained to cover a set amount of material in class. If multiple groups have the same question, it indicates that the topic should be subsequently addressed in another way. The flipped format allows for such adjustments to (a) pause the group activities to begin an impromptu lecture and class discussion or (b) create a short, timely video recording that addresses any specific issues raised in class for students to view as supplemental to the main recordings.

Computing and Teaching Assistant

The GAISE report (Table 1) recommends using technology “for developing conceptual understanding and analyzing data” (ASA, 2012, p. 4), so a weekly computer laboratory session was introduced into the course. This allowed the students to learn a statistical software package without encroaching on class time. Early in the semester, computer laboratory time was devoted to helping students navigate the steep learning curve of the statistical software. However, based on feedback from the students a few weeks into the semester, laboratory time expanded in scope to include homework recitation.

A teaching assistant (TA) was assigned to help with the integrated course for 10 hours per week. This was an exceptionally valuable component of a flipped course. In this instance, the TA was an advanced nursing PhD student well into her dissertation research. She had taken the statistics sequence a few years prior, so she was familiar with the core material. The students found her to be approachable, especially with questions for which they did not perceive they should bother the author. The TA was utilized in several key areas: holding weekly office hours, conducting the computer laboratory sessions, and attending class to serve as an additional resource to the small groups as they worked through their exercises. Weekly feedback sessions between the author and the TA were held for discussion of the students’ progress and planning for the upcoming class period. The TA briefed the author on her correspondence with the students, as well as alerted him about problem areas so they could be addressed in the next set of activities.

Student Reactions and Outcomes

The GAISE report (ASA, 2012) recommends using assessments of student learning, and because this experience was novel for these students, the author requested frequent feedback. Initially, feedback was gathered following the third week of class via a Word document downloaded from the online course management system and completed anonymously. The questionnaire contained a series of questions regarding the flipped format and its impact on their learning and engagement. The questions were rated on an ordinal scale of 1 to 5, ranging from 1 = strong disagreement to 5 = strong agreement to reflect the students’ levels of endorsement. The results are shown in Table 3.

Results of the Student Assessment Administered After the Third Week of Class (n = 8)

Table 3:

Results of the Student Assessment Administered After the Third Week of Class (n = 8)

Early in the semester, students appeared to perceive the flipped format as a positive aspect of the course, although they perhaps were not yet convinced of its advantages. The timing of this assessment allowed for the fine-tuning of course aspects, according to the students’ perceived needs. Responsiveness to students’ suggestions, which are made in good faith, can lead to their increased appreciation of the dynamic and personalized nature of the flipped approach.

Feedback was also requested with 1 month remaining in the semester, using a similar anonymous questionnaire via a downloadable Word document. This questionnaire asked students to rate various aspects of the course on a scale ranging from 1 = very unfavorable to 5 = very favorable, along with space provided for comments. Results of this assessment are provided in Table 4. With this final assessment, students could reflect over the course of the semester to provide input, as well as to allow the author to refine aspects of the course for future cohorts. These ratings, although not directly comparable with the earlier assessment, suggest an improved and favorable view of the flipped classroom by the students.

Results of the Student Assessment Administered During the Last Month of Class (n = 9)

Table 4:

Results of the Student Assessment Administered During the Last Month of Class (n = 9)

Anecdotally, students reflected their positive reaction to the flipped format via comments regarding their pride in learning the material, viewing this as a noteworthy accomplishment. They also acknowledged the format as being an intense learning experience, although they recognized it as being a worthwhile expenditure of time and effort. Students realized the value of being able to use their own data and apply the methods to their individual field of research, citing a refreshed passion for their area of interest as a result. During the semester’s last class, students were asked to list two or three points of advice for the next year’s students on how to succeed in the course, which could then be made available as tips to guide future students about how to successfully navigate the course.

A pretest versus posttest learning assessment was incorporated into the course as an objective measure of students’ progress. On the first day of class, an unannounced quiz was administered, which consisted of problems relating to material of a moderate level of difficulty that would eventually be covered in the course. Not surprisingly, the class average score was low (28% correct). At the time, these quizzes were not graded or returned to the students. The identical quiz was given at the end of the semester, again on an unannounced basis; the class average had substantially improved to 75% correct. Of course, these postscores could have been higher had the quiz been announced in advance. The graded pretests and posttests were returned simultaneously to the students so they might see for themselves just how much they had learned during the course of the semester, as well as to establish the effectiveness of the flipped format. Although the author believes that students learned at least as much as they would have under a traditional lecture-based format, he did not collect data that would allow for a formal head-to-head comparison of the method.

On the formal, anonymous, online end-of-course evaluations conducted by the university, the students reflected their receptivity to and appreciation for the course (and thereby the flipped classroom). On a rating scale of 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree, 70% of the students strongly agreed that “overall, this course was excellent,” with an average response of 4.5 (median, 4.8). Of importance, this offers evidence against the notion that students will resist the flipped method, despite the increased demands it places on them both outside and inside the classroom. As this course concluded, the students presented the author with a box of chocolates and a card with their handwritten comments, such as “we really learned an amazing amount of challenging material” and “learning methods are exceptional.” This gesture was considered a high compliment and an affirmation of the flipped approach.

Lessons Learned

Flipping a course is not a trivial task and should not be approached lightly by instructors considering this move. From this author’s experience, valuable lessons may be learned; many of which are discussed below. Most importantly, the flipped format was successful in effectively resolving the issues that had served as its impetus for adoption of the method in this course—the author could now control the pacing of material covered in weekly lectures and, furthermore, could increase the amount of material covered in the course.

However, a considerable time burden associated with the initial implementation exists, although this can be viewed as a long-term investment that pays off over time. This flipped format requires an instructor to exercise the mental agility and flexibility necessary to modify the class period according to the observed needs of the students regarding a particular topic.

The small-group activities are critically important pieces of the flipped course. Hence, finding the right composition of the groups is essential. Not knowing the background of each student, an instructor may need to shuffle the membership of each group for the class period multiple times until the right mix is found. This mix of group members can address the challenge of having students in both tails of the distribution curve regarding their level of understanding. The stronger students will ideally serve as peer instructors to those who need additional explanation. Of course, those stronger students also benefit from this activity, as forming and expressing their thoughts in ways their peers can understand will further solidify their understanding. Instructors can also consider assigning bonus activities for those who are progressing through the activities more quickly than the rest of the class.

It is essential for the instructor to be highly organized in his or her approach to the flipped classroom. This is important not only because so many different activities occur in a given class period but also because many students require scaffolding to successfully tie together all the material for a given topic. One student’s feedback related that when she was able to see the organizational approach to the course, she prepared a large binder to file notes, homework, responses to the in-class activities, and her software code and output, which, in turn, aided her learning and prepared her for the examinations.

Students were better prepared for class when they had previously viewed the lecture, as the class would begin with the application of that material. The lecture provided the building blocks on which students could apply their acquired knowledge to various scenarios. By finding applications that were relevant to the nursing profession and to the types of activities the students would expect to encounter in their careers (e.g., critiquing manuscripts), students were more motivated to learn the material for reasons other than the course being required as part of their curriculum.

The flipped classroom emphasizes a student-centered learning environment. After all, the goal of teaching is not to simply cover all course material but rather for the students to absorb that material, synthesize it with their experiences, and repackage it in ways that are highly relevant to them and their future careers. Flipping a course can help students to move in that direction. The instructor becomes, in essence, a facilitator of in-class problem solving. Students can self-pace their learning; some students might require a longer period of time to process and comprehend the material relative to their peers. Hence, this approach accommodates the heterogeneity present in the backgrounds of the class. Finally, students learn to self-monitor their progress. If they are not able to engage fully in the small-group activities because their progress lags behind their peers, they realize they need to perform additional work prior to the class period. The instructor can also address their needs and questions on an individual basis, without delaying the rest of their group or the rest of the class who are ready to move ahead.

The role of the instructor shifts from conveyer of information to one who responds to individual or group questions and guides in-class problem solving. Instructors should strive to create a positive classroom environment where students feel safe to ask any question and where they can expect to receive clarifying responses to these questions. If an instructor is more interested in the students’ correct reasoning than in their ability to simply produce correct responses without fully comprehending the underlying concepts, the flipped format can facilitate students’ engagement with the material in that manner. Students will quickly learn that they are responsible for the prerecorded material when the instructor does not rehash the material in class.

By assigning individual work prior to assembling the students into their small groups, each individual will spend time thinking deeply about the material and integrating new knowledge with his or her existing beliefs before engaging in discussion with his or her peers. Two such individual-based possibilities are (a) the think-pair-share approach, where students think through an exercise before pairing with another student and sharing their thoughts, and (b) distributing an ungraded quiz that allows students to formulate their argument and then in turn convince the members of their small group that their response is correct.

The students reported that they liked the formats of the videos (Table 4). The prerecorded nature of the videos provided flexibility to accommodate students’ obligations, such as work schedules or family responsibilities. Students could view the lectures at their individual optimal time of learning, whether early in the day or late at night. One of the final requests from the students was to have the video recordings archived and kept available as they progressed through the PhD program, which is a testament to the value of the recorded lectures as a learning resource for the students.

Limitations

Although the advantages of a flipped classroom are clear, instructors may also encounter some limitations as they implement these methods. It may seem overwhelming to fully flip a course in terms of both time and additional effort. However, this may be done incrementally, and need not be done all at once. One could flip perhaps just one module of a course at first, then refine the process and continue to flip increasing amounts of the course over multiple semesters. Also, the approach described in this context may not be broadly generalizable to all levels and types of nursing education and may not apply as easily in a nonstatistical setting. Instructors who find themselves in contexts different from those described herein may find other obstacles, although many of these may be surmountable. For example, each of this course’s class periods lasted 3 hours, so there was sufficient time to develop extensive active learning modules each week. Shorter class periods would require a refinement of the activities to ensure that they fit within the allotted time period. Many statistics courses in nursing have large enrollments, although the issue of class size can be accommodated through the use of small groups. Making the case for additional TAs to ensure adequate student support is essential. The physical layout of the classroom is also important; round tables or swiveling chairs would be ideal. However, most classroom structures can accommodate a flipped format if students are creative in arranging their small groups (e.g., even large auditoriums with fixed seating can be used if some students face forward and others backward for the small-group activities).

Instructors will inevitably encounter students who do not wish to engage in active learning, insisting they prefer a traditional lecture format. However, it is likely that these students would indeed see gains in deeper understanding of the material if they were to engage in active, rather than passive, styles. Students may not initially be comfortable with the active nature of the flipped classroom, so instructors should emphasize the new set of expectations—including the shifted responsibility for learning— from the first day so students can reorient themselves. To avoid criticizing an individual’s reasoning, instructors may frame the discussion to have students present their group’s response, rather than their own. If an instructor discerns that students are not prepared for class and have not adequately reviewed the video recordings, he or she may wish to implement graded quizzes at the beginning of each class.

Future Directions

Having implemented this approach only for the first time, the author has several areas to refine for future offerings. For example, because the author now has a library of video recordings that covers the basis of the course material, enhanced usage of just-in-time video recordings can be made in response to specific areas of difficulty, without allocating large amounts of time or effort.

Video recordings of statistical software tutorials can be produced using the same technology as the other video recordings. An instructor’s voice can be recorded while performing step-by-step implementation of the statistical software for various statistical methods, and the output can be annotated to guide the students in interpreting the results. Although the use of computer laboratories accomplished this during the initial flipped course offering, further efficiency might be realized by transferring some of this material outside the instructional period.

One further possibility is to create video recordings that show step-by-step solutions of selected homework problems. As with the other recordings, the added advantage is that the students can hear the instructor’s voice and see his or her writing through the virtual step-by-step process of attacking and solving various problems. Importantly, this will provide the opportunity for the students to hear the instructor’s reasoning behind each step of the solution.

Conclusion

As evidenced above, this experience indicates that the flipped classroom format was highly effective in supporting PhD nursing students’ learning of statistical material. The improved efficiency of the use of classroom instructional time is of great importance. Not only was all the material from the previous two 3-credit courses successfully incorporated into the new integrated 4-credit course without overloading the students, but valuable supplemental computing material (such as essential data management skills) not central to the course material was added, which will benefit the students’ further studies and careers.

The notion of the flipped classroom is a transformative teaching and learning experience that can open doors to greater levels of student achievement, which may not have been tapped in a traditional format. Although the instructor needs to maintain a high degree of flexibility in class, it comes at a great benefit of tailoring to the needs of a particular set of students. Several challenges associated with this approach exist, but these can be overcome by the instructor’s careful planning and by keeping the ultimate goal of enhanced student learning in mind.

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Summary of GAISE Recommendations for Statistical Education

Emphasize statistical literacy and develop statistical thinking

Use real data

Stress conceptual understanding, rather than mere knowledge of procedures

Foster active learning in the classroom

Use technology for developing conceptual understanding and analyzing data

Use assessments to improve and evaluate student learning

Selected Software Resources for Video Recordings

ProductPurpose
BlackboardCommercial course management system
Camtasia Studio®Commercial software for screen recording and video editing
Echo360®Commercial software to integrate video (e.g., PowerPoint slides) with audio
Microsoft® Movie MakerCommercial software to integrate video with audio
Microsoft® PowerPointCommercial presentation software; compatible with stylus input
Microsoft® WordCommercial document software; compatible with stylus input
SakaiOpen-source course management system
SankoréOpen-source virtual whiteboard software
SMART® TechnologiesCommercial virtual whiteboard software
Wacom Bamboo®Commercial tablet peripheral device with a USB connection to a computer
VoiceThreadCommercial software to integrate video with audio

Results of the Student Assessment Administered After the Third Week of Class (n = 8)

ItemMean (SD)
I generally prefer the flipped classroom format, where lectures are provided online and the classroom is used primarily for small-group activities (compared with a traditional classroom format, where lectures occupy the classroom period).4.1 (0.8)
The flipped format is helping to make the materials and activities in the course more interesting to me.3.6 (0.5)
The flipped format is helping to increase my understanding of the concepts in the course.4.3 (0.7)
The flipped format is helping to increase my participation in class over what I would have expected coming into the course.3.6 (1.3)

Results of the Student Assessment Administered During the Last Month of Class (n = 9)

ItemMean (SD)
Rating of the flipped classroom format, where lectures are provided online and the classroom is used primarily for small-group activities (compared with a traditional classroom format, where lectures occupy the classroom period and exercises occur as homework)4.4 (0.7)
Rating of the format of small-group class exercises used during the class period4.0 (0.9)
Rating of the format of the lectures (recorded and online)5.0 (0.0)

10.3928/01484834-20140325-02

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