The impact of the transition from flipped classroom to online lectures on learning outcomes and student satisfaction in a rehabilitation medicine clerkship during the COVID-19 pandemic

BACKGROUND: The flipped classroom (FC) is a well-known active learning module that activates the prior knowledge of students and promotes their cognitive skills during in-class activities. However, most on-site teaching during the COVID-19 pandemic had to be conducted online. The FC in our rehabilitation medicine clerkship curriculum was also shifted to online asynchronous lectures (OLs), without real-time interactions. There is no previous comparison of effectiveness between these two methods. Therefore, this study aimed to compare learning outcomes and student satisfaction in both FC and OL models. METHODS: The study design was a historically controlled study. A physical modality was chosen for the content. The FC group (n = 233), in the academic years 2018 and 2019, was assigned to perform a pre-class activity consisting of reading study materials. Thereafter, the in-class activity comprised a small-group case-based discussion. The OL group (n = 240) in the academic years 2020 and 2021 followed an online model during the COVID-19 lockdown. They were also asked to read the online materials and then watch a self-paced recorded lecture video on Learning Management Systems. The learning outcomes, including their multiple-choice questions (MCQs) scores, final exam scores, grade points, and letter grades, were evaluated. Their overall course satisfaction ratings were also collected. RESULTS: The OL group had an overall higher MCQ score for the physical modality portion than the FC group (p = 0.047). The median (lower quartile, upper quartile) of the total 50-MCQ scores were 34 (31, 37) in the OL group and 33 (29, 36) in the FC group (p = 0.007). The median final exam scores of the OL and FC groups were 69.5 and 68.3, respectively (p = 0.026). The median grade points and the letter grades were not significantly different between the groups. The proportions of satisfaction were significantly higher in the FC group than in the OL group. CONCLUSIONS: The OL group revealed significantly higher learning outcomes than the FC group. However, the FC group showed more satisfaction with interactivity than the OL group. The authors are of the view that a combination of both FC and OL methods will likely result in better outcomes.