Heeseung Choi; Jeongeun Kim; Kyung-Sook Bang; Yeon-Hwan Park; Nam-Ju Lee; Chanhee Kim

doi:10.4040/jkan.2015.45.6.939

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Original Article
Applying the Flipped Learning Model to an English-Medium Nursing Course: Heeseung Choi¹, Jeongeun Kim¹, Kyung-Sook Bang¹, Yeon-Hwan Park¹, Nam-Ju Lee¹, Chanhee Kim²; Journal of Korean Academy of Nursing 2015;45(6):939-948.
DOI: https://doi.org/10.4040/jkan.2015.45.6.939
Published online: December 15, 2015

¹College of Nursing and the Research Institute of Nursing Science, Seoul National University, Seoul

²College of Nursing, Seoul National University, Seoul, Korea

¹College of Nursing and the Research Institute of Nursing Science, Seoul National University, Seoul

²College of Nursing, Seoul National University, Seoul, Korea

Address reprint requests to : Choi, Heeseung College of Nursing and the Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-740-8850 Fax: +82-2-765-4103 E-mail: hchoi20@snu.ac.kr

• Received: January 7, 2015 • Revised: January 16, 2015 • Accepted: August 11, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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Abstract
REFERENCES

Abstract

Purpose
An emerging trend in Asian higher education is English-medium instruction (EMI), which uses English as the primary instructional language. EMI prepares domestic students for international leadership; however, students report difficulty in learning, and educators have raised questions concerning the effectiveness of EMI. The flipped learning model (FLM), in which lecture and homework activities for a course are reversed, was applied to an English-medium course offered by a college of nursing in Korea. The aims of this study were to: 1) revise an existing English-medium nursing course using the FLM; 2) explore students’ learning experiences and their acceptance of the FLM; and 3) identify key factors in the success of FLM.
Methods
We used a descriptive, cross-sectional, mixed-methods design and the participants were students at one nursing school in Korea. A series of course development meetings with faculties from the nursing school and the center for teaching and learning were used to develop the course format and content. We conducted course evaluations using the Flipped Course Evaluation Questionnaire with open-ended questions and focus group interviews.
Results
Students (N=75) in a 15-week nursing course responded to a survey after completing the course. Among them, seven students participated in one of two focus groups. Overall, students accepted and favored the flipped learning strategy, and indicated that the method enhanced lecture content and their understanding of it. Factors associated with effective instruction included structured monitoring systems and motivational environments.
Conclusion
The FLM requires sufficient preparation to facilitate student motivation and maximize learning outcomes.
Keywords: Educational model; English; Learning; Nursing education

Figure 1.

Flipped course format for the course titled,“Human Beings and Health”.

Table 1.

Content Outline of the Course

Content	Activities and assignments
Main Topics	2-minute self-video on the concepts of health, humans, and
1. Meta-paradigms in nursing: Humans, health, environment, & nursing	nursing: Peer feedback and class discussions
2. Theories of human development: Physical, psychosocial, cognitive, and	Group project: An analysis of a movie or drama using four
moral development	nursing meta-paradigms: Peer feedback
3. Human developmental characteristics: Prenatal and infancy	Health promotion project: Peer feedback on both progress and
4. Human developmental characteristics: Childhood	final outcomes of each other’s projects
5. Human developmental characteristics: Adolescence	Critical thinking activities: Euthanasia, sexual behaviors among
6. Human developmental characteristics: Early and middle adulthood	adolescents, depression and suicide among college students,
7. Human developmental characteristics: Late adulthood and theories of aging	health disparities
Special Topics
1. How to utilize cTL and eTL services
2. How to create self-videos
3. How to use movie maker program
4. Mass media influences on health and sexuality
5. Hospice care and nursing
6. Facts about suicide among college student

Table 2.

Learning Activities using Pre-recorded Lectures (N=75)

Learning activities	Categories	n (%)
1. Have you watched the pre-recorded lectures	I watched every pre-recorded lecture	40 (53.3)
prior to the class?	I missed the pre-recorded lectures 1~2 times	33 (44.0)
	I missed the pre-recorded lectures 3~4 times	2 (2.7)
	I missed the pre-recorded lectures more than 5 times	0 (0.0)
2. How did you watch the pre-recorded	I watched the pre-recorded lectures from beginning to end	19 (25.3)
lectures?	I watched all of the pre-recorded lectures and the parts that I did not understand again	49 (65.3)
	I watched only the parts that I did not understand	5 (6.7)
	No response	2 (2.7)
3. Have you reviewed pre-recorded lectures	Yes	51 (68.0)
when preparing for the final exam?	No	24 (32.0)
4. Do you think reviewing recorded lectures	Yes, it was helpful because I could repeatedly review parts that I did not understand	38 (74.5)
helped you to prepare for the final exam?^*	Yes, it was helpful because I could review only parts I did not understand	10 (19.6)
	No, it was not helpful for examinations	1 (2.0)
	No response	2 (3.9)

^*Only students who answered “yes” to question #3 responded to question #4 (n=51).

Table 3.

Evaluations of the Flipped Learning Method (N=75)

Compared to traditional learning methods, the flipped learning method	Disagree	Neutral	Agree	No response
	n (%)	n (%)	n (%)	n (%)
was strange and more uncomfortable	27 (36.0)	32 (42.7)	15 (20.0)	1 (1.3)
was more time-consuming	8 (10.7)	10 (13.3)	56 (74.7)	1 (1.3)
was more difficult to understand	42 (56.0)	19 (25.3)	11 (14.7)	3 (4.0)
was less interesting	33 (44.0)	22 (29.3)	19 (25.4)	1 (1.3)
was less efficient than a traditional class	39 (52.0)	18 (24.0)	18 (24.0)	0 (0.0)
made it harder to concentrate	23 (30.7)	14 (18.7)	38 (50.6)	0 (0.0)
was less effective in academic achievement	40 (53.3)	21 (28.0)	12 (16.0)	2 (2.7)

Table 4.

Major Themes and Subthemes Extracted from the Focus Group Interviews

Main themes	Subthemes
Benefits of the flipped course	Improved comprehension
	Able to preview and review material as needed
	Able to watch the lectures at one’s own pace
	Able to prepare questions for instructor
	Able to identify key concepts
	Flexibility & Efficiency
	Able to choose best time and place for learning
	Able to concentrate on materials
	Able to review material regularly and avoid cramming for final exam
	Enhanced learning experiences
	Able to pursue in-depth knowledge through critical questions and class discussions
	Experience sense of accomplishment as a result of self-directed learning
	Understand concepts of human beings and nursing from diverse perspectives
	Gain critical thinking skills
	Experience new ways of learning
	Gain ability to engage in diverse activities during class
	Being exposed to diverse lecture content
Limitations or challenges	Demands, both time and effort
	A lack of timely assessment and feedback on students’ questions
	Not familiar with class discussions
	Class size matters
Key success factors	Structured monitoring systems
	Strategies to assess students’ performance
	Mandatory participation on online discussions
	Maintaining an open communication channel
	Motivational environment: Well-thought-out plans
	For class activities: Effective utilization of class hours
	For class discussion: Topics appropriate to the learning level and class size
	Pre-recorded lecture: Proper length (25~30 minutes, no more than 40 minutes)

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Figure & Data

REFERENCES

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Applying the Flipped Learning Model to an English-Medium Nursing Course

J Korean Acad Nurs. 2015;45(6):939-948. Published online December 15, 2015

DOI: https://doi.org/10.4040/jkan.2015.45.6.939

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Applying the Flipped Learning Model to an English-Medium Nursing Course

Figure 1. Flipped course format for the course titled,“Human Beings and Health”.

Figure 1.

Applying the Flipped Learning Model to an English-Medium Nursing Course

Content	Activities and assignments
Main Topics	2-minute self-video on the concepts of health, humans, and
1. Meta-paradigms in nursing: Humans, health, environment, & nursing	nursing: Peer feedback and class discussions
2. Theories of human development: Physical, psychosocial, cognitive, and	Group project: An analysis of a movie or drama using four
moral development	nursing meta-paradigms: Peer feedback
3. Human developmental characteristics: Prenatal and infancy	Health promotion project: Peer feedback on both progress and
4. Human developmental characteristics: Childhood	final outcomes of each other’s projects
5. Human developmental characteristics: Adolescence	Critical thinking activities: Euthanasia, sexual behaviors among
6. Human developmental characteristics: Early and middle adulthood	adolescents, depression and suicide among college students,
7. Human developmental characteristics: Late adulthood and theories of aging	health disparities
Special Topics
1. How to utilize cTL and eTL services
2. How to create self-videos
3. How to use movie maker program
4. Mass media influences on health and sexuality
5. Hospice care and nursing
6. Facts about suicide among college student

Learning activities	Categories	n (%)
1. Have you watched the pre-recorded lectures	I watched every pre-recorded lecture	40 (53.3)
prior to the class?	I missed the pre-recorded lectures 1~2 times	33 (44.0)
	I missed the pre-recorded lectures 3~4 times	2 (2.7)
	I missed the pre-recorded lectures more than 5 times	0 (0.0)
2. How did you watch the pre-recorded	I watched the pre-recorded lectures from beginning to end	19 (25.3)
lectures?	I watched all of the pre-recorded lectures and the parts that I did not understand again	49 (65.3)
	I watched only the parts that I did not understand	5 (6.7)
	No response	2 (2.7)
3. Have you reviewed pre-recorded lectures	Yes	51 (68.0)
when preparing for the final exam?	No	24 (32.0)
4. Do you think reviewing recorded lectures	Yes, it was helpful because I could repeatedly review parts that I did not understand	38 (74.5)
helped you to prepare for the final exam?^*	Yes, it was helpful because I could review only parts I did not understand	10 (19.6)
	No, it was not helpful for examinations	1 (2.0)
	No response	2 (3.9)

Compared to traditional learning methods, the flipped learning method	Disagree	Neutral	Agree	No response
	n (%)	n (%)	n (%)	n (%)
was strange and more uncomfortable	27 (36.0)	32 (42.7)	15 (20.0)	1 (1.3)
was more time-consuming	8 (10.7)	10 (13.3)	56 (74.7)	1 (1.3)
was more difficult to understand	42 (56.0)	19 (25.3)	11 (14.7)	3 (4.0)
was less interesting	33 (44.0)	22 (29.3)	19 (25.4)	1 (1.3)
was less efficient than a traditional class	39 (52.0)	18 (24.0)	18 (24.0)	0 (0.0)
made it harder to concentrate	23 (30.7)	14 (18.7)	38 (50.6)	0 (0.0)
was less effective in academic achievement	40 (53.3)	21 (28.0)	12 (16.0)	2 (2.7)

Main themes	Subthemes
Benefits of the flipped course	Improved comprehension
	Able to preview and review material as needed
	Able to watch the lectures at one’s own pace
	Able to prepare questions for instructor
	Able to identify key concepts
	Flexibility & Efficiency
	Able to choose best time and place for learning
	Able to concentrate on materials
	Able to review material regularly and avoid cramming for final exam
	Enhanced learning experiences
	Able to pursue in-depth knowledge through critical questions and class discussions
	Experience sense of accomplishment as a result of self-directed learning
	Understand concepts of human beings and nursing from diverse perspectives
	Gain critical thinking skills
	Experience new ways of learning
	Gain ability to engage in diverse activities during class
	Being exposed to diverse lecture content
Limitations or challenges	Demands, both time and effort
	A lack of timely assessment and feedback on students’ questions
	Not familiar with class discussions
	Class size matters
Key success factors	Structured monitoring systems
	Strategies to assess students’ performance
	Mandatory participation on online discussions
	Maintaining an open communication channel
	Motivational environment: Well-thought-out plans
	For class activities: Effective utilization of class hours
	For class discussion: Topics appropriate to the learning level and class size
	Pre-recorded lecture: Proper length (25~30 minutes, no more than 40 minutes)

Table 1. Content Outline of the Course

Table 2. Learning Activities using Pre-recorded Lectures (N=75)

Only students who answered “yes” to question #3 responded to question #4 (n=51).

Table 3. Evaluations of the Flipped Learning Method (N=75)

Table 4. Major Themes and Subthemes Extracted from the Focus Group Interviews