Abstract:

Introduction:
The profile of the 21st century health care professionals is one of the driving forces for the adoption of active instructional strategies in higher education. Flipped classroom is a student-centred instructional strategy credited with positive effects on learning.
We aim to describe the views of undergraduate nursing students on flipped classroom in a “Pharmacology and Therapeutics” module.

Methods:
In the theoretical component of “Pharmacology and Therapeutics”, a first year module of the nursing bachelor degree, 7 of the 27 non-compulsory 2h-lectures were converted to flipped classroom. About one week before each class, students were given resources to prepare the in-class activities plus an online quiz with automated feedback, via BlackBoard learning management system. Quizzes were considered for summative assessment (total 14 points out of 100). Lectures were then used to explore topics aligned with learning outcomes, with the aid of a voting system (Mentimeter).
Students’ views pertaining to the 2017/18 academic year were collected through an anonymous, voluntary online questionnaire, as part of regular pedagogical monitoring. The questionnaire encompassed six closed-ended questions on flipped classroom with a three points scale (positive, negative and unsure), one closed-ended question on preference (didactic lecture, flipped classroom, mixed, unsure) and one open-ended question for comments or suggestions.
Numeric data were analysed using SPSS version 27. Textual data were coded and analyzed for themes.

Results:
The survey was answered by 151 of the 411 students enrolled in the module (37% of response rate); all consented to the use of data for scientific purposes. We excluded from analysis six students with no contact with flipped classroom.
The average age of respondents was 20 years (SD=3,7); most were female (n=131; 90,3%). About 10% were repeating the module (n=15; 10,3%) and 15,3% were working students (n=22).
The majority of respondents reported feeling comfortable using computers (n=133; 91,7%).
About 75% (n=109; 75,2%) of the respondents agreed that preparatory work before in-class activities contributed to knowledge acquisition (unsure n=19; 13,1%). Approximately half (n=79; 54,9%) considered flipped classes more interesting to attend comparatively to didactic lectures (unsure n=24; 16,7%).
Additionally, 55,9% (n=81) of the respondents agreed that flipped classroom contributed to their academic success in the module (unsure n=36; 24,8%).
Given a choice, 62,5% (n=90) stated they would prefer a mixed model, with didactic lectures plus flipped classroom, whilst 17,4% (n=25) declared a preference for flipped learning.
Thematic analysis illuminated the reasons underlying students’ views. Two key reasons explained the lack of wide “buy-in” from students: perceptions of increased workload and beliefs about teacher-centeredness in classroom practices.

Conclusion:
Respondents' views on flipped classroom were not unanimously positive; it is uncertain how the relatively low response rate may have affected findings.
Taken together, our findings suggest that flipped classroom can be used in conjunction with didactic lectures to enhance active learning and contribute to a shift towards a student-centred paradigm.

Keywords:

Flipped classroom, higher education, nursing education, teaching-learning, students’ perceptions.