ReportEnhancing Student Engagement Using the Flipped ClassroomMary Beth Gilboy, PhD, RDN1; Scott Heinerichs, EdD, ATC2; Gina Pazzaglia, PhD, RDN1

1Departmvania, W2DepartmPennsylvAddressCollegeScienceE-mail: m�2014 Shttp://dx

Journal

ABSTRACT

The flipped classroom is an innovative pedagogical approach that focuses on learner-centered instruction.The purposes of this report were to illustrate how to implement the flipped classroom and to describestudents’ perceptions of this approach within 2 undergraduate nutrition courses. The template providedenables faculty to design before, during, and after class activities and assessments based on objectives usingall levels of Bloom’s taxonomy. The majority of the 142 students completing the evaluation preferred theflipped method compared with traditional pedagogical strategies. The process described in the report wassuccessful for both faculty and students.Key Words: flipped class, active learning, higher education (J Nutr Educ Behav. 2014;-:1-6.)

Accepted August 5, 2014.

INTRODUCTION

Higher education has come underintense scrutiny with regard to thedemonstration of student learning.Some of this discussion focuses onthe idea that institutions shouldconsider alternative ways to delivercurricula to meet the demands of theincreasing amount of knowledge andskills students are expected to retainand use upon graduation.1 The callsfor accountability have encouragedfaculty to move from being a ‘‘sageon the stage’’ to more of a ‘‘guide onthe side’’ (King, p. 30)2 in their teach-ing approaches as first introduced byKing over 20 years ago. A sage on thestage is an instructor who impartsknowledge on the student throughlecture alone, whereas a guide on theside provides students with assistanceand correction to explore the contentindependently or within a group.Although King proposed a movementfrom one approach to the other, itshould be understood that both of

ent of Nutrition, College of Health Scest Chester, PAent of Sports Medicine, College of Hania, West Chester, PAfor correspondence: Mary Beth Gilboof Health Sciences, West Chester UnivCenter 319, West Chester, PA 19383; Pgilboy@wcupa.edu

OCIETY FOR NUTRITION EDUC.doi.org/10.1016/j.jneb.2014.08.008

of Nutrition Education and Behav

these approaches have merit in highereducation. When faculty membersserve as both a sage on the stage aswell as a guide on the side, they cantransform their course to meet the de-mands of today's learners and the callsfor accountability.

Educators have found that thein-class lecture continues to prevailas the predominant instructionalstrategy in most classrooms acrossthe country.3 This form of directedinstruction is what King referred toas the ‘‘sage on the stage.’’2 The class-room lecture alone has been criticizedby many as an ineffective way to helpstudents acquire needed knowledgeand skills.4,5 In addition, researchon lectures has demonstrated that astudent's attention declines after thefirst 10 minutes of class, and althoughit may return at the end of a class,students remember only about 20%of material presented during thelecture.6,7 When used as the solemodality for a course, this type ofpassive learning takes classroom

iences, West Chester University of Pennsyl-

ealth Sciences, West Chester University of

y, PhD, RDN, Department of Nutrition,ersity of Pennsylvania, Sturzebecker Healthhone: (610) 738-0559; Fax: (610) 436-2860;

ATION AND BEHAVIOR

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time away from challenging studentthinking, guiding them to solvingpractical problems, and encouragingdirect application of material throughactive learning with the instructorpresent.8 Although lecture has beencriticized, it is well documented thatthis form of directed instruction isnecessary to teach students in situa-tions where they hold little or no priorknowledge and where skills must betaught for students to apply later intheir career.

King's2 ideal of the guide on theside is rooted in the constructivist the-ory of learning. This theory indicatesthat knowledge does not comepackaged in professors' or students'heads to be transmitted to oneanother.9 Rather, these individuals(professors and students) possess in-formation, not knowledge. Thus,knowledge must be constructed or re-constructed by individuals by tryingto make sense of new information interms of what they already mayknow. The construction and recon-struction of knowledge in whichstudents engage is best done throughthe use of active learning strategies(eg, problem-based learning, sim-ulation, think-pair-share). A newinstructional approach in higher edu-cation is the flipped classroom. Thisinstructional approach combinesboth approaches described by Kingand enables faculty members to bemore thoughtful and strategic in theircourse design to achieve all levels ofBloom's taxonomy10 with the stu-dents present.

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In the flipped classroom, what istraditionally done in class and ashomework are switched or flipped.For example, instead of studentslistening to a lecture on public policyin class and then going home towork on a nutrition policy paper,they read material and view videoson policy before coming to class andthen engage in active learning strate-gies such as debates on current policyissues and case studies duringclass. This type of instruction enablesthe professor to be with studentswhen they are engaging in higherlevels of Bloom's taxonomy, such asapplication, analysis, and synthesis.10

Although there has been little researchon the educational outcome as it re-lates to whether the flipped classroomincreases student learning, there hasbeen a lot of indirect research (eg,student and instructor satisfactionsurveys) promoting this approach.Specifically, this instructionalapproach is being used more oftenwithin several allied health care disci-plines (medicine, nursing, and phar-macy)11-15 and has demonstratedimproved student–teacher interac-tions, opportunities for real-time feed-back, and an increase in studentengagement by ‘‘speaking the lan-guage of today's students through theuse of technology.’’8

Within themedical education litera-ture, Pluta and colleagues11 reportedcollaborative learning trends usingmethods such as problem-basedlearning and digital media to enhancecontent delivery outside the lecturehall. Faculty in a graduate-level nursepractitioner program reported thattheir pediatric nursing course was notengaging students.12 Faculty rede-signed the course using the flippedclassroom instructional approach byadding weekly out-of-class videos andpre-class modules. Weekly onlinequizzes taken after students completedthe modules assessed students' knowl-edge of the material. Graduate nursingstudents reported satisfaction with theflipped classroom and the activelearning methods used.12

Pharmacy educators redesigned abasic pharmacy course using theflipped classroom approach with on-line videos replacing class lecturesand structuring class time as activelearning strategies. Student-centeredgoals structured the course redesign

with active learning strategies suchas pair-and-share activities, studentpresentations and discussions, andindividual or paired quizzes empower-ing students to reach higher levels ofBloom's taxonomy.13 The researchersstated that students in the flippedclass more often reported that instruc-tors consistently encouraged activestudent engagement and learningcompared with a traditional class.Educators at the School of Pharmacy,University of North Carolina, rede-signed a first-year pharmaceuticscourse that was a large lecture-styleclass into small-group, case-basedclasses to encourage more collabora-tive learning.14 Pierce and Fox15 im-plemented a flipped classroom for 1module of their renal pharmaco-therapy course. They used videopodcasts of lectures for students toview before class. During face-to-faceclass time, students discussed interac-tive patient case scenarios to applytheir knowledge. Students in the flip-ped class had significantly higherscores than those in the traditionalclass; in addition, students had posi-tive opinions on the active learningstrategies. Although there is a lack ofdirect educational outcome researchin this area, this is a novel approachto teaching, and as Goodwin andMiller16 pointed out, ‘‘the absence ofevidence does not mean there isevidence of absence.’’ If the flippedclassroom is implemented withconscious thought as to what theeducational research tells us aboutlearner-centered instruction, there isa reason to believe the flipped class-room can directly affect studentlearning. The purposes of this reportwere to illustrate the implementationof the flipped classroom and todescribe students' perceptions of thisapproach within 2 undergraduatenutrition courses.

DESCRIPTION OFINTERVENTIONFaculty Preparation

Two nutrition professors were invitedto participate in a university-wideinitiative focused on the flipped class-room led by the university's facultyassociate for teaching, learning, andassessment. This initiative required

faculty to engage in the redesign of 1traditionally delivered course to ablended course (50% online and 50%face-to-face [F2F]) using the flippedclassroom as an instructionalapproach. Faculties attended monthlymeetings throughout the semesterand were provided pedagogicalresources to help them better under-stand how to flip the classroom fortheir specific course. One tool pro-vided to faculty was a template outlin-ing the 3 components of the flippedclass: before class, during class (F2F),and after class. The template allowedfaculty to be more intentional in theircourse design by requiring them toclearly articulate the activities to occurwithin each component for everycourse topic. In addition, the templateencouraged faculty to demonstratethat all levels of Bloom's taxonomy10

were evident within a course topic(Figure). For example, the workstudents engage in before the F2F classfocused more on lower levels ofBloom's taxonomy (eg, remember,understand) whereas the F2F portionof the flipped class allowed forhigher-level learning such as appli-cation, analysis, and synthesis. Thefinal component, the after-class,continued to build on these higherlevels of learning through formativeor summative assessments. In theend, when this tool was executed itallowed both of King's2 approachesto be easily accomplished to enhancestudent learning.

Application of Flipped Design

Two 400-level, undergraduate nutri-tion/dietetics (majors-only) classes,Professional Skills in Dietetics (PS)and Community Nutrition (CN),were identified to explore the fe-asibility of modifying traditional lec-tures into flipped classes for 4 coursetopics. The class formats used a com-bination of passive (lecture) andactive learning strategies (discussionand case studies). During the semesterof the application, 148 students wereenrolled in 4 sections of PS and 48students were in 2 sections of CN. Stu-dents in CN suggested spending moreclass time discussing cutting-edgetopics such as major public policychanges and concerns with vulnerablepopulations. In PS, students practiced

Figure. Example of the flipped classroom planning template used for before, during,and after the Professional Skills class.

Journal of Nutrition Education and Behavior � Volume -, Number -, 2014 Gilboy et al 3

professional skills and needed moretime for application and practice. Theinstructors of the nutrition courses

applied the template (Figure) to helporganize the 3 components of a flippedclassroom (before, during, and after).

Before Class

Designing the online portion of theflipped classroom (also referred to asoffloaded content) took into accountthe work that the students couldmaster individually and most oftenincluded lower-level learning (eg,knowledge, comprehension). A sampletopic objective for the CN course wasStudents will be able to recall policychanges as these relate to nutrition. Bothdelivery and content were structuredto help the student acquire contentknowledge and prepare for the applica-tionof that content in the F2F class. Forthe flipped design, online modulesincluded mini-lectures (between 10and 15 minutes), videos obtainedfrom sources such as Khan Academy17

or Technology, Entertainment andDesign (TED) Talks,18 worksheets, orwritten prompts to help students cap-ture important material from the lec-tures. Also used during the before-class session were textbooks and sup-plemental reading materials. Instruc-tors used offloaded content that wasrelevant to the topic of the class sessionand avoided unnecessary overload orbusywork for the student. Instructorsused screen capture software (Camta-sia, TechSmith, Okemos, Michigan,2003; Snagit, TechSmith, 1990) to digi-tize lectures to create the videos. Afterrecording and editing the lectures, thematerial was uploaded on the univer-sity's learning management system forstudents to use. Upon conclusion ofthe before-class assignments, studentscompleted a table as a low-stakes assess-ment (low stakes is an assignment thatis a minimal percentage of the finalcourse grade as a way to ensure compli-ance for the before-class work). Stu-dents were required to bring the low-stakes assessment to the F2F class to in-crease student accountability andencourage in-class participation.

During Class (F2F)

With the topic objectives in mind, theF2F class was designed to apply theknowledge acquired by students inthe online component using activelearning strategies. Active learningstrategies enabled students to achievehigher levels of learning withinBloom's taxonomy (eg, application,analysis, and synthesis). There are

4 Gilboy et al Journal of Nutrition Education and Behavior � Volume -, Number -, 2014

many active learning strategies for ed-ucators to use in the F2F class. Whendesigning the F2F component, it isimportant to choose only afew active learning strategies to usethroughout the course rather than adifferent one for each class. This willallow students to become familiarwith the active learning strategy andavoid the risk of students focusingon the process of the strategy ratherthan the learning related to content.

In the PS course, an active learningstrategy called the jigsaw was used toteach theories and approaches tobehavior change in nutrition coun-seling.19 This active learning strategyrequired students to use a worksheettable that was completed during theonline component. Students werealso encouraged to bring any otherma-terials they needed to completeactivities in class. Students gatheredin their original workgroups (set up atthe beginning of the semester). Eachperson in the workgroup was assigneda theory or approach. In accordancewith the jigsaw activity process, all stu-dents in each groupwhowere assignedTheory 1moved to the Theory 1 ExpertGroup. In these expert groups, stu-dents worked on a series of criticalthinking questions provided by theinstructor. Poster paper and markerswere supplied to each group and groupanswers were recorded on the posterpaper. The instructor monitored theprocess throughout and was able toguide student thinking as well asclarify misconceptions or incorrect in-formation. After all expert groupscompleted the F2F class assignmentand taped their posters along the wallsof the classroom; students went backto their original groups. At that point,each group rotated around the roomand the expert for each theory ex-plained the information to originalgroup members.

After Class

Assessments are an integral part of theafter-class component of the flippedclassroom and should be alignedwith the objectives of the offloadedcontent and the in-class activities.These can be formative (eg, at theend of the class assignment) orsummative (eg, exam, or portion ofan exam that covers several weeks of

content). For example, for the topicof theories and approaches to behaviorchange using the jigsaw activity, stu-dents completed essay questions onthe final exam. Becausemany activitieswere subject to either formal orinformal grading by the instructor inthe F2F class, assessments did notalways have to be graded and wereable to be part of a summative assess-ment. Assessments take many formsincluding, but not limited to, essayexams, case studies, presentations,reflection papers, test creation by stu-dents, and group testing.

DESCRIPTION OFEVALUATIONStudents’ Reactions

The Human Subjects Committee ofWest Chester University approvedthe surveys for this study. Instructorsfor CN and PS distributed anonymoussurveys either in class or via an onlinesurvey to all students (n ¼ 196) toassess their perceptions of the flippedclassroom learning environment.The survey was constructed by the fac-ulty associate who had experience inpedagogy related to this approachand led the campus-wide initiativeon the flipped classroom. Cronbachalpha for the 5 Likert scale items wasperformed and revealed a value of.71, an acceptable value for reli-ability.20 The survey also included 2open-ended questions on students'opinions of the work before and dur-ing the flipped class. A total of 142of 196 students (72%) voluntarilycompleted the surveys.

The Table lists students' level ofagreement on the key items from thesurvey. Approximately three-fourthsof students (76%) preferred watchingthe video lecture over F2F lecture forthe topic. A majority of students(64%) would rather participate in thein-class activities for 2 class periodsrather than listen to the professorlecture for the same amount of time.Almost two-thirds of students (62%)thought that they learned the mate-rial more effectively by viewing theonline recorded lecture rather thanF2F lecture. Half of the students(56%) believed that they learnedhow to use the material for each topicmore effectively using the flippedclassroom format (eg, screen capture

lecture plus active learning in class)compared with traditional methods(eg, lecture only). A majority of stu-dents (70%) felt connected to theteacher during the virtual onlinecomponent of the flipped classroom.

The open-ended comments of thesurvey revealed several majorstrengths of the flipped class format.Students liked the ability to work attheir own pace and time and wereable to apply what they learnedduring F2F class and throughout thecourse. Concerns raised by thestudents included not having the pro-fessor available to ask questions dur-ing the out-of-class portion and thepossibility that other students wouldnot be prepared for the F2F activelearning strategies. These concernsare similar to what have beendiscussed in the literature regardingcriticisms of this pedagogicalapproach.21-23 Suggestions for im-provement based on these concernsare the use of a discussion board thatis set up to have alerts sent to theprofessor when the students postindividual questions and ensuring aquality check is done by theinstructor at the beginning of theF2F class for the low-stakes assess-ments that students complete. Anexample of a quality check would bethe professor circulating the roomand evaluating student work quicklyat the beginning of class so studentsunderstand this work is valued andare more willing to comply.

LESSONS LEARNED

Engaging in this type of course rede-sign is a rewarding experience butthere are several things to be awareof to ensure success. The upfronttime to digitalize lectures as well asthink of appropriate active learningstrategies to use in class is extensive.Faculty should seek help from instruc-tional designers as well as teachingand learning centers on their respec-tive campuses to assist them. Also,although students are more engagedwith this type of instruction, it isimportant to obtain buy-in fromstudents the first day of class. Specif-ically, students need to understandthe what, why, and how as theypertain to the flipped classroom. Inthe end, instructors need to be direct

Table. Students’ Perceptions of Flipped Class Before and During Class

Survey ItemsTotal

Items, naStrongly

Agree, n (%)Agree,n (%)

Neutral,n (%)

Disagree,n (%)

StronglyDisagree, n (%)

I liked the ability to watch thevideo rather than havingstraight lecture for this topic.

141 55 (39) 52 (37) 20 (14) 11 (8) 3 (2)

I would rather have theprofessor lecture for 2 classperiods than complete theactivities that were carriedout.

140 6 (4) 21 (15) 23 (16) 45 (32) 45 (32)

The use of screen casting(videos) the lecture enabledme to learn the material moreeffectively than lecture alone.

142 32 (23) 56 (39) 32 (22) 19 (13) 3 (2)

I learned how to use thematerial with these teachingmethods (screen cast oflectures and active learning inclass) of instruction morethan I did when we usedtraditional methods (lectureonly) of instruction.

142 27 (19) 53 (37) 41 (29) 17 (12) 4 (3)

I felt disconnected without ateacher being present duringthe virtual online class.

139 6 (4) 19 (14) 17 (12) 59 (42) 38 (27)

aOverall n ¼ 142; not all respondents answered every question.

Journal of Nutrition Education and Behavior � Volume -, Number -, 2014 Gilboy et al 5

with students and define what theflipped classroom is, why thislearner-centered teaching approachmay be better than what is done inmost traditional courses, and howthe instructor is going to accomplishthis (eg, provide a clear example usinga topic). There are several clips on theInternet that faculty can view andshow the first day of class to capturethis information and then speak tothe video so that it is discipline-specific to obtain student buy-in. Inaddition, it is important to rememberthat the traditional F2F lecture can beup to an hour long. However, withonline lectures, students become boredor distracted if the recorded lecture isover 15 minutes.6,7 Therefore, even ifcontent requires more time, recordedlectures should be purposively se-gmented (eg, 10–15 minutesmaximum) to help minimize boredomand distractions. When applicable,faculty should seek alternative formsof lectures that capture the content,such as Khan Academy or TED Talks.

In the flipped classroom, studentsare held accountable to complete ac-tivities before coming to class. For

continual monitoring purposes, fac-ulty should take advantage of revie-wing their course level analyticswithin the respective learningmanagement software (D2L, Kitch-ener, Ontario; Moodle, East Perth,Western Australia; Blackboard, Wash-ington, DC; WebCT, Washington,DC, etc) to track student log-in andtime spent in modules for virtual classsessions.

Limitations

As previously noted, because of thenovelty of this teaching approach,there is limited educational out-come research on the effectiveness ofthe flipped classroom. A limitationof this report is that the results focusonly on students' satisfaction re-garding their experience with the flip-ped classroom. However, it is valuableto understand students' perceptionsand these findings are promisingfor future studies within the disci-pline. Specifically, future researchcan examine grades from assessments(eg, exams, papers, and projects) from

past years when the course was taughtin a traditional format, to becompared with grades on assessmentsfrom the flipped classroom.

IMPLICATIONS FORRESEARCH ANDPRACTICE

The flipped classroom is an instruc-tional approach for use in collegeand university nutrition courses.Active learning is being used bymany in higher education. However,what makes the flipped classroominnovative is that it weds the sage onthe stage with the guide on the sideso that all learning styles can beaddressed throughout the course.When this is done in a strategic anddeliberate way as described in thisreport, faculty are able to achieve alllevels of Bloom's taxonomy with theinstructor present. Educators in otherhealth professions are using the flip-ped classroom approach to promotestudent-centered, active learning.This report describes the process ofimplementing the flipped class in 2

6 Gilboy et al Journal of Nutrition Education and Behavior � Volume -, Number -, 2014

nutrition courses. Through this studythe authors have demonstrated thepotential for the flipped classroomapproach in nutrition courses, buil-ding on observations from its use inother health professions. They re-commend that other nutrition educa-tors consider redesigning appropriatecourses to engage students in new,more meaningful ways and considerhow to collect direct educationaloutcome research to add to the schol-arship in this area.

ACKNOWLEDGMENTS

Funding for faculty training was pro-vided by West Chester University.

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