Evaluation of Flipped Classroom Teaching Methods in Improving the Knowledge and Readiness of Medical Students in Disasters

---

Extended Abstract
Background
Effective education and teaching is one of the most important and significant issues in the clinical performance of medical university students. Flipped classroom as one of the new educational techniques can lead to effective clinical practice. Although this method has a lot of advantages, it has several limitations and challenges such as incentives, costs, and time. Referring to the importance of depth of learning in the inverted classrooms, Haqqani considered the lecture method as the best suited one for large classes of students because the lessons related to disasters and emergencies are more consistent with the teaching method of the flipped classroom. This study used the flipped classroom teaching method to improve the knowledge and preparedness of Shiraz medical students in the face of emergencies and disasters.
Methods
This quasi-experimental single-group pretest-posttest study included a total of 106 medical students at Shiraz University of Medical Sciences, Iran. The participants were selected from the students admitted to the course in two consecutive years 2018 and 2019. The study population comprised all medical students attending the “Health in Disasters and Emergencies” course. The teaching method and type of intervention was face-to-face (10 lectures, group discussion, educational clip), practice and maneuver and practical (4 sessions). In order to evaluate the course, a questionnaire was designed by the researchers and administered based on knowledge, attitude, and overall disaster preparedness. Also, a pre-test at the beginning of the course and a post-test four months later were given to the students. Due to the very high risk of earthquakes in the country and Fars province, the basis of the scenario was considered earthquake risk. Also, to measure the validity of quantitative content, two content validity ratio (CVR) indices were used to check the necessity of the items and the content validity index (CVI) was used to check the relevance of the items. The Waltz and Basel CVI was also used to determine the relevance of each item in the questionnaire. If the score of each item was more than 79.0, that item remained in the questionnaire and if their CVI score was less than 79.0, they were removed. The reliability of the questionnaire was obtained using Cronbach's alpha (0.75). Also, internal consistency values were calculated using Cronbach's alpha coefficient in each dimension.
Results
Based on the results, out of 106 participants (65 or 61.3% females vs. 41 or 38.7% males), 85 students completed the course. The age group of students was 19-39 years (mean age: 20.29±3.27). There was no significant relationship between gender and readiness in terms of knowledge and attitude (P≥0.05). There was a significant difference between attitude and level of preparation before and after the test. The average level of knowledge, attitude, and readiness in response to risks increased by 1.93%, 3.82%, and 3.35%, respectively, in the post-test as compared to the pre-test (after teaching upside down). Also, the variables of knowledge (19.8%) and readiness (24.5%) of students were found to be very well. The mean of knowledge, attitude, and readiness in the post-test compared to the pre-test (after teaching) increased by 1.93%, 3.82%, and 3.35%, respectively, but this increase was not statistically significant (P>0.05). The mean score of knowledge, attitude, and readiness in the post-test compared to the pre-test (after teaching) increased by 1.93%, 3.82%, and 3.35%, respectively.
Conclusion
According to the research results, the flipped classroom teaching method in health in disasters led to creating a dynamic and active atmosphere, increasing motivation to learn and participate in education, as well as changing the knowledge and attitude of medical students. Students expressed satisfaction with the quality of this educational method by expressing their satisfaction and changing their views on emergencies and disasters. Our teaching methods included offline and online training, video streaming, role-playing, designing small and large group discussion teams. Flipped classroom teaching was found to be very attractive in learning. In the present study, the disaster preparedness questionnaire was used with a focus on earthquake risk. The questionnaire had the desired validity and reliability (reliability coefficient of the questionnaire was 0.7). This good evaluation value indicates that this questionnaire can be used in other universities across the country as the first questionnaire to measure earthquake risk preparedness. Finally, it is suggested to study the inverted classroom teaching method with the new virtual teaching methods used during the COVID-19 pandemic.