Flipping an Introductory Biostatistics Course: A Case Study of Student Attitudes and Confidence

Figures & data

Figure 1. Video length divided into lecture (PPT) and tutorial (SPSS) time.

Table 1. Sample sizes for pre-and post-course surveys.

	Flipped A	Flipped B	Traditional A	Traditional B
Pre-course surveys collected	27	25	32	22
Post-course surveys collected	25	21	30	22
Loss to followup (%)	2 (7%)	4 (16%)	2 (6%)	0 (0%)

Table 2. Student demographics and previous experience: counts and percentages.

	Flipped (n = 45)	Traditional (n = 52)	Effect size^a	p-Value^b
Gender			0.02	0.828
Male	14 (%)	15 (28.8%)
Female	31 (%)	37 (71.2%)
Current Degree Program			0.19	0.246
BS	11 (24.4%)	22 (42.3%)
Accelerated BS/MPH	3 (5.2%)	2 (3.8%)
MPH	30 (66.7%)	27 (51.9%)
Other^c	1 (2.2%)	1 (1.9%)
Previous Statistics Course			0.04	0.835
Yes	27 (60.0%)	33 (63.5%)
Previous Research Methods Course			0.11	0.374
Yes	11 (24.4%)	18 (34.6%)
Calculation Tool^d			0.37	0.221
By hand/basic calculator	2 (6.7%)	5 (13.2%)
Graphing calculator	5 (16.7%)	12 (31.6%)
Excel	11 (36.7%)	10 (26.3%)
Minitab	2 (6.7%)	0 (0.0%)
SAS	2 (6.7%)	0 (0.0%)
SPSS	5 (16.7%)	9 (23.7%)
Stata	1 (3.3%)	0 (0.0%)
R	2 (6.7%)	2 (5.3%)

NOTES:

^aCramer's V.

^bFisher's exact tests.

^cOne MS. Biomedical Engineering (flipped) and one PhD (traditional).

^dPercentages are with respect to the number of responses to this question. Zero responses for options JMP and Other (not shown).

Table 3. Counts and percentages of students answering “Agree” or “Strongly Agree” to each question on baseline questionnaire.

	Flipped (n = 45)	Traditional (n = 52)	Effect size^a	p-Value^b
Views of biostatistics
Relevant to PH research	43 (95.6%)	50 (96.2%)	0.06	0.663
Relevant to PH practice	42 (93.3%)	49 (94.2%)	0.06	0.703
Relevant to my career	33 (73.3%)	42 (80.8%)	0.11	0.344
Important for average citizen	23 (53.1%)	28 (53.8%)	0.04	0.840
Confidence in biostatistics
Interpreting claims in media	29 (64.4%)	28 (53.8%)	0.09	0.415
Understanding results of PH research	18 (40%)	24 (46.2%)	0.07	0.543
Performing one-sample t-test^c	16 (35.6%)	23 (44.2%)	0.10	0.410
Performing independent-sample t-test	9 (20.0%)	17 (32.7%)	0.15	0.172
Performing paired-sample t-test	8 (17.8%)	12 (23.5%)	0.07	0.617
Performing analysis of variance	4 (8.9%)	3 (5.8%)	0.06	0.703
Performing chi-square test for indep	12 (26.7%)	25 (48.1%)	0.23	0.036
Performing linear regression	13 (28.9%)	18 (34.6%)	0.07	0.523
Performing logistic regression	7 (15.6%)	6 (11.5%)	0.05	0.767

NOTES:

^aCramer's V.

^bFisher's exact tests.

^cQuestions asked whether students felt confident performing and interpreting the results from each type of analysis.

Table 4. Attitudinal changes and course experience.

	Flipped (n = 45)	Traditional (n = 52)	Effect Size^a	p-Value^b
Views
Relevant to PH research	13 (28.9%)	11 (21.2%)	0.08	0.484
Relevant to PH practice	13 (28.9%)	15 (28.8%)	0.01	1.000
Relevant to career	19 (42.4%)	15 (28.8%)	0.13	0.210
Important to average citizen	16 (35.6%)	14 (26.9%)	0.09	0.511
Confidence Understanding
News media	21 (46.7%)	30 (57.7%)	0.12	0.311
PH research	29 (64.4%)	34 (66.7%)	0.02	0.836
Confidence Performing and Interpreting
One-sample t-test	34 (75.6%)	38 (73.1%)	0.01	1.000
Independent samples t-test	37 (82.2%)	41 (78.8%)	0.02	1.000
Paired samples t-test	39 (88.6%)	42 (82.4%)	0.05	0.790
ANOVA	40 (88.9%)	49 (94.2%)	0.12	0.298
Chi-square test for independence	31 (68.9%)	32 (61.5%)	0.06	0.673
Linear regression	32 (71.1%)	38 (73.1%)	0.04	0.823
Logistic regression	33 (73.3%)	40 (76.9%)	0.06	0.645
Course Experience
Hours spent preparing for class	2.5 (2.13)	1.7 (1.42)	0.45	0.016
Hours spent completing homework	3.3 (2.00)	2.7 (1.80)	0.32	0.046
Topic Learned Most			0.24	0.061
Theory	3 (6.5%)	11 (21.2%)
Reasoning	18 (39.1%)	12 (23.1%)
Analysis	24 (52.2%)	27 (51.9%)
Topic Learned Least			0.27	0.033
Theory	38 (82.6%)	32 (61.5%)
Reasoning	2 (4.3%)	10 (19.2%)
Analysis	4 (8.7%)	8 (15.4%)

NOTES:

Views and confidence: counts and percentages of students with increased score from pre-course. Course experience: means and standard deviations (in hours) for numerical variables, counts and percentages for categorical variables.

^aCramer's V for nominal variables, Cohen's d for numerical variables.

^bFisher's exact test for nominal variables, Wilcoxon rank sum test for numerical variables.

Figure 2. Changes in student confidence from beginning to end of course.