Development of Kampo（traditional Japanese medicine）e-learning program: evaluation of the flipped classroom for medical students

Figures & data

Table 1. Evaluation comments

Kampo diagnostic examinations It was easier to imagine how to perform the examinations, dispense medicine and give patient compliance instructions by seeing them done on video.

Systematic Kampo curricula It was easier to understand it through e-learning than by attending the lesson in a traditional classroom. It was easier to understand Kampo terms when described verbally, because Kampo text contains many difficult kanji characters. It was easy to learn because we could watch the screen and understand the lecture delivered through voice. It was easy to concentrate on, understand, and remember the lecture content because the volume of content to be handled per session had been narrowed down. It was convenient and easy to access the lesson using a mobile phone. It felt like there were little review questions asked. It would be more enjoyable if there were questions with accompanying photos, for example, ‘What is this crude drug?’ It might be helpful to test us for the final exams and to test us on past questions of national exams. It is better to include more practical questions and to confirm our knowledge through a question and answer session. It is better to provide slides and transcripts of the lecture.

Reference materials It was helpful to link the lecture to the commentary page with photos.

Table 2. Kampo e-learning course based on feedback

(i) Kampo diagnostic examinations

(ii) Systematic Kampo curriculum: 88 lessons History (2) Kampo theory (22) Phamacognosy (10) Kampo formula (20) Kampo clinical application (34)

(iii) Reference materials Kampo formulas (224) Crude drugs (180)

(iv) Kampo quizzes What is this crude drug? (Looking at a photo) What is this Kampo formula? (Looking at the composition of crude drugs) What is the Kampo formula in this text? (Looking at the original text)

(v) National examination - National Examination for Pharmacists

(vi) Botanical gardens Makino Botanical Garden Tokyo Metropolitan Botanical Garden Tsukuba Botanical Garden

(vii) Archival contents Lectures by the late Keisetsu Otsuka

Table 3. Student background (N = 118)

Number of registered students on the e-learning system	113 (95.8%)
Number of attendees in the session	100 (84.7%)
Number of respondents to the web questionnaire	88 (74.6%)

Figure 1. Experience of flipped classroom and completion rate of e-learning contents (n = 88)

(a) Have you ever heard of ‘flipped classroom’?(b) Have you ever participated in a flipped classroom session?(c) Did you complete the designated 5 contents?(d) Did you complete some of the other contents?

Table 4. Comparing the item ‘completing designated five contents’ against other items

Items	Completing	Agree	Disagree	P-value
Satisfaction	All None	29 8	2 2	0.2093
Comprehension	All None	28 6	3 4	0.0267*
Adoption	All None	25 8	6 2	0.9643

Figure 2. Students’ answers about FC (n = 88)

(a) Please rate your satisfaction with the session.(b) Please rate your comprehension level.(c) Do you think the flipped classroom must be adopted?

Table

Case 1.	Patient: Female, 74 years old When the patient was 68 years old, she underwent surgery for ascending colon cancer. After the surgery, she was constipated and felt cold in her lower abdominal region. She was hospitalized three times and recovered by fasting. After taking purgative medication, she suffered from lower abdominal pain and could not move, and was sensitive to cold. Height: 148 cm; Weight: 38 kg; Pulse: 68/min and normal; Blood pressure　132/68; Signs of weak abdominal muscles Q: What is her pattern? a. Deficiency b. Excess c. Medium Q: What is her pattern? a. Cold b. Heat c. Moderate d. Both cold and heat Q: What should you prescribe? a. 麻子仁丸 (Mashiningan) b. 大柴胡湯 (Daisaikoto) c. 大建中湯 (Daikenchuto) d. 防風通聖散 (Bofutsushosan) e. 大黄牡丹皮湯 (Daiobotampito)
Case 2.	Patient: Female, 68 years old She has had weak digestion since she was a child. For the past two months, she has been very worried, and then she began to have stomach aches, which began before meals and disappeared after eating. She underwent a gastro camera, had redness and vascular permeability in the pylorus area, and was diagnosed with chronic gastritis. Anorexia was noted during these two months, and her weight dropped by 2 kg. She was prescribed a proton pump inhibitor, and this treatment relieved her stomach ache, but she still had no appetite. Height: 154 cm; Weight: 46 kg; Pulse: 84/min and normal; Blood pressure　124/70; Signs of weak abdominal muscles. No signs of 胸脇苦満(hypochondrium resistance and discomfort). Q: What should you prescribe? a. 四逆散　(Shigyakusan) b. 安中散　(Anchusan) c. 平胃散　(Heiisan) d. 大建中湯　(Daikenchuto) e. 黄連解毒湯　(Orengedokuto)
Case 3.	Patient: Male infant, three years old The fever began last night, and vomiting and diarrhea appeared this morning. Vomiting occurred suddenly, and it occurs after the patient drinks water. Recently, several cases of rotavirus infection have appeared in nursery schools. The body temperature is 39.1°C. Q: What should you prescribe? a. 葛根湯　(Kakkonto) b. 真武湯　(Shimbuto) c. 五苓散　(Goreisan) d. 半夏瀉心湯　(Hangeshashinto) e. 大黄牡丹皮湯　(Daiobotanpito)