Use of the Community of Inquiry Framework to Measure Student and Facilitator Perceptions of Online Flipped Classroom Compared with Online Lecture Learning in Undergraduate Medical Education

Figures & data

Figure 1 Online Flipped Classroom Model. In September 2020, second-year medical students (N = 92) at Stanford School of Medicine prepared for an online-only, flipped classroom thyroid tutorial by watching short didactic videos prior to class. Links to cases and questions were sent out to the students in Zoom chat at the beginning of the tutorial. Four clinical cases were discussed in depth during the tutorial.

Table 1 Student Survey Responses on Effectiveness of Online Flipped Classroom Tutorial Based on CoI Framework

CoI Presence Domain	Survey Items	Percentage of Students Rating Item 4 or 5	Item mean Rating ± SD	Domain Mean Rating ± SD
Cognitive Presence	Engaging in exchange of ideas	74%	4.0 ± 1.0	3.9 ± 1.0
	Stimulating your curiosity	72%	4.0 ± 0.9
	Applying ideas or concepts	72%	4.0 ± 0.9
	Identifying relevant new information	72%	3.9 ± 0.9
	Identifying key issues	70%	3.9 ± 0.8
	Synthesizing ideas	70%	3.9 ± 1.0
	Resolve problems	64%	3.8 ± 1.0
	Understand concepts	58%	3.7 ± 1.1
Social Presence	Feeling part of the class community	64%	3.8 ± 1.0	3.6 ± 0.9
	Sustaining discussion	64%	3.7 ± 1.0
	Responding to others’ comments	62%	3.5 ± 0.9
	Asking questions	58%	3.7 ± 1.0
	Referring to others by name	55%	3.7 ± 0.9
	Being open (ie, disclosing your personality)	43%	3.4 ± 0.9
	Expressing your emotions	40%	3.4 ± 0.9
Teaching Presence	Feeling satisfied with teaching interaction	74%	4.0 ± 1.0	3.7 ± 0.9
	Receiving teacher assistance in reaching consensus	66%	3.9 ± 1.0
	Feeling comfortable engaging in discussion	66%	3.8 ± 0.9
	Accepting teacher feedback	66%	3.8 ± 1.0
	Receiving teacher intervention	64%	3.8 ± 1.0
	Feeling comfortable with teaching methods	60%	3.7 ± 0.9
	Activities are well designed	60%	3.6 ± 0.8
	Taking responsibility	58%	3.8 ± 0.9
	Set climate for learning	57%	3.7 ± 0.8
	Assess learning outcomes	53%	3.6 ± 1.0
	Understanding organization of the class	51%	3.6 ± 0.9
	Summarize discussion	47%	3.5 ± 0.9
	Expectations are communicated clearly	40%	3.4 ± 0.9

Notes: Students were asked to rate the current online flipped classroom experience in comparison to recent online lectures from much worse (rating 1) to much better (rating 5). Surveyed questions were based on the Community of Inquiry (CoI) framework, which describe cognitive, social, and teaching presence as key components of an online educational structure. Survey items are listed from highest to lowest percentage of students rating the item a score of 4 or 5. N = 53.

Table 2 Facilitator Survey Responses on Effectiveness of Online Flipped Classroom Tutorial

Survey Item	Percentage of Facilitators Rating Item 4 or 5	Item Mean Rating ± SD
I feel the students learned the basics of thyroid clinical principles by the end of the tutorial.	100%	4.9 ± 0.4
I enjoyed teaching in this online small group tutorial format more than I have in online traditional lecture formats.	100%	4.7 ± 0.5
The online small group tutorial format was more effective than an online traditional large group lecture format.	100%	4.7 ± 0.5
The students were engaged during the tutorial session.	100%	4.6 ± 0.5
The students understood each case material by the end of its tutorial.	100%	4.4 ± 0.5
Overall, the thyroid small group tutorial was effective in the online format.	100%	4.4 ± 0.5
The students were prepared for the tutorial session (ie, watched the pre-tutorial lecture videos).	57%	3.4 ± 0.9
Tutorials should be delivered in an online format more.	0%	1.9 ± 0.8
The small group tutorial was more effective online than in-person.	0%	1.7 ± 0.5

Notes: Facilitators were asked whether they agree with a series of statements regarding the online flipped classroom tutorial in comparison to online lectures and in-person formats from strongly disagree (rating 1) to strongly agree (rating 5). Statements are ordered from highest to lowest percentage of facilitators rating the item a score of 4 or 5, and then from highest to lowest mean rating if the percentage was the same. N = 7.