Evaluation of the Flipped Classroom Model in Infectious Disease Nursing Education
Conditions
Keywords
Flipped Classroom; Infectious Disease Nursing; Nursing Students; Retrospective Cohort Study; Undergraduate Nursing Education
Brief summary
The goal of this retrospective cohort study was to evaluate whether the flipped classroom (FC) teaching model improved academic performance and student engagement in an integrative Infectious Disease Nursing course, compared with traditional lecture-based instruction. The main questions it aimed to answer were: 1. Did the flipped classroom model produce higher final examination scores than traditional lectures after adjusting for students' prior academic achievement? 2. Did the flipped classroom model enhance students' self-reported course interest and engagement? 3. How did prerequisite course performances contribute to final achievement in this integrative nursing course? Researchers compared undergraduate nursing students taught via the flipped classroom in the 2024-2025 academic year (n = 18) with historical controls who received lecture-based instruction in the 2023 academic year (n = 36) at a single university in China. Participants in the flipped classroom group (2024-2025 cohort): 1. Completed weekly pre-class preparation modules (e.g., reviewing recorded lectures, reading assignments) before each session 2. Attended in-class sessions that emphasized student-led presentations and case-based group discussions 3. Completed a final written examination covering integrative Infectious Disease Nursing content 4. Provided anonymous feedback ratings on their course interest and overall learning experience The historical control group (2023 cohort) received traditional lecture-based instruction and completed the same final examination and feedback survey.
Detailed description
This is a single-center, retrospective cohort study designed to evaluate the effectiveness of the flipped classroom (FC) teaching model compared with traditional lecture-based instruction in an integrative Infectious Disease Nursing course. The study was conducted at Shantou University Medical College, China. Undergraduate nursing students enrolled in the Infectious Disease Nursing course during the 2024-2025 academic year (the FC cohort, n = 18) were compared with historical controls who received lecture-based instruction during the 2023 academic year (the control cohort, n = 36). All participants were from the same instructional track and completed the same course requirements. For the FC cohort, the instructional design consisted of weekly modules that required students to complete pre-class preparation activities, including reviewing recorded educational videos and assigned readings. In-class sessions were structured around student-led presentations and case-based group discussions to reinforce the pre-class content. The historical control cohort received conventional teacher-centered lectures covering the same course content during the 2023 academic year. Data were extracted retrospectively from existing academic records and course evaluation databases. The primary outcome measure was final examination score, which consisted of multiple-choice questions and open-questions covering integrative Infectious Disease Nursing content. Secondary outcome measures included gain scores (calculated as final examination score minus the average prerequisite course score) and course feedback ratings on student interest and overall learning experience. Statistical analyses were performed using SPSS 30.0 and Python 3. Group differences in continuous variables were compared using independent-samples t-tests. Partial correlation analysis was conducted to examine the independent contributions of prerequisite course performances to Infectious Disease Nursing achievement. Analysis of covariance (ANCOVA), with gain score as a covariate, was used to evaluate the independent effect of the FC model after adjusting for prior academic achievement. All statistical tests were two-sided, with a significance level set at P \< 0.05. Because this study was retrospective in nature and involved analysis of existing educational records, no study intervention was assigned as part of the protocol. The study was conducted in accordance with the Declaration of Helsinki and received ethical approval from the Ethics Committee of Shantou University Medical College (Approval No.: SUMC-2026-013).
Interventions
OTHERFlipped Classroom (FC) as the teaching mode
The FC comprised seven weekly modules. Pre-class: (a) guided readings (textbook chapters, articles, 15-20-min videos on epidemiology, pathophysiology, clinical manifestations); (b) independent PubMed search summarizing ≥5 relevant articles; (c) knowledge-synthesis worksheet identifying microbiological mechanisms (pathogen traits, transmission, virulence), immune responses, Nursing Care Plan (NCP) components from prerequisite Adults Nursing (AN), and transmission-based precautions. In-class (90 min/week, small groups): student presentations (30 min, groups of 2-3 linking mechanisms, NCP, precautions); case discussions (20 min); facilitator feedback and misconception correction (30 min); peer feedback (10 min on integration quality and evidence). Post-class: reflective prompts on challenging integration aspects and knowledge gaps.
Sponsors
Shantou University Medical College
Second Affiliated Hospital of Shantou University Medical College
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* documented grades in both prerequisite courses (Microbiology \& Immunology and Adults Nursing) AND * completion of the final examination
Exclusion criteria
* incomplete prerequisite records OR * withdrawal from the course
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Final examination score | At the end of the semester, approximately 12 weeks after course commencement | All students completed the same final examination (100 points), consisting of three item types: knowledge recall items (30 points; A1-type multiple-choice questions on disease characteristics, transmission routes, and precaution protocols), clinical application items (40 points; A3-type multiple-choice questions presenting clinical case scenarios requiring cross-disciplinary synthesis and clinical judgment), and integrated case analysis items (30 points; case-based items requiring integration of microbiological knowledge, NCP (Nursing Care Plan) frameworks, and precaution decisions for complex patient scenarios). All responses were scored by the automated examination system, and a research assistant independently verified the scoring of all answer sheets against the system output; no discrepancies were detected. |
| Gain score | At the end of the semester, approximately 12 weeks after course commencement | To index knowledge integration relative to each student's own starting point, a gain score was computed: examination score minus the mean of the two prerequisite course scores. Positive gain scores indicate performance above one's prerequisite baseline. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Course feedback | At the end of the semester, approximately 11 weeks after course commencement | A post-course survey administered in the final week measured three dimensions on a 10-point Likert scale (1 = strongly disagree, 10 = strongly agree): interestingness, understanding, and overall effectiveness. One open-ended question invited suggestions for improving the course. |
Countries
China
Outcome results
None listed