Nursing professor Casey Norris learned a lot by flipping a pathophysiology course of 125 students. Here is how she made the format work on a large scale.
Clinical Assistant Professor of Nursing,The University of Alabama in Huntsville
DNP, MSN, RN, PCNS-BC, BSN
For years, flipping the classroom has been a popular way to increase student engagement and free up classroom time for meaningful discussion and hands-on work. The approach, of course, involves covering informational content outside of the classroom (usually online). The idea intrigued Casey Norris, DNP, MSN, RN, PCNS-BC, a clinical assistant professor of nursing at the University of Alabama in Huntsville. The only problem was that the pathophysiology course she wanted to use it in had a roster bulging with about 115 students. It also covered incredibly serious and dense material—the mechanical, physical, and biochemical changes that occur in the body as a result of disease—within a nursing ftramework.
Still, Norris was ready for a change: She had noticed that students were becoming increasingly distracted in class, especially those who had covered the material before. “I would lecture, and some students would take notes, but others would surf the Internet, play games, shop, and watch movies,” she says. “I had two repeaters tell me one day that they didn’t need to take part in the embedded class activities because they had seen them before and already knew the answers. This opened my eyes that I needed to shake things up.”
So, in 2018, Norris tried the flipped classroom approach on a class of 13. It went so well that she felt more confident about scaling it up to 100-plus students. “I dove in and found ways to not only include all the students but also make sure I was including videos and information and materials that appeal to students’ different learning styles.” Below, she shares seven learnings and related tips.
“Since we changed [to a flipped classroom] format, we’ve seen much better results as far as grades and retention of material. Some students said they preferred the lecture format, as it helped them to stay focused, so you can’t please everyone. But the majority love it, and the overall positive results speak for themselves.”
-Casey Norris, DNP, MSN, RN, PCNS-BC
Course description: The course is designed to help the student build on previous knowledge of anatomy and physiology and microbiology. Adaptations and alterations in health status throughout the lifespan are emphasized. Students explore the implications of lifestyle to pathology within a nursing framework, and learn to relate normal body functioning to the pathophysiological changes that occur in, and as a result of disease.
7 tips for flipping a stadium-size course
If you are considering flipping your class, Norris offers the following tips, which she feels are especially helpful for working with large groups of students.
1. Give them a heads-up before the first day
One of Norris’s initial concerns was that students—particularly nontraditional ones—might be resistant to her interactive teaching approach. To secure buy-in, Norris begins by messaging students a few days before the first class to explain what she plans to do and why. She lets them know that they will need to do preparatory work (reading, watching videos, etc.) prior to class so that they can use classroom time for more interactive and interesting exercises.
2. Explain the science of active learning
Gaining buy-in on anything can be harder when you are dealing with more than 100 people, but Norris has found that presenting the benefits of a flipped classroom can win over most—or at least leave them cautiously optimistic. Norris begins by explaining that she has taught the class for more than three years and has seen how bored students can get when they have to sit through a three-hour lecture. She also shares some compelling research on the effectiveness of active learning, quoting a study that found students retain only 5% to 10% of information delivered in a lecture, yet about 85% when they actively take part in their learning. (She cites the book Teach Students How to Learn, by Saundra Yancy McGuire, as one of her inspirations.)
3. Supply materials for a range of learning styles
The larger the class size, the more diverse it is likely to be in terms of how people like to learn. For that reason, each module (which is posted on the school’s online learning management system about a week in advance) typically includes a PowerPoint presentation of the upcoming week’s lecture, links to audiovisuals such as videos, selected passages from books, and more. In class, she follows up to see whether students need any additional explanation, especially as the semester wears on, and they become more tired and stressed. “You can’t just post information and assume the students accessed it all and understood it,” she says.
4. Incorporate assessments into class time
Students in a flipped classroom benefit from being assessed more regularly than usual, says Norris. But grading 100-plus quizzes takes time. So Norris uses the free game-based learning platform Kahoot! to run quick checks for understanding at the beginning of each class. (The short quiz covers only material learned the previous week.) This software enables Norris to create multiple-choice questions that display on a large screen, with students responding in real time using their computer, tablet, or smartphone. She has found that this is particularly engaging for students who are gamers. “Interactivity is second nature to them,” she says.
5. Ask for feedback, and make tweaks as needed
Norris checks in regularly with students to ask how their studying is going overall. She does this both informally during class and with a short mid-term survey that ensures that she gets feedback from everyone in the class.
“You need to be open to comments, use what works, and make changes when something doesn’t work,” she says. “For example, if students want me to show more visuals in class, I will. I will put up a presentation, picture, or a chart if they want. Classes do vary, and I pay attention to the makeup of each one.”
6. Create a small-classroom feel, too
Small-group interaction helps students learn how to work with different personalities, says Norris. “That is a big part of what they’ll be doing as nurses. So it’s essential that they learn how to do this, even in a bigger class like this one.” For that reason, after every one or two lectures, she splits the class into groups of four to six to do a team-based activity, with one member of each group presenting the results to the larger class. For instance, she will assign them to work on concept maps in groups so that they can split up the information, then come together to put all their research together. She also has them make teaching brochures for disease processes. “This allows them to get creative and learn about an exemplar (disease), using all of the concepts that we focus on,” she says.
7. Give every student some personal attention
“I walk around the class and engage everyone,” Norris says. “I don’t rely on the students who are most likely to respond. As an instructor, you have to work the classroom.” She usually stays on the periphery of large stadium-style classes, but she sometimes walks through the rows to hand the microphone to a student with a question, so everyone can hear what is being asked.
This is especially vital in a flipped classroom, says Norris, because the whole point of the format is to provide opportunities for discussion and active learning with peers. While Norris wants quiet or shy students to understand that it is OK to be a bit more introverted, she knows that nurses must be able to communicate with their diverse patients and colleagues. By drawing them out, she hopes to build their confidence and their comfort level with interpersonal communication.
“My career before teaching was doing patient education in a children’s hospital,” she adds. “I loved exploring deep questions with patients, and now I love it with students. I am a cheerleader and just want my students to be successful.”
Is the approach a success? In her first full year of teaching this way, Norris can see a positive difference in the students’ performance and engagement, compared to the previous three years teaching the same class.
“Since we [Norris and her two co-instructors] changed the format, we’ve seen much better results as far as grades and retention of material,” she says. “Some students said they preferred the lecture format as it helped them to stay focused, so you can’t please everyone. But the majority love it, and the overall positive results speak for themselves.”