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The flipped classroom: Capnography in use

The flipped classroom is an inquiry-based learning strategy designed to improve student engagement, discovery and outcomes


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A growing trend among allied health educators is using a flipped classroom approach to facilitate student learning. The flipped classroom is an inquiry-based learning strategy designed to improve student engagement, discovery and outcomes [1].

This strategy is well suited to incorporate other popular learning philosophies, such as active learning, peer instruction and case-based or problem-based learning. The main purpose of a flipped classroom is to improve student application and evaluation of conceptual knowledge instead of merely focusing on student recall [2,3,4]. Flipping the classroom is an innovative way to facilitate student learning of capnography.

Here is a three-step process for developing a flipped classroom lesson in capnography.

The main purpose of a flipped classroom is to improve student application and evaluation of conceptual knowledge instead of merely focusing on student recall. (Photo/USAF)
The main purpose of a flipped classroom is to improve student application and evaluation of conceptual knowledge instead of merely focusing on student recall. (Photo/USAF)

1. Establish your lesson objectives

Include objectives for all three domains of learning (cognitive, psychomotor and affective). Determine the objectives that you will and won’t cover in the flip. For example, some of your objectives may include:

  1. Discuss the obstacles and attitudes in EMS that may limit the use of capnography in clinical practice (cognitive/affective).
  2. Understand the different methods of EtCO2 measurement, including quantitative and qualitative capnometry and capnography (cognitive).
  3. Identify and understand the components of a normal capnogram waveform and how they change in response to disease (cognitive).
  4. Identify abnormal capnogram waveforms and apply this knowledge in managing various case scenarios (psychomotor/cognitive).

2. Create your lesson plan

Identify the objectives that would yield themselves to student discovery and what objectives would be best facilitated in the classroom or practical setting. For example, objective 4 would be best facilitated in the practical setting. Most of objective 1 could be completed in the pre-class setting with the wrap-up portion completed in class.

Include a timeline for the lesson. How long will the out-of-classroom activities take? I generally find that student completion of out-of-classroom activities typically decreases beyond 12-15 hours of work, so I try to limit any pre-work to about 10 hours or less.

However, sometimes the pre-work does exceed 12 hours, in which case I have a discussion during class the previous week to discuss the expectation and rationale. Of course, some topics are less risky to exceed the pre-work threshold, such as cardiology, pharmacology and trauma. Other content areas can result in a flipped nightmare until you get really innovative, such as documentation, pathophysiology and research.

Reference 8
Reference 8

3. Determine what objectives represent real challenge content areas for students

Any experienced educator can think back to previous semesters and recall the content areas that students struggled with. Be sure to share the lesson plan with students that incorporates the pre-course activities and in-class assignments. Students often report that having a global idea of the lesson establishes them as larger stakeholders in their own education.

For example, I usually find that students can achieve the first part of objective 3  on their own, but most will need an in-class discussion to understand how the capnogram components change in the presence of disease. Objective 2 is very effectively facilitated pre-class with a video lesson and mini-lecture. I use a variety of lesson activities that include online searches, discussion/group forums, video mini-lessons and recording mini-lectures just to list a few. I post most of my video lessons to Vimeo as it allows me to limit the sharing of educational and copyrighted materials for educational use.

When you begin planning the content for your flipped lesson, it may not be obvious which topics would benefit most from the flip, which activities students will find most engaging, which content should be developed, and how to structure pre-class and in-class activities and assignments [5].

As with any new pedagogical strategy, experimentation and evaluation of your process will be critical. This is particularly true with refining your flipped classroom as it is a strategy that adds complexity and is highly participant-dependent [6,7].

Stay flexible during implementation as you may need to make adjustments or deletions off the cuff. Realize flipping your classroom will be a learning process for you as well, so focus on improving the process.

References

1. Jenkins, M., Bokosmaty, R., Brown, M., Browne, C., Gao, Q., Hanson, J., & Kupatadze, K. (2017). Enhancing the Design and Analysis of Flipped Learning Strategies. Teaching & Learning Inquiry: The ISSOTL Journal, 5(1). doi:10.20343/5.1.7

2. Hughes, H. (2012). Introduction to Flipping the College Classroom. In T. Amiel & B. Wilson (Eds.), Proceedings of World Conference on Educational Multimedia, Hypermedia and Telecommunications 2012 (pp. 2434-2438). Chesapeake, VA: AACE.

3. Zappe, S., Leicht, R., Messner, J., Litzinger, T., & Lee, H. W. (2009). 'Flipping' the Classroom to Explore Active Learning in a Large Undergraduate Course. Paper presented at the American Society for Engineering Education Annual Conference, Portland, Oregon.

4. Hamdan, N., McKnight, P., McKnight, K. and Arfstrom, K. (2013) A Review of Flipped Learning [Internet]. Retrieved from: http://www.flippedlearning.org/cms/lib07/VA01923112/Centricity/Domain/41/LitReview_FlippedLearning.pdf 

5. Fisher, R., Ross, B., Laferriere, R., & Maritz, A. (2017). Flipped learning, flipped satisfaction, getting the balance right. Teaching & Learning Inquiry, 5(2), 114. doi:10.20343/teachlearninqu.5.2.9

6. Jo, I. (2018). The Learning Analytics And Flipped Pbl For Ill-Structured Problem-Solving Learning. EDULEARN18 Proceedings. doi:10.21125/edulearn.2018.0659

7. Presti, C. R. (2016). The Flipped Learning Approach in Nursing Education: A Literature Review. Journal of Nursing Education, 55(5), 252-257. doi:10.3928/01484834-20160414-03

8. Shiau S, Kahn LG, Platt J, et al. (2018). Evaluation of a flipped classroom approach to learning introductory epidemiology. BMC Medical Education, 18(1). doi:10.1186/s12909-018-1150-1

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