Keywords
Models - educational - health education - formative feedback - academic performance
- distance learning
1 Introduction
The Master's degree in Health Engineering [1] is the only one offered at the Faculty of Medicine and Pharmacy in Grenoble (France).
It has been built in 2003 in order to rationalize a combination of previously existing
master's degrees. This revamped Master's degree educates more than 400 students and
is composed of 17 sub-specialty programs that together comprise more than 120 different
teaching units (TUs). This modification helped rationalize teaching resources by bringing
teaching teams together so as to eliminate redundancies when a given topic was taught
in separate uncoordinated degrees, as it was the case prior to the creation of the
new Master's degree. Moreover, prior to the creation of the Master's degree in Health
Engineering a student was expected to attend all the lectures then pass final end-of-semester
exams in order to validate a given TU, without personal follow-up or adaptation of
courses to his/her level and needs. On the contrary, the revamped Master's degree
required the design and implementation of quality education criteria to adapt education
modalities to the heterogeneity of students’ levels but also to offer individualized
training that is always qualitative and equitable. One of the major drivers for changing
the previous organization of multiple master's degrees was the significant increase
of the number of master students, which was a consequence of the increased attractiveness
of Grenoble's unique health technology ecosystem. Besides, the teaching team recognized
that there was a lack of personalized follow-up of students, as well as of personalized
feedback to teachers and institutions. All of those drivers prompted the teaching
team to propose and implement this pedagogical transition initiated in 2006 within
the Faculty of Medicine, and to create the new Master's degree.
Since the infrastructure and human resources of teachers remained unchanged, it was
necessary in 2010 to adapt and develop education and innovative assessment of health
training since 2003. The changes in the teaching paradigm were inspired by the one
initially described in 1990 by Dean E. Mazur from Harvard [2], with the implementation of a teaching methodology based on the “flipped classroom”
model and the theory of multimedia learning using information and communication technologies
for teaching[3]
[4]. In 2006, the Faculty of Medicine initiated its full transition to a blended learning
model based on lipped classroom which has since then been extended to all years of
the medical curriculum, then to the Faculty of Pharmacy, and beyond [5]. Other studies have reinforced this change in the educational paradigm, confirming
the value of such an optimized approach[6]
[7]. This reform allows to make students active in their learning, to ensure equity
in examinations for all students by offering the same working conditions regardless
of the number of students enrolled, and to introduce new teaching methods to reinforce
student learning through understanding rather than by rote. In addition, because of
the significant increase in the number of students enrolled, these innovative education
modalities have provided an effective way of organizing teachers’ time to ensure the
quality of courses but also to focus the teaching contribution to the practical application
of knowledge. These education modalities have made it possible to optimize the logistical
infrastructure available, without having to build a 400-seat amphitheater. Existing
training rooms such as 40-seat practical workrooms and 200-250-seat amphitheaters
have been used extensively with usage rates of 12 hours per day. The Information and
Communication Technologies for Education and an IT platform dedicated to the Master's
degree in human learning were the main tools used in this paradigm shift.
The pedagogical re-organization allowed the detection of students’ level of knowledge
in TUs and provided a means to propose learning paths that were adapted to those levels.
Similarly, offering autonomy and adaptation of individual learning tasks in a free
but structured format allowed for greater equity in training by providing the time
and personal organization necessary for each student's learning. For involved teachers,
the creation of the single Master's degree has made it possible to overhaul the content
of TUs and to rationalize the two years of master's studies. This has also provided
a basis to standardize the content in terms of levels, with the removal of contents
that were too basic and hence unsuitable for the master's level. In this paper we
summarize the results from the formal feedback we collected on the implementation,
advantages, and limitations of these innovative education modalities.
2 Methods
2.1 General Information on the Teaching Methods Used in Grenoble
Since 2006, medical curriculum in Grenoble has relied on the principle of blended
learning based on the flipped classroom principle (see [figure 1]). We therefore mix distance and face-to-face times for learning, but also for continuous
evaluation. The lecture part of the course provides the transfer of knowledge that
is completed without the presence of the teacher, whilst the work on the application
and the explanation of the course (illustration exercises, assignments, problems,
and other activities) is done in person by the teacher in a classroom. This original
model has been declined and adapted to the needs of the Master’ degree.
Fig. 1 Blended learning model based on flipped classroom.
2.2 Pedagogical Model Used for the Mediatization of TUs in the Master's Degree
Within this framework, teaching is organized in sequences of consecutive activities
with three learning activities and two evaluation activities per week (see igure 1).
In the irst activity, the student must study scripted knowledge capsules (KCs) and
make summaries of each one. The second activity is devoted to questions related to
the KCs of the previous activity. Learners will either post their own questions or
vote for others’ questions but always using the Interactive On Line Question (IOLQ)
module. Questions are accessible to all groups so that everyone can try to answer
or check them with a “like” to quantify a question's interest. At the closing date
of the module, questions are sorted in descending order of interest and then sent
to the teacher-in-charge so that he/she can prepare his/her Interactive On Site Training
and Explanation Meeting (IOSTEM). The third activity corresponds to the first face-to-face
contact with the teacher in charge of KCs. It is a one or two-hour IOSTEM which allows
learners to better understand the content of KCs and how to put it into practice as
a true health professional.
The first three activities are therefore focused on knowledge acquisition, whereas
the following two activities (4 and 5) are focused on practice acquisition and the
last two activities (6 and 7) offer training quizzes. Activity 4 is fully autonomous
and allows students to test and re-test as many times as needed. The fifth activity
is organized according to the same modalities (on a tablet, in dedicated, connected,
and supervised rooms) as the final examination of activity 7. Activity 6 has two overlapping
steps, the first one being an anonymous pedagogical evaluation of all these activities.
Successful completion of this anonymous evaluation is mandatory to move to the second
step that provides a personalized result of the tests. Finally, the last activity
of the Grenoble organization is the final exam performed on a tablet with a random
display of questions and items. The exam is corrected immediately and securely by
the examination server. Each sequence is organized for a volume of KCs adapted to
the number of European Credits Transfer System (ECTS) (dematerialized lectures are
not an unaccounted-for surplus of work for students).
2.3 Optional Innovative Pedagogical Activities Offered to the TUs of the Master's
Degree
Some TUs benefit from optional innovative educational and evaluations activities,
such as an initial positioning test. This test allows creating three groups of levels
of increasing difficulty, from low to medium to high. The same global content is then
proposed, but in three different forms depending on the group level. Students in the
high level group will not waste their time and those in the low level group will be
able to receive more attention from teachers. This has been put into practice for
the “clinical research initiation” TU. This approach has been widely developed with
the introduction and dissemination of digital desktop tools and the widespread use
of tablets during digital exams.
Another activity allows the detection of errors in the Multi Choice Questions (MCQs)
used during evaluations and allows the selection of KCs in self-catching only those
related to the erroneous responses of the student's MCQs.
A digital skill file repository is also proposed in particular for the “Information
and Communication Technology (ICT) in health” teaching unit. Over four months, this
activity allows students to produce personal digital content at their own pace, put
it into an e-portfolio, and finally self-assess it. This implementation allows a high
degree of autonomy in the student's production over a long period of time and is often
associated with a collaborative approach. It is secured through a personal repository
with official digital identification provided by the university system. Thus, each
student progresses at his own pace and can give feedback to the teacher of his own
skills. Thus, the majority of mediatized TUs now use dematerialized exams to validate
knowledge.
Finally, another peer review activity complements the range of innovative activities
on collaborative student productions. Each student produces a standard compulsory
content which is made anonymous and distributed to two other students in order to
be evaluated and justified according to a predefined grid.
Two final activities contribute to improving the evaluations of TUs. A systematic
anonymous evaluation following the same structure of questions for all students is
focused on the organization of TUs. All students must complete this evaluation before
the final test. These systematic individual assessments are the basis for a debriefing
session with the responsible teachers, student delegates, and health administration
to propose changes for subsequent sessions.
3 Results
Grenoble Alpes University has opened many teaching units in digital training and blended
learning based on lipped classroom, particularly at the medical school and the faculty
of pharmacy. Several teaching units also use digital learning and flipped classroom
in health engineering masters. Of the 120 TUs offered by these master programs, 10
follow this format at least partially, mainly for transversal TUs and in the fields
of medtechs, statistics, and biotechnologies. Each year, new TUs are converted to
this model for different reasons, essentially based on the good will of the person
in charge of the TU and the students’ request. As all TUs are systematically evaluated,
this feedback, combined with the biannual debriefing sessions involving students,
teachers, and administration staff, allowed us to build and define the SWOT of this
model as presented in [Table 1].
Table 1
Master in health SWOT focused of the blended learning teaching units based on flipped
classroom switch
|
|
We analyzed one transversal TU of the master's degree, the “Basic BioStatistics and
Modelling Tools” TU offered to all first-year students of the Master's degree. Between
90 and 220 people apply every year to follow this TU. In 2019-20, there were 118 registrants
including at least five ghost students who did not participate in any learning or
assessment activities. Up to 80% (91/113) of the students completed the TU form. [Table 2] shows the results of the systematic evaluation realized by students of the first
year of the Master's degree.
Table 2
Summary of the final evaluation of the Master's Bio-Statistics TU (n=91)
|
n (%) [CI95]
|
Positive (Very Good and Good)
|
Negative (Insufficient and Very Insufficient)
|
|
Quality of knowledge capsules
|
75 (82.4%) [74.6 - 90.2])
|
16 (17.6%) [9.8 - 25.4])
|
|
Quality of the supports used in IOSTEM
|
68 (76.4%) [67.6 - 85.2]
|
21 (23.6%) [14.8 - 32.4]
|
|
Quality ofthe explanations obtained in IOSTEM
|
73 (84.9%) [77.3 - 92.5]
|
13 (15.1%) [7.5 - 22.7]
|
|
Interactivity during IOSTEM
|
74 (88.1%) [81.2 - 95.0]
|
10 (11.9%) [5.0 - 18.8]
|
|
Interest of courses in your professional project
|
76 (83.5%) [75.9 - 91.1]
|
15 (16.5%) [8.9 - 24.1]
|
|
Organization of this TU
|
67 (73.6%) [64.6 - 82.7]
|
24 (26.4%) [17.3 - 35.4]
|
The form always ends with a free field of expression in which students provide comments
that are considered to identify areas for improvement. Examples of these comments
include: “During the positioning tests, we are not asked about R-Software, so why
so many R's during practical works, why not give us directly some tracks to interpret?”,
“Online courses not very fun”, “The videos of the courses, some of them not very clear”,
“Practical works: it's complicated to concentrate in amphitheater and sometimes you
don't have time to do the exercise by yourself, think about it”, “The ANOVA course
was not dynamic enough unlike the other courses which were more participatory”, “More
application exercises”, “The IOSTEM allows you to ‘review’ and repeat some important
points, so perfect”, “The teacher answers all the questions asked and tries to really
understand where the difficulties are for the students, which makes IOSTEMs very interesting
and helps people in difficulty”, “All misunderstood notions were addressed. The session
is very interactive and it is easy to start asking questions”.
4 Discussion
Blended learning based on flipped classroom is not an obstacle to learning or teaching
at the Master's level [8]. Flipped classrooms are available both at Master's degrees and for medical training
[5]. After nine years of using this “flipped classroom” approach, the ∼200 annual master
students feedback relating to KCs and to IOSTEMs are between 66% and 75% positive.
Even the usually undervalued subjects, such as biostatistics, succeeded in mobilizing
learners to become active participants. The switch to blended learning could equally
be applied to large or small ECTS. The blended learning approach is particularly adapted
to TUs that provide prerequisite content. This allows teachers to be focused on higher
value-added steps such as skills and abilities[5]
[9].
4.1 Master's Students
Free access to KCs and on-line interactivity modules are a training advantage regardless
of the terminal (computers, tablets, smart-phones, connected objects...). These scripted
KCs, in small sections of ive to 15 minutes, allow students to listen without extraneous
noise (such as what occurs amongst students in a classical lecture room) and to be
rapidly focused on the subject of the KC. Screen-based materials do not change much
in the reading of courses compared to paper-based materials [10]. In comparison to the tension of a large amphitheater, where inhibiting the participation
of learners to ask questions is often observed, the on-line capability to ask questions
coupled with the anonymity of results allows learners to more frequently ask relevant
questions. Moreover, the capacity to submit a written question provides time for reflection
and allows the learner to pose a more thoughtful question [11]. Finally, offering learners to vote or not on the questions asked by the others
in the group also allows them to practice by trying to answer the question by themselves.
Thus, there is an added pedagogical value for the learners in preparing written questions.
Another advantage of this blended learning approach is the freedom of learning time
and learning location (e.g. Erasmus, International internship), which also leads to
a reduction in the stress of accessing amphitheaters and reduced travel costs. The
students are required to travel to the classroom only for activities devoted to the
face-to-face exchange of skills and abilities. In addition, the “new” autonomy such
as collaborative work can be more complicated to manage for the students if it is
always needed to travel to a central location [12]. For this purpose, intermediate steps based on knowledge tests are added during
the KCs in order to provide personalized follow-up to learners with positioning in
relation with the other students but also with personal progress between tests and
personalized advice. The blended format eliminates the time spent in lectures where
most of student activity was concentrated on note-taking. IOSTEM time is no longer
focused on note-taking but on putting this knowledge into the perspective of a professional
application. Students become more active participants, more involved in learning and
they improve their knowledge with the skills they acquire.
4.2 Master's Teachers
Concerning the organization of a TU, the switch to blended learning depends on at
least two factors: (i) the involvement of the professor in charge to reorganize his
teachings and record capsules; and (ii) the possibility of completing the switch because
some lessons are not adapted to blended learning (e.g. practical classes that require
bench time or very specific technical equipment). Theoretical thinking or prerequisites
are perfect candidates for switching to the blended learning approach. The involvement
of teachers is also a key element [13], with an initial reluctance and fear of the unknown to make a complete teaching
change. The teacher leaves his comfort zone; he must learn again to teach according
to these new modalities where classical lectures are replaced with pre-recorded KCs
and IOSTEM sessions. The initial investment is important for the implementation of
these modalities with a complete overhaul of supports, the scripting and the recording
of KCs. The list of questions asked is also a heavy task in the first years, to correct
inaccuracies or errors in KCs (the questions are the first evaluative feedback of
KC quality). This list of questions is transmitted by different means of communication
(platform and email) and sorted by the number of votes, allowing the teacher to better
prepare his answers to priority questions. The free feedback and comments of the systematic
evaluation are always thoughtful and they allow a reasoned exchange during the final
semi-annual debriefing session. The obligation to prepare closed-ended questions for
positioning tests but also for certification tests requires the teacher to organize
himself beforehand in order to provide “turnkey” tests that also include corrections
to the questions. The Learning Management System also provides analytics to categorize
MCQs and provide a balanced draw of MCQ series for subsequent events. There is no
more correction delays or variability in the correction. Statistical analyses of the
corrected copies also make it possible to update potential correction errors. Finally,
the summary tables of the tests can be automatically sent to the semester jury of
the master.
4.3 Master's Institutions
The use of new digital tools for managing positioning tests and terminal tests has
also created a major change in the administration. Assessment procedures for the blended
learning approach require less paper logistics and also less exam supervisors. Also,
there is no need to specifically anonymize paper copies, there are no longer heavy
piles of paper copies to transmit for correction, the time for correction is reduced
and there is less risk of losing the paper copies. But there is an important constraint
on the need to work in conjunction with the faculty's digital services to ensure optimal
and interference-free Wi-Fi access. For this point a virtual local area network (VLAN)
is required to secure proofing and transmission of digital copies.
5 Conclusions in the Context of General Pedagogy in Other Institutions
5 Conclusions in the Context of General Pedagogy in Other Institutions
The development of student autonomy is a central concern of trainers setting up blended
pedagogy, whatever its form [14]. Promoting autonomy in the technical, methodological, social, and language fields
looks obvious in these training courses. On the other hand, the psycho-affective,
informational, cognitive, and metacognitive aspects seem to be less taken into consideration.
Some very specific training contexts may require the use of blended learning in order
to make the school career more equitable. For example, access to knowledge of minority
populations [15]; or, closer to Grenoble Master's degree in Health Engineering, equity in competition
[16].
The development of blended learning in recent years has led to regular pedagogical
innovations adapted to different learning contexts. As the paradigms are different
in each case, it seems difficult to find a recipe that can be adapted to each learning
situation. However, the panel of existing methods, ranging from the simple revision
of knowledge on digital media to completely reversed teaching[17]
[18] allows any motivated teacher to be able to engage students.
There are some additional advantages of switching the educational paradigm to a blended
learning approach, including an easier follow-up of students with an activity such
as internships, Erasmus internships, or professional public in continuing education,
just since it becomes feasible to forward a TU or a piece of a TU to students in other
cities or even other countries. Thus, this facilitates exchanges of TUs or courses
within the master but also beyond. As a consequence, it may be considered that switching
to blended education is ethically beneficial, as “equithical” training.
