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Discuss the significance of the academic literature by comparing and contrasting different theories and findingsBRIEF REPORT
Effect of a Flipped Classroom Compared With a
Traditional Lecture on Physician Assistant Students’
Exam Performance
Matthew Wright, MS, PA-C, RD; Yuane Jia, PhD; Erich Vidal, MS, PA-C;
Claire Babcock O’Connell, DrPH, PA-C; Lori Palfreyman, DHSc, PA-C; J. Scott Parrott, PhD
Purpose The purpose of this study was to retrospectively
compare the exam performance of physician assistant (PA)
students given asthma instruction in a flipped classroom
with PA students in a traditional lecture setting while
controlling for students’ previous academic performance
and clinical asthma experience.
Methods Three cohorts of PA students (n = 146) from the
years 2017 (traditional-lecture setting) and 2018 and 2019
(flipped-classroom setting) were included in the study.
Academic performance across cohorts was compared
using answers to 11 exam questions reflective of the
asthma content.
Active learning strategies have been demonstrated to
improve the academic performance of undergraduate and
graduate students in basic science and health education curricula.1-4 A large meta-analysis of active versus traditional
teaching strategies1 found significantly greater course
achievement among students in a variety of active learning
settings than with traditional lecture settings. Students taught
with traditional instruction experienced a 5 times greater
likelihood of failure. These results remained significant across
all undergraduate sciences explored regardless of class size.1
Two additional meta-analyses that compared problembased active instruction with traditional lectures demonstrated similar academic improvements in pharmacy and
medical school courses.2,4 Exam performance was consistently
higher with active teaching strategies regardless of high- or
low-tech delivery, including written paper cases and
computer-simulated virtual cases.4
Additional academic benefits were noted when a flipped
classroom was used in a study involving a spectrum of health
professions students.3 In the flipped-classroom format, lecture
content or required readings are completed as preclass study.
Class time is devoted to active learning strategies such as
case-based or problem-based discussion to apply preclass
study concepts.5,6 At the time of this study’s commencement,
only one paper had examined the academic performance
The authors declare no conflict of interest.
J Physician Assist Educ 2021;32(4):261–264
Copyright ª 2021 Physician Assistant Education Association
DOI 10.1097/JPA.0000000000000393
Results Findings demonstrated significantly greater performance in the flipped classroom compared with traditional lecture. The 2018 and 2019 cohorts scored 9.4% and
13.2% higher, respectively, compared with the 2017 cohort.
Exam performance of students with a low likelihood of
clinical exposure to asthmatic patients before PA school
was similar to those with a high likelihood.
Conclusion This study found improved exam performance
with a flipped classroom. The flipped classroom represents
a potential opportunity to maximize similar performances
by both less experienced students and more experienced
benefits of a flipped classroom for PA students.7 In that study,
students participated in a flipped classroom for 4 weeks of a
12-week behavioral health course. Students’ academic performance on clinical vignette questions was compared with
the performance of students from the previous year, where a
traditional lecture approach was used. Results demonstrated
significantly greater performance under flipped-classroom
learning compared with traditional lecture.7 However, findings from that trial were potentially confounded by unmeasured baseline differences between comparison cohorts in
clinical experience and academic performance, both of which
have been associated with successful academic performance
in PA school.8
The goal of the current study was to compare differences
in exam performance among 3 PA student cohorts, where
traditional versus flipped-classroom approaches to
instruction were used while controlling for prior academic
performance (GPA) and clinical background. We hypothesized that students in the flipped classroom would perform
significantly better on standardized exam questions than
those in a traditional setting. We anticipated that improved
performance in a flipped classroom would be maintained
while controlling for prior academic performance (GPA) and
clinical experience.
The current study received approval from the Rutgers University institutional review board. In total, exam performance
data for 146 students enrolled in the fall semesters of 2017,
2018, and 2019 were included in the current study. PA students
from the 3 cohorts received comprehensive asthma instruction
December 2021 Volume 32 Number 4
Copyright © 2021 Physician Assistant Education Association. Unauthorized reproduction of this article is prohibited.
Table 1. Descriptive Statistics by Cohort
2017 Cohort, n (%)
2018 Cohort, n (%)
2019 Cohort, n (%)
Total, n (%)
41 (80.4%)
40 (83.3%)
36 (76.6%)
117 (80.1%)
Some clinical asthma experience
29 (56.9%)
23 (47.9%)
25 (53.2%)
77 (52.7%)
2017 Cohort, Mean (SD)
2018 Cohort, Mean (SD)
2019 Cohort, Mean (SD)
Total, Mean (SD)
25.61 (5.08)
24.19 (2.86)
25.51 (4.32)
25.11 (4.23)
PA school entry GPA
3.62 (0.24)
3.63 (0.16)
3.69 (0.22)
3.64 (0.21)
First-year GPA
3.55 (0.35)
3.32 (0.40)
3.42 (0.31)
3.43 (0.37)
Asthma exam items†
76.29 (13.37)
84.85 (13.57)
88.01 (12.30)
82.88 (13.94)

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