title: A novel integration of online and flipped classroom instructional models in public health higher education.
abstract: BACKGROUND
  In 2013, a cohort of public health students participated in a 'flipped' Environmental and Occupational Health course. Content for the course was delivered through NextGenU.org and active learning activities were carried out during in-class time. This paper reports on the design, implementation, and evaluation of this novel approach.
  
  
  METHODS
  Using mixed-methods, we examined learning experiences and perceptions of the flipped classroom model and assessed changes in students' self-perceived knowledge after participation in the course. We used pre- and post-course surveys to measure changes in self-perceived knowledge. The post-course survey also included items regarding learning experiences and perceptions of the flipped classroom model. We also compared standard course review and examination scores for the 2013 NextGenU/Flipped Classroom students to previous years when the course was taught with a lecture-based model. We conducted a focus group session to gain more in-depth understanding of student learning experiences and perceptions.
  
  
  RESULTS
  Students reported an increase in knowledge and survey and focus group data revealed positive learning experiences and perceptions of the flipped classroom model. Mean examination scores for the 2013 NextGenU/Flipped classroom students were 88.8% compared to 86.4% for traditional students (2011). On a scale of 1-5 (1 = lowest rank, 5 = highest rank), the mean overall rating for the 2013 NextGenU/Flipped classroom students was 4.7/5 compared to prior years' overall ratings of 3.7 (2012), 4.3 (2011), 4.1 (2010), and 3.9 (2009). Two key themes emerged from the focus group data: 1) factors influencing positive learning experience (e.g., interactions with students and instructor); and 2) changes in attitudes towards environmental and occupation health (e.g., deepened interest in the field).
  
  
  CONCLUSIONS
  Our results show that integration of the flipped classroom model with online NextGenU courses can be an effective innovation in public health higher education: students achieved similar examination scores, but NextGenU/Flipped classroom students rated their course experience more highly and reported positive learning experiences and an increase in self-perceived knowledge. These results are promising and suggest that this approach warrants further consideration and research.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada. lpg@sfu.ca.
authors.forename: Lindsay P
authors.initials: LP
authors.lastname: Galway
authors.forename: Kitty K
authors.initials: KK
authors.lastname: Corbett
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Takaro
authors.forename: Kate
authors.initials: K
authors.lastname: Tairyan
authors.forename: Erica
authors.initials: E
authors.lastname: Frank
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D015331:Cohort Studies; D003194:Computer-Assisted Instruction; D003479:Curriculum; D003625:Data Collection; D004500:Education, Graduate / Q000458:organization & administration*; D004782:Environmental Health / Q000193:education*; D017144:Focus Groups; D006801:Humans; D017145:Models, Educational; D016272:Occupational Health / Q000193:education*; D009862:Online Systems / Q000458:organization & administration*; D011634:Public Health / Q000193:education*