title: Flipping Radiology Education Right Side Up.
abstract: In flipped learning, medical students independently learn facts and concepts outside the classroom, and then participate in interactive classes to learn to apply these facts. Although there are recent calls for medical education reform using flipped learning, little has been published on its effectiveness. Our study compares the effects of flipped learning to traditional didactic instruction on students' academic achievement, task value, and achievement emotions.
  
  
  
  At three institutions, we alternated flipped learning with traditional didactic lectures during radiology clerkships, with 175 medical students completing a pretest on general diagnostic imaging knowledge to assess baseline cohort comparability. Following instruction, posttests and survey examinations of task value and achievement emotions were administered. Linear mixed effects analysis was used to examine the relationship between test scores and instruction type. Survey responses were modeled using ordinal category logistic regression. Instructor surveys were also collected.
  
  
  
  There were no baseline differences in test scores. Mean posttest minus pretest scores were 10.5% higher in the flipped learning group than in the didactic instruction group (P = 0.013). Assessment of task value and achievement emotions showed greater task value, increased enjoyment, and decreased boredom with flipped learning (all P < 0.01). All instructors preferred the flipped learning condition.
  
  
  
  Flipped learning was associated with increased academic achievement, greater task value, and more positive achievement emotions when compared to traditional didactic instruction. Further investigation of flipped learning methods in radiology education is needed to determine whether flipped learning improves long-term retention of knowledge, academic success, and patient care.
authors.affiliation: Department of Radiology, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140. Electronic address: oconnoe@temple.edu.
authors.forename: Erin E
authors.initials: EE
authors.lastname: O'Connor
authors.affiliation: Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Jessica
authors.initials: J
authors.lastname: Fried
authors.affiliation: Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Nancy
authors.initials: N
authors.lastname: McNulty
authors.affiliation: Department of Radiology, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19140.
authors.forename: Pallav
authors.initials: P
authors.lastname: Shah
authors.affiliation: Robert C. Byrd Health Sciences Center, Department of Radiology, West Virginia University School of Medicine, Morgantown, West Virginia.
authors.forename: Jeffery P
authors.initials: JP
authors.lastname: Hogg
authors.affiliation: Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Petra
authors.initials: P
authors.lastname: Lewis
authors.affiliation: Department of Psychology, Temple University, Philadelphia, Pennsylvania.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeffiro
authors.affiliation: Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Vikas
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: University of Southern California Keck School of Medicine, Los Angeles, California.
authors.forename: Sravanthi
authors.initials: S
authors.lastname: Reddy
mesh_terms: D002982:Clinical Clerkship; D002983:Clinical Competence; D015331:Cohort Studies; D004501:Education, Medical; D005260:Female; D006801:Humans; D008297:Male; D018794:Problem-Based Learning; D011871:Radiology / Q000193:education*; D011795:Surveys and Questionnaires
keywords: Flipped classroom; achievement emotions; clerkship; flipped learning; imaging; neuroimaging; task value