title: Friend or Foe? Flipped Classroom for Undergraduate Electrocardiogram Learning: a Randomized Controlled Study.
abstract: BACKGROUND
  Interpreting an electrocardiogram (ECG) is not only one of the most important parts of clinical diagnostics but also one of the most difficult topics to teach and learn. In order to enable medical students to master ECG interpretation skills in a limited teaching period, the flipped teaching method has been recommended by previous research to improve teaching effect on undergraduate ECG learning.
  
  
  METHODS
  A randomized controlled trial for ECG learning was conducted, involving 181 junior-year medical undergraduates using a flipped classroom as an experimental intervention, compared with Lecture-Based Learning (LBL) as a control group. All participants took an examination one week after the intervention by analysing 20 ECGs from actual clinical cases and submitting their ECG reports. A self-administered questionnaire was also used to evaluate the students' attitudes, total learning time, and conditions under each teaching method.
  
  
  RESULTS
  The students in the experimental group scored significantly higher than the control group (8.72 ± 1.01 vs 8.03 ± 1.01, t = 4.549, P = 0.000) on ECG interpretation. The vast majority of the students in the flipped classroom group held positive attitudes toward the flipped classroom method and also supported LBL. There was no significant difference (4.07 ± 0.96 vs 4.16 ± 0.89, Z = - 0.948, P = 0.343) between the groups. Prior to class, the students in the flipped class group devoted significantly more time than those in the control group (42.33 ± 22.19 vs 30.55 ± 10.15, t = 4.586, P = 0.000), whereas after class, the time spent by the two groups were not significantly different (56.50 ± 46.80 vs 54.62 ± 31.77, t = 0.317, P = 0.752).
  
  
  CONCLUSIONS
  Flipped classroom teaching can improve medical students' interest in learning and their self-learning abilities. It is an effective teaching model that needs to be further studied and promoted.
authors.affiliation: Department of Cardiovascular Diseases, West China Hospital, School of Clinic Medicine, Sichuan University, Chengdu, China.
authors.forename: Zeng
authors.initials: Z
authors.lastname: Rui
authors.affiliation: Department of Public affairs development, West China Hospital, School of Clinic Medicine, Sichuan University, Chengdu, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Lian-Rui
authors.affiliation: Department of Nephrology, West China Hospital, School of Clinic Medicine, Sichuan University, Chengdu, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Rong-Zheng
authors.affiliation: Department of Internal Medicine, West China Hospital, School of Clinic Medicine, Sichuan University, Chengdu, China.
authors.forename: Zeng
authors.initials: Z
authors.lastname: Jing
authors.affiliation: Department of Internal Medicine, West China Hospital, School of Clinic Medicine, Sichuan University, Chengdu, China.
authors.forename: Wan
authors.initials: W
authors.lastname: Xue-Hong
authors.affiliation: Department of Rheumatology and Immunology, West China Hospital, School of Clinic Medicine, Sichuan University, Chengdu, China. zcsiren@163.com.
authors.forename: Zuo
authors.initials: Z
authors.lastname: Chuan
mesh_terms: D001291:Attitude of Health Personnel; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007858:Learning; D008297:Male; D018794:Problem-Based Learning / Q000379:methods; D011795:Surveys and Questionnaires; D013663:Teaching; D055815:Young Adult
keywords: Flipped classroom; Lecture-based learning, Electrocardiogram learning; Medical education