The effectiveness of the fully online flipped classroom for nursing undergraduates during the COVID-19: Historical control study

Aim: Evaluate the fully online flipped classroom's effects during the pandemic.Design: A comparative descriptive study with historical control design.Methods: In an internal medicine nursing course, the fully online flipped classroom instruction was used with 53 undergraduates in 2020. Their final examinations were compared with the 50 students taught with traditional offline methods in 2019. Online interactions and students' experiences were described. Pass rates in both classes were over 90% (X-2 = 0.276, p = 0.60), but the median score in 2019 was higher than in 2020 (Z = -2.491, p = 0.01). There were 996 online interactions and 734 valid interactions in total. All 49 students believed the online flipped classroom schedule was reasonable and all but three said it was helpful. However, 19 students (39%) felt traditional teaching is more effective.Conclusions: The fully online flipped classroom method was fairly effective during the pandemic. This model also did increase class participation and sufficient faculty-student interactions in remote education. However, fewer students earned outstanding scores, with possible reasons including the online flipped classroom, lack of clinical practice, stress from COVID-19 and the shortened exam time. Overall, the method is worth recommending under public health emergencies like COVID-19, and future research exploring potential concerns about scores is necessary.