Engagement with homework assignments is important to be able to actively process content during in-class activities in flipped classroom education. Active engagement with the content is assumed to promote deeper understanding and to improve retention of knowledge. This comparative case study aims to explore student workload during homework activities and examines in-class activities next to student motivation and their retention of knowledge in both traditional education and flipped classrooms. This quasi-experimental study was conducted in a Hematology and Oncology course, which is scheduled in the second year of medical education, in Utrecht, the Netherlands. Students’ self-reported study time in traditional classrooms (2014) and flipped classrooms (2015) were measured during one course with a daily online questionnaire and in-class activities were explored using an observation scheme and audio recordings. Cognitive evaluation theory was used to investigate student motivation by measuring perceived autonomy and competence (self-efficacy) of students at the end of the course. Knowledge retention and self-efficacy were (again) measured after 10 months. The in-class observations suggested more interactivity in flipped classrooms. All participating students reported similar workload during the course, whereas exam preparation after flipped classrooms was significantly less time consuming. Students in flipped classrooms reported higher scores for self-efficacy, whereas perceived autonomy was comparable to students learning in traditional classrooms. Ten months after the course, retention of knowledge and self-efficacy scores showed no difference. This study indicated that flipped classroom education required less time investment when preparing for the end-of-course exam and students perceived higher self-efficacy, which is relevant in the light of student stress and burn-out. However, comparison of long-term measurements (retention of knowledge and self-efficacy) showed similar outcomes for students in traditional classrooms and flipped classrooms. It would be interesting to learn whether students trained in flipped classroom education turn out to be better problem solvers in their future careers. For example, if the students in this study are better able to handle patient cases during their clinical rotations.
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