Flipped out: Methods and outcomes of flipping abnormal psychology
Amanda K Sommerfeld, Ph.D.
Abnormal psychology is taught in virtually every undergraduate psychology department across country (Perlman & McCann, 1999). However, despite its popularity, the course is not immune from critiques. Like many college courses, abnormal psychology is often lecture-based (Benjamin, 2002). Although such a pedagogical approach is popular among faculty because of its effectiveness in maximizing content delivery (Kendra, Cattaneo, & Mohr, 2012), in some cases lectures also may be less effective than other methods for promoting learning (c.f., Halonen, 2005).
Abnormal psychology courses have also been critiqued as lacking both context and nuance. As Norcross, Sommer, and Clifford (2001) note, in abnormal psychology classes, “the painful human experience of psychopathology is frequently overshadowed by descriptions of disembodied symptoms and impersonal treatment” (p. 126). As a result, despite many professors’ intentions to use abnormal psychology courses to decrease stigma (Kendra et al., 2012) and increase student understanding of the contextual factors that shape psychiatric conditions (Lafosse & Zinser, 2002), courses may fall short of these desired outcomes. That was certainly my experience when I first taught abnormal psychology.
Psychopathology I (PSY 233) is a core course for students who are majoring in psychology with a clinical/counseling concentration at my college. Because of this, as well as the content, the class is frequently filled to capacity (40 students). When I inherited the class in Fall 2014, I kept using what Benjamin (2002) refers to as “the Velveeta (cheese) of teaching methods” (p. 57), otherwise known as a lecture-centered approach (which is comparable to the cheesy foodstuff in that despite the fact that no one admits to liking it, it remains the most popular pedagogical approach; Halonen, 2005). I enhanced the class with media critiques, group projects, and in-class discussions, however class time remained lecture-driven.
According to my students the course was successful. Students gave high ratings on course evaluation items (rated from 1=strongly disagree to 5=strongly agree) such as “The use of teaching aids was effective” (μ=4.9) and “The instructor answered questions in class in a patient and helpful manner“ (μ=4.9). Students’ qualitative feedback supported these ratings.
Despite this positive feedback, I was dissatisfied with several aspects of the course. For example, lower student ratings on items such as, “I learned a great deal in this class” (μ=4.6) and “The course raised challenging questions or issues” (μ=4.6), led me to wonder if students were basing their assessments on how much they liked the course rather than their actual learning. What is more, at the end of the semester I didn’t feel confident that I’d met my objective of challenging students to consider how cultural norms and biases contribute to psychiatric conditions. As a result, I was left with the sense that, because of the format, I had reduced the course content to a list of diagnostic criteria, leaving little time for acknowledging symptom variation, challenging stereotypes, or encouraging the development of advocacy attitudes. To combat these shortcomings, I decided to change the class radically, and, with the support of a grant from my college’s Cromwell Center for Teaching and Learning, I flipped—or inverted—the class.
There is no single definition of flipped instruction (He, Holton, Farkas, & Warschauer, 2016). However, the underlying intent of the approach is to move lecture-based material outside of class, leaving in-class time for “face to face engagement between students and teachers” (Forsey, Low, & Glance, 2013, p. 472). This is commonly achieved by delivering course content before class meetings using recorded lectures, podcasts, or videos. Material is then applied during face-to-face meetings through discussions, activities, and hands-on demonstrations.
To date, the research on flipped instruction is incomplete. As O’Flaherty and Phillips (2015) note, few studies have “actually demonstrated robust evidence to support that the flipped learning approach is more effective than conventional teaching methods” (p. 94). Despite this, anecdotal evidence is encouraging, with some studies claiming that flipped instruction results in greater student engagement (c.f., Jamaludin & Osman, 2014) and higher test scores and overall grades (c.f., Mason, Shuman, & Cook, 2013). Based on this available evidence, and the issues that I observed in the first iteration of Psychopathology I, flipping the class seemed a worthwhile venture.
Flipping Psychopathology I required me to create two sets of materials: out-of-class and in-class. The bulk of class content (i.e., diagnostic criteria, prevalence rates, treatment approaches, etc.) was delivered outside of class through video lectures that were uploaded to the course’s online learning platform. For the first iteration of the flipped course, these lectures were simple, with my voice recorded over PowerPoint slides using SnagIt. These videos were limited to ten minutes so students could easily review information. Prior to class students were required to watch between one and three videos and complete an online quiz. The quizzes were intended to encourage mastery, so students were able to repeat the quizzes multiple times.
In-class time was focused on application and discussion (Pluta, Richards, & Mutnick, 2012). This required me to create individual and group activities for each class meeting. Sample activities included having students evaluate media depictions of psychiatric disorders for accuracy, writing vignettes of imaginary clients, and discussing the systemic factors that affect how clients manifest symptoms.
I evaluated the effectiveness of the flipped versus traditional instruction based on data collected at two times: following a lecture-based course in Fall 2014 (N=27) and following a flipped-style course in Fall 2015 (N=34). Data I collected at both points in time included student test scores and grades, student course evaluations, student responses to questions developed for the Web Learning Project (Calderon, Ginsberg, & Ciabocchi, 2012), and instructor reflections.
Data from the traditional and flipped offerings of Psychopathology I suggested the pedagogical change affected outcomes in three domains: student learning, student engagement, and instructor experience.
Impacts on student learning
Researchers suggest that flipped instruction is successful because students are able to learn and review pre-class material on their own time and at their own pace (McDonald & Smith, 2013). Many of my students agreed with this assessment, sharing on course evaluations that, “I like how the videos were before class. It allowed for deeper understanding of the material because I can pause, write down questions, and review as needed.” Accordingly, students also rated the “adequacy of resources” as significantly higher than students in the lecture class (t(54)=-2.11, p=.04).
In opposition to the literature, the accessibility of material outside of class did not translate into higher grades for my students. In fact, although there were no significant differences in final grades between the two classes, students in the flipped class had significantly lower exam grades than students in the lecture-based class (t(58)=2.42, p=.02). What is more, student responses to the item “I learned a lot in this course” were lower in the flipped course (μ=4.3) than in the lecture course (μ=4.6).
It is possible that some of the student learning drawbacks of the flipped class were related to perceptions of the difficulty of the course. In comparison to students in the lecture class, students in the flipped class rated the course as having a significantly higher “workload” (t(56)=-6.02, p=.00) and being more “difficult” (t(55)=-3.19, p=.00). Further, student qualitative feedback reinforced these ratings, suggesting the flipped style made learning more difficult for some students.
This perception runs contrary to previous studies that have suggested students perceive flipped courses as less difficult than courses taught using traditional methods (He et al., 2016). However similar to previous research (c.f., O’Flaherty & Phillips, 2015), students in my flipped course suggested the difficulty predominantly stemmed from the increased responsibility they felt: “The flip style makes learning just a little bit harder because it puts all the responsibility on what you do outside of the classroom.”
Impacts on student engagement
The fundamental purpose behind flipped instruction is to use in-class time for active learning. Given this, some of the feedback from students in the flipped class led me to question the effectiveness of my in-class activities. For example, students in the flipped course rated the “learning value of in-class materials” significantly lower than students in the lecture course (t(56)=2.326, p=.02). These data were supported by comments such as, “class meetings are interesting but not necessarily informative.”
Based on these data, it seems that my implementation of flipped pedagogy may have fallen short because of how I structured face-to-face meetings. It may be that, similar to O’Flaherty and Phillips’ (2015) findings in their scoping review, I failed to explain the link between the pre-class activities and the face-to-face sessions. As a result, the in-class material may not have engaged the students.
With that said, data also suggested students interacted more in the flipped class, which may have facilitated student engagement. For example, students in the flipped course rated the amount and quality of “interaction with other students” as significantly greater than students in the lecture course (t(56)=-6.06, p=.00). Student comments reinforced these data, with one student noting, “I like that we get more time to ask questions in class,” and another mentioning that “the interaction during class time helps to solidify the information.”
Impact on instructor
Researchers who study flipped instruction routinely note how demanding it is on instructors. That was certainly my experience in flipping Psychopathology I. Similar to other instructors’ experiences, it took considerable planning and preparation for me to design engaging, interactive in-class activities (c.f., Mason et al., 2013). A great deal of lead-in time was also required to record and edit lectures in advance of class meetings.
The process of making the videos was also complicated by the limited technical support available to me. Although I consulted with members of the academic technology team at my institution, they did not have the time or resources to help me record or edit the videos. As a result, I had to learn how to use the software and troubleshoot issues on my own. Perhaps because of the amount of time and expertise required to create even simple videos, it is not surprising that researchers have recommended having a support staff or technical team available (c.f., Ferreri & O’Connor, 2013).
Despite these issues, I also found the flipped course had multiple strengths. Most importantly, because students could access and review the lectures before class meetings they were less concerned with taking notes in class. This freed up the students to listen to their classmates, contribute to discussions, and engage fully in activities. As a result, a greater proportion of students participated in the flipped versus the traditional class.
Finally, I also found the flipped class provided students with increased opportunities to consider more nuanced issues related to psychiatric disorders. In particular, because the students were introduced to diagnostic criteria and prevalence rates prior to class, they were more prepared to apply and critique that material in class, opening up discussions about stigma, social norms, and systemic forms of privilege and oppression that affect psychological health and illness.
The flipped version of Psychopathology I had both strengths and weaknesses. Students appreciated the opportunities for review that the flipped style provided, were better able to consider the nuances of psychiatric conditions, and were more engaged during in-class meetings. On the other hand, some students reported the flipped style made learning more difficult and I found the flipped course took more time to prepare. Given these data, it is not possible to say flipping Psychopathology I improved the course as a whole, at least not after the first offering. However, with revision the flipped course could hold considerable promise to help students develop more critical perspectives on topics relevant to abnormal psychology.
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