This week’s topic was in my opinion the most interesting topic so far of the ONL course. In the PBL groups, we explored resources on online and blended learning. By definition, blended learning is a teaching method that integrates online media and technologies (e.g. films, online discussions, quizzes) with traditional teacher-led classroom activities. Importantly, the online and in-person activities are integrated, creating a flexible and customized learning experience (  

There are several types of blended learning techniques, of which the flipped-classroom design is one. In the flipped-classroom design the students prepare for in-person class, by engaging with online materials before the in-person class. I find this method interesting, and have read some articles and web-pages about it. Below follow a brief summary of what I have learned. The flipped-classroom design usually follows four main steps: 1) Introduce the task. In this step, the teachers should clearly explain and introduce the tasks, what the students will be doing and the amount of time they will need to invest to be ready for the in-class activity. 2) Online activities. These can include (but are not limited to) videos (should not be longer than 10-15 minutes), websites, readings, screencasts, and narrated PowerPoints. 3) Assessing the online learning. To ensure that the students are prepared for the in-class activity, the online activities can be assessed for example by self-assessment quizzes. 4) In-class activities. These should include opportunities for active learning and be clearly linked to the learning outcomes and online activities. I found a lot of useful tips on this web-site:

When searching scientific literature on flipped-classroom in medical education, I found a meta-analysis, suggesting that the flipped-classroom approach yields a statistically significant improvement in learner performance compared with traditional teaching methods (1). I noticed however that most of the included studies used historical controls, which may limit the validity of the results. Nevertheless, I think that this is a promising pedagogical approach that may be worth trying with my students. Importantly, I think that the most suitable learning design depend on the specific context, i.e. it may vary by intended learning outcomes, settings and student groups.  

I wanted to further deepen my knowledge on this learning technique. Therefore, I looked for examples of how this technique has been used in topic related to my own teaching. I found an article comparing a flipped-classroom approach to traditional in-class teaching, using a quasi-experimental design (historical comparison) (2). Participants were students in a masters-level public health course. The first group of students (the comparison group), was tough through in-class lectures and out-of-class reading assignments. The in-class time also included small group work and discussions. Approximately, 60% of the in-class time was lecture-based. For the second croup of students (the blended-learning group), all lectures were pre-recorded and posted online for the students to view before the in-class activities. At least 80% of in-class time was devoted to active learning approaches, which involved analyzing and applying the concepts of the pre-recorded lectures. Some lecturing took place to clarify some points or to integrate new knowledge with an active learning activity. The authors found a statistically significant increase in student performance under the blended learning approach. Due to the quasi-experimental approach these results must be interpreted with caution.

For this week’s topic, I started with listening to a pre-recorded by Martha Cleveland about the Community of Inquiry (COI). According to the COI, the educational experience consists of three elements: social presence, cognitive presence and teaching presence. She also talked about emotional presence, as a potential independent element. Later, at the Tuesday’s webinar, we heard about emotional presence in the community of inquiry. Apparently, social engagement is important to offer a comfortable academic environment. Interestingly, we heard at the webinar that research has shown that emotion is at play not only in the social environment but also in teaching presence and cognitive presence. Obviously, it is important to set norms, be clear about expectations, and to discuss expectations. Personally, I think that it is more challenging to pay attention to emotions in online teaching than when meeting students in person. Therefore, in online teaching, we must pay extra attention to these signals and learn how to recognize certain signals of emotional expression. Further, at the webinar, we learned that it is important to form smaller groups in PBL to create engagement and to get the students be feel comfortable. 

Taking together the learning from the lectures and readings of this week, I feel more prepared to implement a blended learning approach in my own teaching. I am planning to use this approach for one part of a course on healthy aging from a multiprofessional perspective. The specific part of the course for which I am planning a flipped-classroom approach is about complexity of health in old age. I am planning to have pre-recorded lectures on multimorbidity and frailty, together with an online quiz. The students will prepare for the in-class activities by viewing the lectures and answering the quiz. They will also prepare a case description of a patient with complex health problems. Based on the results from the online quiz, I plan to start the in-class teaching with a brief lecture clarifying some of the concepts from the online lectures. The lecture will be followed by small-group work where the students will discuss the cases based on the lectures. Their task is to define multiprofessional SMART goals (Specific, Measurable, Realistic, Timed) for each case. The cases will then be presented and discussed in the entire class.


  1. Khe Foon HEW and Chung Kwan LO. Flipped classroom improves student learning in health professions education: a meta-analysis. BMC Med Educ 18, 38 (2018) doi:10.1186/s12909-018-1144-z
  2. Kiviniemi, M.T. Effects of a blended learning approach on student outcomes in a graduate-level public health course. BMC Med Educ 14, 47 (2014) doi:10.1186/1472-6920-14-47
Topic 4: Design for online and blended learning