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The Application of Case-Based Learning with Microlectures and Flipped Classroom Teaching Methods in the Teaching of Physiology to Nursing Undergraduates

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Title: The Application of Case-Based Learning with Microlectures and Flipped Classroom Teaching Methods in the Teaching of Physiology to Nursing Undergraduates
Language: English
Authors: Gui-Feng Lu (ORCID 0000-0001-6120-0856), Meng-Qi Huang (ORCID 0009-0009-2307-1411), Fei Geng (ORCID 0000-0002-6075-7975)
Source: Innovations in Education and Teaching International. 2025 62(4):1149-1162.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 14
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Case Method (Teaching Technique), Lecture Method, Flipped Classroom, Undergraduate Students, Nursing Students, Physiology, Instructional Effectiveness, Nursing Education
DOI: 10.1080/14703297.2024.2357711
ISSN: 1470-3297
1470-3300
Abstract: A blended teaching mode is necessary to improve the study efficiency of nursing students. This study aimed to explore the effects of the use of case-based learning (CBL), involving microlectures and flipped classroom teaching methods (flipped CBL mode), via online tools on the teaching of physiology to nursing undergraduates. A total of 207 nursing undergraduates were divided into a control group and a flipped CBL group. The control group received lecture-based learning, while the flipped CBL group received flipped CBL. The results showed that the final exam scores of the flipped CBL group were higher than those of the control group. The majority of nursing students believed that the flipped CBL model could provide guidance for future clinical practice, and could help in their study of physiology. Thus, the use of flipped CBL mode may improve the quality of teaching of physiology and enhance the comprehension and clinical thinking skills of nursing students.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1476985
Database: ERIC
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  Value: <anid>AN0186641501;hzj01aug.25;2025Jul17.02:49;v2.2.500</anid> <title id="AN0186641501-1">The application of case-based learning with microlectures and flipped classroom teaching methods in the teaching of physiology to nursing undergraduates </title> <p>A blended teaching mode is necessary to improve the study efficiency of nursing students. This study aimed to explore the effects of the use of case-based learning (CBL), involving microlectures and flipped classroom teaching methods (flipped CBL mode), via online tools on the teaching of physiology to nursing undergraduates. A total of 207 nursing undergraduates were divided into a control group and a flipped CBL group. The control group received lecture-based learning, while the flipped CBL group received flipped CBL. The results showed that the final exam scores of the flipped CBL group were higher than those of the control group. The majority of nursing students believed that the flipped CBL model could provide guidance for future clinical practice, and could help in their study of physiology. Thus, the use of flipped CBL mode may improve the quality of teaching of physiology and enhance the comprehension and clinical thinking skills of nursing students.</p> <p>Keywords: Physiology; nursing undergraduates; CBL; flipped classroom; microlectures</p> <hd id="AN0186641501-2">Introduction</hd> <p>In the teaching system of basic medical and nursing courses, the discipline of physiology relates to the phenomena, laws and mechanisms of the life activities of the body (Wood et al., [<reflink idref="bib33" id="ref1">33</reflink>]). The study of physiology not only offers links with the teaching of anatomy, histology and other basic courses but also serves as a foundation for pathophysiology and pathology courses which are critical to clinical practice (Shang & Liu, [<reflink idref="bib26" id="ref2">26</reflink>]). As an important bridge connecting basic medicine and clinical nursing, a comprehensive understanding of physiology is necessary for the provision of nursing to patients with clinical diseases. Nurses require a sufficient understanding of the physiological characteristics of the human body in order to keenly observe the changes in the human body and carry out precise care.</p> <p>Physiology is the first functional discipline that nursing students encounter in their study. It is characterised by complex theories and abstract content, making it very difficult for nursing students to learn and apply physiological knowledge. Accordingly, the use of a good teaching model is critical to help students learn the physiology of the human body (Shang & Liu, [<reflink idref="bib26" id="ref3">26</reflink>]). Teaching in medical colleges is primarily based on lecture-based learning (LBL). This traditional teaching method is teacher-centred; students are recipients and knowledge is instilled by teachers to students in one direction. Students are in a passive receiving state, and thus, their learning initiative declines. Students often report that physiological knowledge is difficult to understand and remember in this context. Moreover, in this passive mode, the participation of students is low, and there is no time for independent thinking. This hinders the academic and clinical development of nursing students (Asghar et al., [<reflink idref="bib1" id="ref4">1</reflink>]; Salih et al., [<reflink idref="bib25" id="ref5">25</reflink>]). As such, reform of the physiology teaching mode for nursing undergraduates is imperative.</p> <p>New teaching models are constantly being applied in medical education, especially in the education of nursing students. Case-based learning (CBL) pedagogy considers students as the main body, and teachers play a guiding role. In clinical courses, the CBL teaching method has been widely applied with good results. CBL uses typical clinical cases as a guide and explains and discusses these clinical case problems as the means to provide basic medical teaching; this offers simulation of actual clinical situation (Ginzburg et al., [<reflink idref="bib10" id="ref6">10</reflink>]). In the teaching of nursing undergraduates, this method has been proven to help students achieve a firmer grasp of theoretical knowledge, integrate clinical medicine and basic medicine, promote critical thinking and clinical thinking, and improve students' comprehensive quality (Topperzer et al., [<reflink idref="bib30" id="ref7">30</reflink>]). Microlectures are characterised by a shorter duration, strong systematic correlations between knowledge contents, clear themes and novel forms (Quail & Boyle, [<reflink idref="bib23" id="ref8">23</reflink>]; Yu & Fang, [<reflink idref="bib37" id="ref9">37</reflink>]). Microlectures fragment and liberalise learning content; this can overcome the difficulties in the teaching of physiology courses, to a certain extent. Flipped classrooms are those in which students undertake independent learning by watching videos or consulting materials outside of class; teachers no longer teach knowledge unilaterally in the classroom; instead, students explore problems and consolidate knowledge through teacher-student interaction. The responsibility for learning shifts from the teacher to the student, and the student becomes the protagonist of independent inquiry (Moquin et al., [<reflink idref="bib18" id="ref10">18</reflink>]). This approach has been shown to improve students' active learning abilities, enhance their independent thinking and problem-solving skills, and help students better internalise knowledge (Pollack et al., [<reflink idref="bib22" id="ref11">22</reflink>]).</p> <p>This study applied the flipped CBL mode via online tools to the teaching of physiology to nursing undergraduates. The flipped CBL mode applied in this study makes full use of the advantages of the three teaching methods in order to cultivate the ability of students to actively learn, think and solve problems independently and promote the combination of basic medicine and clinical nursing practice. The aim was to overcome the 'difficult to teach' and 'difficult to learn' problems in physiology. The findings presented within this study offer theoretical and practical references for the application of blended physiology teaching for nursing undergraduates on a global scale.</p> <hd id="AN0186641501-3">Theoretical basis and research hypothesis</hd> <p></p> <hd id="AN0186641501-4">The existing problems in the use of CBL to teach physiology to nursing students</hd> <p>The CBL teaching method has been widely used in clinical courses with good results. CBL teaching involves the presentation of clinical cases as part of the teaching process. These cases are discussed and explained for the purpose of simulating clinical practice. The CBL method has been used in the teaching of physiology to nursing undergraduates for several years; however, there remain several problems with this approach.</p> <hd id="AN0186641501-5">Teachers' time allocation</hd> <p>If CBL is adopted for all physiology courses, students are likely to have a deep understanding of the presented cases and related knowledge but often lack a breadth of knowledge breadth, making it difficult to achieve a solid knowledge foundation (Oliver, [<reflink idref="bib19" id="ref12">19</reflink>]). This is an important consideration when choosing this kind of teaching method. In addition, there are also time limitations associated with the CBL teaching method. First, the introduction of interdisciplinary clinical case knowledge requires teachers to spend a lot of time preparing for the lesson. Secondly, case analysis and discussion in class often cover several disciplines, which is time-consuming (Tayem, [<reflink idref="bib29" id="ref13">29</reflink>]). Thus, if this method is used, the time available for teaching other basic physiology knowledge will be greatly reduced and teaching progress will be delayed. As such, efforts are needed to address this contradiction between the time required for the teaching process and the time allocated to classes. Accordingly, microlectures, as used in this study, can help students learn relevant knowledge outside of class, thus freeing up more class time.</p> <hd id="AN0186641501-6">The requirements of teachers' clinical professional knowledge</hd> <p>In order to implement the CBL teaching method and introduce clinical cases, teachers must not only have a solid basic knowledge of physiology but must also have certain clinical knowledge (Pålsson et al., [<reflink idref="bib20" id="ref14">20</reflink>]). Currently, many teachers lack clinical knowledge and practice skills. Many teachers even have non-medical professional backgrounds and have not undertaken basic clinical courses. This has had severe effects on the teaching of physiology. Some physiology teachers also lack the ability to relate physiology knowledge to clinical cases. Moreover, some teachers exhibit a disconnection between theoretical knowledge and clinical practice. Take humoral cardiovascular regulation as an example. To teach this, it is necessary to focus on epinephrine and norepinephrine. According to textbooks and some teachers, norepinephrine acts on vascular α receptors, raises blood pressure, and is often used as a pressor drug. However, in clinical practice, dopamine drugs are often widely used in the treatment of various types of shock, heart failure and acute kidney injury, as well as perioperative blood pressure maintenance. This disconnection is at odds with the original intent of CBL. In the present study, videos of clinical cases were used to improve teachers' clinical professional knowledge and deepen their understanding of relevant knowledge points to be taught in the physiology course.</p> <hd id="AN0186641501-7">The selection of clinical cases</hd> <p>The selection of clinical cases by physiology teachers also poses a challenge. The selected cases may be scientific studies or clinical practice examples. This is important as not every medical student will become a doctor; many medical students will eventually become teachers, researchers, technicians, company employees, etc. However, for nursing undergraduates, clinical cases may be better (Donkin et al., [<reflink idref="bib8" id="ref15">8</reflink>]). CBL can help students to achieve a deep understanding of basic nursing knowledge, improve their hands-on practical abilities, enhance their ability to deal with emergencies, promote their enthusiasm and initiative to participate in class, and help to enliven the classroom atmosphere. In the selection of clinical cases, teachers should first select cases that are moderately processed by specialised persons. In the context of physiology courses, it is not necessary for students to directly analyse and explain clinical cases in detail. This is because clinical cases are a complex combination of various diseases, symptoms and disciplines. Instead, for the basic teaching of medicine, it is necessary to choose clinical cases that can reflect the required physiology knowledge points. Secondly, teachers should choose the most appropriate cases for the teaching of physiology to nursing undergraduates. For example, clinical cases related to the teaching of arterial blood pressure could include hypertension, tachycardia, myocarditis, etc. The best case in this context would be hypertension case, as this would be helpful for nursing students to understand the formation and factors that influence arterial blood pressure. Another example is that we can focus on some symptoms caused by hypokalaemia, such as reduced atrioventricular conduction. Such a case is beneficial to explain the factors affecting myocardial bioelectricity and conductivity, because an understanding of myocardial bioelectricity is the basis for an understanding of the overall function of the heart. In general, selective and progressive use of cases may be better for the purpose of improving the clinical and physiology knowledge of nursing undergraduates (Liu, [<reflink idref="bib14" id="ref16">14</reflink>]). Based on the above, it is clear that the appropriate selection of clinical cases in this study is critical to improving physiology teaching.</p> <hd id="AN0186641501-8">Hierarchical case teaching</hd> <p>Historically, physiology teaching has been based on students' majors, levels and other conditions (Pan et al., [<reflink idref="bib21" id="ref17">21</reflink>]; Shen et al., [<reflink idref="bib27" id="ref18">27</reflink>]). High school students studying liberal arts may have difficulty understanding bioelectricity. Medical students of different majors undertake different courses. For example, students in basic medicine learn systematic anatomy, but they do not learn regional anatomy. Thus, we propose that CBL in physiology adopts a hierarchical teaching approach. Students with different majors should be exposed to different cases. Physiology teachers must fully explain the clinical cases to students undertaking clinical majors, while an explanation of basic and common cases should be given to students undertaking non-clinical majors. Physiology teaching should focus on oral diseases for stomatological majors, eye-related clinical cases for ophthalmology majors, and reproduction-related clinical cases for obstetrics and gynaecology majors. Nursing undergraduates come from different high school backgrounds. Therefore, the implementation of CBL in a hierarchical manner for the teaching of physiology to nursing students must be explored. In this study, the teachers focused on clinical nursing and the explanation of symptoms in common cases.</p> <hd id="AN0186641501-9">The actual situation of CBL in physiology</hd> <p>When teachers perform CBL teaching in physiology courses, the physiology teaching effect for nursing undergraduates can be evaluated and the positive significance for future nurses can be predicted (Chen et al., [<reflink idref="bib6" id="ref19">6</reflink>]). As the audience of the CBL teaching method, students may be concerned about the similarity between knowledge points taught via CBL teaching and the final physiology examination. If the clinical cases and knowledge points within the CBL method are not closely aligned with the final exam, the students may not treat CBL courses seriously. Further, if CBL teaching is implemented frequently, how should students deal with knowledge points that are not introduced to them during the teaching practice or are introduced briefly? Further, this teaching mode requires the active participation of students. Students' usual performance in the final exam will affect their enthusiasm during the class. In addition, students tend to listen to what they are interested in. However, they still need to learn topics that are not very interesting. In this study, students' performance in class was factored into the final exam scores. The clinical cases and knowledge points within this study were closely aligned with the final exam.</p> <hd id="AN0186641501-10">The application of microlectures and flipped classroom teaching methods in CBL for the teachi...</hd> <p>The 60-second course and the one-minute speech were the earliest microlecture prototypes (Li et al., [<reflink idref="bib15" id="ref20">15</reflink>]). Microlectures are widely recognised and valued by schools and educators because of their favourable characteristics, including their short duration, clear theme and novel form. Students can choose any time and place to learn, with the ability to tailor these videos to the student's progress; this can meet the needs of students of different majors and different levels (Berrocal et al., [<reflink idref="bib4" id="ref21">4</reflink>]).</p> <p>Flipped classroom involves realignment of teaching practices inside and outside the classroom; this approach transfers the onus for learning from the teacher to the student. Teachers no longer use class time to teach basic knowledge; instead, this is assigned to students in advance. Students can watch videos or consult materials outside of class. In class, teachers and students explore the learned concepts and interact with each other based on their individual learning situations. In 2011, flipped classroom was introduced in China (Zhang & Zhao, [<reflink idref="bib38" id="ref22">38</reflink>]) and are now widely recognised by many middle schools and universities. Flipped classroom may help improve students' independent learning abilities, enhance their problem-solving abilities, increase their collective writing awareness, and improve their academic performance (Bashir & Hamid, [<reflink idref="bib3" id="ref23">3</reflink>]).</p> <p>As modern educational technologies, microlectures and flipped classroom teaching methods are widely used in physiology teaching. Through the combination of knowledge introduction and clinical cases, students can effectively master the basic knowledge of physiology and improve their clinical literacy. Various microlecture videos have been recorded in physiology education, and many open teaching resources are available online. Against the background of the gradual increase in mobile learning, the limitations of the traditional teaching are becoming more and more obvious (Chu, [<reflink idref="bib7" id="ref24">7</reflink>]). Flipped classroom is now widely applied in physiology teaching (Xu et al., [<reflink idref="bib34" id="ref25">34</reflink>]). Students complete the course independently. Any difficulties identified during independent learning are solved through interactive discussion and group learning between teachers and students during classes (Doo et al., [<reflink idref="bib9" id="ref26">9</reflink>]).</p> <p>To sum up, the application of physiology microlecture resources and flipped classroom can improve physiology teachers' preparation and reflection during the teaching process and enhance personalised and in-depth learning among nursing undergraduates. The combination of these approaches can mitigate the limitations of existing CBL teaching practices. Accordingly, the present study aimed to address the problems that exist in CBL teaching by applying microlectures and flipped classroom as means to explore effects of the flipped CBL mode on the teaching of physiology to nursing undergraduates. The ultimate goal of this research was to effectively improve the quality of physiology teaching for physiology teachers and nursing students.</p> <hd id="AN0186641501-11">Materials and methods</hd> <p></p> <hd id="AN0186641501-12">Sample</hd> <p>A total of 207 undergraduate nursing students were selected as participants for this study. The students were divided into a control group (<reflink idref="bib100" id="ref27">100</reflink>) and an observation group (<reflink idref="bib107" id="ref28">107</reflink>) based on basic feature matching between the groups. The sample comprised 18 males (8.70%) and 189 females (91.30%) ranging in age from 17 to 20 years old.</p> <hd id="AN0186641501-13">Teaching methods</hd> <p>The physiology course was delivered in the second semester of the first academic year, based on the training requirements and the undergraduate nursing syllabus. The Chapter 'blood circulation' was the main content taught, and the course occupied 10 teaching hours. The teachers, hours and teaching materials of both groups in this study were the same. The control group received the traditional LBL teaching method while the observation group received the flipped CBL method.</p> <hd id="AN0186641501-14">Control group</hd> <p>According to the syllabus, teachers used the LBL teaching method to systematically present the teaching content. Key and difficult topics were explained in detail.</p> <hd id="AN0186641501-15">Experimental group</hd> <p>The blood circulation chapter was introduced during five teaching sessions, each teaching session lasted for two hours. Before class, students were given a clinical case for their self-learning, and the flipped classroom teaching method was adopted during class. The teaching process was as follows. (<reflink idref="bib1" id="ref29">1</reflink>) Teaching preparation stage: Physiology teachers designed clinical cases for the blood circulation chapter, integrated the blood circulation chapter knowledge points, and ensured that the required basic medical knowledge and clinical practice were fully integrated. According to the teaching objectives of the blood circulation chapter, teachers collected and produced microlecture videos. The videos presented the key conceptual knowledge points of the chapter. Each video was limited to five minutes and corresponded to a small section of the chapter. (<reflink idref="bib2" id="ref30">2</reflink>) Teaching stage: The observation group was randomly divided into 10 groups, with each group comprising 10–11 people. One week before class, the teacher sent the microlecture videos containing clinical cases to the students through the online teaching platform Changjiang Rain Classroom or chat tool software. At the same time, three to five clinical case-related questions were disseminated to allow students to carry out independent inquiry-based learning using guided questions. This was to improve the students' learning efficiency. In the classroom, students worked in small groups. The group leader presided over the group members. The students used the knowledge learned before class to think about and discuss the case and answer relevant questions. The group leader reported the pre-class case questions and the physiological knowledge points mastered in this case; each group had 10–15 minutes for their presentation. Teachers played a guidance role, providing supplemental information and consolidation of relevant theoretical knowledge after each group's report. During the report, teachers listened to students' feedback on the process of self-learning, so as to improve the teaching content and improve the teaching effect in a timely manner. Subsequently, the teachers could systematically review, reflect on and improve the chapters of this lecture, connect the fragmented knowledge points of the microlectures, and establish a complete physiological knowledge framework. (<reflink idref="bib3" id="ref31">3</reflink>) Teaching quality inspection: In addition to the students' final examination scores, classroom performance was evaluated in order to measure the quality of CBL teaching (30% of the final score). Teachers evaluated students' learning effects based on the students' comprehension abilities and thinking development level during class when answering questions and participating in group discussions.</p> <hd id="AN0186641501-16">Questionnaire</hd> <p>The application of the flipped CBL teaching mode in physiology teaching was evaluated via a questionnaire distributed to the students. The questionnaire addressed the following key points in relation to the effect of the flipped CBL model: help to learn physiology; promote interest in scientific research; improve active learning and problem-solving ability; guide future clinical practice; enhance communication skills; increase final scores; offer a good learning experience. Each question had three response options: disagree, general agree, and agree. Agreement was regarded as high satisfaction and disagreement represented low satisfaction. At the end of the chapter, 107 questionnaires were distributed, and 107 were returned, with an effective rate of 100%.</p> <hd id="AN0186641501-17">Statistical processing</hd> <p>SPSS 16.0 statistical software was used to process the data. The measurement data were expressed as the mean ± standard error, and <emph>t</emph> tests were used to compare the means of the two groups. The test level was <emph>α</emph> = 0.05, and a difference was considered statistically significant at <emph>p</emph> < 0.05.</p> <hd id="AN0186641501-18">Results</hd> <p></p> <hd id="AN0186641501-19">Distribution of final grades between the two groups</hd> <p>As shown in Table 1, 91.65% of the students in the flipped CBL group passed the final exam, while only 75% of the students in the non-flipped CBL group passed the final exam. The number of good and excellent (≧80 points) students in the flipped CBL group was significantly higher than in the non-flipped CBL group (23 vs 4 students).</p> <p>Table 1. Distribution of Physiology scores of students in the flipped CBL group and non-flipped CBL group [n (%), <emph>n</emph> = 107,100].</p> <p> <ephtml> <table><thead><tr><td>Grade</td><td>Flipped CBL group</td><td>Non-flipped CBL group</td></tr></thead><tbody><tr><td>90–99</td><td>4(3.74)</td><td>0(0)</td></tr><tr><td>80–89</td><td>19(17.76)</td><td>4(4)</td></tr><tr><td>70–79</td><td>37(34.58)</td><td>25(25)</td></tr><tr><td>60–69</td><td>37(34.58)</td><td>46(46)</td></tr><tr><td><60</td><td>10(9.35)</td><td>25(25)</td></tr></tbody></table> </ephtml> </p> <p>The average final exam total score (include classroom performance) of the flipped CBL group was (71.38 ± 1.02), and the average final exam score of the non-flipped CBL group was (65.25 ± 0.86). The total score in the flipped CBL group was significantly higher than that of the non-flipped CBL group (<emph>p</emph> < 0.001). These results indicated that the nursing undergraduates in the flipped CBL group achieved significantly better performance in the final physiology exam.</p> <hd id="AN0186641501-20">Evaluation of the application of the flipped CBL mode in the teaching of physiology to nursin...</hd> <p>As shown in Table 2, a total of 107 students participated in the survey, and the questionnaire recovery rate was 100%. For those in the flipped CBL group, a total of 86.92% (93 people) and 83.18% (89 people) of students were satisfied with the teaching mode's ability to guide future practice and help students learn physiology, respectively. However, the satisfaction rate in relation to improved overall grades and promoting interest in scientific research was low, with only 41.12% (44 people) and 52.34% (56 people) of students, respectively, reporting satisfaction. Overall, most students found that the flipped CBL mode was beneficial for promoting interest in scientific research, improving active learning and problem-solving abilities, and enhancing communication skills and future clinical practice; all of these skills helped in the study of physiology. In general, the satisfaction of the flipped CBL group was high.</p> <p>Table 2. Results of questionnaire survey in application of flipped CBL mode in nursing undergraduate students [n(%), <emph>n</emph> = 107].</p> <p> <ephtml> <table><thead><tr><td>Items</td><td>Agree</td><td>Generally agree</td><td>Disagree</td></tr></thead><tbody><tr><td>Help to learn Physiology</td><td>89(83.18)</td><td>13(12.15)</td><td>5(4.67)</td></tr><tr><td>Promote interest in scientific research</td><td>56(52.34)</td><td>31(28.97)</td><td>20(18.69)</td></tr><tr><td>Improve active learning and problem-solving abilities</td><td>82(76.64)</td><td>21(19.62)</td><td>4(3.74)</td></tr><tr><td>Guide future clinical practice</td><td>93(86.92)</td><td>12(11.21)</td><td>2(1.87)</td></tr><tr><td>Enhance communication skills</td><td>61(57.01)</td><td>33(30.84)</td><td>13(12.15)</td></tr><tr><td>Increase final scores</td><td>44(41.12)</td><td>33(30.84)</td><td>30(28.04)</td></tr><tr><td>Offer a good learning experience</td><td>85(79.44)</td><td>11(10.28)</td><td>11(10.28)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0186641501-21">Discussion</hd> <p>The present study revealed that the flipped CBL mode can improve the quality of physiology teaching, to a certain extent, and enhance nursing students' comprehension and clinical thinking abilities. In the following section provides an expanded discussion of the findings and presents suggestions for the application of the flipped CBL mode.</p> <hd id="AN0186641501-22">The flipped CBL mode can improve the learning effects for nursing undergraduates undertaking...</hd> <p>In this study, a greater proportion of students in the flipped CBL group passed the exam, as compared to the non-flipped CBL group (91.65% vs 75%). Moreover, the average score on the final exam for the flipped CBL group was higher than that of the non-flipped CBL group (71.38 ± 1.02 vs 65.25 ± 0.86). In Table 1, the number of students in the flipped CBL group with scores between 80–100 was significantly higher than that in the non-flipped CBL group. Table 2 shows that 83.18% of the nursing students believed that the flipped CBL model could help nursing students study physiology. These results indicate that the flipped CBL mode can improve the learning of physiology among nursing students.</p> <p>The teaching method adopted in this study differs from the traditional teaching mode. In the traditional lecture-based teaching method, students cannot effectively exert their subjective initiative in the learning process. Students are in a state of passive acceptance of knowledge and lack independent thinking and problem-solving skills. This is at odds with the cultivation of modern and innovative medical talents. New teaching models are increasingly being applied to nursing education (Jordan, [<reflink idref="bib11" id="ref32">11</reflink>]; Mohallem et al., [<reflink idref="bib17" id="ref33">17</reflink>]) in order to cultivate nursing medical talents.</p> <p>In this study, CBL, microlectures and flipped classroom methods were integrated into the teaching of physiology to nursing undergraduates. The CBL pedagogy is guided by clinical cases and can help students to integrate basic and clinical knowledge. CBL can further promote the development of critical thinking and problem-solving skills. Although CBL has several advantages compared to traditional lecture teaching, there are still some problems, including the contradiction between the teaching process and course time allocation, as well as students' lack of enthusiasm and initiative in completing their independent learning prior to class (Yang et al., [<reflink idref="bib35" id="ref34">35</reflink>]). In order to address these problems with the CBL teaching method, microlectures and flipped classroom were applied in this study. Microlectures can fragment and liberalise learning content. By using microlectures, the time for learning is no longer confined to the classroom; students can choose to watch the microlecture videos at any time and place to achieve targeted or gap-filling learning (Kong et al., [<reflink idref="bib13" id="ref35">13</reflink>]). In our study, nursing students were able to adjust their learning progress through the use of microlecture videos targeted at their own learning needs. They were also able to use the internet to find information related to the learning content. Back in the classroom, students were able to engage in face-to-face communication with teachers to answer questions and absorb and digest the physiology knowledge. The flipped classroom in our study shifted the decision-making power of the classroom to the hands of the students, who become the protagonists of independent inquiry. The classroom time was redistributed, and the teaching content was transferred to outside of the classroom. At the same time, the communication and discussion that occurred in the classroom could better establish the knowledge framework (Wong et al., [<reflink idref="bib32" id="ref36">32</reflink>]), helping students to better internalise the required physiology knowledge. Thus, the use of physiology microlectures and flipped classroom in the present study was able to address the limitations of the CBL teaching method. The results of the current study indicated that the application of the flipped CBL mode could effectively improve the learning of physiological theoretical knowledge by nursing undergraduates.</p> <hd id="AN0186641501-23">The flipped CBL mode helps to improve the comprehension abilities of nursing undergraduates</hd> <p>The flipped CBL mode adopted in the current study integrated basic medicine and clinical medicine. At present, the nursing teaching programme in medical colleges and universities mainly follows a sequential process from basic medicine to clinical medicine. In this model, the boundaries of each discipline are clear, and the horizontal connection is limited. Thus, students' basic medical knowledge cannot be integrated with clinical practice in a timely manner. The clearest intuitive manifestation is that when nursing students study clinical courses, it is observed that basic medical knowledge has been partially forgotten (Baker, [<reflink idref="bib2" id="ref37">2</reflink>]; Cervantes et al., [<reflink idref="bib5" id="ref38">5</reflink>]). The application of CBL brings scientific theory and clinical applications together sooner, reinforcing the connections and supporting learning (Slieman & Camarata, [<reflink idref="bib28" id="ref39">28</reflink>]), which was consistent with the present study. The flipped CBL mode within this study involved a set of teaching methods with the CBL teaching method at the core, accompanied by microlectures and flipped classroom teaching methods as the driving forces. Table 2 shows that 52.34% of the nursing students believed that this flipped CBL model could promote interest in scientific research, and 86.92% of the nursing students believed that flipped CBL could help guide future clinical practice. These results suggest that the flipped CBL mode plays a bridging role between basic medical knowledge of physiology and clinical nursing practice, and further cultivates the clinical thinking of nursing undergraduates.</p> <p>The flipped CBL mode helped to improve the comprehension abilities of nursing undergraduates in this study. This new teaching mode does not limit learning to direct instruction of new knowledge by teachers in the classroom, breaking the restrictions of time and space. Students can study in a relaxed and pleasant environment, at a time and place of their choice. When they encounter problems, they can stop to think and look up information. Simple and clear content can be moved through quickly; the pace of learning within this mode is controlled by the students. Multimedia is currently of great interest to students. Through microlectures, students' interest in the content is stimulated, promoting an atmosphere of learning. In this study, microlectures were conducive to consolidating and strengthening knowledge points before class and were suitable for checking knowledge points after class. Students were able to watch microlecture videos repeatedly through the online learning platform, which provides convenience for students' independent learning. When the learning time and place are no longer limited, students' autonomy in learning will gradually improve. The rate of satisfaction in the flipped CBL group in relation to the ability of CBL to improve active learning and problem-solving was also as high as 76.64%. It is believed that the flipped CBL mode can improve the in-depth learning of physiology among nursing undergraduates, and the application of microlectures and the communication with teachers in flipped classroom can achieve personalised teaching. The case-centred autonomous knowledge internalisation mode (Wipawayangkool & Teng, [<reflink idref="bib31" id="ref40">31</reflink>]) in the flipped CBL mode can enrich the learning experience of nursing undergraduates and greatly improve their independent thinking and problem-solving abilities. Students changed from passive dissemination to knowledge reception from clinical cases. Nursing students reported that they had greater communication skills through the process of flipped CBL (57.01%), which is consistent with a previous study (Yoo & Park, [<reflink idref="bib36" id="ref41">36</reflink>]). Thus, the flipped CBL mode comprehensively stimulated the subjective initiative of nursing undergraduates, deepened their understanding of physiological knowledge, and promoted a sense of achievement. In general, these findings suggest that the flipped CBL method promoted the overall development of students.</p> <hd id="AN0186641501-24">Problems and countermeasures in the application of the flipped CBL mode in physiology teachin...</hd> <p>Based on our study, the flipped CBL mode can indeed break the 'difficult to teach' and 'difficult to learn' problem of physiology courses, to some extent, and can improve the physiology teaching quality. Most students indicated that they had a good learning experience (79.44%, Table 2). However, there are still several unresolved problems associated with the flipped CBL mode applied in this study that must be addressed before its future application, including the difficulty and high cost of microlecture production in the early stage and the large workload and high investment required to establish a case database. Further, the traditional theoretical examinations and teacher satisfaction evaluations are not suitable for the comprehensive and objective evaluation of the flipped CBL mode. It is necessary to establish an effective scientific evaluation feedback system so that the flipped CBL mode can play a real driving and promoting role in the teaching of physiology to nursing students. At the same time, the flipped CBL mode has higher requirements on teachers' teaching abilities, with teachers required to have higher professional and clinical knowledge reserves (Mason et al., [<reflink idref="bib16" id="ref42">16</reflink>]). Further, the flipped CBL mode requires students to engage in fragmented active learning in relation to a specific knowledge point. Fragmented learning has disadvantages such as fragmentation and arbitrariness (Junsawang et al., [<reflink idref="bib12" id="ref43">12</reflink>]; Ryu et al., [<reflink idref="bib24" id="ref44">24</reflink>]). This requires teachers to disassemble cases in detail, and students to improve their classroom participation and discussion, so as to build a good knowledge foundation.</p> <p>In summary, the use of the flipped CBL mode in the teaching of physiology to nursing undergraduates can improve the teaching quality to a certain extent, improve the comprehension and clinical thinking abilities of students, and lay a foundation for future clinical nursing practice. However, it should be noted that this study only investigated the teaching of physiology to nursing undergraduates and the duration of teaching implementation was short. Accordingly, the application of this flipped CBL mode in the teaching practice of physiology will need to be explored and promoted in related medical disciplines in the future.</p> <hd id="AN0186641501-25">Acknowledgments</hd> <p>We are grateful to all participants within the study, and the reviewers and editors who provided value suggestions, which contributed to the completion of the paper.</p> <hd id="AN0186641501-26">Disclosure statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <hd id="AN0186641501-27">Data availability statement</hd> <p>Upon a reasonable request, the authors will provide the original data that support the findings of the study.</p> <hd id="AN0186641501-28">Ethics approval and consent to participate</hd> <p>This study was approved by the Ethics Committee of Shantou University Medical College (SUMC-2023-053). The survey contents and analysis protocol satisfied the relevant guidelines. 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Practice and exploration of "tries-tries" flipped classroom teaching mode in mechanical courses. https://doi.org/10.2991/assehr.k.201214.121</bibtext> </blist> </ref> <aug> <p>By Gui-Feng Lu; Meng-Qi Huang and Fei Geng</p> <p>Reported by Author; Author; Author</p> <p></p> <p>Gui-Feng Lu , Shantou University Medical College, Doctor of Medicine, Associate Professor, good at medical education, wrote the draft.</p> <p>Meng-Qi Huang , Shantou University Medical College, Undergraduate, engaged in the study and analysed data.</p> <p>Fei Geng , Shantou University Medical College, Doctor of Physiology, Professor, good at Physiological education, conceived the study, wrote the draft and performed teaching.</p> </aug> <nolink nlid="nl1" bibid="bib33" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib26" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib25" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib10" firstref="ref6"></nolink> <nolink nlid="nl5" bibid="bib30" firstref="ref7"></nolink> <nolink nlid="nl6" bibid="bib23" firstref="ref8"></nolink> <nolink nlid="nl7" bibid="bib37" firstref="ref9"></nolink> <nolink nlid="nl8" bibid="bib18" firstref="ref10"></nolink> <nolink nlid="nl9" bibid="bib22" firstref="ref11"></nolink> <nolink nlid="nl10" bibid="bib19" firstref="ref12"></nolink> <nolink nlid="nl11" bibid="bib29" firstref="ref13"></nolink> <nolink nlid="nl12" bibid="bib20" firstref="ref14"></nolink> <nolink nlid="nl13" bibid="bib14" firstref="ref16"></nolink> <nolink nlid="nl14" bibid="bib21" firstref="ref17"></nolink> <nolink nlid="nl15" bibid="bib27" firstref="ref18"></nolink> <nolink nlid="nl16" bibid="bib15" firstref="ref20"></nolink> <nolink nlid="nl17" bibid="bib38" firstref="ref22"></nolink> <nolink nlid="nl18" bibid="bib34" firstref="ref25"></nolink> <nolink nlid="nl19" bibid="bib100" firstref="ref27"></nolink> <nolink nlid="nl20" bibid="bib107" firstref="ref28"></nolink> <nolink nlid="nl21" bibid="bib11" firstref="ref32"></nolink> <nolink nlid="nl22" bibid="bib17" firstref="ref33"></nolink> <nolink nlid="nl23" bibid="bib35" firstref="ref34"></nolink> <nolink nlid="nl24" bibid="bib13" firstref="ref35"></nolink> <nolink nlid="nl25" bibid="bib32" firstref="ref36"></nolink> <nolink nlid="nl26" bibid="bib28" firstref="ref39"></nolink> <nolink nlid="nl27" bibid="bib31" firstref="ref40"></nolink> <nolink nlid="nl28" bibid="bib36" firstref="ref41"></nolink> <nolink nlid="nl29" bibid="bib16" firstref="ref42"></nolink> <nolink nlid="nl30" bibid="bib12" firstref="ref43"></nolink> <nolink nlid="nl31" bibid="bib24" firstref="ref44"></nolink>
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  Data: The Application of Case-Based Learning with Microlectures and Flipped Classroom Teaching Methods in the Teaching of Physiology to Nursing Undergraduates
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  Data: <searchLink fieldCode="AR" term="%22Gui-Feng+Lu%22">Gui-Feng Lu</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6120-0856">0000-0001-6120-0856</externalLink>)<br /><searchLink fieldCode="AR" term="%22Meng-Qi+Huang%22">Meng-Qi Huang</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0009-2307-1411">0009-0009-2307-1411</externalLink>)<br /><searchLink fieldCode="AR" term="%22Fei+Geng%22">Fei Geng</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-6075-7975">0000-0002-6075-7975</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22Innovations+in+Education+and+Teaching+International%22"><i>Innovations in Education and Teaching International</i></searchLink>. 2025 62(4):1149-1162.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Case+Method+%28Teaching+Technique%29%22">Case Method (Teaching Technique)</searchLink><br /><searchLink fieldCode="DE" term="%22Lecture+Method%22">Lecture Method</searchLink><br /><searchLink fieldCode="DE" term="%22Flipped+Classroom%22">Flipped Classroom</searchLink><br /><searchLink fieldCode="DE" term="%22Undergraduate+Students%22">Undergraduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Nursing+Students%22">Nursing Students</searchLink><br /><searchLink fieldCode="DE" term="%22Physiology%22">Physiology</searchLink><br /><searchLink fieldCode="DE" term="%22Instructional+Effectiveness%22">Instructional Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Nursing+Education%22">Nursing Education</searchLink>
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  Data: 10.1080/14703297.2024.2357711
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  Data: 1470-3297<br />1470-3300
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  Data: A blended teaching mode is necessary to improve the study efficiency of nursing students. This study aimed to explore the effects of the use of case-based learning (CBL), involving microlectures and flipped classroom teaching methods (flipped CBL mode), via online tools on the teaching of physiology to nursing undergraduates. A total of 207 nursing undergraduates were divided into a control group and a flipped CBL group. The control group received lecture-based learning, while the flipped CBL group received flipped CBL. The results showed that the final exam scores of the flipped CBL group were higher than those of the control group. The majority of nursing students believed that the flipped CBL model could provide guidance for future clinical practice, and could help in their study of physiology. Thus, the use of flipped CBL mode may improve the quality of teaching of physiology and enhance the comprehension and clinical thinking skills of nursing students.
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    Identifiers:
      – Type: doi
        Value: 10.1080/14703297.2024.2357711
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 14
        StartPage: 1149
    Subjects:
      – SubjectFull: Case Method (Teaching Technique)
        Type: general
      – SubjectFull: Lecture Method
        Type: general
      – SubjectFull: Flipped Classroom
        Type: general
      – SubjectFull: Undergraduate Students
        Type: general
      – SubjectFull: Nursing Students
        Type: general
      – SubjectFull: Physiology
        Type: general
      – SubjectFull: Instructional Effectiveness
        Type: general
      – SubjectFull: Nursing Education
        Type: general
    Titles:
      – TitleFull: The Application of Case-Based Learning with Microlectures and Flipped Classroom Teaching Methods in the Teaching of Physiology to Nursing Undergraduates
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Gui-Feng Lu
      – PersonEntity:
          Name:
            NameFull: Meng-Qi Huang
      – PersonEntity:
          Name:
            NameFull: Fei Geng
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 1470-3297
            – Type: issn-electronic
              Value: 1470-3300
          Numbering:
            – Type: volume
              Value: 62
            – Type: issue
              Value: 4
          Titles:
            – TitleFull: Innovations in Education and Teaching International
              Type: main
ResultId 1