The refinement of flipped teaching implementation to include retrieval practice.

There has been growing evidence that flipped teaching (FT) can increase student engagement. Traditional lecture-based teaching (TT) method was compared with FT and FT combined with retrieval practice (FTR) in a 400-level Exercise Physiology course over eight semesters. In the FT format, lecture content was assigned for students to prepare before class along with an online quiz. During class, the assigned content and quiz questions were reviewed, and a team-based learning (TBL) activity was conducted. Students found FT implementation three times a week (FT3) to be overwhelming, which led to reconfiguration of the FT design to minimize the quiz and TBL sessions to one per week. Subsequently, FT was combined with retrieval exercises (FTR), which involved recalling information, thus promoting retention. The students in the FTR format were given weekly quizzes in class, where no notes were allowed, which affected their quiz grade negatively compared with FT (P < 0.0001). Again, no resources were permitted during FTR's TBL sessions. When exam scores were compared with TT, student performance was significantly greater (P < 0.001) with the FT and FTR methods, suggesting these methods are superior to TT. While both male and female students benefited from FT and FTR methods compared with TT (P = 0.0008), male students benefited the most ((P = 0.0001). Similarly, when the exam scores were organized into upper and lower halves, both groups benefited from FT and FTR (P < 0.0001) approaches. In conclusion, both FT and FTR methods benefit students more compared with TT, and male students are impacted the most.