A Comparative Study Between Traditional Face-To-Face, Audience Response System, and A Flipped Classroom Plus Audience Responce System in Pharmacology Education.

Background: Active learning methods, audience response system (ARS) and flipped classroom (FC), have applied in higher education internationally. However, these outcomes in Japan are uncertain. This study presents a comparison of teaching methods such as the traditional face-to-face (TFF), ARS, and FC plus ARS that are used to enhance student pharmacists’ understanding of pharmacology.Methods: Sophomores at Ohu University were recruited for this study from 2017 to 2019. The TFF were performed in 2017; the ARS were performed in 2018; and the FC plus ARS were performed in 2019. Exam scores were compared between the three methods and anonymous questionnaires were also surveyed in 2018 and 2019 to compare students’ preferences. The Kruskal-Wallis test and ANOVA were carried out depending on data distributions. Categorical data were analyzed using the Chi square test and the Fisher’s exact test. The ANCOVA was performed if background information between the three cohorts was significantly different.Results: The groupings of the participants went as follows: 49 students in 2017, 78 students in 2018, and 90 students in 2019. Their academic backgrounds of each year at the end of their freshman year were similar except for their grade point averages (GPAs). The medians of their pharmacology exam correct rates for the TFF, ARS, and FC plus ARS were 73.3%, 90.0%, and 93.3%, respectively. ANCOVA utilizing GPA as the covariance revealed that the ARS and the FC plus ARS significantly improved exam correct rates compared with the TFF (p < 0.001). There was no significant difference between the ARS and the FC plus ARS groups (p = 0.487). A subgroup analysis in terms of gender difference revealed that the ARS was a significantly improved method compared to the FC plus ARS for female students (p = 0.009), whereas the ARS was not for male students (p = 0.819). Anonymous questionnaires revealed that students in the FC plus ARS lectures had good readiness, enjoyed their classes, and felt fulfillment compared with the ARS lectures. Conclusions: Active learning methods including the ARS and FC plus ARS are significantly more effective than TFF methods.