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conducted. Next day, in second component, three groups of

students were made to sit in different classrooms. They were
given the stem of MCQs from the same topic and were instructed
to formulate 3 distracters and 1 key using their textbooks without
peer consultation. At the end of this exercise, each student read
out the distracters formed by them and was discussed with the
teaching faculty. In the third component, 1st post test was
conducted the next day and in the last component, a delayed
post test was conducted a week later. There was a statistically
significant difference between pre-test and post-test in all the
high performers and low performers. Also, the retention of
performance was seen in all the three groups as there was no
statistically significant change in the delayed post-test
performance compared to the first post test. Although there was
no statistical significance between the gains obtained by all the
three groups, appreciable gain was observed for low performers
(+ 1.0698). Formulation of distracters of MCQs for a given stem
enhanced the comprehension and performance of medical
undergraduate students in medical biochemistry.

Exploring the Effectiveness of Flipped Classroom
with Poll Everywhere
K S Gubbiyappa1, A Barua2, B Das2, H Z Baloch3
School of Pharmacy, International Medical University (IMU),
Kuala Lumpur, Malaysia; 2School of Medicine, International
Medical University (IMU), Kuala Lumpur, Malaysia; 3Department
of Learning Resources, International Medical University (IMU),
Kuala Lumpur, Malaysia
Keywords: Flipped Class, Blended Learning, Poll Everywhere
Flipped classroom (FC) is an instructional method to engage
student- learning process by replacing didactic lectures. With the
advancement of e-learning tools and technology it is possible to
design and develop interactive and self-learning lectures.
Students could access them from anywhere outside of the
classroom. Learners may learn at their own pace. Poll everywhere
(an Audience Response System(PE-ARS)) may be employed in a
FC setting to make teaching-learning activities more interesting,
engaging, collaborative and interactive. This research focused on
the perception of undergraduate Pharmacy students on FC
activity using PE-ARS and the effectiveness of FC activity as a
teaching-learning tool for delivering Complementary Medicine
Module (CMM) in the undergraduate Pharmacy programme. In
this non-randomized trial on interrupted time series study, FC
session was conducted with 112 students enrolled in B Pharm
(Semester 5). The topic selected was popular herbal remedies in
the CMM. Online interactive and self-learning material was
provided prior to the FC. During the FC, audio and video
presentation were employed as a quiz using 10 One Best Answer
(OBA) type of multiple choice questions covering the learning
objectives. Audience response was captured using web-based
interaction with PE-ARS. Feedback was obtained from
participants at the end of FC activity and debriefing was done.
Results were promising. Randomly selected 112 complete
responses were included in the final analysis. 47 (42.0%) were
male and 65(58.0%) were female respondents. The overall
Cronbachs alpha of feedback questionnaire was 0.912. Low- or
middle- achievers of quiz session (pre-test) during the FC activity
were 3 times (95% CI = 1.18.9) at risk of providing neutral or
negative feedback than high achievers (p = 0.040). Those who
provided neutral or negative feedback on FC activity were 3.9

times (95% CI = 1.311.8) at risk of becoming low or middle

achievers during the End of Semester Examination (p = 0.013).
From our data analysis, we conclude that PE-ARC made FC
activity more engaging and interactive.

Teaching and Learning

Trends of Research Purpose in the Asia-Pacic
Region in the Last 5 Years: A Systematic Review
W S Lim1, K M Tham2, W C Wong1, H Y Neo3, I Lim4, D
Department of Geriatric Medicine, Tan Tock Seng Hospital,
Singapore; 2Yong Loo Lin School of Medicine, National
University of Singapore, Singapore; 3Department of Palliative
Medicine, Tan Tock Seng Hospital, Singapore; 4Health Outcomes
and Medical Education Research, National Healthcare Group,
Keywords: Research Purpose, Asia Pacific, Systematic Review
Little is known about the progress of medical education research
in advancing the field through clarification studies situated within
a strong conceptual framework. We aimed to determine if there is
a trend towards increase in clarification studies as opposed to
description and justification research purposes (Cook et al., 2008)
in the Asia-Pacific region in the last 5 years. We conducted a
systematic review of eligible original research abstracts presented
at the 2008, 2010 and 2012 Asia Pacific Medical Education
Conferences (APMEC). We conducted trended Chi-square tests
with post-hoc pairwise comparisons followed by logistic regression
adjusted for variables that are significant in bivariate analyses, to
determine if there is a longitudinal trend towards increase in
clarification studies. Our sample comprised 517 abstracts (2008:
136; 2010: 195; 2012: 186). There was a significant trend through
the study period (Clarification studies: 4.4% vs 8.7% vs 12.9%;
p = 0.001), with post-hoc analyses significant for clarificationdescriptive (p = 0.004) but not clarification-justification (p = 0.19)
comparisons. The trend remained significant even after excluding
submissions from non-Asian countries (5.0% vs 7.4% vs 12.9%;
p = 0.003). When adjusted for professional group, country of
study, presence of clear study aims and non-descriptive study
design, abstracts in 2012 were still significantly more likely to have
a clarification research purpose compared to 2008 (OR 2.74, 95%
CI 1.047.23). Our results of a trend towards increased rigor of
research purpose, even after excluding submissions from nonAsian countries, affirm the progress made in the quality of medical
education research in the Asia-Pacific region in the last 5 years.

Is Acting Training Benecial to Standardized
N Ngiam1, J Gilmer2, C Y Hor1, J Wang1
Centre for Healthcare Simulation, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore;
Department of Visual and Performing Arts (Drama), National
Institute of Education, Singapore
Keywords: Standardized Patients, Training Methods, Acting Skills
Standardized patients (SPs) are healthy people who portray
patients. Acting skills could have a positive impact on their

2014 The Authors

Medical Education 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48 (Suppl. 2): 119

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