Flipped classroom intervention studies have reported mixed findings on student satisfaction. These results may be related to differences in strategies that various instructors use in synchronous classroom activities. Activities such as case studies may provide students with an opportunity to critically analyze real-world scenarios based on foundational knowledge. The purpose of this study was to gather undergraduate student perceptions of case studies in a highly-structured flipped classroom. A single course instructor led weekly interactive lecture review sessions in an online, synchronous learning environment. A teaching assistant presented pre-assigned case studies in tutorials prior to invigilating a multiple-choice quiz. In an anonymized, two-part survey, students first rated their experience with whether case studies had been beneficial to their learning on a 7-point Likert scale (strongly disagree, disagree, slightly disagree, neutral, slightly agree, agree, strongly agree). Five major items were rated by students, including the benefit of having: access to case studies available prior to tutorials, case presentations led by a teaching assistant, case authenticity, content relevance, and opportunities for knowledge application. Students also responded to two open-ended survey questions: "Describe which case study activities, if any, have been most helpful/beneficial to your learning during the tutorial" and "Describe what possible changes could be made to the case studies, if any, to improve your learning during the tutorials". Respondents (n=135 students in total) included 68% of undergraduate students enrolled in a first-year human anatomy and physiology course (n=67 participants / 99 enrolled in the course) and 81% of students enrolled in a second year altered physiology course (n=68 participants/84 enrolled in the course). Aggregated data (e.g., grouped by positive, neutral, and negative affect) from survey responses were analyzed. In part one of the survey, nearly three quarters of participants had a positive perception of accessing case studies prior to tutorials. Approximately 85-90% of participants had a positive perception of the case studies that were presented by the teaching staff, case authenticity, content relevance, and opportunities for knowledge application. In comparison to first year students, second year students had more positive perceptions of the benefits of case study presentations led by a teaching assistant (p=0.02, Cohen’s d: 0.41), case authenticity (p=0.02, Cohen’s d: 0.40), content relevance (p=0.003, Cohen’s d: 0.52), and opportunities for knowledge application (p=0.003, Cohen’s d: 0.52). In the second part of the survey, relevant survey respondents (n=94) identified content relevance (n=20), assessment (n=12), access to a more knowledgeable other (n=11) and case authenticity (n=9) as perceived benefits of case studies. A small number of respondents suggested that less information be provided (n=4) or additional interactive activities (n=4) with the case studies. In summary, case-based learning in the flipped classroom may promote high satisfaction among undergraduate students.

Keywords: Case studies, case-based learning, flipped classroom, instructional design.