"Learning to Learn" in the Extended Inverted Classroom: An Evaluation of the Effects of Interactive teaching on Knowledge and Cognitive Regulation in Medical Students.

INTRODUCTION The evidence regarding the effects of the Inverted Classroom on students' metacognitive skills is limited. This study evaluates these effects on student perceptions about knowledge and cognitive regulation during a surgical course. METHODS We measured student perceptions before and after a conventional Inverted Classroom in surgery using the Metacognitive Awareness Inventory. We evaluated the mean differences between the scores of the two measurements using Student's t-test (p<0.05), and the size of the effect on knowledge and cognitive regulation using Cohen's d test (95%CI). RESULTS A total of 158 students (pre-intervention) and 155 students (post-intervention) were included in the analysis. Significant differences were found (p<0.05)in, as well as positive effects on, the students' abilities to know their own learning (declarative knowledge) (d=0.24; 95%CI, 0.02-0.47), to use learning strategies (procedural knowledge) (d=0.19; 95%CI, -0.02 to 0.41) and to understand when and why to use these strategies (conditional knowledge) (d=0.20; 95%CI, -0.01 to 0.42), in addition to the abilities to plan (d=0.31; 95%CI, 0.09-0.53) and to evaluate their learning (d=0.31; 95%CI, 0.08-0.53). CONCLUSIONS The Inverted Classroom has positive effects on metacognitive skills according to students' perceptions. Further studies are required that compare these effects with other methodologies for teaching in the classroom and the workplace.