Design of the study
The present study investigated the effect of mediation in flipped writing classroom of medical university students. An experimental research design was used to compare the experimental group (a combination of mediation and flipped classroom) with the control group (traditional writing instruction).
The study favored 47 medical students who enrolled in a 3-unit compulsory writing course as a prerequisite for the fulfillment of a degree at Shiraz University of Medical Sciences in the spring semester of 2019–2020. To control instruction effects, purposive sampling was implemented to select two writing classes that were instructed by the same writing instructor from among the six offered courses. The experimental and control groups consisted of 25 and 22 male and female students respectively.
To ensure that the participants were homogenous in their writing ability, they were required to complete a writing task before instruction. Later, the writings were marked and analyzed by an independent sample t-test. Since the p-value between the two writing groups was 0.408, it was concluded that the two writing groups were homogenous.
Medical students’ writing prompts
To assess the students’ writing level before instruction and make further comparisons possible, the students were asked to write a paragraph on childhood obesity as a serious problem in many countries at the beginning of the semester. They were asked to explain the main causes of this problem, elaborate on its effects, and suggest some possible solutions. With respect to the students’ major and the fact that they had already passed the nutrition course in the previous year, it was assumed that the students possessed the necessary background knowledge to complete the task appropriately.
The other implemented instrument was the students’ writings on the midterm exam. The students in both the experimental and control groups were asked to write on the topic of health promotion and whether they felt that it needed to be built into all the policies.
The midterm exam was given after 3 months (12 weeks) from the beginning of the semester. The reason for specifying a 12-week time interval can be attributed to the fact that a 6- to 8-week intervention has generally been considered appropriate for experimental studies (Chwo, Marek, & Wu, 2018). Besides, a 12-week time interval can minimize the novelty effect.
Writing grading rubric
The Analytic Rubric (Jacobs et al., 1981) was used to score the participants’ writing samples. The scale assesses writing ability using the traits of content, organization, language use, vocabulary, and mechanics. In this rubric, the content section assesses knowledgeable, substantive, and thorough development of the thesis statement. The organization part assesses the fluency of expression, clarity in the statement of ideas, support, organization of ideas, and sequencing and development of ideas. The vocabulary part looks at the sophisticated range, effective word choice, word form mastery, and appropriate register. The language use section is concerned with the use of effective complex construction, agreement, tense, number, and word order. The mechanics section deals with spelling, punctuation, capitalization, and paragraphing. The scores which are allocated to each trait are as follows: content, 25; organization, 25; language use, 25; vocabulary, 15; and mechanics, 10. The total mark was100 points.
Writing video contents used in the flipped classroom
According to the educational rules and regulations of Iranian medical universities, 30% of the writing instructions in all majors in medical universities in Iran could be flipped, so out of 17 weeks of writing instruction comprising of 34 90-min session writing lessons, 6 sessions were flipped using pre-recorded grammar lessons recorded professionally in the Virtual University of Medical Sciences. These lessons were uploaded to Navid (http://sumsnavid.vums.ac.ir/) which is a learning management system used by all medical universities across Iran. Accessing Navid requires the student’s ID number and the self-created password. The videos were uploaded and made accessible only to the students of the experimental group. To ensure that the students in the control group could not access the files on Navid, the download option was disabled. Furthermore, since the research design of the present study required the students to watch the videos prior to attending writing class, their viewing habits were monitored through Navid, and reminders were sent to those who had not watched the videos.
Note that all of the writing videos uploaded to Navid were recorded and edited professionally at Virtual University of Medical Sciences and approved by the advisory committee there. More information regarding the software used for making videos and the snapshots of the introductory video uploaded to Navid can be seen in Appendices 1 and 2. The syllabus given to the students of the experimental group at the beginning of the semester can be seen in Appendix 3 in Table 6.
Data collection procedure
To collect the data, the participants were divided into two groups as the control in which the traditional instruction was carried out and the experimental group in which the flipped classroom was conducted. The researchers explained the objectives and benefits of the study, and then, a consent form was distributed to seek the participants’ permission and tendency to be included in the study. Before an experiment, both groups were asked to write a paragraph. Then, the researchers started the experiment which lasted for six 90-min sessions in 4 weeks. The experimental group received flipped classroom, whereas the control group received traditional instruction. After that, the students were asked to write a paragraph again on a specific topic explained in the earlier section to collect the data after the treatment (posttest).
Experimental group treatment: mediation in the flipped classroom
For this study, students were required to have already watched the assigned videos completely before attending their writing class. They were asked to watch typically 20–30-min video lectures of instructions in six 90-min sessions covering a particular topic including different types of sentences in English, parallel structure, subject-verb agreement, noun clauses, adjective clauses, and adverbial clauses.
To ensure allocating equal class time for experimental and control groups, the time students spent watching clips related to each session was deducted from their class time, and the remaining was spent to do exercises. Thus, when attending the flipped classroom sessions, students were required to do class exercises (such as editing and rewriting paragraphs) provided by their writing instructor individually or in groups. In this way, the writing contents that were usually taught by the writing instructor in the classroom were covered by students themselves at home, and the assignments that were typically done at home were covered and supervised by the writing instructor in the classroom. A thorough sample of how one or two writing sessions proceeded is discussed in the following parts.
Second week/first mediation
Using modeling as one of the major scaffolding techniques in writing, the students were required (in pairs/groups) to study certain sentences in the prompt and identify certain features (Appendix 4).
Using teacher-student and student-student conferencing strategy, the students were asked to reflect on their tasks (connecting the sentences). The writing instructor offered further on the spot explanation and guided the students, if necessary (Le & Nguyen, 2010). The assistance was gradually withdrawn as the students internalized the patterns (Lipscomb, Swanson, & West, 2010).
While the students were reading and discussing the punctuation or grammatical points, the teacher explained and discussed the errors to the students. Errors like fragments, comma splices, run-ons, and stringy sentences were also extensively discussed. This scaffolding technique is called “offering explanation” and includes explicit teaching to develop the students’ understanding of declarative knowledge, conditional knowledge, and procedural knowledge (Roehler & Cantlon as cited in Dewi, 2013).
Finally, using talk-aloud modeling, the writing instructor showed the medical students the original model of the paragraph to explicitly explain, analyze, and discuss the genre, academic vocabulary used, and grammatical patterns applied in the model (Lange, 2002).
Fourth week/second mediation
To further explore and practice the video contents, the students were asked to read a paragraph about aspirin and not only use the strategies that they had been taught previously to make the paragraph more coherent, but also expand the paragraph by adding more information to and punctuate it appropriately. This scaffolding technique which is called “Joint Construction” is the strategy in which the writing instructor helps the students to construct a similar text within the given text. To give the students a better understanding of aspirin, a video was shown to them twice (https://www.uspharmacist.com/article/lowdose-aspirin), and they were asked to write down whatever information they thought might help them write a paragraph on aspirin using different types of sentences. Using this scaffolding technique, which is called “Contextualization,” the writing instructor provided sensory context by using pictures, manipulatives, film, or authentic objects to enhance the students’ understanding and made the concepts more relatable. The “schema-building strategy” was also used to discuss and brainstorm the topic in pairs or groups. This strategy can lead to the activation of the students’ schemata (Sun, 2014).
Control group: traditional writing instruction
The students in the control group received conventional instruction consisting of teaching all the contents covered by the experimental group (the structure of the paragraph, process paragraph, compare and contrast paragraph). However, the grammatical lessons including sentence types, parallel structure, subject-verb agreement, adjective clauses, noun clauses, and adverbial clauses were fully covered in the classroom through six 90-min sessions, and the assignments were assigned as homework as the instructor was involved in teaching the materials in the classroom and there was limited time for doing assignments as classwork. In the following sessions, the writing instructor provided the answers to the students in the classroom and ensured they did not have any problems accordingly.
Since the students’ pretests and posttests were analyzed and marked by two human raters (university lecturers), the inter-rater reliability was calculated (Neuendorf, 2002). Before marking the papers, the researchers discussed the writing rubric with the two raters comprehensively. To ensure the homogeneity of the scoring procedures, the raters were asked to mark two paragraphs using the rating rubric. Then, 47 assignments of the pretest and 47 assignments of the posttest were given to the raters, and a month deadline was determined for the writing rubric to be checked for each paper.
To assess the inter-rater reliability, Pearson product-moment correlation was calculated based on the average ratings on scores for the six individual components of each writing task. To this end, inter-rater reliability of the scores given by the two raters was examined. The reliability for total score was .678. The reliability for the components of content, organization, word choice, sentence structure, grammar, and mechanics was .681, .647, .743, .618, and .698 respectively. This is indicative of a high consistency between the two raters with respect to rating the participants’ knowledge of writing and its components. Moreover, the correlation coefficients were all significant indicating that both raters were significantly consistent in scoring the participants’ writing tasks.
The data analysis was conducted in two phases. In the initial phase, the data were checked for the normal distribution assumption using a one-sample Kolmogorov-Smirnov test. According to the results of this test, the distribution of the scores was not normal, so non-parametric test including the Wilcoxon and Mann-Whitney test were used. In the next phase, descriptive statistics and the Wilcoxon signed-rank test were run to see whether mediation had any significant effect on different aspects of medical students’ writing in flipped classroom. Mann-Whitney test was also used to identify any significant difference between the writing performance of medical students in flipped and traditional classrooms. ANOVAs were also run to determine which writing component(s) (content, organization, vocabulary, language use, and sentence mechanics) were/was more affected by mediation in the flipped writing classroom. Caution was exercised to control the effect of pretests or computer difference between posttest and pretest mean scores (by Mann-Whitney test).