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BMC Med Educ. 2018 Oct 24;18(1):243. doi: 10.1186/s12909-018-1351-7.

Medical certificate education: controlled study between lectures and flipped classroom.

Author information

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.
Social Insurance Institution of Finland, Kuopio, Finland.
School of Applied Educational Sciences and Teacher Education, University of Eastern Finland, Joensuu, Finland.
Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
Faculty of Education, University of Oulu, Oulu, Finland.
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.



Finnish permanent residents are covered by social security insurance administered by the Social Insurance Institution of Finland. The procedure of insurance is initiated with medical certificate written by the treating doctor. Thus, the doctor must have certificate writing skills accompanied with the knowledge of the content and goals for insurance. Quality certificates are important part of doctors' professional skills worldwide and most effective teaching methods for learning these should be investigated.


Medical certificate data were collected from two independent courses of fourth-year student taught in autumn 2015 (N = 141) and 2016 (N = 142) in the medical faculty of the University of Eastern Finland. A random sample of 40 students per course was drawn for the analysis. All certificates were analyzed as one sample. This was done to obtain reliable results with internal control group on the differences between two teaching methods, the traditional approach and the flipped classroom (FC) approach, in 2015 and 2016, respectively. The medical certificates were evaluated and scored with a rubric (range: - 4.00-14.25) by two independent experienced specialists.


Compared to students in the traditional classroom, students involved in the FC received significantly higher scores in all relevant sections of the assessed certificates. The mean of the total scores was 8.87 (SD = 1.70) for the traditional group and 10.97 (SD = 1.25) for the FC group. Based on the common language effect size, a randomly selected student from the FC group had an 85% probability of receiving a higher total score than a student from the traditional group.


In this study, the FC approach resulted in a statistical significant improvement in the content and technical quality of the certificates. The results suggest that the FC approach can be applied in the teaching of medical certificate writing.


Flipped classroom; Lecture-based learning; Medical certificate education; Medical education; Quantitative research methods

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