Teaching Psychomotor Skills at a Distance: A Randomized, Mixed-Methods Comparison of Flipped and Team-Based Learning in Physiotherapy Education

The COVID-19 pandemic posed challenges in implementing the team-based (TB) learning model for psychomotor skill-dependent manual therapy courses, necessitating alternative approaches such as the flipped classroom (FC) model. This study aims to measure senior physiotherapy students' theoretical knowledge, clinical practice skills (CPS), and motivation toward instructional materials while learning with TB and FC models. Participants were divided into the TB group (n=34) and the FC group (n=32). Theoretical knowledge was assessed through pre-, post-, retention tests; CPS through first and retention practical exams; student motivation through Instructional Materials Motivation Survey; and qualitative data through semi-structured interviews. There was no significant difference in post-test knowledge (PostK) and retention knowledge (RetK) between the groups following the experimental intervention. However, both groups showed a significant increase in PostK compared to pre-test knowledge (PreK). The FC group scored significantly higher than the TB group in some sub-dimensions of the first practical skills exam (FPex). No significant changes were observed in retention practical skills exams (RPex) in both groups compared to FPex. In conclusion, the FC model is as effective as the TB model in facilitating theoretical knowledge acquisition and provides greater benefits in CPS development. Students reported advantages of the FC model, such as the ability to rewatch instructional videos and increased flexibility in time and space. Motivation toward instructional materials was higher in the FC group. Considering both theoretical and practical skill acquisition, as well as qualitative advantages, physiotherapy educators may prefer the FC model for psychomotor skill-based courses.新冠疫情（COVID-19 pandemic）给依赖精神运动技能的手法治疗课程中实施基于团队（TB）学习模式带来了挑战，亟需翻转课堂（FC）模式等替代教学方案。本研究旨在评估高年级物理治疗专业学生在采用TB与FC模式学习时的理论知识、临床实践技能（CPS）以及对教学材料的动机水平。研究参与者被分为TB组（n=34）与FC组（n=32）。其中，理论知识通过前测、后测、保持测试进行测评；临床实践技能通过首次实践考试与保持性实践考试进行测评；学生动机采用教学材料动机量表进行评估；质性数据则通过半结构化访谈收集。实验干预后，两组的后测知识（PostK）与保持性知识（RetK）无显著差异；但相较于前测知识（PreK），两组的后测知识均出现显著提升。FC组在首次实践技能考试（FPex）的部分子维度得分显著高于TB组，而两组的保持性实践技能考试（RPex）得分相较于首次实践考试均未出现显著变化。综上，FC模式在促进理论知识习得方面与TB模式效果相当，且在临床实践技能培养上更具优势。学生反馈了FC模式的多项优势，例如可反复观看教学视频，以及在时间与空间上具备更高灵活性；FC组对教学材料的动机水平更高。综合考量理论与实践技能的习得效果以及质性优势，物理治疗教育者可优先选择FC模式开展依赖精神运动技能的课程。