Redesigning a Cardiovascular Unit in a Large Lecture Course
NUR 320 enrolls 96 second-semester students in one lecture hall, 75 minutes twice weekly, taught by two faculty. The end-of-course exam is 100 NCLEX-style items. Last year 31 percent of students failed the cardiovascular unit exam. Students report watching recorded lectures at double speed and doing readings only before quizzes; optional weekly review draws 18 students. Two students have approved testing accommodations requiring extended time in a reduced-distraction room. Faculty disagree: one wants to add more cardiac rhythm lecture content, the other wants a flipped format but has never run one and worries about content coverage. The unit starts in 3 weeks. You have one 90-minute faculty development slot and no budget for new software.
1. Using only the evidence in the setup, diagnose the core learning problem and propose two design changes that fit the constraints. For each change, name the learning principle it relies on and the specific evidence from the setup that supports it.
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Diagnosis. The problem is not insufficient lecture content. The evidence points to passive consumption (recorded lectures at double speed), massed reading before quizzes, low voluntary engagement (18 of 96 at review), and a mismatch between the exam format (NCLEX-style application) and the instructional format (lecture). A 31 percent unit failure rate is a design signal, not only a student motivation signal. Adding cardiac rhythm lecture content would increase coverage without increasing retrieval or application.
Change 1: Pre-class retrieval plus in-class application. Replace one weekly lecture block with short pre-class videos totaling 15 to 18 minutes and a 5-item low-stakes quiz due before class. Use class time for cardiac rhythm cases in pairs with immediate feedback. Principle: the testing effect and spaced retrieval. Supported by: students already watch recordings, so the delivery channel is familiar; the quiz creates a reason to read before class rather than only before quizzes.
Change 2: Weekly formative check with misconception review. Add a 5-item low-stakes quiz at the start of each week and a 10-minute review of the two most-missed concepts. Principle: formative assessment and metacognitive calibration. Supported by: the 31 percent failure rate and the pattern of reading only before quizzes suggest students cannot judge what they do not know.
Constraints. Caption all videos; the two accommodated students receive extended time on quizzes and the reduced-distraction room for any graded in-class assessment. No new software: use printed case cards and show-me response cards. Use the 90-minute faculty development slot to co-teach one segment with the skeptical colleague, and pilot only the cardiovascular unit so content coverage risk is bounded.
2. Design the first 75-minute flipped session for all 96 students in the lecture hall. Show how you will keep students accountable, protect content coverage for the skeptical colleague, and know by the end of class whether the session worked.
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Before class (48 hours ahead). Three captioned videos of 5 to 6 minutes each covering normal conduction, basic rhythm identification, and the three rhythms most likely to appear on the unit exam. Each video ends with two embedded questions. Completion is worth 2 points and is due 24 hours before class so I can review the item report.
In class (75 minutes).
- 0 to 8 minutes: mini-lecture on the two concepts with the lowest pre-class accuracy. This directly answers the coverage concern because the content is chosen by student data, not faculty preference.
- 8 to 33 minutes: paired case work with six printed rhythm strips. Each pair answers three questions per strip and records a confidence rating.
- 33 to 48 minutes: response-card polling with peer instruction. Students answer individually, then discuss with a neighbor, then re-answer. This surfaces the misconception in real time without new software.
- 48 to 63 minutes: whole-class debrief of the two most-missed strips, with a one-page summary sheet.
- 63 to 75 minutes: individual exit ticket, two NCLEX-style items plus a confidence rating and a muddiest point.
Accountability. Pre-class quiz completion, collected case worksheets, response-card participation, and the exit ticket. None is high stakes individually; together they create weekly retrieval.
Coverage. A content map shown to the colleague lists every unit objective and where it is taught (video, reading, or class). Nothing is removed from the curriculum; factual transmission moves to video so class time can do application.
Evidence of success. Exit ticket accuracy of 70 percent or higher, a pre to post confidence shift, and a comparison of unit exam item performance on the three target rhythms against last year. If exit tickets show the same misconceptions, the next session targets them. If the colleague remains concerned, we review the content map together before the unit exam.