University of Oulu

Tusa, N., Sointu, E., Kastarinen, H. et al. Medical certificate education: controlled study between lectures and flipped classroom. BMC Med Educ 18, 243 (2018).

Medical certificate education : controlled study between lectures and flipped classroom

Saved in:
Author: Tusa, Nina1; Sointu, Erkko2; Kastarinen, Helena3;
Organizations: 1Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
2School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
3Social Insurance Institution of Finland, Kuopio, Finland
4School of Applied Educational Sciences and Teacher Education, University of Eastern Finland, Joensuu, Finland
5Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
6Faculty of Education, University of Oulu, Oulu, Finland
7Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link:
Language: English
Published: Springer Nature, 2018
Publish Date: 2021-03-01


Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

see all

Series: BMC medical education
ISSN: 1472-6920
ISSN-E: 1472-6920
ISSN-L: 1472-6920
Volume: 18
Article number: 243
DOI: 10.1186/s12909-018-1351-7
Type of Publication: A1 Journal article – refereed
Field of Science: 516 Educational sciences
Copyright information: © The Author(s). 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.