Woman sitting at computer on a Zoom meeting
HealthSeptember 02, 2020

Active study methods with students in a virtual setting

By: Lindy Mitchell, MSN, RN
Covid-19 threw the world into unfamiliar territory and demonstrated to the world the importance of quality healthcare. This was my experience; March 10th, 2020 in the classroom with nursing students all day using a lesson plan that involved case studies and role-play.

March 11th, 2020 faculty meetings and discussion of a new curriculum that the organization would be using. March 12th, 2020, I opened my email to see an announcement that as of Monday, classes would be virtual and the link I would be using needed to be sent to students that day. Cue the self-doubt and where I began to question my knowledge skills as well as my ability to function in this new environment. But like any nurse educator, I looked at the research and began to make my plan of care for the classroom.

Where do we go from here?

The nursing profession is certainly not afraid of change; we encounter it daily. As nurse educators, we get comfortable in our classrooms, but at our roots, we are still nurses and are not afraid of change or thinking outside the box. This pandemic demonstrated where we have gaps in our delivery of education for healthcare and I encountered this when I began to create my lesson plans. We have many resources right at our fingertips that we can use in the virtual classroom.

The literature has demonstrated the flipped classroom deepens learning. This forced transition to a virtual setting made this method of teaching seem daunting and caused me to question how I could make it possible. There is good news during the last five months though, I have discovered that the flipped classroom is still possible in a time of virtual education. Faculty just must keep thinking outside the box. Students and educators found the transition to virtual learning challenging. Both students and educators lost collaboration and became isolated. Many established nurses chose to pursue advanced degrees in an online setting. This works well because the nurse already has expertise in critical thinking, skills, and client interactions. The traditional BSN student however still needs to develop these skills. As an educator that is comfortable in the classroom but also a millennial myself, I took this challenge and wanted to ensure that I used the available resources to help my students to achieve success.

The problems

When we made the switch to the virtual setting, or as we lovingly call it Remote Synchronous Education, I saw one set of problems while the students saw others. One of the most verbalized complaints that my students have conveyed to me is the lack of access to the traditional study groups. They felt that they were losing the communities they had built themselves for success.

As an educator, a frustration of mine was the challenge of how to flip my classroom without losing the student’s attention. I wanted to have a meaningful experience without compromising the rigor of the course. At the start of each class period, I make a habit of having five minutes for “housekeeping”. This is where the students are given the opportunity to ask questions about prior material or assignments and I give updates. At the start of the pandemic, the traditional BSN students I worked with expressed concerns. Many of these concerns related directly to the loss of face-to-face contact creating isolation with both themselves and their families. This isolation created barriers to learning. I decided to change some of my delivery and after a few weeks of teaching online, I sent out an anonymous online survey asking them how they felt about the delivery of the content and what they liked and disliked. In this, I opened myself up knowing that the criticism could be harsh. What I found though was that the students recognized that there was an attempt on my part to do better. They gave very kind suggestions and gave honest feedback. I am going to share my tips and tricks here. I hope these suggestions help you in continuing to deliver an interactive experience in the virtual classroom world.


With so many options for an online platform, my organization did not mandate one over another. The faculty at my institution were able to pick our choice and after sampling many, we chose Zoom for our synchronous sessions. We found that the features were very user-friendly and many of the families were using this for their children’s education, so it eliminated some of the learning curves. The use of the breakout room is great for allowing them to work on case studies and other activities that I would have done in a small group setting in a traditional classroom.

Then came the challenge of the remediation sessions I like to hold between exams to fill in gaps that I identify with the exams and clarify confusing concepts before the next exam. The solution was right in front of me, the continued use of Zoom which has a free. 40-minute feature that the students could use on the Zoom accounts they have set up for their courses. Using the short study sessions and a web link, the students are now able to have study groups.

Time management

I am a huge advocate of the Pomodoro Technique. This is a time management technique that can be used in a variety of settings. I even use it in my own work life. The Pomodoro Technique builds breaks and maximizes the productivity of the user. I had students set a timer for 25 minutes so they would study and work as a group diligently. When the time is up, they are done or they can spend the break time socializing. I encourage this technique in independent study, in the classroom during flipped activities and peer study groups. By using this technique, the students are motivated to achieve more while they are working. The students can work very quickly which minimizes the interruptions that are common when studying at home.

Flipping the classroom

The use of QSEN learning strategies has been something that I have incorporated in the classroom and many of these translate well to the online environment. Breaking the students up into breakout rooms has been a game-changer when it comes to small group work and allows me the ability to still flip my class. There are a variety of strategies that can be used in these breakout rooms and many translate well with little modification. QSEN has a great navigation feature where you can look up strategies for each specialty area.

The fun stuff

I encourage the following in my classroom: charades, video case studies, reverse case studies and QSEN learning strategies such as Draw Your Day Room. With each of these, I want to challenge the students. I ask them to have their books and notes out and I encourage the use of their clinical documents such as the care plan for the course. I tell them to go as far as they can without using their book and then to look up whatever did not come to them and concept map it after their timed break. The students will take their syllabi and determine the disorders to be studied and use their assigned care plan to document during all of their study sessions. Here are some examples of my favorite activities in more detail:


Most of us have played charades for fun, but it is a great group study tool especially in skills labs. Charades is an effective supplement strategy for medical/surgical, mental health, and community health courses.

  • Groups of two to five students
  • Students will pick a disorder in the syllabus
  • Students take turns being the nurse and client
  • The nurse will use the clinical care plan to guide and document
  • The students will time themselves five to 10 minutes of acting
  • The care plan will allow them to document their findings and determine the client’s diagnosis

Video case studies

YouTube has many short videos that students can use as video case studies. I post links to approved videos in the LMS for our institution and can ensure that the content is adequate and meets the standards without bias, unnecessary or inaccurate information that they may find when they look on their own.

  • Groups of three to four students are ideal
  • Watch the video on screen share
  • The students will then fill out their care plan in a document such as a Google Doc where they can track the changes and edits
  • Have them send the document to the instructor for feedback
  • Encourage them to actively discuss at a future session by posing hypothetical questions to them

Reverse case studies

In a reverse case study, the students will use a Google Doc that they can edit in real-time. This document takes the place of the beloved whiteboard that students use in their study rooms and library time. This is a fun puzzle for them to fill out and helps them to look at the picture in another way.

  • The instructor creates a document with chief complaints and medications
  • The students then work in groups to determine
    • Assessment findings
    • Past medical history
    • Interventions
    • Evaluations

Nursing students feel isolated and are despondent when exam scores are not translating to the time that they have studied the material. Interacting with their classmates helps to fill the void and build the community that nursing students’ value and use for their overall success. Nurse educators can create meaningful interactions with students during this challenging time. By using active study techniques in this virtual setting, we can set them up for success and demonstrate to them that while there is a screen between us, we are still together.

Lindy Mitchell, MSN, RN
Expert Insights Contributor for Wolters Kluwer, Nursing Education
Lippincott® Nursing Education
Preparing today’s students to become tomorrow’s nurses
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