Comparison of Flipped vs Traditional Classroom Teaching for Primary Surgical Skills in Postgraduate Surgical Trainees

Comparison Of Flipped Classroom Versus Traditional Class Room Teaching Methodology For Primary Surgical Skills In Postgraduate Trainees Of Surgery And Allied

The aim of this study is to evaluate the effectiveness of the flipped classroom approach in improving the surgical skills of MS Surgery and allied specialty trainees compared with the traditional classroom method. Traditional classroom teaching relies on face-to-face lectures, demonstrations, textbooks, and classroom discussions. Although it facilitates direct interaction between faculty and trainees, recent advances in educational technology have emphasized the need for learner-centered approaches that promote active learning, critical thinking, and practical skill development.

The flipped classroom is an instructional model in which trainees study theoretical content before class using videos, reading materials, and other online resources. Classroom time is then used for interactive discussions, case-based learning, simulation, hands-on practice, and instructor feedback. This approach encourages self-directed learning while allowing faculty to focus on reinforcing concepts and developing clinical and technical skills.

Although the flipped classroom has shown promising results in undergraduate medical education, evidence regarding its effectiveness in postgraduate surgical training remains limited, particularly in low- and middle-income countries. Surgical education requires the integration of theoretical knowledge, technical competence, clinical decision-making, and teamwork. Evaluating innovative teaching strategies in this context may improve training quality and optimize available educational resources.

This randomized controlled trial will include 92 MS Surgery and allied specialty trainees from Services Hospital and Jinnah Hospital, Lahore. Participants will be randomly allocated to either the traditional classroom or flipped classroom group. Both groups will receive instruction on identical surgical topics and practical skills from the same faculty using standardized learning objectives. Outcomes will be assessed through a standardized 10-station Objective Structured Clinical Examination (OSCE).

Data will be analyzed using SPSS version 23. Descriptive statistics will summarize participant characteristics, while paired and independent t-tests will compare performance within and between groups. Statistical significance will be set at p ≤ 0.05 with a 95% confidence interval.

The findings will provide evidence on the effectiveness of the flipped classroom in postgraduate surgical education and may support its incorporation into surgical training curricula to enhance trainee competence and clinical preparedness.

Study Overview

• Status: Enrolling by invitation
• Conditions: Traditional Classroom-Based Learning; Surgical Skill Training; FLIPPED CLASSROOM METHODS
• Intervention / Treatment: Other: flipped classroom; Other: traditional method of teaching,

Detailed Description

Introduction

Traditional classroom teaching is the conventional educational approach in which instructors deliver knowledge through face-to-face lectures, demonstrations, textbooks, and classroom discussions. It provides direct interaction, immediate clarification of concepts, and structured learning; however, advances in educational technology have highlighted the need for learner-centered teaching strategies that promote active participation, critical thinking, and practical skill development.

The flipped classroom is an innovative instructional model in which learners study theoretical material before class using videos, presentations, and reading resources. Classroom time is then devoted to interactive discussions, case-based learning, problem-solving, simulation, and supervised hands-on practice. This approach promotes self-directed learning, encourages active participation, and enables instructors to focus on reinforcing concepts and practical skills.

Over the past decade, flipped learning has gained popularity in medical education and has been associated with improved engagement, motivation, knowledge retention, and learner satisfaction. However, most evidence is derived from undergraduate medical education, while studies involving postgraduate surgical trainees remain limited, particularly in low- and middle-income countries. Surgical training requires the integration of theoretical knowledge, technical competence, clinical decision-making, and teamwork. Evaluating innovative teaching methods may therefore improve trainee performance and optimize educational resources.

Literature Review

Traditional classroom teaching primarily emphasizes instructor-led lectures, whereas the flipped classroom shifts theoretical learning outside the classroom and reserves classroom time for active learning. This approach promotes collaborative learning, critical thinking, and practical application of knowledge.

Several studies have demonstrated the educational benefits of flipped learning, including improved learner engagement, deeper understanding, enhanced problem-solving skills, better academic performance, higher motivation, and improved long-term knowledge retention. Pakistani studies have also reported high student satisfaction, greater classroom participation, and improved understanding of medical concepts. Faculty members have similarly perceived flipped learning as an effective strategy that enhances learner engagement and classroom interaction. Successful implementation depends on faculty development, well-designed pre-class learning resources, and institutional support. Despite these encouraging findings, evidence regarding postgraduate surgical education remains scarce, justifying the present study.

Hypothesis

Flipped classroom methodology is more effective than traditional classroom methodology for teaching primary surgical skills to MS Surgery and allied specialty trainees.

Objective

To compare the effectiveness of flipped classroom and traditional classroom teaching in improving the performance of postgraduate surgical trainees in primary surgical skills.

Operational Definitions

Effectiveness: Improvement in OSCE scores following teaching.

Flipped Classroom: A teaching model in which theoretical learning occurs before class and classroom sessions focus on discussion, problem-solving, and practical application.

Traditional Classroom: Teacher-centered instruction delivered through face-to-face lectures, demonstrations, and classroom discussions.

Primary Surgical Skills: Fundamental surgical competencies including aseptic technique, instrument handling, tissue handling, knot tying, suturing, and wound management.

Subjects and Methods

Study Design: Parallel-group randomized controlled trial (CONSORT 2010).

Setting: Services Hospital Lahore and Jinnah Hospital Lahore.

Duration: Four months.

Sample Size: Ninety-two first-year MS Surgery and allied specialty trainees (46 per group), calculated using the WHO sample size calculator with 90% power, 5% significance level, and adjusted for anticipated dropouts.

Sampling Technique: Simple random sampling.

Inclusion Criteria First-year MS Surgery and allied trainees. No previous structured training in primary surgical skills. Written informed consent. Availability for the complete intervention and assessment. Exclusion Criteria Beyond first-year residency. Previous formal surgical skills training. Participation in other educational interventions. Inability or unwillingness to complete the study. Missing more than 20% of teaching sessions. Methodology

Ethical approval will be obtained from the Institutional Review Boards of both participating hospitals. Written informed consent will be obtained before enrolment.

Ninety-two eligible trainees will be randomly allocated into flipped classroom (n = 46) and traditional classroom (n = 46) groups using sealed opaque envelopes prepared separately for each institution to ensure allocation concealment.

The intervention will last eight weeks with one two-hour session weekly. Both groups will receive identical learning objectives, topics, faculty, and lesson plans.

The traditional classroom group will attend lectures, demonstrations, and supervised practical sessions. The flipped classroom group will receive videos, presentations, and reading material three to five days before each session. Classroom time will be dedicated to case discussions, problem-solving, hands-on practice, and instructor feedback.

At the end of the intervention, all trainees will undergo a standardized 10-station Objective Structured Clinical Examination (OSCE) using identical stations, examiners, and assessment criteria. Participants will also complete a confidence questionnaire, while faculty will independently assess procedural competence using standardized evaluation forms.

Statistical Analysis

Data will be entered into SPSS version 27.

Categorical variables will be presented as frequencies and percentages, while continuous variables will be summarized as mean ± standard deviation. Normality will be assessed using the Shapiro-Wilk test. Independent t-test or Mann-Whitney U test will compare OSCE scores between groups according to data distribution. Chi-square or Fisher's exact test will analyze categorical variables. Internal consistency of the assessment tool will be evaluated using Cronbach's alpha, and post-examination item analysis will assess OSCE quality. Statistical significance will be considered at p ≤ 0.05 with a 95% confidence interval.

Outcome and Utilization

This study will determine whether flipped classroom teaching improves the acquisition of primary surgical skills compared with traditional classroom instruction among postgraduate surgical trainees. Outcomes will include objective assessment of technical competence through OSCE, learner confidence, and faculty evaluation. The findings will provide evidence to guide curriculum development in postgraduate surgical education and may support wider integration of flipped learning into residency training programs. If effective, this learner-centered approach could improve trainee competence, engagement, clinical readiness, and efficient utilization of faculty time and educational resources while providing a foundation for future multicenter research.

• Study Type: Interventional
• Enrollment (Estimated): 92
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Services hospital lahore
    • Lahore, Punjab Province, Pakistan, 54000
      • Jinnah Hospital Lahore

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria: • All 1st-year MS trainees in surgery and allied at Services Hospital Lahore and Jinnah Hospital Lahore.

• Trainees who have not previously participated in any formal workshop or structured training program focused on primary surgical skills.
• Trainees who provide written informed consent to participate in the study.
• Trainees who are available and committed to complete the full 8-week intervention and follow-up OSCE assessment.
• Trainees with no physical or cognitive impairments that would limit their ability to perform surgical skills or participate fully in the training sessions.

Exclusion Criteria:

• Trainees who have completed more than one year of MS surgical training or are beyond the 1st year level.
• Trainees who have previously attended any workshop, course, or formal training specifically targeting primary surgical skills.
• Trainees currently involved in other interventional studies or educational programs that may confound the outcomes of this study.
• Trainees unwilling or unable to provide informed consent or commit to the full duration of the study.
• Trainees with any medical condition or disability that could compromise their ability to safely perform surgical tasks or participate in the OSCE evaluation.
• Trainees who miss more than 20% of scheduled training sessions during the 8-week period.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: cases; taught via flipped method: All 1st-year MS trainees in surgery and allied at Services Hospital Lahore and Jinnah Hospital Lahore.; Trainees who have not previously participated in any formal workshop or structured training program focused on primary surgical skills.; Trainees who provide written informed consent to participate in the study.; Trainees who are available and committed to complete the full 8-week intervention and follow-up OSCE assessment.; Trainees with no physical or cognitive impairments that would limit their ability to perform surgical skills or participate fully in the training sessions.	Other: flipped classroom; Participants will be randomly assigned to either the flipped classroom (FC) group or the traditional classroom (TC) group, with 46 trainees in each group. Randomization will be carried out using the lottery method with sealed, opaque envelopes prepared separately for each institution. Each participant will select one envelope in the presence of two independent witnesses to ensure transparency and maintain allocation concealment. The group assignment will be recorded immediately after the envelope is opened.
Active Comparator: controls; taught via traditional method: • All 1st-year MS trainees in surgery and allied at Services Hospital Lahore and Jinnah Hospital Lahore.; Trainees who have not previously participated in any formal workshop or structured training program focused on primary surgical skills.; Trainees who provide written informed consent to participate in the study.; Trainees who are available and committed to complete the full 8-week intervention and follow-up OSCE assessment.; Trainees with no physical or cognitive impairments that would limit their ability to perform surgical skills or participate fully in the training sessions.	Other: traditional method of teaching,; Trainees in the traditional classroom group will attend conventional face-to-face lectures followed by demonstrations and supervised practical sessions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
OSCE	The effectiveness of the teaching methodologies will be assessed using both practical and theoretical outcome measures. Practical surgical skills will be objectively evaluated through a standardized 10-station Objective Structured Clinical Examination (OSCE) using validated checklists. Theoretical knowledge will be assessed using a standardized written examination comprising multiple-choice questions and concept-inventory style questions designed to evaluate conceptual understanding, clinical reasoning, and application of knowledge. Together, these assessments will provide a comprehensive evaluation of participants' competence in primary surgical skills.	6 MONTHS

Collaborators and Investigators

• Sponsor: University of Health Sciences Lahore
• Investigators: Study Director: Amina Ahmed, MHPE, CMH Lahore Medical College and IOD

Study record dates

Study Major Dates

• Study Start (Actual): December 5, 2025
• Primary Completion (Actual): July 5, 2026
• Study Completion (Estimated): December 5, 2026

Study Registration Dates

• First Submitted: July 10, 2026
• First Submitted That Met QC Criteria: July 22, 2026
• First Posted (Actual): July 27, 2026

Study Record Updates

• Last Update Posted (Actual): July 27, 2026
• Last Update Submitted That Met QC Criteria: July 22, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: traditional; flipped; primary surgical skills
• Other Study ID Numbers: UHS/DPS-25/450

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No