The flipped-classroom approach to teaching horizontal strabismus in ophthalmology residency: a pilot study

Abstract

Purpose: To compare the flipped classroom (home pre-taped lectures followed by in-class group exercise) to the traditional classroom (home reading assignment followed by in-class lecture) for horizontal strabismus didactics in ophthalmology residency.

Methods: All PGY2-4 residents from four U.S. ophthalmology residencies without prior residency flipped-classroom experience were invited to esotropia and exotropia sessions sequentially, with random order and assignment to flipped and traditional classrooms. Content test scores before and after the two classrooms were compared. Surveys were administered to assess participant experience.

Results: A total of 40 residents attended each session. Likert scale evaluation of preparatory material and classroom activity did not differ between sessions; however, divided by year of training, 70% of senior residents (PGY3-4) and 39% of first-year (PGY2) residents preferred the flipped classroom over the traditional classroom. Pre- and post-test scores for the flipped classroom exceeded those of the traditional classroom for the exotropia course (P = 0.01 and P = 0.001, resp.) but not for the esotropia course. There was significant improvement between pre- and post-tests for both styles of learning.

Conclusions: The flipped classroom had a favorable effect on test scores for only one of the two strabismus subjects but was preferred over the traditional classroom among PGY3-4 residents.

Copyright © 2019 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

Figures

FIG 1.

Schematic showing the randomization of each participating institution to topic (esotropia and exotropia) as well as classroom style (flipped classroom and traditional lecture). The order of classes is also shown, with the top panel representing the first class and the bottom panel representing the second class. DMEI, Dean McGee Eye Institute at University of Oklahoma; Duke, Duke University; ET, esotropia; UCD, University of California at Davis; UW, University of Washington, Seattle. XT, exotropia.

FIG 2.

Graph shows mean score out of 5 Ophthalmic Knowledge Assessment Program (OKAP)-style content test questions given immediately before (pretest) and after (post-test) the classroom to ophthalmology residents at 4 institutions. Error bars show the standard deviation. Results compare the flipped classroom to the traditional classroom for all classes, the exotropia class and the esotropia class. Both class styles demonstrated a significant improvement in test scores between pretest and post-test (P = 0.04 and P < 0.001, resp.). The post-test scores favored the flipped classroom style for exotropia (P= 0.001) but favored the traditional classroom for esotropia (P = 0.009).