Results of a Flipped Classroom Teaching Approach in Anesthesiology Residents

Abstract

Background: In a flipped classroom approach, learners view educational content prior to class and engage in active learning during didactic sessions.

Objective: We hypothesized that a flipped classroom improves knowledge acquisition and retention for residents compared to traditional lecture, and that residents prefer this approach.

Methods: We completed 2 iterations of a study in 2014 and 2015. Institutions were assigned to either flipped classroom or traditional lecture for 4 weekly sessions. The flipped classroom consisted of reviewing a 15-minute video, followed by 45-minute in-class interactive sessions with audience response questions, think-pair-share questions, and case discussions. The traditional lecture approach consisted of a 55-minute lecture given by faculty with 5 minutes for questions. Residents completed 3 knowledge tests (pretest, posttest, and 4-month retention) and surveys of their perceptions of the didactic sessions. A linear mixed model was used to compare the effect of both formats on knowledge acquisition and retention.

Results: Of 182 eligible postgraduate year 2 anesthesiology residents, 155 (85%) participated in the entire intervention, and 142 (78%) completed all tests. The flipped classroom approach improved knowledge retention after 4 months (adjusted mean = 6%; P = .014; d = 0.56), and residents preferred the flipped classroom (pre = 46%; post = 82%; P < .001).

Conclusions: The flipped classroom approach to didactic education resulted in a small improvement in knowledge retention and was preferred by anesthesiology residents.

Conflict of interest statement

Conflict of interest: The authors declare they have no competing interests.

Figures

Figure 1

Research Design and Analysis Abbreviations: FC, flipped classroom group; TL, traditional lecture group. Note: The pretest was administered the week preceding the start of the educational block. Each educational session was followed up with a survey to determine how the residents prepared for the session. The posttest was administered at the conclusion of the educational block. Following the last educational session, residents completed attitudinal surveys. The retention test was administered 4 months after the conclusion of the educational sessions. Institutions were deidentified in figure 1 to protect the confidentiality of the participants.

Figure 2

Adjusted Means (Least Squares Means) of the Percentage Correct on the Knowledge Test Over Time Abbreviations: FC, flipped classroom group; TL, traditional lecture group. Note: Pretest, posttest, and retention stand for adjusted means (least squares mean) of the percentage correct on the pretest, posttest, and 4-month follow-up retention test, respectively. Adjusted mean is the mean of the percentage correct on the test after adjusting for difference in pretest and covariates. Therefore, the adjusted means of pretest percentage correct are different from the means of pretest percentage correct summarized in the Table. Error bars shown are standard error of the adjusted mean obtained from the mixed effect model; effect size d = effect size Cohen's d; 95% CI = 95% confidence interval of d.