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ABSTRACT
Context
Bedside clinical teaching is the backbone of clerkship education. Data-driven methods for supplementing bedside encounters with standardized content from vetted resources are needed.
Objective
To compare a flipped-classroom versus an interactive online-only instruction for improving knowledge, skills, self-directed learning (SDL) behaviors, and satisfaction in a medical school clerkship.
Methods
An IRB-approved prospective study employing a peer-reviewed clinical reasoning curriculum in neurology was conducted; 2nd-4th year medical students rotating through a required clerkship were enrolled. Students were randomized to flipped-classroom (i.e., flipped) or interactive asynchronous online instruction (i.e., online-only), which supplemented existing bedside teaching. Baseline and end-of-course knowledge, skill development, SDL behaviors, satisfaction, and long-term retention were assessed by peer-reviewed clinical reasoning exam, NBME scores, faculty/resident clinical evaluations, non-compulsory assignment completion, end-of-clerkship surveys, and objective structured clinical exam (OSCE).
Results
104 students (49 flipped, 55 online-only) were enrolled. Age, gender, and training level did not differ by group (all p > 0.43); baseline knowledge was higher in the flipped group (p = 0.003). Knowledge-based exam scores did not differ by group even after adjusting for differences in baseline knowledge (2.3-points higher in flipped group, 95%CI −0.4–4.8, p = 0.07). Clinical skills were significantly higher in the flipped group, including examination skills (4.2 ± 0.5 vs. 3.9 ± 0.7, p = 0.03) and future housestaff potential (4.8 ± 0.3 vs 4.5 ± 0.6, p = 0.03). Students in the online-only group were more likely to engage in SDL (42 vs. 12%, p = 0.001) and reported more hours studying (6.1 vs. 3.8 hours, p = 0.03). Satisfaction (p = 0.51) and OSCE scores (p = 0.28) were not different by group.
Conclusions
In this comparative study of two evidence-based curricular delivery approaches, we observed no difference in knowledge acquired. Greater clinical skills were observed with flipped instruction, while more SDL was observed with online-only instruction. Supplementing bedside teaching with blended instruction that balances live skill development with vetted online resources is optimal for clerkship education.
Acknowledgments
The authors would like to thank Neurology Continuum® for providing the peer-reviewed multiple-choice examination questions. The authors would also like to thank the Johns Hopkins School of Education Center for Technology in Education for supporting the development, maintenance, and hosting of the web-based platform (the Electronic Learning Community, JHU Office of Technology Transfer, Reference number Nunn1605, February 2002) utilized in this study.
Disclosure Statement
Dr. Paul has no conflicts to disclose. Dr. Leung has no conflicts to disclose. Dr. Salas has entered into an agreement with UpToDate, Inc. and has been paid royalties for her {Citation}received royalties from sales of the MySleep101 iPad app. She has received less than $75. Ms. Krum has no conflicts to disclose. Dr. Saylor has no conflicts to disclose. Dr. Abras has no conflicts to disclose. Ms. Gugliucciello has no conflicts to disclose. Dr. Nunn has no conflicts to disclose. Dr. Gamaldo has entered into an agreement with UpToDate, Inc. and has been paid royalties for her contribution of medical articles for this publication. She has received less than $400. She has received royalties from sales of the MySleep101 iPad app. She has received less than $75. Dr. Strowd serves as a consultant for Monteris Medical. He receives an editorial stipend from the American Academy of Neurology. He has received research/grant support from the American Academy of Neurology, American Society for Clinical Oncology, Southeastern Brain Tumor Foundation, Jazz Pharmaceuticals, and the International Association for Medical Science Educators.
Author Contributions
Dr. Paul contributed to analysis and drafting the manuscript and has approved this final version.
Dr. Leung contributed to analysis and drafting the manuscript and has approved this final version.
Dr. Salas contributed to the study design, analysis, drafting, and supervision of the manuscript and has approved this final version.
Ms. Cruz contributed to the study design, data collection/curation, project administration, and drafting the manuscript and has approved this final version.
Dr. Abras contributed to the study design, analysis, and drafting of the manuscript and has approved this final version.
Dr. Saylor contributed to the study design, analysis, and drafting of the manuscript and has approved this final version.
Ms. Gugliucciello contributed to the online instructional design and development of the web-based platform and has approved this final version.
Dr. Nunn contributed to the web-based platform’s online instructional design and development and has approved this final version.
Dr. Gamaldo contributed to the study design, analysis, drafting and supervision of the manuscript and has approved this final version.
Dr. Strowd contributed to the study design, methodology, conceptualization, analysis, and drafting the manuscript and has approved this final version.
Data Availability Statement
Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.
Supplemental data
Supplemental data for this article can be accessed online at https://doi.org/10.1080/10872981.2022.2142358.