Flipping the Advanced Cardiac Life Support Classroom with Team-based Learning: Comparison of Cognitive Testing Performance for Medical Students at the University of California, Irvine, United States.

Craig L. Anderson,Julie Youm,Roman Navarro,Mark I. Langdorf,Christopher E. McCoy,Justin Yanuck,Mary Frances Ypma-Wong,Megan Boysen-Osborn,Suzanne Strom

doi:10.3352/jeehp.2016.13.11

Abstract

Purpose:It aimed to find if written test results improved for advanced cardiac life support (ACLS) taught in flipped classroom/team-based Learning (FC/TBL) vs. lecture-based (LB) control in University of California-Irvine School of Medicine, USA.Methods:Medical students took 2010 ACLS with FC/TBL (2015), compared to 3 classes in LB (2012-14) format. There were 27.5 hours of instruction for FC/TBL model (TBL 10.5, podcasts 9, small-group simulation 8 hours), and 20 (12 lecture, simulation 8 hours) in LB. TBL covered 13 cardiac cases; LB had none. Seven simulation cases and didactic content were the same by lecture (2012-14) or podcast (2015) as was testing: 50 multiple-choice questions (MCQ), 20 rhythm matchings, and 7 fill-in clinical cases.Results:354 students took the course (259 [73.1%] in LB in 2012-14, and 95 [26.9%] in FC/TBL in 2015). Two of 3 tests (MCQ and fill-in) improved for FC/TBL. Overall, median scores increased from 93.5% (IQR 90.6, 95.4) to 95.1% (92.8, 96.7, P=0.0001). For the fill-in test: 94.1% for LB (89.6, 97.2) to 96.6% for FC/TBL (92.4, 99.20 P=0.0001). For MC: 88% for LB (84, 92) to 90% for FC/TBL (86, 94, P=0.0002). For the rhythm test: median 100% for both formats. More students failed 1 of 3 tests with LB vs. FC/TBL (24.7% vs. 14.7%), and 2 or 3 components (8.1% vs. 3.2%, P=0.006). Conversely, 82.1% passed all 3 with FC/TBL vs. 67.2% with LB (difference 14.9%, 95% CI 4.8-24.0%).Conclusion:A FC/TBL format for ACLS marginally improved written test results.

Highlights

Traditional education reflects passive transfer of information from lecturer to students in a large group
Ninety five final year students from the School of Medicine participated in the flipped classroom” (FC)/Team-based learning (TBL) advanced cardiac life support (ACLS) course in 2015
For the 7 case fill-in-the-blank tests, scores improved from 94.1% correct for LB (89.6, 97.2) to 96.6% for flipped classroom/team-based Learning (FC/TBL) (92.4, 99.20 P= 0.0001)

Summary

Introduction

Traditional education reflects passive transfer of information from lecturer to students in a large group. This has been shown inferior to active learning [1], which promotes more thorough and lasting understanding [2]. Active learning is a process whereby students engage in activities, such as reading, writing, discussion, or problem solving that promotes analysis, synthesis, and evaluation of class content [3]. In a FC, students receive a first exposure to material prior to class, for example, by reading or watching podcasts at home. In TBL, students collaborate through group interactions in class to solve clinical problems and reflect on their learning [4].

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