S1279 Web-Based Comparison of Traditional Didactics and Flipped Classroom on the Management of Clostridioides difficile Infection Among Internal Medicine Interns

Abstract

INTRODUCTION: Interns in internal medicine are expected to manage a wide array of diseases; one being Clostridioides difficile infection (CDI). Considerable knowledge gaps in internal medicine exist in first year residents and thus we sought to focus intern education on the prevention, containment, and treatment of CDI. Furthermore, delivering education has faced a major challenge given the COVID-19 pandemic, forcing teaching to online platforms. Resident education often follows a passive teacher-centered model. In contrast, flipped classroom is an instructional model focused on student engagement while promoting active learning. The goals of this study were to determine CDI knowledge-gaps of interns at a large, tertiary care academic medical center and compare the effectiveness of traditional didactics (TD) vs. flipped classroom (FC) on an online platform. METHODS: A CDI curriculum was created using ACG and IDSA 2017 guidelines covering four major areas: epidemiology, diagnostics, medical management, and advanced management (Figure 1). Nineteen interns were enrolled: ten receiving the TD lecture and nine receiving the FC method (Figure 2) via an online conferencing site. TD learners individually completed an electronic 10-question pre-intervention survey to assess prior CDI knowledge. FC learners were provided with a pre-intervention lecture over video and answered the survey while collaborating in small groups on video chat rooms. All interns were surveyed again four-week post intervention. The primary outcome was the pre-post intervention increase in standardized CDI test scores. Secondary outcomes included quantification of CDI knowledge gaps of interns in internal medicine. RESULTS: Eighteen interns completed the study and were included in the analysis. Pre-intervention test results included epidemiology (25%), medical management (40%), diagnosis (53%), and advanced management (65%) for an overall average of 46% (Figure 3). There was no improvement in subtopic scores or overall score in the TD group. The FC group demonstrated an improvement in performance over three major subtopics with a pre-to-post increase in total score of 37% (P < 0.001). CONCLUSION: Interns in internal medicine have considerable knowledge gaps pertaining to CDI. Our FC strategy provided superior results than TD in terms of pre-to-post intervention survey scores. FC can be successfully executed using an online platform, thereby facilitating continued effective teaching for residents especially in times of social distancing.Figure 1.: Breakdown of the Clostridioides difficile curriculum used for both TD and FC groups.Figure 2.: TD learners (n = 10) were given a pre-test prior to in-class learning with slide presentation. FC learners (n = 9) were sent a video lecture prior to in-class team-based learning (TBL). All learners were asked to repeat the survey after four weeks.Figure 3.: A direct comparison of topic specific pre-test results with TD and FC post-intervention test results. Pre-test results were taken from TD learners only as they were individually completed prior to any intervention.