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Am J Perinatol 2024; 41(S 01): e2562-e2573
DOI: 10.1055/s-0043-1772227
Original Article

Best Practices and Educator Strategies for Facilitating a Flipped Classroom in Graduate Medical Education

Alison Falck
1   Department of Pediatrics, University of California, San Francisco, California
,
Heather French
2   Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
,
Rita Dadiz
3   Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
,
Megan M. Gray 
4   Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
,
Amber Mendres-Smith
5   Department of Pediatrics, University of Maryland, School of Medicine, Baltimore, Maryland
,
Bret Nolan
6   Department of Pediatrics, Children's Hospital of Orange County, Orange, California
,
Kirsti Martin
7   Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts
,
Margarita M. Vasquez
8   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Health San Antonio, San Antonio, Texas
› Author Affiliations Funding This study was funded by SPARK-Ed: Penn Medicine Educational Grant.
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Abstract

Objective Effective flipped classroom (FC) education fosters learner engagement, promoting higher-level cognitive skills. FC learning in graduate medical education (GME) has increased, but few educators have significant experience with FC facilitation. There are no evidence-based practices to support professional development of FC facilitation skills in GME. The objective of this study is to identify best practices for effective FC facilitation in GME.

Study Design We conducted a mixed-methods, cross-sectional study of faculty educators who participated in a randomized controlled trial (RCT) using FC for physiology education in neonatal–perinatal medicine. Educators completed a 25-question survey about effective strategies for FC facilitation. A subset of educators participated in interviews to share their FC facilitation experiences and strategies to maximize learner engagement. Quantitative survey data were analyzed with descriptive statistics. Qualitative survey and interview data were coded and analyzed inductively to identify themes.

Results Seventy-five educators completed the survey (75/136, 55% response rate), and 11 participated in semistructured interviews. While educators facilitated a median of two FC sessions (interquartile range: 1, 5) during the RCT, 43 (57%) had not received prior training in FC facilitation. Qualitative data analyses generated five themes that aligned with quantitative survey results: (1) educator preferences, (2) unique FC facilitation skills, (3) learning environment optimization, (4) subject matter expertise, and (5) learner behavior management. Sixty-two educators (83%) felt they were well prepared to lead FC sessions. Thirty-six educators (48%) reported that unprepared learners disrupt the learning environment, and the provision of clear expectations and adequate time to prepare for FCs improves learner preparation. Strategies to facilitate effective FC sessions included creating a safe learning environment and engaging learners in critical thinking.

Conclusion Educators highlighted faculty development needs, strategies, and actions to promote effective FC facilitation. Further exploration through learner interviews will provide additional evidence for the development of best practices and resources for FC facilitation.

Key Points

  • Educators prefer the FC educational modality over traditional didactic lectures.

  • Prior experiences in simulation debriefing provide foundational skills for new FC facilitators.

  • Setting learner expectations and ensuring safe space in the classroom encourage learner engagement.

  • Educator and learner preparation for FC is essential to optimize the learning experience.

  • Unique approaches in facilitation are required to support all types of learners.

Keywords

neonatal–perinatal medicine - fellowship - educator - flipped classroom - facilitator

Note

The Children's Hospital of Philadelphia's Institutional Review Board approved this study and waived written consent.


Authors' Contributions

H.F. and M.M.G. conceptualized this work. A.F., A.M-S., and R.D. provided themes and categories for qualitative interview data and A.F. wrote up the qualitative data for the manuscript. M.M.G. provided the figures and interpretation of the data. M.V. drafted the initial manuscript and reviewed and completed the final manuscript. H.F. and R.D. reworked the manuscript and provided edits and discussion. All authors reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.




Publication History

Received: 01 April 2023

Accepted: 10 July 2023

Article published online:
09 August 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Kaufman DM. Applying educational theory in practice. BMJ 2003; 326 (7382) 213-216
    CrossrefPubMedSearch in Google Scholar
  • 2 Prober CG, Khan S. Medical education reimagined: a call to action. Acad Med 2013; 88 (10) 1407-1410
    CrossrefPubMedSearch in Google Scholar
  • 3 Tolks D, Schäfer C, Raupach T. et al. An introduction to the inverted/flipped classroom model in education and advanced training in medicine and in the healthcare professions. GMS J Med Educ 2016; 33 (03) Doc46
    PubMedSearch in Google Scholar
  • 4 Williams DE. The future of medical education: flipping the classroom and education technology. Ochsner J 2016; 16 (01) 14-15
    PubMedSearch in Google Scholar
  • 5 Bloom BS, Engelhart MD, Furst EJ, Hill WH, Kratwohl DR. Taxonomy of educational objectives: the classification of educational goals. Handbook 1: Cognitive Domain. Longman Green and Co, London, England; 1956
    Search in Google Scholar
  • 6 Boysen-Osborn M, Anderson CL, Navarro R. et al. 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. J Educ Eval Health Prof 2016; 13: 11
    CrossrefPubMedSearch in Google Scholar
  • 7 Fox J, Faber D, Pikarsky S. et al. Development of a flipped medical school dermatology module. South Med J 2017; 110 (05) 319-324
    PubMedSearch in Google Scholar
  • 8 Moraros J, Islam A, Yu S, Banow R, Schindelka B. Flipping for success: evaluating the effectiveness of a novel teaching approach in a graduate level setting. BMC Med Educ 2015; 15: 27
    CrossrefPubMedSearch in Google Scholar
  • 9 Moraros J, Ashrafi A, Yu S, Banow R, Schindelka B. Correction to: Flipping for success: evaluating the effectiveness of a novel teaching approach in a graduate level setting. BMC Med Educ 2017; 17 (01) 203
    CrossrefPubMedSearch in Google Scholar
  • 10 O'Connor EE, Fried J, McNulty N. et al. Flipping radiology education right side up. Acad Radiol 2016; 23 (07) 810-822
    CrossrefPubMedSearch in Google Scholar
  • 11 Rui Z, Lian-Rui X, Rong-Zheng Y, Jing Z, Xue-Hong W, Chuan Z. Friend or foe? Flipped classroom for undergraduate electrocardiogram learning: a randomized controlled study. BMC Med Educ 2017; 17 (01) 53
    CrossrefPubMedSearch in Google Scholar
  • 12 Shatto B, LʼEcuyer K, Quinn J. Retention of content utilizing a flipped classroom approach. Nurs Educ Perspect 2017; 38 (04) 206-208
    CrossrefPubMedSearch in Google Scholar
  • 13 Tan E, Brainard A, Larkin GL. Acceptability of the flipped classroom approach for in-house teaching in emergency medicine. Emerg Med Australas 2015; 27 (05) 453-459
    CrossrefPubMedSearch in Google Scholar
  • 14 Tune JD, Sturek M, Basile DP. Flipped classroom model improves graduate student performance in cardiovascular, respiratory, and renal physiology. Adv Physiol Educ 2013; 37 (04) 316-320
    CrossrefPubMedSearch in Google Scholar
  • 15 Young TP, Bailey CJ, Guptill M, Thorp AW, Thomas TL. The flipped classroom: a modality for mixed asynchronous and synchronous learning in a residency program. West J Emerg Med 2014; 15 (07) 938-944
    CrossrefPubMedSearch in Google Scholar
  • 16 Blair RA, Caton JB, Hamnvik OR. A flipped classroom in graduate medical education. Clin Teach 2020; 17 (02) 195-199
    CrossrefPubMedSearch in Google Scholar
  • 17 Gray MM, Dadiz R, Izatt S. et al. Comparison of knowledge acquisition and retention following traditional didactic vs. flipped classroom education utilizing a standardized national curriculum: a randomized controlled trial. J Perinatol 2022; 42 (11) 1512-1518
    CrossrefPubMedSearch in Google Scholar
  • 18 French H, Arias-Shah A, Gisondo C, Gray MM. Perspectives: the flipped classroom in graduate medical education. Neoreviews 2020; 21 (03) e150-e156
    CrossrefPubMedSearch in Google Scholar
  • 19 Moffett J. Twelve tips for “flipping” the classroom. Med Teach 2015; 37 (04) 331-336
    CrossrefPubMedSearch in Google Scholar
  • 20 Sharma N, Lau CS, Doherty I, Harbutt D. How we flipped the medical classroom. Med Teach 2015; 37 (04) 327-330
    CrossrefPubMedSearch in Google Scholar
  • 21 Dalkey N, Helmer O. An experimental application of the DELPHI method to the use of experts. Manage Sci 1963; 9 (03) 458-467
    CrossrefPubMedSearch in Google Scholar
  • 22 Charmaz K. Teaching theory construction with initial grounded theory tools: a reflection on lessons and learning. Qual Health Res 2015; 25 (12) 1610-1622
    CrossrefPubMedSearch in Google Scholar
  • 23 Bonachea E, Carbajal MM, Gillam-Krakauer M, Vasquez MM. MedEd on the Go - Developing Your Expertise as a Flipped Classroom Facilitator. August 2018 Accessed March 13, 2023 at: https://www.mededonthego.com/Pediatrics/Video/program/412
    PubMedSearch in Google Scholar
  • 24 Rudolph JW, Raemer DB, Simon R. Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simul Healthc 2014; 9 (06) 339-349
    CrossrefPubMedSearch in Google Scholar
  • 25 Halamek L. Debriefing in simulation-based training in neonatology: an outcomes-based approach. In: Soghier LM, Robin B. Neonatal Simulation: A Practical Guide. Itasca, IL: American Academy of Pediatrics; 2021
    Search in Google Scholar
  • 26 Ross S. Twelve tips for effective simulation debriefing: a research-based approach. Med Teach 2021; 43 (06) 642-645
    CrossrefPubMedSearch in Google Scholar
  • 27 Eppich W, Cheng A. Promoting excellence and reflective learning in simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefing. Simul Healthc 2015; 10 (02) 106-115
    CrossrefPubMedSearch in Google Scholar
  • 28 Rudolph JW, Simon R, Rivard P, Dufresne RL, Raemer DB. Debriefing with good judgment: combining rigorous feedback with genuine inquiry. Anesthesiol Clin 2007; 25 (02) 361-376
    CrossrefPubMedSearch in Google Scholar
  • 29 Gilkison A. Techniques used by “expert” and “non-expert” tutors to facilitate problem-based learning tutorials in an undergraduate medical curriculum. Med Educ 2003; 37 (01) 6-14
    CrossrefPubMedSearch in Google Scholar