Department of Neurology, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA.
The Counseling Center, University of Maryland, College Park, 20742, MD, USA.
Med Educ Online. 2023 Dec;28(1):2142358. doi: 10.1080/10872981.2022.2142358.
Bedside clinical teaching is the backbone of clerkship education. Data-driven methods for supplementing bedside encounters with standardized content from vetted resources are needed.
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.
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., ) or interactive asynchronous online instruction (i.e., ), 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).
104 students (49 , 55 ) were enrolled. Age, gender, and training level did not differ by group (all p > 0.43); baseline knowledge was higher in the 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 group, 95%CI -0.4-4.8, p = 0.07). Clinical skills were significantly higher in the 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 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.
In this comparative study of two evidence-based curricular delivery approaches, we observed no difference in knowledge acquired. Greater clinical skills were observed with instruction, while more SDL was observed with instruction. Supplementing bedside teaching with blended instruction that balances live skill development with vetted online resources is optimal for clerkship education.
床边临床教学是实习教育的支柱。需要数据驱动的方法来补充床边遇到的标准化内容。
比较翻转课堂与互动在线教学对医学实习中知识、技能、自我指导学习（SDL）行为和满意度的影响。
一项经过同行评审的临床推理课程在神经病学中的应用进行了机构审查委员会批准的前瞻性研究；参加必修实习的 2 至 4 年级医学生被纳入研究。学生被随机分配到翻转课堂（即 ）或互动异步在线教学（即 ），补充现有的床边教学。通过同行评审的临床推理考试、NBME 分数、教师/住院医师临床评估、非强制性作业完成情况、实习结束时的调查以及客观结构化临床考试（OSCE）评估基线和课程结束时的知识、技能发展、SDL 行为、满意度和长期保留情况。
共有 104 名学生（49 名女性，55 名男性）入组。年龄、性别和培训水平在组间无差异（均 p > 0.43）； 组的基线知识更高（p = 0.003）。即使在校正基线知识差异后，知识基础考试成绩也没有因组而异（ 组高 2.3 分，95%CI-0.4-4.8，p = 0.07）。临床技能在 组显著更高，包括检查技能（4.2 ± 0.5 对 3.9 ± 0.7，p = 0.03）和未来住院医生的潜力（4.8 ± 0.3 对 4.5 ± 0.6，p = 0.03）。 组的学生更有可能进行 SDL（42%对 12%，p = 0.001），并且报告的学习时间更多（6.1 对 3.8 小时，p = 0.03）。满意度（p = 0.51）和 OSCE 分数（p = 0.28）在组间无差异。
在这项关于两种循证课程交付方法的比较研究中，我们观察到获得的知识没有差异。与在线教学相比， 指导下观察到更大的临床技能，而 指导下观察到更多的 SDL。在床边教学中补充平衡现场技能发展与经过审查的在线资源的混合式教学，对实习教育最为理想。
