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J Surg Educ. 2017 Jul 19. pii: S1931-7204(17)30341-0. doi: 10.1016/j.jsurg.2017.07.007. [Epub ahead of print]

The Effectiveness of a Simulation-Based Flipped Classroom in the Acquisition of Laparoscopic Suturing Skills in Medical Students-A Pilot Study.

Author information

1
Division of Thoracic Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Department of Medical Education, Taipei Medical University Hospital, Taipei, Taiwan; Department of Education and Humanities in Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Animal Science and Technology, National Taiwan University, Taipei, Taiwan.
2
Department of Medical Education, Taipei Medical University Hospital, Taipei, Taiwan; Department of Education and Humanities in Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan.
3
Division of Acute Care Surgery and Traumatology, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
4
Division of Acute Care Surgery and Traumatology, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan.
5
Department of Medical Education, Taipei Medical University Hospital, Taipei, Taiwan; Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan; Cancer Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Medical Research, Translational Laboratory, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical University, Taipei, Taiwan. Electronic address: poliwei66@gmail.com.

Abstract

OBJECTIVE:

To evaluate the effectiveness of a simulation-based flipped classroom in gaining the laparoscopic skills in medical students.

DESIGN:

An intervention trial.

SETTING:

Taipei Medical University Hospital, an academic teaching hospital.

PARTICIPANTS AND METHODS:

Fifty-nine medical students participating in a 1-hour laparoscopic skill training session were randomly assigned to a conventional classroom (n = 29) or a flipped classroom approach (n = 30) based on their registered order. At the end of the session, instructors assessed participants' performance in laparoscopic suturing and intracorporeal knot-tying using the assessment checklist based on a modified Objective Structured Assessment of Technical Skills tool.

RESULTS:

Students in the flipped group completed more numbers of stitches (mean [M] = 0.47; standard deviation [SD] = 0.507) than those in the conventional group (M = 0.10; SD = 0.310) (mean difference: 0.37; 95% CI: 0.114-582; p = 0.002). Moreover, students in the flipped group also had higher stitch quality scores (M = 7.17; SD = 2.730) than those in the conventional group (M = 5.14; SD = 1.767) (mean difference = 2.03; 95% CI: 0.83-3.228; p = 0.001). Meanwhile, students in the flipped group had higher pass rates for the second throw (p < 0.001), third throw (p = 0.002), appropriate tissue reapproximation without loosening or strangulation (p < 0.001), needle cut from suture under direct visualization (p = 0.004), and needle safely removed under direct visualization (p = 0.018) than those in the conventional group.

CONCLUSIONS:

Comparing with traditional approach, a simulation-based flipped classroom approach may improve laparoscopic intracorporeal knot-tying skill acquisition in medical students.

KEYWORDS:

Medical Knowledge; Practice-Based Learning and Improvement; clinical skills; flipped classroom; laparoscopic suture; medical education; simulation

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