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J Paediatr Child Health. 2019 Jan 22. doi: 10.1111/jpc.14366. [Epub ahead of print]

Introducing early-phase medical students to clinical paediatrics using simulation and a flipped-classroom.

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School of Women's and Children's Health, Sydney Children's Hospital, University of New South Wales, Sydney, New South Wales, Australia.
Department of General Paediatrics, Sydney Children's Hospital, Sydney, New South Wales, Australia.
Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, New South Wales, Australia.
School of Education, University of New South Wales, Sydney, New South Wales, Australia.
Department of Nephrology, Sydney Children's Hospital, Sydney, New South Wales, Australia.



Both simulation and the flipped-classroom improve learning outcomes in medical education, with evidence emerging that they are effective in combination ('flipped-simulation'). Previous studies evaluating simulation in paediatrics have assessed efficacy for senior students. This study aimed to assess whether using flipped-simulation in early-phase medical student education would show similar benefits.


A flipped-simulation session was introduced into the earliest phase of the University of New South Wales Sydney's undergraduate medical program. A pre-test-post-test study design was used to assess short-term knowledge gains with an eight-item quiz administered before and after students attended the session. A retrospective cohort design was used to assess long-term knowledge retention, with student scores from a 10-item quiz administered at the second-phase paediatric course orientation, compared between a group that completed the flipped-simulation course and a group that attended an alternative play-based session. Additional survey data regarding student satisfaction were gathered.


Students demonstrated short-term knowledge gains: mean test scores improved from the pre-test to post-test (3.4 ± 1.5 vs. 6.0 ± 1.3, P < 0.001). Students attending the flipped-simulation course retained knowledge more effectively in the longer term: mean test scores of students who completed the flipped-simulation session were significantly higher than those who attended the alternative play-based session (4.4 ± 1.9 vs. 3.4 ± 1.8, P < 0.001). Survey data demonstrated high student confidence in practical skills.


Combining simulation and the flipped-classroom is effective for early-phase medical students, with improved knowledge over the short and long term, and high student satisfaction.


education; flipped-classroom; medical; paediatrics; simulation; students


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