Simulation-Based Education with Flipped Classrooms Improve Resident Clinical Performance in Intensive Care: a Pilot Study

10.6145/jme201701

Yen-Yu Liu；Chia-Yuan Liu；Charles Jia-Yin Hou；Chang-Yi Lin；Chuan-Lei Chao；Chao-Hsien Chen；Tseng-Yu Huang；Yung-Wei Hsu；His-Hsien Hsu；Hung-I Yeh；Shou-Chuan Shih；Ching-Chung Lin

flipped classroom ； simulation base education ； intensive care ； resident

Journal of Medical Education

21卷1期（2017 / 03 / 01）

1 - 8

英文

Background: Pre-medical intensive care (MICU) training is crucial for ICU-naïve residents, but there is still huge gap between awareness and clinical performance by means of didactic lecture in the classroom. Objectives: The purpose of this study aimed to combine flipped classroom (FC) and simulation-based education (SBE) to facilitate secondyear residents (R2) in pre-MICU training. Methods: A well-trained third-year resident (R3) (control mode) and thirteen R2 who did not practice in the MICU were included as participants. Each participant read the teaching material and online instruction before the FC and manipulated the SBE scenarios. The pre-curriculum written test score and the SBE results were compared as manifestation of a ＂match mismatch highlight (MMH).＂ Post-curriculum feedback questionnaire was provided for self-evaluation. Results: As a result, the residents achieved relatively higher scores in the written test than in the simulation (80.3 ± 9.4 vs. 68.7 ± 4.2), which confirmed the mismatch gap in awareness and performance. Compared to R3, the R2 fell short in the five scenarios, especially in first aid teamwork, invasive procedure, and mechanical ventilator. The training workshop not only earned their satisfaction toward FC and SBE, but also enhanced participants' ability in MICU (Likert scales, from 2.53 to 3.15, p＜0.05) and alleviated MICU difficulties (Likert scales, from 4.38 to 4, p＜0.05). Conclusion: The integrated FC and SBE workshop associated with MMH analysis may serve as an innovate methodology for pre-MICU training.

1. Lin, JL,Hsu, YW,Lin, RL(2014).Small-scale OSCE is useful for evaluation of the ACGME general competencies of PGYI residents in internal medicine.J Med Educ,18,93-91.
   連結：
2. Aebersold, M,Tschannen, D(2013).Simulation in nursing practice: the impact on patient care.Online J Issues Nurs,18,6.
3. Bond, WF,Deitrick, LM,Arnold, DC(2004).Using simulation to instruct emergency medicine residents in cognitive forcing strategies.Acad Med,79,438-46.
4. Bradley, P(2006).The history of simulation in medical education and possible future directions.Med Educ,40,254-62.
5. Dellinger, RP,Levy, MM,Rhodes, A(2013).Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.Crit Care Med,41,580-637.
6. Fiedor, ML(2004).Pediatric simulation: a valuable tool for pediatric medical education.Crit Care Med,32,S72-4.
7. Gallagher, TH,Waterman, AD,Ebers, AG(2003).Patients' and physicians' attitudes regarding the disclosure of medical errors.JAMA,289,1001-7.
8. Gauger, PG,Gruppen, LD,Minter, RM(2005).Initial use of a novel instrument to measure professionalism in surgical residents.Am J Surg,189,479-87.
9. Gordon, JA,Shaffer, DW,Raemer, DB(2006).A randomized controlled trial of simulation-based teaching versus traditional instruction in medicine: A pilot study among clinical medical students.Adv Health Sci Educ Theory Pract,11,33-9.
10. Littlewood, KE,Shilling, AM,Stemland, CJ(2013).High-fidelity simulation is superior to casebased discussion in teaching the management of shock.Med Teach,35,e1003-e10.
11. Ottestad, E,Boulet, JR,Lighthall, GK(2007).Evaluating the management of septic shock using patient simulation.Crit Care Med,35,769-75.
12. Roehl, A,Reddy, SL,Shannon, GL(2013).The flipped classroom: an opportunity to engage millennial students through active learning strategies.J Fam Consum Sci,105,44-49.
13. Singer, BD,Corbridge, TC,Schroedl, CJ(2013).First-year residents outperform third-year residents after simulation-based education in critical care medicine.Simul Healthc,8,67-71.
14. Steadman, RH,Coates, WC,Huang, YM(2006).Simulation-based training is superior to problem-based learning for the acquisition of critical assessment and management skills.Crit Care Med,34,151-7.
15. Strayer, JF(2012).How learning in an inverted classroom influences cooperation, innovation and task orientation.Learn Environ Res,15,171-93.
16. Wu, CY,Weng, HC,Chen, RC(2013).Time trends of assessments for medical dispute cases in taiwan: a 20-year nationwide study.Intern Med J,43,1023-30.

1. Yu, Tsung-Han,Yang, Hsiu-Wu,Tsai, Weide,Su, Po-Hua,Shen, Ching-Yi,Liu, Yen-Yu,Lin, Ching-Chung,Huang, Chih-Chun,Cheng, Yu-Jung,Chen, Hsin-Tang(2018).A Preliminary Study of Simulation in Emergency Medicine Training in A Taiwanese Teaching Hospital.醫學教育,22(1),1-8.