Trial of the flipped classroom for open suturing and simulated laparoscopic cholecystectomy for medical students.

Takashi Iwata, MD, PhD¹, Masashi Akaike, MD, PhD¹, Kozo Yoshikawa, MD, PhD², Jun Higashijima, MD, PhD², Toshihiro Nakao, MD, PhD², Masaaki Nishi, MD, PhD², Chie Takasu, MD, PhD², Mitsuo Shimada, MD, PhD². ²Department of Digestive Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, ¹Research Center for Education of Health Bioscience, Institute of Biomedical Sciences, Tokushima University Graduate School

Background: In practice of medical students, it may not secure enough time for practical skill exercise due to explanation and a lecture to perform in the beginning. Flipped classroom is a novel approach to learning where students watch lectures online and at their own pace, typically at home. Class is then reserved for active learning exercises and interactive activities, which illustrate important concepts. The aim of this study was to investigate the usefulness of flipped classroom for training of open suturing and simulated laparoscopic cholecystectomy.

Materials and Methods: Forty medical students in 5th grade of The Univ. of Tokushima were participated. They were divided into two groups; conventional group (conv group: n=20) and flipped classroom group (flip group: n=20). Flip. group learned open suturing technique with Procedure CONSULT® on internet and procedure of laparoscopic cholecystectomy with original contents prior to suturing and/or laparoscopic training. Open suturing training was performed with suturing simulator and simulated laparoscopic cholecystectomy was performed with Lap MENTOR IITM. Pre-training and post-training test, open suturing technique, simulated laparoscopic cholecystectomy technique and lecture time were investigated in both open suturing training and simulated laparoscopic cholecystectomy.

Results: Flip. group showed a good result in both open suturing training and simulated laparoscopic cholecystectomy. Pre-training test score (20 points of perfect scores, average): 13.5 vs. 18.6 (conv. group vs flip. group), pre-training suturing evaluation (100 points of perfect scores, average): 62.6 vs. 91, Lecture time: 63 vs. 18.3 minutes. There was no difference between conv. group and flip. group in test score and suturing evaluation after training.

Pre-training test score (100 points of perfect scores, average): 52.3 vs. 88.5 (conv. group vs flip group), pre-training operative evaluation (100 points of perfect scores, average): 53.2 vs. 86.5, Lecture time: 17.2 vs. 5.4 minutes. There was no difference between conv. group and flip. group in test score and operative evaluation after training.

Conclusions: The training using the technique of the flipped classroom can shorten lecture time, save much time for practice, and make students show a high understanding degree of surgical techniques.