A Flipped Classroom Model to Enhance Simulation Education for Percutaneous Renal Surgery

The limitations of lectures are magnified when teaching technical skills. A "flipped classroom" (FC) model allows learners to first review material and replaces lectures with active teacher-learner engagement. FC has been shown to improve knowledge retention, but its impact on skill acquisition is unknown. This exploratory study assesses the feasibility and learner perception of an FC model for percutaneous nephrolithotomy (PCNL) simulation.

Urology residents participated in a PCNL simulation curriculum. Residents first reviewed materials on obtaining percutaneous access, followed by an in-person discussion and 4 simulation activities. Pre-/post-simulation surveys were collected regarding prior experience, confidence in skills (rating scale from 1-5, unable to perform to can perform independently), and scores on a validated Flipped Classroom Perception Instrument (agreement scale 1-5).

Thirteen residents with varying PCNL experience reported significantly increased confidence in obtaining access across all measures (P < .01): performing new access overall, new fluoroscopic access with bull's-eye and triangulation techniques, and using existing access. There was no difference in the increase in confidence ratings based on prior PCNL experience. FC was highly rated, with mean scores on the perception instrument 4.0 to 4.5 before and 4.2 to 4.7 after the activity. Each simulation component was perceived as highly effective (overall mean, 4.7; pre-simulation materials, 4.3; in-person discussion, 4.4; simulation, 4.8). There was no difference based on prior PCNL experience.

An FC model was feasible and rated by learners as highly effective for teaching percutaneous renal access and significantly improved residents' skill confidence regardless of prior PCNL experience.