Effect of flipped classroom to anesthesia crisis management simulation education: a quasi-experimental study

While simulation is widely employed in anesthesia crisis management training, its effectiveness is often hindered by lack of preparation. Flipped classroom (FC) is a novel teaching method that encourages active student engagement and preparation. We aim to investigate whether FC could enhance the residents' engagement in preparation activities and improve the learning outcomes in anesthesia crisis management simulation.

This quasi-experimental study included anesthesiology residents from the anesthesiology department, Shanghai General Hospital between January 2023 and July 2023. The participants were randomly divided into the FC group and the conventional lecture (CL) group. The primary outcome was the Anesthetists' Non-Technical Skills (ANTS) scores of all participants. Secondary outcomes included crisis response performance, theoretical test scores, and time spent on training-related activities.

A total of 40 anesthesiology residents in their first two postgraduation years at Shanghai General Hospital were recruited for analysis. The FC group (n = 20) achieved significantly higher overall ANTS scores (FC vs. CL: 11.95 ± 2.14 vs. 9.55 ± 2.40, p = 0.002) than the CL group. The FC group had higher correct response rates in two out of six observational checkpoints in the simulation (FC vs. CL: 'Recognize acute pulmonary embolism and deal with it accordingly', 95% vs. 60%, p = 0.020; 'Provide circulatory support and heparin treatment', 100% vs. 75%, p = 0.047). The FC group also obtained higher post-training theoretical test scores (FC vs. CL: 90.9 ± 4.8 vs. 84.8 ± 7.8, p = 0.005) than the CL group. While the FC group spent more time studying before the simulation session (FC vs. CL (mean [min, max]): 2.6 [1.3, 3.6] vs. 1.3 [0.3, 2.3], p < 0.0001), there was no significant difference in total studying time between the two groups (FC vs. CL (mean [min, max]): 3.6 [2, 5.6] vs. 3.4 [1.8, 4.9], p = 0.418).

FC may improve the learning performance in the management of perioperative pulmonary embolism within anesthesia crisis management simulation training compared to CL-based learning.

The study was registered with No. ChiCTR2300070086.