The Flipped Operating Room: Designing a Flipped Classroom Curriculum to Catalyze Intraoperative Medical Student...

Anesthesiology rotations teach widely translatable skills and connect students with mentors in the field. However, their composition and pedagogy vary nationally, and the time available for attendings and residents to engage in intraoperative teaching is limited. Flipped classroom curricula, when applied to the operating room setting, have the potential to catalyze intraoperative teaching.

We developed a flipped classroom curriculum consisting of daily modules synchronized across learner-educator teams and arranged on a perpetual calendar. The primary outcomes were learners' (ie, medical students) self-reported preparation for intraoperative teaching, appraisal of intraoperative teaching/learning quality, engagement, and critique of the curriculum. The secondary outcomes were educators' (ie, attendings and residents) assessments of intraoperative teaching/learning quality and their perception of students' preparation and engagement. A preintervention and postintervention survey design was implemented employing questions scored on 5-point Likert scales.

Twenty-one medical students, 41 attending educators, and 50 resident educators were enrolled during a 6-month pilot period. Preintervention and postintervention scores were compared. After the intervention, medical students more consistently came to the operating room with a defined learning goal based on self-assessment (mean [SD], 3.5 [1.1] vs 4.3 [1.0], p = .03, d = 0.6) and the assessment of educators (attending: 3.2 [0.7] vs 4.2 [0.6], p < .001, d = 1.5; resident: 3.2 [1.3] vs 4.0 [1.3], p = .02, d = 0.6). They also more consistently reviewed foundational information in preparation for teaching based on self-assessment (3.3 [1.2] vs. 4.4 [1.1], p = .006, d = 0.7) and that of educators (attending: 3.0 [0.7] vs 4.1 [0.8], p < .001, d = 1.5; resident: 3.0 [1.1] vs 3.8 [1.3], p = .05, d = 0.6). Attendings perceived that students also more consistently came to the operating room with specific questions about a topic (3.0 [1.0] vs 3.9 [0.9], p < .01, d = 1.0). Students and educators found the curriculum to be a valuable, organized, and efficient primer that promoted student engagement and higher order teaching.

A flipped classroom curriculum can be implemented in the intraoperative arena to catalyze learners' preparation for the clinical day, set an agenda for the teaching-learning session, and promote engagement while also supporting and elevating teaching by attending and resident educators. Our synchronized format positioned on a perpetual calendar was also perceived as valuable and well-constructed.