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Abstract

Objectives: To explore the published practices in the use of the flipped classroom for training in technical clinical skills at the 3 stages of design; pre-class, in-class and after-class, seeking links between aspects of design and soft and hard outcomes. Methods: A review of the literature on the use of the flipped classroom to teach technical clinical skills to medical and nursing students over a 15 year period (2007-2021) was conducted. Data on the 3 stages of design, as well as outcomes, were extracted and analysed independently by both reviewers. Reviewers then independently sought any links between the two, finalizing the synthesis of data by discussion and reaching a consensus. Results: Positive student views were attributed to the flexibility and adaptability of the flipped classroom, allowing the integration of multiple teaching approaches to suit diverse learning styles. A plethora of preparatory material, predominantly online, have resulted in mixed outcomes. However, the data indicated that customized material as well as combinations of different modalities of preparatory material which complemented simulated and collaborative in-class activities were more efficient. Embedded pre-session self-assessments ensure accountability and help gauge student preparation for tailored instruction. Despite being learner-centred, the instructor seems to remain invaluable as a guide and facilitator. While student satisfaction was predominantly positive, increased student motivation and confidence did not always accompany significantly improved knowledge and/or skills gain. Discussion: The increase in skills gain may be attributed to the ability of the flipped classroom to support the complex interaction between psychomotor, cognitive and affective factors on skill performance. The evidence was synthesized to provide pragmatic insight in the form of 8 tips for the evidence-based design of the flipped classroom for teaching technical clinical skills to ensure maximum learning efficiency in undergraduate medical education

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