title: Effectiveness of the Surgery Core Clerkship Flipped Classroom: a prospective cohort trial.
abstract: BACKGROUND
  The flipped classroom has been proposed as an alternative curricular approach to traditional didactic lectures but has not been previously applied to a surgery clerkship.
  
  
  METHODS
  A 1-year prospective cohort of students (n = 89) enrolled in the surgery clerkship was taught using a flipped classroom approach. A historical cohort of students (n = 92) taught with a traditional lecture curriculum was used for comparison. Pretest and post-test performance, end-of-clerkship surveys, and National Board of Medical Examiners (NBME) scores were analyzed to assess effectiveness.
  
  
  RESULTS
  Mean pretest and post-test scores increased across all modules (P < .001). There was no difference between mean NBME examination score in the prospective and historical cohorts (74.75 vs 75.74, P = .28). Mean ratings of career interest in surgery increased after curriculum completion (4.75 to 6.50, P < .001), with 90% reporting that the flipped classroom contributed to this increase.
  
  
  CONCLUSIONS
  Implementation of a flipped classroom in the surgery clerkship is feasible and results in high learner satisfaction, effective knowledge acquisition, and increased career interest in surgery with noninferior NBME performance.
authors.affiliation: Department of Surgery, Goodman Surgical Education Center, Stanford School of Medicine, 300 Pasteur Drive, H3552, Stanford, CA, 94305, USA. Electronic address: cara.liebert@stanford.edu.
authors.forename: Cara A
authors.initials: CA
authors.lastname: Liebert
authors.affiliation: Department of Surgery, Goodman Surgical Education Center, Stanford School of Medicine, 300 Pasteur Drive, H3552, Stanford, CA, 94305, USA.
authors.forename: Dana T
authors.initials: DT
authors.lastname: Lin
authors.affiliation: Department of Surgery, Goodman Surgical Education Center, Stanford School of Medicine, 300 Pasteur Drive, H3552, Stanford, CA, 94305, USA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Mazer
authors.affiliation: Department of Surgery, Goodman Surgical Education Center, Stanford School of Medicine, 300 Pasteur Drive, H3552, Stanford, CA, 94305, USA; Stanford Center for Medical Education Research and Innovation, Palo Alto, CA, USA.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Bereknyei
authors.affiliation: Department of Surgery, Goodman Surgical Education Center, Stanford School of Medicine, 300 Pasteur Drive, H3552, Stanford, CA, 94305, USA.
authors.forename: James N
authors.initials: JN
authors.lastname: Lau
mesh_terms: D000328:Adult; D002321:Career Choice; D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence; D015331:Cohort Studies; D003479:Curriculum; D005260:Female; D013502:General Surgery / Q000193:education*; D065386:Historically Controlled Study; D006801:Humans; D008297:Male
keywords: Clerkship; Flipped classroom; Medical student; Surgery