title: Flipping the Advanced Cardiac Life Support Classroom with Team-based Learning: Comparison of Cognitive Testing Performance for Medical Students at the University of California, Irvine, United States.
abstract: OBJECTIVE
  It aimed to find if written test results improved for advanced cardiac life support (ACLS) taught in flipped classroom/team-based Learning (FC/TBL) vs. lecture-based (LB) control in University of California-Irvine School of Medicine, USA.
  
  
  METHODS
  Medical students took 2010 ACLS with FC/TBL (2015), compared to 3 classes in LB (2012-14) format. There were 27.5 hours of instruction for FC/TBL model (TBL 10.5, podcasts 9, small-group simulation 8 hours), and 20 (12 lecture, simulation 8 hours) in LB. TBL covered 13 cardiac cases; LB had none. Seven simulation cases and didactic content were the same by lecture (2012-14) or podcast (2015) as was testing: 50 multiple-choice questions (MCQ), 20 rhythm matchings, and 7 fill-in clinical cases.
  
  
  RESULTS
  354 students took the course (259 [73.1%] in LB in 2012-14, and 95 [26.9%] in FC/TBL in 2015). Two of 3 tests (MCQ and fill-in) improved for FC/TBL. Overall, median scores increased from 93.5% (IQR 90.6, 95.4) to 95.1% (92.8, 96.7, P=0.0001). For the fill-in test: 94.1% for LB (89.6, 97.2) to 96.6% for FC/TBL (92.4, 99.20 P=0.0001). For MC: 88% for LB (84, 92) to 90% for FC/TBL (86, 94, P=0.0002). For the rhythm test: median 100% for both formats. More students failed 1 of 3 tests with LB vs. FC/TBL (24.7% vs. 14.7%), and 2 or 3 components (8.1% vs. 3.2%, P=0.006). Conversely, 82.1% passed all 3 with FC/TBL vs. 67.2% with LB (difference 14.9%, 95% CI 4.8-24.0%).
  
  
  CONCLUSIONS
  A FC/TBL format for ACLS marginally improved written test results.
authors.affiliation: Department of Emergency Medicine, University of California-Irvine School of Medicine, Orange, CA, USA.
authors.forename: Megan
authors.identifier: 0000-0001-6676-6429
authors.initials: M
authors.lastname: Boysen-Osborn
authors.affiliation: Department of Emergency Medicine, University of California-Irvine School of Medicine, Orange, CA, USA.
authors.forename: Craig L
authors.identifier: 0000-0003-2230-5131
authors.initials: CL
authors.lastname: Anderson
authors.affiliation: Department of Emergency Medicine, University of California-Irvine School of Medicine, Orange, CA, USA.
authors.forename: Roman
authors.identifier: 0000-0001-9185-8480
authors.initials: R
authors.lastname: Navarro
authors.affiliation: University of California-Irvine School of Medicine, Orange, CA, USA.
authors.forename: Justin
authors.identifier: 0000-0003-4202-2016
authors.initials: J
authors.lastname: Yanuck
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California-Irvine School of Medicine, Orange, CA, USA.
authors.forename: Suzanne
authors.identifier: 0000-0002-7765-0517
authors.initials: S
authors.lastname: Strom
authors.affiliation: Department of Emergency Medicine, University of California-Irvine School of Medicine, Orange, CA, USA.
authors.forename: Christopher E
authors.identifier: 0000-0002-6719-0852
authors.initials: CE
authors.lastname: McCoy
authors.affiliation: Department of Emergency Medicine, University of California-Irvine School of Medicine, Orange, CA, USA ; Department of Microbiology and Molecular Genetic, University of California-Irvine School of Medicine, Orange, CA, USADivision of Educational Technology, University of California-Irvine School of Medicine, Orange, CA, USA.
authors.forename: Julie
authors.identifier: 0000-0002-1267-9175
authors.initials: J
authors.lastname: Youm
authors.affiliation: Department of Microbiology and Molecular Genetic, University of California-Irvine School of Medicine, Orange, CA, USADivision of Educational Technology, University of California-Irvine School of Medicine, Orange, CA, USA ; Department of Microbiology and Molecular Genetics, University of California-Irvine School of Medicine, Orange, CA, USA.
authors.forename: Mary Frances
authors.identifier: 0000-0003-3863-6365
authors.initials: MF
authors.lastname: Ypma-Wong
authors.affiliation: Department of Emergency Medicine, University of California-Irvine School of Medicine, Orange, CA, USA.
authors.forename: Mark I
authors.identifier: 0000-0002-9019-2047
authors.initials: MI
authors.lastname: Langdorf
mesh_terms: D022561:Advanced Cardiac Life Support / Q000193:education*; D002140:California; D002755:Choice Behavior; D003479:Curriculum; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D018794:Problem-Based Learning / Q000379:methods*; D000066908:Simulation Training / Q000379:methods*; D013337:Students, Medical / Q000523:psychology*
keywords: Advanced cardiac life support; Choice behavior; Learning; Students; United States