Flipping the Quality Improvement Classroom in Residency Education.
The flipped classroom (FC), in which instructional content is delivered before class with class time devoted to knowledge application, has the potential to engage residents. A Mayo Clinic Internal Medicine Residency Program study was conducted to validate an FC perception instrument (FCPI); determine whether participation improved FC perceptions; and determine associations between resident characteristics, change in quality improvement (QI) knowledge, and FC perception scores.



All 143 internal medicine residents at Mayo Clinic, Rochester participated from 2014 to 2015; some experienced a flipped QI curriculum and others completed the traditional nonflipped course. The FCPI was developed, and factor analysis revealed an intuitive two-factor structure: preclass activity and in-class application. Residents were surveyed before and after the monthlong curriculum to measure changes in perception, and the QI Knowledge Assessment Tool was employed to measure knowledge improvement.



Postcourse FCPI scores significantly increased for three of the eight items. QI knowledge increased significantly among residents who experienced the FC compared with residents who completed the non-FC curriculum. Those without prior FC exposure demonstrated a significant increase in QI knowledge compared with those with previous FC experience. The FCPI had compelling validity evidence with improved scores after curriculum exposure and associations with greater engagement in online modules.



Residents who participated in the FC demonstrated improved QI knowledge compared with the control group. Residents valued the in-class application sessions more than the online component. These findings have important implications for graduate medical education as residency training programs increasingly use FC models.
S.L. Bonnes is senior associate consultant, Division of General Internal Medicine, Mayo Clinic, and assistant professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. J.T. Ratelle is senior associate consultant, Division of Hospital Internal Medicine, Mayo Clinic, and assistant professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. A.J. Halvorsen is a statistician, Division of General Internal Medicine, Mayo Clinic, and assistant professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. K.J. Carter is assistant professor of general and geriatric medicine, University of Kansas Medical Center, Kansas City, Kansas. L.T. Hafdahl is senior associate consultant, Division of Primary Care Internal Medicine, Mayo Clinic, and instructor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. A.T. Wang is assistant professor, Division of General Internal Medicine, Harbor-UCLA Medical Center, Torrance, California. J.N. Mandrekar is consultant, Division of Biomedical Statistics and Informatics and Division of Behavioral Neurology, Mayo Clinic, and professor of biostatistics and neurology, Mayo Clinic College of Medicine, Rochester, Minnesota. A.S. Oxentenko is consultant, Division of Gastroenterology and Hepatology, Mayo Clinic, and associate professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. T.J. Beckman is consultant, Division of General Internal Medicine, Mayo Clinic, and professor of medical education and medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. C.M. Wittich is consultant, Division of General Internal Medicine, Mayo Clinic, and associate professor of medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
Sara L
SL
Bonnes
John T
JT
Ratelle
Andrew J
AJ
Halvorsen
Kimberly J
KJ
Carter
Luke T
LT
Hafdahl
Amy T
AT
Wang
Jayawant N
JN
Mandrekar
Amy S
AS
Oxentenko
Thomas J
TJ
Beckman
Christopher M
CM
Wittich
D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008910:Minnesota; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D013663:Teaching