title: Flipping the classroom: Case-based learning, accountability, assessment, and feedback leads to a favorable change in culture.
abstract: The 88-week Thoracic Surgery Curriculum is challenging to implement because of the large content in a traditional lecture format. This study investigates flipping the classroom by using a case-based format designed to stimulate resident preparation and engagement.
  
  
  
  The didactic conference format was altered. Curricular reading assignments, case review, and conference participation prepared residents for novel formative assessment quizzes. Ten residents participated, and faculty served as controls. Scores were compared with the use of linear regression adjusted for clustering of responses for each person. A survey was administered to determine impressions of this educational technique.
  
  
  
  A majority of residents completed curricular readings (82%) and reviewed case presentations (79%). Resident performance initially lagged behind faculty but exceeded faculty performance by the conclusion (interaction P = .047). Junior resident overall performance was superior to senior residents over the entire analysis (P = .026); however, both groups improved over time similarly (P = .34) Increased reading from the curriculum (5% increase per level, P = .001) and case presentation review (6% increase per level, P < .0001) were associated with improved quiz performance. Residents presenting cases at their session performed no better than other quiz-takers for the same session (P = .38). The majority of residents viewed this method favorably.
  
  
  
  This method stimulated increased resident participation and engagement in this pilot study. Assessment scores increased at both resident levels, and resident performance exceeded faculty performance with time. By using experiential learning principles, flipping the classroom in this manner may improve educational culture by enhancing accountability, assessment, and feedback.
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash. Electronic address: mokadamn@uw.edu.
authors.forename: Nahush A
authors.initials: NA
authors.lastname: Mokadam
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Wash.
authors.forename: Todd F
authors.initials: TF
authors.lastname: Dardas
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Hermsen
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Pal
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Mulligan
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors.forename: L Myria
authors.initials: LM
authors.lastname: Jacobs
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Wood
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Verrier
mesh_terms: D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D004522:Educational Status; D005246:Feedback; D006801:Humans; D007396:Internship and Residency; D010865:Pilot Projects; D018794:Problem-Based Learning / Q000379:methods*; D011446:Prospective Studies; D066231:Surgeons / Q000193:education* / Q000523:psychology; D013663:Teaching
keywords: curriculum; motivation; pilot projects; problem-based learning; thoracic surgery