title: Flipping the Continuing Medical Education Classroom: Validating a Measure of Attendees' Perceptions.
abstract: New teaching approaches for CME are needed. In flipped classrooms, coursework is completed beforehand and applied during class time. Studies of flipped classrooms and their potential benefits in CME have not been published. We sought to develop and validate an instrument measuring flipped classroom perceptions, identify whether participation changed perceptions, and determine which flipped classroom components were perceived as most effective.
  
  
  
  In this cross-sectional validation study, 167 participants in the Mayo Clinic's 2015 Internal Medicine Board Review course received surveys. Online modules were developed to deliver content before flipped classroom courses on acid-base disorders and electrolyte disorders. A flipped classroom perception instrument (FCPI) was developed and validated. The FCPI, with eight items structured on 5-point Likert scales, was given to participants before and after their flipped classroom experiences.
  
  
  
  Of the 167 participants, 111 returned surveys. Flipped classroom perceptions improved, with mean (SD) FCPI scores increasing from 3.74 (0.75) to 3.94 (0.76) (P < .001). The percentage of participants who preferred flipped classrooms increased from 38% before the course to 53% after (P = .002). Positive changes in FCPI scores were unrelated to module completion. Most participants thought knowledge was enhanced by in-class sessions and online modules equally.
  
  
  
  The FCPI, the first validated measure of participants' perceptions of a CME flipped classroom, has strong validity evidence. Participants' perceptions of and preference for the flipped classroom improved after experiencing the flipped CME classroom. These findings support the need to further explore flipped classroom models in CME.
authors.affiliation: Dr. Stephenson: Assistant Professor of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN. Dr. Wang: Assistant Professor of Medicine, Division of General Internal Medicine, Harbor University of California Los Angeles, Torrance, CA. Dr. Szostek: Assistant Professor of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN. Dr. Bonnes: Assistant Professor of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN. Dr. Ratelle: Assistant Professor of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN. Ms. Mahapatra: Assistant Professor of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN. Dr. Mandrekar: Professor of Biostatistics and Neurology, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. Dr. Beckman: Professor of Medicine and Education, Division of General Internal Medicine, Mayo Clinic, Rochester, MN. Dr. Wittich: Associate Professor of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Stephenson
authors.forename: Amy T
authors.initials: AT
authors.lastname: Wang
authors.forename: Jason H
authors.initials: JH
authors.lastname: Szostek
authors.forename: Sara L
authors.initials: SL
authors.lastname: Bonnes
authors.forename: John T
authors.initials: JT
authors.lastname: Ratelle
authors.forename: Saswati
authors.initials: S
authors.lastname: Mahapatra
authors.forename: Jayawant N
authors.initials: JN
authors.lastname: Mandrekar
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Beckman
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Wittich
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards; D003430:Cross-Sectional Studies; D003479:Curriculum / Q000592:standards; D004502:Education, Medical, Continuing / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D010820:Physicians / Q000523:psychology*; D011795:Surveys and Questionnaires; D013663:Teaching / Q000592:standards*