Implementing a Flipped Classroom Model in an Evidence-Based Medicine Curriculum for Pre-Clinical Medical Students: Evaluating Learning Effectiveness Through Prospective Propensity Score-Matched Cohorts

Background: In a flipped classroom (FC) model, blended learning is used to increase student engagement and learning by having students finish their readings at home and work on problem-solving with tutors during class time. Evidence-based medicine (EBM) integrates clinical experience and patient values with the best evidence-based research to inform clinical decisions. To implement a FC and EBM, students require sufficient information acquisition and problem-solving skills. Therefore, a FC is regarded as an excellent teaching model for tutoring EBM skills. However, the effectiveness of a FC for teaching EBM competency has not been rigorously investigated in pre-clinical educational programs. In this study, we used an innovative FC model in a pre-clinical EBM teaching program. Methods FC’s teaching was compared with a traditional teaching model by using an assessment framework of prospective propensity score matching, which reduced the potential difference in basic characteristics between the two groups of students on 1:1 ratio. For the outcome assessments of EBM competency, we used an analysis of covariance and multivariate linear regression analysis to investigate comparative effectiveness between the two teaching models. A total of 90 students were prospectively enrolled and assigned to the experimental or control group using 1:1 propensity matching. Results Compared with traditional teaching methods, the FC model was associated with better learning outcomes for the EBM competency categories of Ask, Acquire, Appraise, and Apply for both written and oral tests at the end of the course (all p-values<0.001). In particular, the “appraise” skill for the written test (6.87±2.20) vs. (1.47±1.74), p <0.001), and the “apply” skill for the oral test (7.34±0.80 vs. 3.97±1.24, p<0.001) had the biggest difference between the two groups. Conclusions After adjusting for a number of potential confunding factors, our study findings support the effectiveness of applying an FC teaching model to cultivate medical students' EBM literacy. Trial registration: This study was approved by the institutional review committees at Taipei Veterans General Hospital (VGHTPE) (IRB No: 2014-11-008B, 2017-01-020AC).