In 2010 the Future of Medical Education in Canada (FMEC) report recommended increased exposure to the community.  Expansion into the community created a barrier, in that all seminars for our Anesthesia Clerkship rotation were held centrally. To allow these students equal access, videoconferencing was initiated; however there were often technical problems. There was a need to develop a new platform to deliver the curriculum. The “flipped classroom” has been proposed as a model for delivering medical education, where the learning occurs at home (outside the classroom) and the application of knowledge occurs in the classroom. This was an ideal format to remedy our problem.

A flipped classroom was created where e-modules were used to replace the six core central seminars. Six interactive e-modules were developed, with pre and post module tests embedded within for self-assessment. Faculty were available through a discussion board to answer all e-module related questions.

Two of the six e-modules ( Introduction to Anesthesia and  Team functioning & ACLS)  were required to be completed prior to the introductory Simulation Day (Entry SimDay) held on the second day of the rotation. Content retention was reviewed at the start of entry simulation by use of multiple choice questions answered with i-clickers. Only content that was not globally answered well was reviewed prior to the start of the simulation day, which incorporated the knowledge learnt in the two e-modules.

In keeping with the principles of the flipped classroom, an Exit Simulation Day (Exit SimDay) was developed for the second last day of the rotation. Students working in teams (team based learning TBL) rotated through cases involving preoperative (with standardized patients), intraoperative and postoperative cases (using high fidelity simulation) and were scored as a team based on a checklist performance scale.

The Preoperative Case highlighted risk stratification, communication, preoperative assessment and management of the surgical patient. The Intraoperative case highlighted crisis management, mental practice, closed loop communication and team function in a high stakes environment. The Postoperative case highlighted situational awareness and acute pain management.

This was followed in the afternoon by case based learning (CBL) and a game of Anesthesia Jeopardy to review the e-module content and to allow them to integrate core knowledge.

Four cases (CBL) were developed that mapped to the learning objectives of the other four e-modules. Gaming was a key component with team based scores (checklist score plus Jeopardy). 

Anesthesia Jeopardy

The students compete in teams with subject matter highlighting core curriculum content.

We would like to thank all members of the Undergraduate Education Committee, Department of Anesthesia, University of Toronto for the collective vision and development of both the e-modules and the simulation days.