Evaluation of a flipped classroom approach to undergraduate neurology medical education in Zambia

Abstract

Background: Countries in sub-Saharan Africa, including Zambia, have few neurologists, and neurophobia is common amongst medical trainees. While neurology teaching initiatives and training programs are growing in the region, innovative teaching methods are needed to improve neurology knowledge, reduce neurophobia, and encourage medical students to pursue careers in neurology. Furthermore, studies formally evaluating the effectiveness of different neurology teaching methods are needed.

Methods: Fifth and seventh year undergraduate medical students on their internal medicine clinical clerkship were randomized by clerkship group (i.e. all students completing the clerkship in a given time period were randomized together) to either a traditional lecture or flipped classroom curriculum for delivery of the neurology content of their clerkship. In the traditional classroom arm, students attended in-person neurology lectures and accessed corresponding clinical case presentations online. In the flipped classroom arm, students watched pre-recorded neurology lectures, and class time was dedicated to interactive small group review of clinical cases. Students completed anonymous pre- and post-course surveys consisting of knowledge assessments, self-reported confidence in diagnosing/managing neurologic disorders, neurophobia surveys, and course satisfaction surveys. Pre-and post- course score differences and differences in change scores were compared between instructional models along with quantified effect sizes.

Results: In total, 263 fifth year students (100 traditional, 163 flipped) and 99 seventh year students (48 traditional, 51 flipped) had complete data and were included in final analysis. A greater increase in knowledge assessment scores was observed in both the fifth and seventh year flipped classroom groups compared to the traditional groups (p < 0.01 for both). Both fifth and seventh year students in the flipped classroom groups also demonstrated a greater increase in confidence diagnosing and managing common neurologic conditions compared to students in the traditional groups. Flipped classroom students in both year groups reported significantly greater course satisfaction, effective learning, course participation, and course collaboration. Neurophobia scores significantly decreased only in the fifth year flipped classroom group.

Conclusions: A flipped classroom approach improved neurology knowledge, confidence diagnosing/managing neurologic disorders, and course satisfaction in Zambian medical students compared to traditional lectures. The flipped classroom approach may represent a promising pedagogical model for improving neurology education in similar resource-limited settings with few neurologists.

Keywords: Education; Flipped classroom; Medical student; Zambia.