Effects of flipped classroom teaching in anaesthesiology residents: a protocol for systematic review and meta-analysis

Strengths and limitations of this study

  • Subgroup analysis and meta-regression will be conducted to explore the source of heterogeneity, which will determine the influence of different factors on the effects of the flipped classroom teaching model on anaesthesiology residents.

  • The Grading of Recommendation, Assessment, Development and Evaluation approach will be used to assess the quality of evidence for each outcome.

  • High heterogeneity might exist among the included studies due to many factors, such as study region, learning content, outcome assessment criterion and educational level.

Introduction

The flipped classroom teaching model, first proposed in 1984 by Nechkina,1 is widely used for medical education. The flipped classroom moves the teaching of knowledge to the preclass and promotes active and self-directed learning from traditional passive approaches, which aim to improve analytical and integrated abilities, critical thinking skills and teamwork awareness in students.2 Current evidence demonstrates that the flipped classroom has advantages, mainly including higher theoretical knowledge scores and skill scores, over traditional teaching methods in various disciplines, such as nursing,3 radiology,4 pharmacy,5 neurophysiology,6 emergency,7 dermatology,8 cardiology9 and neurosurgery.10 Recently, an increasing number of studies have proposed and investigated the efficacy of the flipped classroom teaching model in anaesthesiology education, which also needs to provide extensive internal and surgical knowledge.11–19 However, a systematic review and meta-analysis has not yet been conducted to determine the effectiveness of the flipped classroom teaching model among anesthesiology residents. Therefore, we aim to perform a protocol of systematic review and meta-analysis to explore whether the flipped classroom teaching model has advantages over traditional methods in terms of theoretical knowledge and skill scores for anaesthesiology residents, which will provide evidence for flipped classroom use for residents’ education in anaesthesiology. Additionally, we will conduct a subgroup analysis according to the heterogeneity among studies to explore the influence of different factors on the effects of the flipped classroom teaching model.

Methods and analysis

This protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO; ID: CRD42024497935) and was developed according to the Preferred Reporting Items for Systematic Evaluation and Meta-Analysis Protocols. Ethical approval is not applicable.

Search strategy

Seven databases, including PubMed, Web of Science, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure, Wanfang Data, and the VIP database, will be systematically searched from their inception to 1 June 2024, with language restrictions to English or Chinese. The anticipated start date and completion date will be 1 June 2024 and 25 December 2024, respectively. The key search terms will include ‘flipped classroom OR flipped teaching OR inverted classroom OR inverted teaching’, ‘anesthesiology OR anaesthesiology’ and ‘randomised controlled trials’ (RCTs). The detailed search plan for all databases is shown in online supplemental file 1. Additional studies will be identified via manual searches on websites such as Google or by reviewing the citation lists of the relevant articles.

Supplemental material

Inclusion and exclusion criteria

The included studies should meet the following criteria: (1) study design: RCTs; (2) language: English or Chinese; (3) participants: anaesthesiology residents; (4) comparisons: flipped classroom teaching model versus traditional methods, and (5) primary outcomes: theoretical knowledge scores and secondary outcomes: skill scores and the proportion of anaesthesiology residents who preferred the flipped classroom model. Skill scores will be evaluated based on common skill levels in anaesthesia, such as mask ventilation, tracheal intubation, intravenous cannulation procedures and spinal or epidural blocks. Studies that reported at least one of the abovementioned outcomes will be included. Retrospective studies, systematic reviews and meta-analyses, reviews, comments, letters, case reports and conference abstracts will be excluded.

Study selection

Two authors (DZ and JX) will independently read the titles and abstracts of the identified studies through the initial search. Then, the full texts of the included studies will be reviewed for inclusion in this meta-analysis. Disagreements will be discussed with a third author (YW). The flowchart for study selection is shown in figure 1.

Figure 1
Figure 1

The flowchart for study selection.

Data extraction

Two authors (DZ and JX) will independently extract the following information from the included studies: publication date, countries, participants’ age and gender, educational levels, intervention measures, duration of intervention, sample size of each group and outcomes. Disagreements will be discussed with a third author (YW).

Risk of bias assessment

Two authors (DZ and JX) will independently assess the risk of bias using the Cochrane Collaboration tool, which contains the following items: (1) selection bias: random sequence generation and allocation concealment; (2) performance bias: blinding of participants and personnel; (3) detection bias: blinding of outcome assessment; (4) attrition bias: incomplete outcome data and (5) reporting bias: selective reporting. The results for each item will be graded as ‘low’, ‘high’ or ‘unclear’. Disagreements will be discussed with a third author (YW).

Statistical analysis

Statistical analysis will be performed using RevMan V.5.4 software. Continuous variables will be summarised as mean differences with 95% CIs, while dichotomous variables will be presented as risk ratios with 95% CIs. The I2 test will be used to determine the statistical heterogeneity. According to the statistical heterogeneity, we will synthesise the data either by a fixed-effect model (I2<50%) or by a random-effect model (I2>50%). Subgroup analysis and meta-regression will be used to identify the source of heterogeneity if I2 is >50%. Sensitivity analyses will be further conducted to assess whether the pooled results are reliable. A p value of <0.05 indicated statistical significance. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach will be applied to assess the quality of the evidence for each outcome.

Patient and public involvement

None.

Ethics and dissemination

Ethical approval is not required for this protocol. We will submit the results to a peer-reviewed journal when finished.

Discussion

Currently, several meta-analyses have provided synthesised evidence that the flipped classroom teaching model is superior to traditional methods for education in various disciplines.3–5 20–24 An increasing number of studies have recently investigated the effects of the flipped classroom teaching model on anaesthesiology residents. However, no systematic reviews or meta-analyses are currently available; therefore, we aim to perform this protocol of systematic review and meta-analysis to determine whether the flipped classroom teaching model is better than traditional methods in education for anaesthesiology residents. Several limitations should be considered. First, high heterogeneity might exist among the included studies because of differences in the study region, study duration, learning content, outcome assessment criterion, skill performance type and educational level. Therefore, subgroup analysis and meta-regression will be conducted to explore the source of heterogeneity and determine the influence of different factors on the effects of the flipped classroom teaching model on anaesthesiology residents. Second, the number of included RCTs and the sample size might be relatively small, which will influence the reliability of the pooled results; therefore, we will use the GRADE approach to assess the quality of evidence for each outcome. Finally, we will only include studies written in English or Chinese, which can cause a high publication bias.

Ethics statements

Patient consent for publication

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