Objective:

To determine whether the preparatory component of a flipped classroom-style simulation curriculum adds benefit in improving knowledge and comfort beyond simulation alone. 

Background:

In the flipped classroom model, learners review preparatory material before active learning. This approach has shown promise in medical and neurology education, but the added value of preparatory materials in simulation-based training remains unclear. We investigated whether providing topic-specific preparatory reading prior to simulation improved knowledge and comfort compared with simulations conducted without topic preparation for neurology residents participating in an acute neurologic emergencies bootcamp.

Design/Methods:

Two independent cohorts of neurology PGY-2 residents participated in simulation scenarios on status epilepticus and elevated intracranial pressure. In cohort 1 (n=13), residents were randomized to receive preparatory reading for one of two scenarios, completing one simulation with and one without topic preparation. In cohort 2 (n=13), residents received either preparatory reading for both scenarios or none. Knowledge (quiz, % correct) and comfort (5-point Likert scale, mean per item) were assessed pre- and post-simulation.

Results:

In cohort 1, knowledge improved significantly when simulations were supported by topic preparation (54% [17] pre vs.  [22] post, p=0.003, Cohen’s d=1.67), but not without preparation (59% [19] vs. 59% [19], p=1.00). Comfort improved significantly overall (3.0 [0.6] vs 3.7 [0.6], p<0.001), with no difference by preparation. In cohort 2, residents with topic preparation had higher knowledge scores than those without (88% [22] vs. 68% [16], p=0.011, Cohen’s d=0.6). Comfort scores were also higher with preparatory material (3.7 [0.4] vs 3.2 [0.5], p=0.045, Cohen’s d=0.96).

Conclusions:

Providing topic-specific preparatory reading reliably enhanced knowledge acquisition beyond simulation alone, while simulation exposure improved comfort even without knowledge gains. Only in one cohort did preparatory reading provide additional comfort benefits. As knowledge and comfort are both critical for performance in acute neurologic emergencies, integrating structured pre-learning into simulation curricula may enhance resident benefit.