29 - Flipping the Laboratory: An Effective Approach to Teaching Clinical Neuroanatomy

Poster Board Number: 29
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Abstract Body : Aim
The purpose of this study was to evaluate learning outcomes using a modified flipped classroom instructional strategy in place of traditional neuroanatomy laboratories in a medical school Neuroscience module.

Introduction
Neuroanatomy is a challenging subject for preclerkship medical students to master. It is usually taught using a combination of didactic lectures followed by group-based laboratory instruction, where students examine images of histological sections of the relevant regions of the brain or spinal cord. In this format, the instructor-facilitated laboratory sessions tend to focus heavily on lower-level learning outcomes such as memorization of structure names and structure identification, with less focus on clinical application. We hypothesized that students’ ability to apply neuroanatomy to clinical problem solving would be enhanced through a flipped classroom approach, in which the identification-based learning would be assigned as asynchronous pre-work, followed by an in-class small group session focused on the application of neuroanatomical knowledge to neurologic localization. In this study, we quantitatively compared learning outcomes from this flipped classroom approach with outcomes from the traditional instructional method.

Approach
Two image-based neuroanatomy laboratories, one on Spinal Cord and one on Medulla, were converted to “flipped laboratories”. For the pre-work, students were given interactive slide sets containing labeled images of myelin-stained sections through the spinal cord or medulla, along with a checklist of structures that they were expected to be able to identify. The follow-up, in-class activities were carried out in small-group format. Groups of 4 students (3 groups per room) were given three clinical vignettes to work through in order to apply their neuroanatomical knowledge. Faculty facilitators included an anatomist and a neurologist in each room. For the present study, student performance on practical and written exam questions was compared for sessions taught with the flipped approach versus the traditional approach from the previous year, using ANOVA and t-tests.

Results
Learner satisfaction with the asynchronous teaching materials and the small group sessions themselves was high, with > 80% of students reporting that they found this instructional method to be helpful for learning anatomy. Student performance on identification-based practical exam questions related to the flipped laboratory content was not significantly different from previous years, indicating that students were able to accomplish the lower-level learning objectives through asynchronous learning. Performance on application-based written exam questions improved following implementation of the flipped laboratory approach. This improvement was statistically significant for questions related to lesion localization in the medulla.

Discussion
We found that the “flipped laboratory” approach was an effective, well-received instructional method for neuroanatomy in a medical school curriculum. This approach could easily be extended to other aspects of the medical curriculum that include components of image-based structure identification, such as histology and radiology.

The opinions expressed here are those of the author and do not necessarily reflect the official position of the Uniformed Services University or the Department of Defense. The author has no conflicts of interest to declare.