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ORIGINAL ARTICLE
Year : 2022  |  Volume : 20  |  Issue : 4  |  Page : 220-224

Introducing flipped classroom to teach basic life-support to first-phase MBBS students in a Medical College of West Bengal


1 Department of Physiology, Burdwan Medical College, Burdwan, West Bengal, India
2 Department of Anatomy, Burdwan Medical College, Burdwan, West Bengal, India
3 Department of Psychiatry, Dr. D. Y. Patil Medical College and Research Institute, Pune, Maharashtra, India

Date of Submission18-Apr-2022
Date of Decision24-Jun-2022
Date of Acceptance26-Jun-2022
Date of Web Publication17-Oct-2022

Correspondence Address:
Dr. Arunima Chaudhuri
Krishnasayar South, Borehat, Burdwan - 713 102, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_43_22

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  Abstract 


Introduction: Basic life support (BLS) consists of a number of medical procedures provided to patients with life-threatening conditions of the body and there exists a significant lack of knowledge regarding the signs and risk factors associated with serious medical conditions among medical students. The present study was conducted to evaluate a module for teaching BLS to first MBBS students using the flipped classroom method. Methodology: The present study was conducted among first-phase MBBS students after taking institutional ethical clearance and informed consent of participants. Students of 2021–2022 were included in a WhatsApp group and YouTube videos were posted on the group where demonstrations of BLS were done and the importance of learning cardiopulmonary resuscitation was discussed. Students were then divided into groups of twenty and each group was asked to make a PowerPoint presentation which they had to present in live sessions and demonstrate the procedure. Students joined an online BLS Certification Course. Feedback was taken from students and faculty members and a program evaluation at Kirkpatrick's level 1 was done. Results: Two hundred students participated in the study. The mean ± standard deviation of marks obtained by students in the certification program was 87.67 ± 5.87 and posttest scores were significantly better as compared to pretest scores. Students and faculty members were satisfied with the program. Conclusions: The BLS module introduced in the Foundation Course using the flipped classroom at the beginning of the first phase of the MBBS course enabled the students to acquire the basic knowledge and skills required.

Keywords: Basic life support, flipped classroom, foundation course, self-directed learning


How to cite this article:
Chaudhuri A, Ghosh T, Saldanha D. Introducing flipped classroom to teach basic life-support to first-phase MBBS students in a Medical College of West Bengal. Curr Med Issues 2022;20:220-4

How to cite this URL:
Chaudhuri A, Ghosh T, Saldanha D. Introducing flipped classroom to teach basic life-support to first-phase MBBS students in a Medical College of West Bengal. Curr Med Issues [serial online] 2022 [cited 2022 Dec 3];20:220-4. Available from: https://www.cmijournal.org/text.asp?2022/20/4/220/358641




  Introduction Top


To manage competently common emergencies every medical student and graduate should possess basic knowledge of emergency care and the skills necessary for dealing with these situations. Adequate education in basic life support (BLS) should be considered an essential aspect of the medical curriculum. BLS consists of a number of medical procedures provided to patients with life-threatening conditions of the body, and all these techniques are focused on helping patients sustain life until more precise medical treatment can begin. These medical techniques refer to the initial assessment, airway maintenance and ventilation, breathing, circulation, and chest compression, consisting of a few steps that must be followed.[1]

The competency-based medical education (CBME) curriculum has been introduced with several pathbreaking reforms in 2019 and best practices like the Foundation course in Phase-I MBBS. BLS has been included in the foundation course. Implementation of the Foundation course requires trained faculty, adequate resources, appropriate pedagogical methods, and active participation of all stakeholders. Expected learning outcomes have been defined by the council. Although the faculty members have been trained in the implementation of CBME, there is no structured program to evaluate the implementation process of the Foundation course. Evaluation of the implementation process of the Foundation course becomes necessary to assess the extent of utilization of resources. It should also reflect the perspectives of stakeholders regarding the strengths, weaknesses, enablers, and barriers in the implementation process of the Foundation course.[2],[3],[4],[5]

The Foundation provides an opportunity to enhance their communication, language, and computer skills and inculcates ethical practices. BLS is an essential skill that 1st-year students need to acquire. Becoming competent in this skill may help young medical students to save lives in cases of emergencies as well as motivate them to teach this skill to people in their community.[1],[6]

The goal of CBME is to produce competent Indian Medical Graduates with five roles: Clinician, communicator, professional, leader, and lifelong learner. To become lifelong learners, students need to develop self-directed learning (SDL) skills. SDL is a process, in which students usually take initiative and responsibility for their own learning.[7],[8],[9],[10],[11] The knowledge and practice of medicine are ever changing, and it is essential for physicians to continuously learn new information and refine their skills throughout their careers.[7],[8],[9],[10],[11]

Effective SDL requires training and is now a focus of our medical education system. Medical educators need to have a deeper understanding of the concepts of SDL as well as the methodological approaches and ability to measure outcomes of SDL, to better prepare and maintain the skills of the physician workforce to meet the needs of patients and society now and in the future, and to support careers that will span across many decades. There are different methods that can be implemented in medical schools for imparting SDL skills among medical students.[7],[8],[9],[10],[11]

Self-direction can be learned as well as taught. New medical students need specific guidance and feedback to motivate them toward SDL; this is not consistent with the philosophical basis of SDL. This may lead to inconsistency among teachers in the facilitation of this process. The initial responsibility of a facilitator of learning is to help students develop competence as self-directed learners.[12],[13] The flipped classroom is considered an essential component in curricular reform and can help students to develop SDL skills. Technological advances and online medical education have enabled asynchronous and distributed learning and facilitated the movement to a competency-based paradigm in healthcare education. The students are provided with didactic material before the class in asynchronous sessions. In the synchronous sessions more engaging and active learning strategies are further used.[14],[15],[16],[17]

Understanding BLS courses and practicing these techniques is a challenging task. BLS techniques need to be acquired as soon as possible in medical school as their core meaning is that of saving a life, the main motivating force behind medical students choosing this career.[1] The present study was conducted in a peripheral medical college in Eastern India to teach BLS to first MBBS students using the flipped classroom method and evaluate learning outcomes through direct observation of performance on manikins and certification.


  Methodology Top


Study period

The present study was conducted for 2 months among first-phase MBBS students of Batch 2021–2022.

Study design, and ethical considerations

This interventional pilot study was conducted after taking Institutional Ethical Clearance (Memo No.BMC/I.E.C./248; Dated: June 7, 2021) and written informed consent of the participants.

Inclusion criteria

Two hundred students of Phase-I MBBS of batch 2021–2022 admitted in a peripheral government medical were included in the present interventional study.

Study settings

The study was conducted in the department of physiology and eight faculty members participated in the study.

A module was developed for the teaching–learning program and two faculty sensitization programs were conducted with the help of the Medical Education Unit of the Institution. Lesson plans were prepared and prevalidated. The feedback questionnaire was prepared by senior faculty members of the department of physiology and item analysis and Content Validity Index were calculated. Interpretation of I-CVI: I-CVI >79% item was considered appropriate.

All students of the 2021–2022 batch of the institution were included in a WhatsApp group and a pretest was conducted to assess their basic knowledge. Information was taken from the students regarding their exposure to any course on BLS. As there were no students who already had exposure to the BLS course beforehand before this course so no students were excluded from the study.

YouTube videos were posted in the group where demonstrations of BLS were done and the importance of learning cardiopulmonary resuscitation was discussed in detail. A live session was arranged to clear the doubts of the students. This lasted only for 30 min and was interactive in nature.

Students were then divided into batches of twenty and ten such groups were formed according to the college roll numbers allotted to them. Each group was asked to make a PowerPoint presentation which they had to present in live sessions in 15 min. Followed by this they had to demonstrate the cardiopulmonary resuscitation (CPR) procedure. When one student performed the maneuver all other students of the same group watched it and helped to correct mistakes committed by their classmates. The faculty members only participated as facilitators of learning and encouraged active participation from the students. It was assured by the faculty members that all students were able to demonstrate the procedure with adequate competency. A learner was assessed by facilitators during the synchronous sessions with the help of a checklist developed for the purpose. The checklist included components such as (1) initiation, (2) communication, (3) critical thinking, and (4) resources: finding and sharing, (5) teamwork: responsibilities and respect for others, and (6) overall involvement.

After 10 such sessions were completed the students were asked to join BLS Certification Course available at https://nhcps.com/cpr-first-aid-online-certification-renewal/using a free link provided by facilitators. https://nhcps.com/share-friends/?mtke = 80.

All faculty members who participated in this study had to get certified in this course first, with this knowledge they could guide the students better in their learning process.

The content contained is based on the most recent International Liaison Committee on Resuscitation publications on BLS. Recommendations for adult BLS from the 2020 Guidelines for CPR and emergency cardiac care included the following:

  • The importance of early initiation of CPR
  • The risk of harm to the patient is low if the patient is not in cardiac arrest. Importance to start CPR even if bystanders are not sure whether the victim is breathing or in cardiac arrest
  • Chains of Survival for both pediatric and adults
  • Care of the patient after the return of spontaneous circulation requires close monitoring of oxygenation, blood pressure control, evaluation for percutaneous coronary intervention, targeted temperature management, and multimodal neuroprognostication
  • After a resuscitation, debriefing for lay rescuers, EMS providers, and hospital-based healthcare workers may be beneficial to support their mental health and well-being
  • Management of cardiac arrest in pregnancy.


The BLS Certification Examination required a passing score of 80% before receiving a Certification and the validity of the certificate is for 3 years.

After completing the course, the students had to appear for the examination in a live session arranged by the department of physiology of the institution. Feedback was taken from the students and faculty members after the completion of the program. Students were also asked to write reflections. Before writing reflection, a session was conducted to make them aware of the importance of writing reflection, and the differences between writing a reflection and a narrative were explained.

A program evaluation at Kirkpatrick level 1 was done with the purpose to determine the satisfaction of the learners with the course offered.

Statistical analysis

Jamovi software available free online was used for the analysis of data.


  Results Top


Two hundred first-phase MBBS students of Batch 21–22 participated in the study. One hundred and forty-four were male students and 66 were female students. In the pretest scores were 45.69 ± 12.8. All students passed the certification examination which had a cut-off mark of a minimum of 80%. The mean ± standard deviation of Marks obtained by students in the certification program was 87.67 ± 5.87 [P < 0.0001** highly significant, [Table 1]]. 112 (56%) were very satisfied, 87 (43.5%) were satisfied and 1 (0.5%) was not satisfied with the teaching–learning process. One hundred and ninety-nine students were satisfied with the support provided to them by faculty members during this course. One hundred and three (51.5%) students were interested in studying physiology, 93 (46.5%) were interested in anatomy, and 4 (2%) were interested in Biochemistry (P < 0.00001 [Chi-square test]). One hundred and forty six (73%) had difficulties in studying Anatomy, 40 (20%) had difficulties in studying biochemistry, and 14 (7%) students had difficulties with studying physiology (P < 0.00001 [Chi-square test]) [Table 2]. Students were highly satisfied with the program as per program evaluation at Kirkpatrick level 1 done with the purpose to determine the satisfaction of the learners with the course offered [Table 3].
Table 1: Comparison of pretest and posttest scores

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Table 2: Opinion of students regarding interest in subjects and difficulties

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Table 3: Program evaluation: Kirkpatrick model (Level I)

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Faculty members were satisfied with the performance of the students but it required much more involvement and time on behalf of the faculty members to facilitate learning with this module. This module helped them to enhance their interactions with the new students and helped in building up bonding with students. They also were motivated to use such modules in teaching other topics in the future.

Some of the important feedback received from the students were as follows

  • It was such a nice, new and innovative experience. Being medical students, this was their first learning apart from course books that gave them a feeling that they could help someone in need. They were motivated to make the best use of this knowledge in serving mankind. As a medico, their motto is obviously to apply this learning experience when needed and also to spread their knowledge among other people. This course helped them to learn a very important life-saving skill
  • Sharing this knowledge can exponentially increase the chance of survival of numerous people who lose their life because the general public does not know BLS techniques
  • According to their opinion, this should be learned by everyone and not only doctors. They wanted to teach this to all their nonmedical friends and try to save a life in circumstances when needed by trying the best of their knowledge
  • Learning BLS was both an important and fun class, it was one of the most practical medical things that could be performed to save lives. Students learned about what to do in an emergency situation when a patient goes into sudden cardiac arrest and how to provide BLS
  • It was a completely different learning experience. So far, they had only seen people giving CPR in movies. However now, they are aware of how to perform CPR and are certified also
  • Making the presentation and contributing to it was a great learning experience. They learned a lot about CPR now and know what to do in situations where BLS is required and also wished to learn more about these courses in the future
  • Students felt that this will help them in their entire medical carrier during certain life-threatening emergencies. This course was a very new and interesting experience for them. This BLS course can save lives and so it is important for people to learn about this and ultimately help other people. This BLS course will be very helpful in case someone is needed to be helped. The students felt that it was a very good practical learning experience for the first time in their medical journey and many more to learn.
  • They felt that it is necessary to also add BLS as a requirement of the care certificate that all health-care workers must complete as part of their induction training
  • It was a good experience on part of the students to get such a certificate and they stated that they will be always eagerly waiting to learn this method and get certified in different skills.
  • Students felt that this learning experience was the first step toward clinical exposure and a learning experience that can be applied to save someone's life and they would like to participate in other similar courses.



  Discussion Top


The revised undergraduate medical curriculum “Competency-based Medical Education” was introduced in 2019 and the foundation course is a part of the new curriculum.[2],[3],[4],[5] The present study was conducted on 200 newly admitted first-phase MBBS students of Batch 2021–22. BLS was taught to the students using a flipped classroom module and all students were certified. All students could get a minimum of 80% marks for being certified and were satisfied with the teaching–learning method. This module also helped them to develop SDL skills and facilitated collaborative learning. Facilitators were satisfied with the performance of the students.

Velusami et al.[18] conducted a study to evaluate the outcomes of a 1-month foundation course among 150 first-phase MBBS students of the batch 2019–2020. Feedback was received from the faculty members and students. A summative approach to the qualitative content analysis was performed. The sessions on learning styles, SDL, communication skills, medical ethics, soft skills, and orientation to health systems in India reflected good consensus. This indicated that these sessions were well received by the new MBBS students. As per the faculty perception, good coordination, teamwork, and proper planning at interdepartmental and intradepartmental levels were the key features for the successful implementation of the program. Both students and faculty members felt that sessions should be more interactive. The main strength of the course was the skill module. We implemented a skill module and tried to develop SDL skills among students of batch 2021–2022 in the present study. As per feedback from faculty and students, our module was well received by students. Our module was interactive and we had planned all sessions well ahead of time. Coordinated teamwork, proper planning, and cooperation among the faculty members were the key factors for the successful implementation of this program.

A study was conducted by Renuka Devi MR et al in 2021[19] to evaluate the students' feedback on the foundation course introduced by the Medical Council of India. One hundred and fifty students of the First MBBS batch participated in the study. Feedback was obtained using a questionnaire. About 97.6% of the students stated that they benefitted from this foundation program and got well oriented toward the health policies of the country, integrity, patient care, ethics and attitude, revised curriculum, and new environment. In the present study also, students were highly satisfied with the teaching–learning module.

The students were more interested to learn physiology as compared to other subjects and they also had fewer problems in learning the subject. We have implemented Flipped classroom in the Department of Physiology and we try to make live sessions interactive and help the students to solve problems. We are trying to motivate students to develop SDL skills. This may be a probable cause of the feedback given by students. Other departments of our institution have not introduced flipped classrooms in teaching–learning modules to date. Hence, the comparison of the opinion of students regarding different departments was taken into consideration in this study as we are trying to motivate other departments to introduce flipped classrooms in their teaching–learning modules.

Limitations and future scope

The main difficulty in introducing such interactive modules in our Institution is the lack of adequate faculty members and motivation of faculty members as these interactive modules require more involvement of faculty members and more time which needs to be taken as extra classes in addition to scheduled duties. We will try to teach Ethics, Professionalism, and Leadership skills to students using a similar approach.


  Conclusions Top


The BLS module introduced in the Foundation Course using the Flipped classroom at the beginning of the first phase of the MBBS course enabled the 1st- year students to acquire the basic knowledge and skills required for all the subsequent phases in the medical course and later on their medical practice and career.

Research quality and Ethics Statement

All authors of this manuscript declare that this scientific study is following standard reporting guidelines set forth by the EQUATOR Network. The authors ratify that this study required Institutional Review Board/Ethics Committee review, and hence prior approval was obtained from IRB Memo No.BMC/I.E.C./248; Dated: June 7, 2021. We also declare that we did not plagiarize the contents of this manuscript and have performed a Plagiarism Check with free software available online at small tools.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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