Teaching medical undergraduates Skills for Eye Examination: Is Flipped Classroom with Mental Rehearsal as Effective as Face-to-Face Teaching?

Introduction: The quality of face-to-face teaching (F2FT) of eye-examination is often suboptimal amidst busy clinics as it demands faculty time for teaching and feedback. Flipped Classroom (FC) and Mental Rehearsal (MR) are established methods to teach clinical skills. A learning module (Supplementary Clinical Ophthalmology Preparatory E-learning [SCOPE]) that combines FC and MR may address this practical problem. This quasi-experimental study compared the efficacy and Faculty Contact Time of SCOPE against F2FT in teaching fourth-year medical undergraduates eye-examination.

Method: The SCOPE group (n = 95) received the same content as F2FT but delivered in deliberate sequence: e learning (instructional videos and Video Modelling Examples), followed by structured, audio guided MR, then face-to-face practice with feedback. The F2FT group (n = 51) learned in a single face-to-face session with live faculty demonstration and Video Modelling Examples, without instructional videos or MR.

Results: Baseline pre-intervention mean Multiple Choice Questions (MCQ) scores were comparable (22.31 versus 22.24, independent t-test, p = .94). Post-learning cognitive assessments found the SCOPE group to have greater gain in total MCQ scores with higher estimated marginal means (p < .001), and higher mean End-of-Rotation Test scores (43.37 versus 40.85, independent t-test, p = .048). On psychomotor assessments, the SCOPE group had superior Micro-CEX performances (three skills, all p < .001, Fisher’s Exact test). SCOPE also shortened Faculty Contact Time, saving on average 57.48 minutes (p < .001, independent t-test).

Discussion: SCOPE improved psychomotor and cognitive performances, and was more faculty time-efficient than F2FT in teaching eye examination skills. These positive results may be attributed to the synergistic effects of its multiple learning components. SCOPE, which combined FC and MR, may better facilitate clinical skill development through deliberate practice than F2FT.