Hybridizing video-based learning with simulation for flipping the clinical skills learning at a university hospital in Pakistan

Background: While learning and practicing on actual patients is a major mode of teaching clinical skills, concerns about patient safety, unavailability, and lack of standardization have led to the development of simulation for medical education. Simulation-based teaching is affected by challenges such as lack of protected time for faculty, inexperienced learners, and the number of students per group. These have led to the integration of various eLearning formats in the curriculum. The hybridized format changes the traditional clinical skills teaching into the flipped classroom. This study aims to measure the effectiveness of hybridizing video-based learning with simulation for flipping the clinical skills teaching of fourth-year medical students at the Department of Paediatrics and Child Health at Aga Khan University, Pakistan.Methods: The study employed a mixed-methods design. Fourth-year medical students of the batch 2020-21 (n = 100) consented to participate in the study. The quantitative component focuses on identifying the effect of the intervention on the perceived self-efficacy of medical students (batch 2020-21) relevant to the clinical skill. Along with this, the performance of the intervention batch of 2020-21 on the end of clerkship objective structured clinical exam (OSCE) was compared with the previous batch of 2019-20, taught using simulation alone. Focused group discussions (FGDs) were used to explore the experiences of medical students (batch 2020-21) about the intervention. Quantitative data underwent descriptive and inferential analysis using Stata v16 while qualitative data underwent content analysis using NVivo software.Results: Hybridization of video-based learning with simulation significantly improved self-efficacy scores for all examinations (cardiovascular, respiratory, neurological, and abdomen) with p-value \u3c 0.05. OSCE scores of the intervention group were significantly higher on the neurological and abdominal stations as compared to the previous batch (p-value \u3c 0.05). In addition, the overall structure of the intervention was appreciated by all the students, who stated it allowed reinforcement of basic concepts, retention, and further insight into clinical applications.Conclusion: The hybridization of video-based learning with simulation facilitated in creation of better opportunities for medical students to revive their prior knowledge, apply core concepts for the problem and engage in clinical reasoning