Comparing the Results of Written Testing for Advanced Cardiac Life Support Teaching Using Team-based Learning and the “Flipped Classroom” Strategy

Sep 23, 2026

Team-based learning combined with a flipped classroom (TBL/FC) was evaluated against a lecture-based (LB) approach for advanced cardiac life support (ACLS) instruction to determine whether cognitive test outcomes changed. ACLS was delivered to two classes of fourth-year medical students (2015–2016) using TBL/FC and compared with three LB control classes (2012–2014). Written assessments used multiple-choice, rhythm-matching, and simulated-case fill-in questions, showing improved combined median scores and reduced non-passing and partial-failure rates with TBL/FC.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Objectives

Methods

Results

Conclusion

Introduction

Active learning and TBL

Flipped classroom model

Simulation and prior evidence

Materials and Methods

Open Access Original Article DOI: 10.7759/cureus.2574 Comparing the Results of Written Testing for Advanced Cardiac Life Support Teaching Using Team-based Learning and the “Flipped Classroom” Strategy Received 02/15/2018 Review began 02/16/2018 Review ended 04/17/2018 Published 05/03/2018 © Copyright 2018 Langdorf et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Mark I. Langdorf 1 , Craig L. Anderson 1 , Roman E. Navarro 1 , Suzanne Strom 2 , C. Eric McCoy 1 , Julie Youm 3 , Mary F. Ypma-Wong 4 1. Department of Emergency Medicine, University of California, Irvine, Irvine, USA 2. Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, USA 3. Medical Education, Univeristy of California, Irvine School of Medicine, Irvine, USA 4. Graduate Division, University of California, Irvine, Irvine , USA Corresponding author: Mark I. Langdorf, [milangdo@uci.edu](milangdo@uci.edu) Abstract Objectives We sought to further determine whether cognitive test results changed for advanced cardiac life support (ACLS) taught in the team-based learning/flipped classroom format (TBL/FC) versus a lecture-based (LB) control. Methods We delivered 2010 ACLS to two classes of fourth-year medical students in the TBL/FC format (2015–2016), compared to three classes in the LB format (2012–2014) . There were 27.5 hours of instruction for the TBL/FC model (TBL-10.5 hours, podcasts-nine hours, small-group simulation-eight hours), and 20 hours (lectures-12 hours, simulation-eight hours) in LB. We taught TBL for 13 cardiac cases while LB had none. Didactic content and seven simulated cases were the same in lecture (2012–2014) or in podcast formats (2015–2016) . Testing was the same using 50 multiple-choice (MC) format questions, 20 rhythm-matching questions, and seven fill-in management of simulated cases. Results Some 468 students enrolled in the course 259 (55 .4%) in the LB format in 2012–2014, and 209 (44 .6%) in the TBL/FC format in 2015–2016. The scores for two out of three tests (MC and fill-in) increased with TBL/FC. Combined, median scores increased from 93.5%(IQR 90.6, 95.4) to 95. 1%(92 .5, 96.8, p = 0 .0001) . More students did not pass one of three tests with LB versus TBL/FC (24 . 7% versus 18.2%), and two or three parts of the test (8 . 1% versus 4.3%, p = 0 .01) . On the contrary, 77.5% passed all three with TBL/FC versus 67.2% with LB (change 10.3%, 95% CI 2 .2%–18 .2%) . Conclusion TBL/FC teaching for ACLS improved written test results compared with the LB format. Categories: Cardiology, Emergency Medicine, Medical Education Keywords: acls, team-based learning, flipped classroom, medical education Introduction The passive transfer of knowledge has been reported to be less effective compared to active learning [1-5]. Active learning requires students to perform activities like reading, writing, and problem-solving with discussion, and promotes synthesis and recall of important material [6] . TBL in small groups is a form of active learning. TBL uses a “flipped classroom”(FC) model to foster content recall. With FC, students review material before class in the form of assigned readings or video podcasts [6] . Then, students work together in class to solve patient care problems [7] . Finally, an instructor explains difficult content and concepts. Instruction with simulation has been used in advanced cardiac life support (ACLS) for some 30 years, yet the small-group learning format has been studied sparsely [8-9]. The most recent ACLS course offered by the American Heart Association (AHA) has adopted a “blended learning” approach that also flips the classroom as one of its approved formats. In the blended learning format, students watch digital recordings bef

FAQs

What was the primary objective of the study?

To determine whether cognitive test results for ACLS differed between the TBL/FC format and a lecture-based (LB) control.

How were the ACLS teaching formats compared?

The study compared two classes taught in TBL/FC (2015–2016) with three classes taught in LB (2012–2014), keeping didactic and simulated content consistent across formats.

What testing approach was used to measure learning outcomes?

Students completed written assessments including 50 multiple-choice questions, 20 rhythm-matching questions, and fill-in management items based on simulated cases.

Sep 23, 2026

Uploaded by Taylor Morgan