Background: Ophthalmology is an important medical science subject, but it is given with insufficient attention in undergraduate medical education. Flipped classroom (FC) and problem-based learning (PBL) are well-known education methods that can be integrated into ophthalmology education to improve students' competence level and promote active learning.

Methods: We used a mixed teaching methodology that integrated a FC and PBL into a 1-week ophthalmology clerkship for 72 fourth-year medical students. The course includes two major sessions: FC session and PBL session, relying on clinical and real-patient cases. Written examinations were set up to assess students’ academic performance and questionnaires were designed to evaluate their perceptions.

Results: The post-course examination results were higher than the pre-course results, and many students gained ophthalmic knowledge and learning skills to varying levels. Comparison of pre- and post-course questionnaires indicated that interests in ophthalmology increased and more students expressed desires to be eye doctors. Most students were satisffed with the new method, while some suggested the process should be slower and the communication with their teacher needed to strengthen.

Conclusions: FC and PBL are complementary methodologies. Utilizing the mixed teaching meth of FC and PBL was successful in enhancing academic performance, student satisfactions and promoting active learning.

Background: Ophthalmology is an important medical science subject, but it is given with insufficient attention in undergraduate medical education. Flipped classroom (FC) and problem-based learning (PBL) are well-known education methods that can be integrated into ophthalmology education to improve students' competence level and promote active learning.

Methods: We used a mixed teaching methodology that integrated a FC and PBL into a 1-week ophthalmology clerkship for 72 fourth-year medical students. The course includes two major sessions: FC session and PBL session, relying on clinical and real-patient cases. Written examinations were set up to assess students’ academic performance and questionnaires were designed to evaluate their perceptions.

Results: The post-course examination results were higher than the pre-course results, and many students gained ophthalmic knowledge and learning skills to varying levels. Comparison of pre- and post-course questionnaires indicated that interests in ophthalmology increased and more students expressed desires to be eye doctors. Most students were satisffed with the new method, while some suggested the process should be slower and the communication with their teacher needed to strengthen.

Conclusions: FC and PBL are complementary methodologies. Utilizing the mixed teaching meth of FC and PBL was successful in enhancing academic performance, student satisfactions and promoting active learning.

目的：探索翻转课堂联合改良的迷你临床演练评估(mini-clinical evaluation exercise，Mini-CEX)在眼科住院医师规范化培训中的应用可行性及效果。方法：回顾性分析上海交通大学医学院附属第九人民医院眼科在2018—2021年所有参加规范化培训结业考核的住院医师，共计39人。比较翻转课堂教学方法实施前后，包括改良Mini-CEX在内的综合能力考核、毕业合格率、课程出勤率及学员对教学模式的满意度。结果：实验组20人(2020及2021年毕业)，对照组19人(2018及2019年毕业)。两组间的性别比例、学历或学制构成差异无统计学意义(P>0.05)。实验组的毕业合格率明显高于对照组(100.00% vs 68.42%，P=0.008)；改良Mini-CEX(P=0.011)及放射诊断(P=0.025)平均成绩也显著高于对照组。两组的理论考核及心电图诊断的平均成绩无统计学差异。4年间的比较发现，学员的改良Mini-CEX平均成绩(P=0.006)及线下课出勤率(P=0.025)出现显著提升。实验组对教学模式的满意度显著高于对照组。结论：翻转课堂联合改良Mini-CEX应用于眼科住院医师规范化培训教学可获得良好效果，提示了积极的深入研究及拓展应用前景。

Objective: To evaluate the application of flipped classroom combined with revised mini-clinical evaluation exercise (Mini-CEX) in standardized training for ophthalmology residents. Methods: A retrospective analysis was performed on 39 residents who participated in the standardized training graduation examination during 2018 to 2021 in ophthalmology department of Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The comprehensive ability assessment including the improved Mini-CEX, pass rate of program completion, course attendance rate, and students’ satisfaction with the teaching mode were compared before and after the implementation of the flipped classroom teaching method. Results: There are no significant difference of sex or educational level was found between the experimental group (20 people graduated in year 2020 and 2021) and the control group (19 people graduated in year 2018 and 2019). Compared with the controls, the pass rate (100.00% vs 68.42%, P=0.008) and the average scores of revised Mini-CEX (P=0.011) and radiology (P=0.025) were significantly higher in the experimental group, while the average scores of basics and electrocardiograph were almost the same. Among the 4 years, the average revised Mini-CEX scores (P=0.006) and attendance rate of off-line courses (P=0.025) significantly progressed. Surveys of satisfaction degree suggested that the experimental group were significantly more satisfied with the education they accepted during their residency training program. Conclusion: It is effective to apply flipped classroom combined with revised Mini-CEX in residency training program of ophthalmology. Further study and development on this teaching pattern is encouraged.