Background: Academic physicians must teach elements in an ACGME-mandated curriculum while balancing career development and clinical workload. Exploring educator perceptions on the learning environment, and comparing two instructional methods (traditional didactics (TD) versus flipped classroom (FC)) in one pediatric subspecialty may elucidate current challenges, barriers and strategies to optimize learning and educator satisfaction. Methods: A randomized trial comparing effectiveness and learner preference for FC versus TD physiology teaching was conducted in ACGME-accredited neonatal-perinatal medicine (NPM) fellowship programs in 2018-2019. Educator preferences were elicited through online surveys pre- and post- intervention. Free-text comments were provided for questions exploring strengths, challenges and opportunities in fellowship education. Statistical analysis included comparisons of demographics and pre-post intervention educator responses between groups. Thematic analysis of text responses was conducted to identify common subthemes. Results: From sixty-one participating programs, 114 FC educators and 130 TD educators completed surveys. At baseline, all educators experienced professional satisfaction from teaching fellows, but noted challenges with time available to create and/or deliver educational content, limited content expertise amongst faculty, colleagues’ limited enthusiasm towards educating fellows, and lack of perceived value of education by institutions given limited protected time or credit towards promotion. Post intervention, educators in both groups noted a preference to teach physiology using FC due to interactivity, learner enthusiasm, and learner-centeredness. FC educators had an 17% increase in preference to teach using FC (p=0.001). Challenges with FC included ensuring adequate trainee preparation, protecting educational time, and providing educators with opportunities to develop facilitation skills. Conclusions: Overall, NPM educators in a trial evaluating a standardized, peer-reviewed curriculum report professional satisfaction from teaching, but described logistical challenges with developing/ delivering content. Educators preferred instruction using FC, but identified challenges with learner preparedness and ensuring adequate educator time and skill. Future efforts should be dedicated to addressing these barriers.

Received: 18 May 2022

Accepted after revision: 12 August 2022

Accepted Manuscript online:
30 August 2022

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