{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:28:27Z","timestamp":1787077707677,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Introduction:<\/jats:title>\n Flipped classroom models, which use active, case-based discussion, have shown promise across graduate medical education. Previous literature demonstrates that transitioning to a flipped classroom model resulted in significant increases in overall Orthopaedic In-Training Examination (OITE) scores. This observational study retrospectively compares foot and ankle OITE scores for orthopaedic surgery residents before and after implementation of a flipped classroom curriculum.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This retrospective study reviewed OITE scores for orthopaedic residents, comparing a lecture-based curriculum (n = 49) to a flipped classroom curriculum (n = 61). Residents who started their second year in July 2020 or later were defined as treated. The curriculum is given to the postgraduate year-2 (PGY2) residents only. Percentage of correct foot and ankle questions (F&A) were analyzed via mixed-effects models using random-subject intercepts. Fixed effects included PGY, overall performance on other sections, and flipped classroom status. All statistical analyses were performed in R version 4.4.1.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Residents in the flipped classroom cohort demonstrated a statistically significant increase in F&A questions answered correctly. The average increase was 7% (95% confidence interval: 4%, 10%; p < 0.001). This improvement trend became clearly visible in PGY3 and grew stronger in senior residents. Specifically, PGY3 residents improved their mean percentage correct from 62.26% to 66.07% (p = 0.16). PGY4 residents improved from 69.16% to 74.83% (p = 0.013), and PGY5 residents improved from 69.03% to 75.53% (p = 0.006). Historically, approximately 75% of traditional PGY5 residents scored lower on the F&A section than on the rest of the examination. Conversely, in the flipped classroom group, approximately 75% of PGY4 and PGY5 residents scored higher on the F&A section compared with other sections<\/jats:p>\n <\/jats:sec>\n \n Discussion:<\/jats:title>\n The implementation of a flipped classroom model was associated with a statistically significant improvement in resident performance on the F&A section of the OITE. The educational benefits of this curriculum appear cumulative over the course of residency, with the most substantial performance gains realized by senior residents in their fourth and fifth years of training.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Level III<\/jats:underline>\n , Observational Study. See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.oa.26.00095","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:00:47Z","timestamp":1787076047000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Case Study in Education: Improving Resident Didactic Training"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9025-1036","authenticated-orcid":false,"given":"Rohan","family":"Charles","sequence":"first","affiliation":[{"name":"Orthopedic Surgery Department, Mayo Clinic Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2839-901X","authenticated-orcid":false,"given":"Lindsey E.","family":"Turner","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery Department, Mayo Clinic Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Channon E.","family":"Cordes Cole","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery Department, Mayo Clinic Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2481-8064","authenticated-orcid":false,"given":"Jonathan D.","family":"Barlow","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery Department, Mayo Clinic Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ryssman","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery Department, Mayo Clinic Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6170-9895","authenticated-orcid":false,"given":"Alexander","family":"Vlasak","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery Department, Mayo Clinic Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3126-9307","authenticated-orcid":false,"given":"Norman S.","family":"Turner","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery Department, Mayo Clinic Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7]]},"reference":[{"issue":"1","key":"R2-20260818","first-page":"117","article-title":"A rebuttal of NTL institute's learning pyramid","volume":"133","author":"Letrud","year":"2012","journal-title":"Education"},{"issue":"23","key":"R3-20260818","doi-asserted-by":"crossref","first-page":"8410","DOI":"10.1073\/pnas.1319030111","article-title":"Active learning increases student performance in science, engineering, and mathematics","volume":"111","author":"Freeman","year":"2014","journal-title":"Proc Natl Acad Sci U S 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providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform."},{"issue":"1","key":"R15-20260818","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1186\/s12909-025-07855-8","article-title":"Application of the flipped classroom combined with BOPPPS model in standardized residency training for gastrointestinal surgery","volume":"25","author":"Luo","year":"2025","journal-title":"BMC Med Educ."},{"issue":"6","key":"R16-20260818","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.jsurg.2023.10.016","article-title":"Flipping the classroom in residency didactics leads to higher American board of surgery in-Training examination scores","volume":"81","author":"Finn","year":"2024","journal-title":"J Surg Educ."},{"issue":"4","key":"R17-20260818","doi-asserted-by":"crossref","first-page":"485","DOI":"10.4300\/JGME-D-17-00128.1","article-title":"Results of a flipped classroom teaching approach in anesthesiology residents","volume":"9","author":"Martinelli","year":"2017","journal-title":"J Graduate Med Educ."}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.26.00095","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:00:50Z","timestamp":1787076050000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.26.00095"}},"subtitle":["A Longitudinal Analysis of a Flipped Classroom Curriculum on Normalized Foot and Ankle OITE 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