OrthoACCESS 2.0: Redesigning a National Orthopaedic Surgery Curriculum for Medical Students using a Flipped-Classroom Blended Learning Model.

Objective: Due to limited musculoskeletal education, students pursuing orthopaedic surgery often feel unprepared for residency. Clinical rotations provide some education; however, prior to the development of the Ortho Acting-Intern Coordinated Clinical Education and Surgical Skills (OrthoACCESS) curriculum in 2019, no standardized didactic curriculum existed. Over time, students desired interactive, case-based learning opportunities. Our objective was to design a flipped-classroom, blended learning curriculum and evaluate its ability to improve medical student orthopaedic knowledge.

Design: OrthoACCESS 2.0 is a 16-week, open-access curriculum consisting of didactic lectures, case discussions, and learning resources. The curriculum was evaluated using pre-curriculum, post-case discussion, and post-curriculum surveys. Likert-item questions were evaluated with paired Wilcoxon signed-rank analysis. Free text responses were reviewed for emerging themes.

Setting: Lectures were presented weekly in-person for students at OrthoACCESS institutions with pre-recorded lectures available for non-rotating students. Faculty-led virtual case discussions consisted of 3 case presentations and breakout rooms for discussion. Learning resources (e.g., Anki Cards, "scut sheets") were posted to the website.

Participants: OrthoACCESS 2.0 was hosted from June to October 2023 with 35 participating institutions. All 226 student registrants completed the pre-curriculum survey and 69 completed the post-curriculum survey. Forty students attended at least 8/16 case discussions.

Results: In the post-curriculum survey, 68% of participants reported "quite" or "extremely" strong orthopedic knowledge, compared to 23% beforehand (p < 0.001). Postcase discussion surveys revealed significant increases in knowledge associated with each lecture and case discussion (p < 0.001). The greatest student-reported benefits were the broad coverage of orthopedic topics (n=41) and learning how to think like an orthopaedic surgeon (n=20). The greatest barrier to attendance was clinical obligations during case discussions (n=44).

Conclusions: This flipped-classroom, blended learning curriculum has improved medical student foundational orthopaedic knowledge nationally. This model may be valuable for other specialties with limited undergraduate medical exposure.