Palliative Care or Hospice? Flipping the Classroom for 1st Year Pre-clinical Medical Students With Interactive Online Content

Abstract

Background

Although palliative care competencies appear on USMLE examinations, pre-clinical curricula devote minimal time to end-of-life education. Traditional lectures cannot cover foundational knowledge and clinical application in a single hour. A flipped classroom approach—where students learn core content before class, and use face-to-face time for application—offers a solution. We redesigned a one-hour Introduction to Palliative Care session using this model.

Approach

We created a 30-minute interactive online module in Articulate 360™ for first year students covering palliative care definitions, eligibility criteria, and care settings. The module incorporated matching, sorting, multiple-choice questions with feedback, process maps, and flashcards. In-class time was restructured to small group case discussions distinguishing primary palliative care, specialty palliative care, and hospice. Students received the module one week before class and were reminded that material could appear on examinations.

Evaluation

Through a quasi-experimental, retrospective cohort study using a pre-post design, we compared examination performance and student perceptions across four academic years (2020-2024, N = 371). Correct responses on a palliative care examination question improved from 57% (2020-2021, virtual lecture) to 66%, 67%, and 80% in subsequent years with the flipped intervention. The pre-work engaged students in learning (79-89% agreement), enabled focus on advanced topics during class (73-77% agreement), and was described as interactive and helpful in teacher evaluations.

Implications

The flipped classroom successfully transformed a content-heavy lecture into interactive learning and is transferrable to other institutions. The results are only suggestive of an impact on knowledge-based outcomes. Resources are freely available from the corresponding author.