A Massive Open Online Course-Based Flipped Classroom Protocol For Pediatric Puncture Skills Training Among Undergraduate Medical Interns

Summary

This protocol describes a MOOC-based flipped classroom approach for training undergraduate medical interns in four core pediatric puncture skills, facilitating pre-class knowledge acquisition and in-class simulation practice.

Abstract

This protocol describes a reproducible teaching model designed to enhance the clinical competency of undergraduate medical interns in performing four essential pediatric puncture skills: thoracic, abdominal, lumbar, and tibial bone marrow punctures. The key procedural approach integrates self-paced, pre-class massive open online course (MOOC) learning with intensive, hands-on, in-class simulation practice. Prior to class, interns complete 10 to 20 min instructional videos covering operation principles, standard procedures, common mistakes, and clinical case analyses, while constructing mind maps to logically organize anatomical and procedural knowledge. During the in-class session, instructional time is completely reallocated from traditional lectures to personalized teacher guidance, peer discussion, and standardized scenario-based simulation practice using high-fidelity pediatric mannequins. The intended application of this protocol is to address the severe time and resource limitations inherent in traditional medical education by maximizing active hands-on practice opportunities. Validation studies indicate that this scalable flipped classroom framework significantly improves medical students' skill mastery, clinical thinking, and theory-practice integration without increasing their overall learning burden, making it highly adaptable for broader clinical skills training programs.

Introduction

Pediatric puncture techniques—specifically thoracic, abdominal, lumbar, and tibial bone marrow punctures—are essential but inherently high-risk clinical skills for undergraduate medical interns. Mastery of these invasive procedures demands standardized, hands-on training to ensure patient safety and diagnostic accuracy¹. However, traditional teaching models heavily rely on a "theoretical lecture plus brief demonstration" approach. This conventional paradigm often results in insufficient practical time, a superficial understanding of operational key points, and poor long-term skill retention, ultimately impeding interns' ....

Protocol

The research protocol was approved by the Medical Ethics Committee of Shenzhen University (Approval No.: SZUGH-2024-032). All participants provided written informed consent after understanding the study purpose, procedures, and potential impacts on academic evaluation.

1. Participant screening, selection, and group assignment

1. Screen potential undergraduate medical intern candidates using the predefined academic and attendance records.
2. Select participants who have successfully completed basic medical courses (anatomy and physiology). Ensure these selected candidates have no prior systematic puncture ski....

Results

Baseline characteristics

A total of 127 students were initially enrolled, of whom 122 were included in the final analysis after the exclusion of 5 students. The final analyzed sample comprised 61 students in the experimental group and 61 students in the control group. As shown in Table 1, no significant differences were observed between the experimental group (n = 61) and the control group (n = 61) regarding gender (male 33/61 vs. 31/61), age (22.2 ± 1.1 year.......

Discussion

The MOOC-based flipped classroom protocol provides a structured and reproducible framework for pediatric puncture skills training, emphasizing the transition from passive knowledge reception to active procedural mastery. By fundamentally reallocating instructional time and space, this methodology addresses the common limitations of traditional clinical education, such as insufficient practice time and superficial understanding of key operations. The success of this approach is rooted in several interconnected methodologi.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Alcohol Cotton Pads	Winner Medical Co., Ltd.	WN-AC70	Medical-grade 70% isopropyl alcohol pads for pre-puncture skin disinfection; individually sealed to ensure aseptic conditions.
Disposable Sterile Syringe	Jiangsu Kanghua Medical Equipment Co., Ltd.	KH-5ML	Used for routine fluid extraction and injection during pediatric puncture skills training; single-use and individually sterilized.
Pediatric Thoracentesis Training Manikin	Shanghai Yilian Medical Simulation Tech	YL-PTM-02	High-fidelity simulation manikin for practicing thoracic puncture with realistic anatomical landmarks and repeatable needle insertion.