Retention of Advanced Cardiac Life Support (ACLS) Skills Following Simulation‑Integrated Flipped Learning in Final‑Year Medical Students

Panitnan Jindamanee; Piriya Treerattanapan

Authors

Panitnan Jindamanee Emergency Department, Trang hospital
Piriya Treerattanapan Emergency Department, Trang hospital

Keywords:

Flipped learning, Cardiopulmonary resuscitation, Simulation, Medical education, Thailand

Abstract

Introduction
Retention of Advanced Cardiac Life Support (ACLS) skills is a common challenge in undergraduate medical education. Although ACLS is a critical competency for final-year medical students, there is limited research on how flipped-classroom methods combined with simulation-based training influence knowledge and skill retention beyond immediate post-training. This study evaluates the effectiveness of a brief ACLS course integrating these strategies to enhance knowledge, skills, and self-reported confidence in advanced resuscitation.
Objectives
To assess changes in knowledge, skills, and confidence among final-year medical students following a brief ACLS training using a flipped-classroom model integrated with simulation.
Methods
This cross-sectional study was conducted at Trang Hospital from September to December 2024. Twenty-four sixth-year medical students completed a 30-question knowledge test and a skills assessment before training. After the brief ACLS course, students were re-assessed on both knowledge and skills immediately after the training and again at three months. Confidence in applying ACLS was assessed before the training and at the three-month follow-up. Data were analyzed using repeated measures ANOVA and paired t-tests.
Results
Mean knowledge scores increased from 18.15 ± 5.19 (pre-test) to 21.35 ± 4.52 (post-test), and slightly increased to 21.75 ± 3.26 at three months (p < 0.001). Skills scores rose from 7.95 ± 2.11 to 12.48 ± 1.78, and further improved 14.38 ± 1.21 at follow-up (p < 0.001). Confidence scores rose from 2.05 to 4.40 (p < 0.001).
Conclusion
A brief ACLS training program integrating flipped learning and simulation effectively enhanced and sustained knowledge, clinical skills, and learner confidence among final-year medical students. This model provides a practical and scalable solution for ACLS education in resource-limited settings.

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