Integrating digital virtual simulation with flipped classroom for neuraxial anesthesia learning in medical undergraduates: a prospective randomized controlled study

To evaluate the efficacy of an innovative teaching model combining flipped classroom methodology with digital virtual simulation software in improving neuraxial anesthesia-related learning outcomes among medical undergraduates, compared with traditional lecture-based teaching. Prospective, randomized, controlled study. Peking University Third Hospital, Beijing, China. Thirty-eight clinical medical students undertaking anesthesiology internships were enrolled and randomly allocated to an intervention group (n=19) or a control group (n=19). All participants completed the study. The intervention group underwent a flipped classroom approach supplemented with 3D body anatomy software for pre-class learning and in-class discussion. The control group received conventional lecture-based teaching using slides and two-dimensional anatomical charts. The intervention lasted throughout the clinical rotation module. The primary outcome was student satisfaction with teaching effectiveness, assessed using a self-developed 5-point Likert scale questionnaire. Secondary outcomes included post-class quiz scores (10-item test, maximum 10 points), theoretical knowledge scores (end-of-rotation examination, 100-point scale), and practical skill performance (100-point assessment). The intervention group showed significantly higher theoretical knowledge scores (71.1 ± 11.9 vs 64.2 ± 5.6, P=0.034) and practical skill scores (85.9 ± 4.1 vs 80.4 ± 2.5, P<0.001) compared with the control group. Satisfaction scores were also significantly higher in the intervention group across multiple domains, including understanding of theoretical knowledge (P<0.001) and practical skills (P=0.002). The integration of flipped classroom with 3D virtual simulation software significantly improves theoretical and practical learning outcomes and increases student satisfaction in neuraxial anesthesia education. This model offers a promising alternative to traditional teaching in medical undergraduate training. Further research should explore its long-term retention effects and applicability to other clinical skills. 1. This study adopted a prospective, randomized controlled design, reducing selection bias and enhancing internal validity. 2. Skill assessments were performed by two instructors blinded to group allocation, minimising observer bias. 3. Sample size was calculated a priori, though the power was limited to 70%. 4. The study was conducted in a single tertiary teaching center, which may affect generalisability to other educational settings. 5. The intervention combined both pedagogical (flipped classroom) and technological (3D software) components, making it difficult to isolate the individual contribution of each element to the observed outcomes.