Background: The American Academy of Pediatrics (AAP) publishes core pediatric clinical practice guidelines advising pediatricians on evidence-based management of common diagnoses. However, multiple studies demonstrate poor guideline compliance by pediatricians. There is no published curriculum on how to teach these guidelines, and on a national survey we conducted of pediatric residency training programs, only two indicated they had a formal curriculum for teaching the guidelines.

Purpose: To evaluate pediatric intern knowledge, confidence and attitudes before and after an innovative “flipped classroom” approach to teaching the clinical guidelines.


-Methods: The guidelines for Acute Otitis Media (AOM), Obstructive Sleep Apnea Syndrome (OSAS), and Attention Deficit Hyperactivity Disorder (ADHD) were chosen for this study. All 29 pediatric interns took a de-identified 32 question pre/post-test. The intervention group received weekly, half-hour flipped classroom lessons for three guidelines (N=9 for OSAS, 10 for AOM and ADHD), and the control group had no formal education about guidelines (N=19). A single investigator was used to grade all tests, using a scoring rubric. Descriptive statistics and unpaired, two-tailed T-test were used (p<0.05) for analysis.

-Results: The interns had an average knowledge score of 44% on the pre-test; by guideline: OSAS (45%), AOM (11%), ADHD (79%). Intervention interns had a statistically significant increase in knowledge 21% vs. 10% for OSAS (p=0.03); 16% vs. 4% for AOM (p=0.009); and 21% vs. -5% for ADHD (p=0.005). There was a statistically significant increase in confidence post vs. pre, but no difference between intervention and control groups. 28 out of 29 interns agreed it is “very important” for a pediatrician to know and use clinical practice guidelines.

Conclusions: Creating a dedicated curriculum to teach AAP clinical practice guidelines to interns resulted in a statistically significant improvement in residents’ confidence, knowledge, and attitudes of using guidelines. Our data suggests the flipped classroom model allows for self-driven interactive learning. Next steps include lesson development for all 10 guidelines and national dissemination to increase adherence of guidelines by all residents in training.