Continuous Flipped Classroom in Anesthesiology: Enhancing Learning Outcomes and Anesthesiology Major Selection in Eight-Year Program Students.

Background: The flipped classroom (FC) is increasingly used in medical education, but the impact of a continuous FC strategy on anesthesiology learning and career choice in eight-year medical program students remains unclear. Methods: In a randomized trial, 200 students received either continuous FC (n=100) or traditional (n=100) anesthesiology instruction. Outcomes included final exam scores, survey-assessed satisfaction, active learning, critical thinking, and post-course specialty selection. Mediation analysis evaluated how a weighted composite of these scores influenced anesthesiology major selection. Results: The continuous FC group demonstrated significantly higher final exam scores, satisfaction, and active learning levels (all P < 0.05). Most importantly, students in the FC group were 21.77 times more likely to choose anesthesiology as their specialty than those in the control group (OR = 21.77, 95% CI: 1.79-264.83, P = 0.016). Mediation analysis indicated that 44.13% of the total effect of the FC intervention on specialty choice was mediated by improvements in the weighted composite score (indirect effect: β = 0.059, 95% CI: 0.024-0.102, P = 0.005). Conclusion: The continuous FC approach enhances learning outcomes, fosters essential skills, and significantly increases the selection of anesthesiology as a specialty. This demonstrates its substantial positive impact and potential value in addressing specialty shortages in medical education.