Presented By: Demidmaa Tuvdendorj, University of Texas Tyler School of Medicine
Co-Authors: Gary Beck Dallaghan, University of Texas Tyler School of Medicine
Allison Hennigan, University of Texas Tyler School of Medicine
Pam Lucchesi, University of Texas Tyler School of Medicine
Michael Skinner, University of Texas Tyler School of Medicine

Purpose 
Assigning learners prework to engage with course material at their own pace facilitates in-class active learning for deeper understanding and retention. Since the success of in-class activities depends on learners consolidating prework, providing appropriate prework material is essential. However, there is little guidance regarding what "appropriate" is. 

Methods
We conducted a systematic literature review to explore prework (e.g., modalities, length, pages) assigned for undergraduate medical education (UME) and other level-comparable programs (e.g., physician assistant, veterinary, dental and pharmacy). Key terms were identified, and a medical librarian assisted. After reviewing 479?abstracts with 2 reviewers, we selected 31 manuscripts for full extraction, using a data extraction form focused on types of pre-work, length of time, test scores, and student satisfaction with different sources of pre-work. 

Results 
Of the 31 manuscripts extracted, 18 had documentation of type and amount of prework used. Twelve compared the test scores and student satisfaction with flipped classroom settings to traditional lecture-based curriculum. Most found that both test scores and student satisfaction improved with a flipped classroom setting. Time students actually spent on assigned prework was reported in 9 articles but predominantly only in the experimental group or with independent study instead of prework. Multiple modalities were evaluated with a general preference for videos, but sample sizes were not large enough to draw a conclusion on the most effective modality. The systematic review was limited to published articles; heterogeneous study design may influence conclusions. 

Conclusions 
The studies confirm that flipped classroom, "efficiency of learning" model is better received by students and is associated with higher test scores. The review raised questions about the amount of prework, the modality of prework assigned, as well as the amount of prework that students are actually doing. Studies are needed to evaluate the intersection between these key factors.