Program Director’s Corner – September 2020
Should we be flipping over the ‘flipped classroom’?
David C. Lieb, MD, FACE, FACP
Program Director, Endocrinology and Metabolism Fellowship
Eastern Virginia Medical School
The flipped, or inverted classroom, is not a new concept. It first became popular in 2007 when two high school chemistry teachers in Denver, Colorado wanted to help students who had missed class due to illness (Bergman, Sams). The teachers pre-recorded their lesson plans and shared them with the students. They soon found that sharing these lessons with all of their students before class led to more robust and interactive discussions.
The chemistry teachers credited their ideas to a paper they had read called “Inverting the Classroom” written by a group of economics professors at Miami University (Ohio) who had used a similar concept in an introductory economics course in 2000 (Lage, Platt, Treglia). These professors found that the traditional lecture format was incompatible with the learning styles of many of their students and felt it would help all students to receive educational materials prior to class in order to better prepare for discussion of the subject matter. These materials included textbook readings, lecture videos, voice-over Powerpoint presentations and printed-out Powerpoint slides. Students were given these materials, as well as worksheets that were periodically collected and graded. The professors noted that they could spend valuable class time on activities that encouraged students to apply what they had learned in small group discussions. The students seemed more motivated to learn, and both students and teachers felt that this new approach was a positive one.
In the flipped classroom model students gain first-exposure learning before class takes place -and are then able to focus on processing what they have learned during class time with instructor assistance. Processing involves synthesizing information, analyzing what one has learned and problem-solving. Students are typically given assignments before class that combine reading and writing assignments. They then receive feedback through processing activities during class. Studies in college students have shown that the flipped classroom approach leads to not only more engaged students, but also higher test scores on the material reviewed.
Data exists demonstrating that the flipped classroom concept is an effective learning-strategy in graduate medical education. A recent publication in The Clinical Teacher by Rachel Blair, Julia Caton and Ole-Petter Hamnvik – who is the Endocrinology Fellowship Program Director at Brigham and Women’s Hospital/Harvard Medical School – evaluated a flipped classroom model in 43 second-year internal medicine residents at their program. Participants watched a video involving pharmacotherapy for type 2 diabetes prior to the in-session class (Blair, Caton and Hamnvik, April 2020). During class time the learners were engaged in case-based discussions. They filled out surveys and a knowledge test before, immediately after and six months after the intervention. The authors found that learners did significantly better on knowledge tests both immediately after and six months after the intervention when compared to before, suggesting retention of knowledge. The majority of learners reported that the pre-class instruction was a valuable use of their time, and 90% of those surveyed preferred the flipped classroom format over a more traditional lecture format. Of note, learners did mention some concerns regarding finding enough time to watch the video prior to class. Importantly, six months after the intervention the residents were likely to consider prescribing one of the medications discussed, and 57% had actually prescribed one of the medications in their clinical practice.
For those of you who are interested in learning more about the flipped classroom model of instruction, I found this page at Vanderbilt University to be very helpful. This blog post at schoology.com is also helpful and includes specific tips and recommendations, as well as a bit of history.
I’d be interested to hear what you all think! Are you currently using a similar flipped classroom for your fellowship didactics? If so, how well does it work? How has the increased use of virtual technology such as Zoom affected your ability to use such a model? Email me at liebdc@evms.edu with your thoughts, and I can share them in a future Program Directors’ Corner!