Flipped classrooms are becoming more and more popular with educators in the past few years. The concept is to teach the basics online and use face-to-face classroom and, in medicine, clinical time for more complex synthesis and application of knowledge and skills.
I interviewed Benjamin R. Doolittle, MD, a program director at Yale University School of Medicine, on the history and current trends in medical training using the flipped classroom model. Yale has had much success in recent years flipping the classroom in their medical school and residency programs.
Josette Akresh-Gonzales: Have educators at your institution begun flipping their classrooms, and how is it going?
Benjamin R. Doolittle, MD: In many ways, the teaching of medicine has always been in a “flipped classroom.” Rounding on the wards or seeing patients alongside a practicing physician has been the way we have taught medicine since the beginning. That said, since the time of William Osler in the early 20th century, steeping medical students in the basic sciences was believed to be important to shape a modern physician. And so, most medical schools instituted 2 years of classroom and labs followed by 2 years of clinical training.
Only recently have we shifted our thinking to connect the classroom learning with clinical experience in a real way. This is not to minimize the importance of, say, the Krebs cycle or the coagulation cascade, but rather place that knowledge in the context of clinical experience.
At Yale, where I teach, the medical school curriculum has been completely reformed in 2016 to reflect this change. Medical students begin on the wards from day one. The “book learning” curriculum is woven into the clinical experience and has been considerably shortened. So far, there is considerable enthusiasm for the new curriculum.
JAG: What is significantly different about flipping the classroom in medical education and training — as opposed to other graduate studies and professions, college, or even high school settings?
BRD: The flipped classroom is perhaps the most natural way of learning medicine compared to other disciplines. Our present structure is not too different from medieval guilds. An apprentice pledges to work alongside a master for a set period. After which, the guild affirms their ability to practice independently. We call this “board certification,” but really it is not much different from the 1500s. The “flipped classroom” perhaps puts more of an emphasis on the experiential learning that is so important to making a diagnosis and treating a patient.
Law, engineering, chemistry, and the like work well in the flipped classroom. You learn by doing. You can attend a lecture about constitutional law, but you really learn it by clerking with a judge. In other disciplines — English, philosophy, history — where do you “flip?” What is the experiential piece? I am not sure if the flipped classroom works for all disciplines.
JAG: Where do faculty get their videos, podcasts, and other material to drive the at-home component of the flipped classroom?
BRD: This is perhaps the biggest challenge for educators. We still are in the mode of using lectures with PowerPoint slides. Does anyone remember when PowerPoint presentations were the new thing? These days, perhaps, we have gotten a bit lazy. We can slap together a few slides and go for it in the classroom. It takes considerably more time and creative thinking to craft a truly interactive, high-yield session.
There may be a generational difference here. The millennials are much more comfortable creating digital content — and accessing it — than their faculty are. We have been slow to adapt. What is the next “big idea” after power point slides? Video-blogs? Podcasts?
JAG: What feedback or stories have you heard from residents and faculty about the flipped classroom model?
BRD: Dr. Jaideep Talwalkar, the course director, and Dr. Joseph Donroe, the physical exam teacher, have done a marvelous job incorporating video recordings into the teaching of history-taking and the physical examination. Students access the relevant video lecture prior to the workshop. They have been very well received. Dr. Talwalkar received the highest teaching award from Yale this past year. He must be doing something right.
JAG: What can be done to encourage faculty to engage in flipped classrooms and to improve and develop their teaching methods with this model?
BRD: Three things: (1) the will to experiment, (2) the mentorship to train and (3) the resources to equip. We have the resources: our library has a modern studio in which to make video recordings. We have the mentorship: there are wonderful, skilled people to take us to the next level. There is a technical aspect to this. How do I make the video camera work? How do I upload the darn thing? More than that, what do I say? Do I simply repeat my lecture? Real partnership with true pedagogues can be helpful here. How can an expert in Wegener’s granulomatosis also be expected to make a jazzy video? For this to work, real partnership needs to happen.
But, do we have the will? The time? The creativity? Some of us do. Some of us don’t. This is a really exciting time to be a medical educator. Time will tell.
JAG: How do faculty deal with struggling residents in the flipped classroom? Is it a different process (or different psychologically) than a normal classroom?
BRD: We are in the very early stages of this. In many ways, the flipped classroom puts more freedom — and also more responsibility — upon the student to learn. They must access content in their own time, digest it, master it, and come to class prepared to engage the content. How do we know if it is working? Yale has a long tradition of not using grades for their classes. This is so important: it creates a true corp d’esprit of learning. We are all in this together. For the most part, this works because the students are so bright.
We shall see if the flipped classroom identifies struggling learners earlier. These days, we do not do such a great job identifying struggling learners until it is too late. They fail the final exam or their boards. What happened? How did we miss this?
Since educators will be lecturing less and engaging with learners more, struggling students may be more easily identified and then coached. We are at the very beginning stages of the flipped classroom. It feels very new — utilizing multimedia to enhance the classroom. It also feels like something old — strengthening the connection between apprentice and teacher. The endpoint is to train outstanding physicians. We will probably stumble a bit along the way, but we are all tired of the PowerPoint slide deck. There must be something better. Hopefully, this is it. I believe we are onto something good here.
Benjamin R. Doolittle, MD, is an expert in burnout and wellness in residents and physicians. He is an associate professor and program director of internal medicine and pediatrics at the Yale University School of Medicine and the medical director of the Yale Medicine-Pediatrics Practice.