A recent Boston Globe article highlights an innovative, interactive group-learning approach now under development at the University of Vermont’s Robert Larner M.D. College of Medicine, which could eliminate traditional classroom lectures at the school by 2019.
To replace lectures for first-and second-year medical students, UVM is adopting multiple new teaching methods, including a flipped classroom concept as well as a problem-based learning technique that tasks students with solving real clinical cases. In the latter, the students work in eight-person, faculty-facilitated teams to:
- Generate multiple diagnostic hypotheses
- Decide what relevant knowledge they lack and need to research
- Prioritize, assign, and independently research their ideas
- Present their findings back to the group
- Use a computer program, linked to real (non-identified) medical records, to simulate the case and generate a diagnosis.
Where physicians in the real cases have ordered the same diagnostic tests as the students, actual results reveal which (if any) of the students’ hypotheses are correct, enabling the students, along with their faculty facilitators, to evaluate what they got right and wrong and learned throughout the process.
Five Key Takeways
Though UVM’s experiment does have its challenges (see following section), the Globe reports several key takeaways that make this an endeavor worth following in coming years:
Greater knowledge retention. UVM’s Dr. Patricia A. King, who leads and trains other faculty to run the new courses, suggests that knowledge is more likely to be retained when students discover it independently. Students interviewed for the Globe article generally concur, though they do note a few bumps in the road, as some of the earlier interactive group learning experiences have worked better than others.
Better board test prep/higher scores. In speaking to the Globe, Senior Associate Dean for medical education at UVM Dr. William B. Jeffries cited both external evidence that experiential learning leads to higher test scores as well as internal research documenting rising test scores among UVM medical students after the team-based learning approach was first introduced.
Better prep for contemporary practice. Insofar as the group-learning approach adds early emphasis on soft skills, such as collaboration, systematic introspection around what knowledge is lacking in specific cases, and consistent practice of self-directed research, it is expected to yield empathetic, critical-thinking physicians who are better equipped to practice effectively in contemporary, team-oriented clinical settings.
Easier to identify and help struggling students. As observed in an earlier post on this blog exploring the flipped classroom concept in general, dedicating more class time to active interaction among students and faculty makes it easier to identify and assist students who may be struggling with course material.
More up-to-date medical knowledge. Where a pure lecture-style approach to teaching carries risks of obsolescence as content may be reused from year to year, pushing different groups of students to research problems independently creates a built-in mechanism for ensuring that medical learning reflects ongoing evolution — and sometimes rapid changes — taking place in medical knowledge.
UVM’s new approach does come with challenges. For one, there are very different learning styles — some students simply prefer and excel in lecture-style environments where they are responsible for both the content and pacing of their own learning.
While the approach may emphasize more up-to-date medical knowledge and perhaps greater integration and synthesis of knowledge across various subspecialties and disciplines, a corollary test will be ensuring that students walk away from their schooling with a consistent base of medical knowledge considered necessary for licensing and board certification.
An even greater challenge may be convincing medical faculty to change their ways. UVM’s new approach requires dedicated investment in constantly creating and refreshing new course content, developing faculty capabilities for effective group facilitation, and perhaps in equipping faculty with the digital skills needed for moving beyond PowerPoint into more interactive and multimedia modes of teaching such as webinar, video, and so forth. At least one UVM medical student interviewed for the Globe article suggests that, where the new courses have succeeded, they’ve clearly improved the learning experience. But, as professors have worked to learn the new formats, they have occasionally missed the mark.
Finally, training and supporting faculty with tools needed to develop engaging interactive course content is expensive. UVM’s medical school is using a $66 million endowment set up by its namesake, Dr. Robert Larner, at a pace of around $4 million per year to pursue its curriculum reform.
Big challenges notwithstanding, we’ll be following UVM’s experiment with interest as it dovetails in many ways with the adaptive learning philosophies and technologies underpinning our own NEJM Knowledge+ products for promoting and reinforcing lifelong medical learning.