Flipping out about flipped classrooms
June 23, 2019 5:43 AM   Subscribe

I have been volun-told to "flip" the first-year medical student module pertaining to my specialty. I have an interest in medical education, but no formal education/pedagogy training, so have been googling to try to figure out what this means and how to do it most effectively. Educators of Mefi: what are the best practices around a flipped classroom model that actually get students to do the pre-class reading/video watching and engage in discussion?

The module in question is a 2-week neurosciences block. This is traditionally a difficult module for students, because of the nit-picky nature of neuroanatomy. They can memorize pathways and random details, but are not shown how to formulate (synthesize) and then struggle in the clinical clerkship. So we want to fix that.

The curriculum committee goal of this flip is to help the students see how the pathways relate to clinical scenarios in order to best prepare them for their neurology rotation the following year. My own goal is to help the students learn how to take in a patient's story and understand how neurological illness relates to the broader sociocultural context of that patient's life. Some but not all of these students will go on to a career in neurology or neurosurgery; I am most interested in conveying material to those who are NOT going to be neurologists, in a way that sticks, because this may be their only exposure to neuroscience in their entire career.

One big constraint is that the faculty are required to have a certain number of face-to-face contact-hours with the students, so this can't be just watch a bunch of videos at home and take a quiz. Part of the reason the curriculum committee is flipping the curriculum is that students are increasingly not coming to lectures, so faculty contact-hours are not at goal and some faculty members are in danger of losing their academic appointments. The other big constraint is that teaching time is largely voluntary for faculty (it's time they are not seeing patients or writing grants i.e. revenue-generating activities), so it's hard to get people to give up clinic time or protected research time to prep for and do a very hands-on activity, as opposed to retooling their latest conference presentation for a student audience.

I personally hated group work in school and had a traditional (non-flipped, lecture based) medical school curriculum myself, so I'm at a loss on how to do this well. Class size is about 120 students. I was told I can divide up class-time (3-4 hr per day) however I want.

Ideas I've had/stolen from The Google:
- videotaped topic lectures (e.g. stroke, epilepsy, migraine, etc) to watch before class. How to make these non-boring?
- assign readings from a textbook or review articles? No one did the readings back in my day....
- NeuroJeopardy -- I have a ppt template for this and plan to do it as review on the last day of the module before their exam
- knowledge checks, 5 question pre-class quiz or interspersed throughout the lecture
- case-based reasoning or a Choose Your Own Adventure type thing (your 8 AM patient complains of a headache. What do you do?). These could be worked through in pairs and then shared.
- patient stories? Bringing in patients who are willing to talk to medical students or standardized patients. Basically helping students translate between normal speech and medicalese.

What else should I be thinking of? Most of the resources I've seen online are geared toward high school or college classrooms, where the model is for a class to last a semester, so plenty of time for spaced repetition or teaching the same content through different formats. I'm not sure how to scale that back down for a 2-week block that by its nature is going to involve a different professor for each day.
posted by basalganglia to Education (8 answers total) 9 users marked this as a favorite
It sounds like what you're looking for is problem based learning - as long as you have the scope for the number of facilitators needed. The advantage though is that if it's in their speciality, the facilitator prep is really just looking at the learning outcomes and the scenario (though having the skills to facilitate is a whole additional thing) - so you can up the faculty contact time without severely upping the prep time.

Couple that with specific e-learning that they do before the class, on e-learning software which validates that the person has actually read the stuff (with a few quizzes in there to get them doing some reading rather than just clicking) and hopefully they have the appropriate background which wil allow them to engage with the classroom scenario.
posted by Vortisaur at 6:51 AM on June 23, 2019

Have you thought about a Team Based Learning approach? TBL format requires a fair amount of work to develop but has good evidence to support its use in medical education. One format is essentially assigned pre-work, in-class individual quiz on the material, group quiz on exact same questions, group activity to emphasize learning objectives which culminates in a simultaneous reporting scenario. The challenge is in creating the quiz questions and group activity. The quiz questions should not have slam dunk right answers. There should be a couple that are similarly “correct” so that it generates discussion amongst the group about why a particular answer is right/wrong. The activity should be similar in that there should be enough ambiguity that it generates debate so that when it gets to the simultaneous reporting part there are some differences among the groups so that it can be used to facilitate robust discussion. I’ve mostly used cases for the activity.

You’re a content expert and that makes development easier. Your challenge is the class size. Groups are usually six people. You’d need to break it into at least two (maybe three) sessions. For my sessions I usually contain everything to two hours.

Check out MedEd Portal. It’s a repository for curriculum created by other medical educators. It’s peer reviewed. There may already be a TBL session there covering your assigned content.
posted by teamnap at 6:58 AM on June 23, 2019 [1 favorite]

Problem based learning is excellent. But I would include a note of caution that if the facilitators don’t actually know/are trained on how to facilitate PBL sessions it turns into a case discussion. Facilitating PBL takes skill to push learners to the edge of what they know and to draw out introverted learners while refraining from answering the learners’ questions about the content. PBL facilitators do not participate in providing content expertise. They challenge students to figure out ways to find answers for themselves. In fact trained PBL facilitators in medical education don’t need to have any medical training at all- just training on how to effectively facilitate. Our program uses PBL for a portion of our curriculum and we’ve had two multiple day training sessions for our facilitators.
posted by teamnap at 7:14 AM on June 23, 2019 [3 favorites]

Does your institution have a center for teaching? I ask because I work at such a place (as a technologist, not a pedagogy expert) and this is exactly the kind of project that we exist to assist with.

Pointers on videos (which is more where my expertise lies than what to do once everyone is in the classroom):
*Keep each video short. 10 minutes or less. It's way way better to have 3 10-minute videos than 1 30-minute video.
*Audio quality is more important than you might think. Make sure you're using a quality mic to record your videos. Do you have an a/v support team?
*Please caption.
*Make sure in your videos you're not referencing any dates or page numbers that might change in the future, so you don't have to redo these things every year.
posted by soren_lorensen at 7:22 AM on June 23, 2019 [7 favorites]

I do standardized patient-esque work (but more interactive; I'm their teacher too) with first-years and our students always do the readings and videos because they're going to be faced with us one-on-one in an exam room with no escape other than "remediation," which is (usually) being told to do it again, but better. So that approach has my vote. We pair the students up so they learn from one another and sees that everyone struggles with something, but bigger groups tend toward side-discussions and we generally won't go above three students in the room. I don't know what to do for neurosciences specifically but if you want to chat about the structure of an SP component, I'd be happy to.
posted by teremala at 7:29 AM on June 23, 2019

I had several flipped classrooms for my graduate work in public health this year. The most successful one (in terms of what I felt I got out of it and student opinion) followed this format. Watch videos at home (generally an hour or two), do part 1 of a case study related to that content that is mostly based of off participation/completion. This was due before the first class each week. In the first block/hour of classroom time we went over the case study/reviewed common issues, etc. The second block/meeting time was later in the week and composed of group work (submitted and graded for the whole group) based of off a deeper understanding of the individual work. The key component was that this group work could be finished entirely in class if you were focused and working. I believe each group member basically took a week to be the final editor which also gave the chance for other people to step back and not have to worry about it/always have to do it each week.We also had peer evaluations on group members which affected their grades.
posted by raccoon409 at 10:06 AM on June 23, 2019

There’s an online neuroscience course from Duke whose pre-existing videos are very good and might cover the material you want to cover.

As a med student who has seen successful flipped classroom stuff and loads of unsuccessful stuff: your students will love you if you look at First Aid and the USMLE materials and keep board material at the core of what you’re covering. Like, maybe even have the take home portion be board-style questions on your topic, and then start your session by talking through the right answers and why they’re right.

If you do TBLs keep the quizzes brief. They can eat up all your discussion time.

Videos are your best bet for getting people to actually review the material in advance. Especially if the videos can be watched at 2x speed.

From my experience, memorizing pathways wasn’t that hard, but correlating them to patient presentations in board-style questions was. The thing that made neuro so tricky wasn’t the material, but rather that we’re tested on it in exactly the same format that we’re tested on everything else, even though it doesn’t translate to that format as readily. If you put a lot of focus on how to understand and answer those questions, you’ll be ensuring that your students’ knowledge goes beyond the basic level.
posted by ocherdraco at 10:21 AM on June 23, 2019

Also: don’t worry too much about whether people do the required work before class. So long as it seems like things are going smoothly, just let it go.

If it seems like people are really unprepared, institute a brief clicker quiz (2-3 questions) at the start of class on material from the pre-class videos, and have that count for some nominal portion of the grade (3% or so). Med students will do almost anything to avoid losing points off their grades.
posted by ocherdraco at 10:27 AM on June 23, 2019

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