The Flipped Classroom Goblin

I just sat down with a group of 1st and john_henry_fuseli_-_the_nightmare2nd year medical students to hear horror stories about their experiences with flipped classrooms. Although many of them liked the idea behind the strategy, these experiences had been overwhelmingly negative.

The stories mainly consisted of 4 categories:

  1. Too Much Content

      1. A three hour lecture is boring in the classroom but it is unwatchable as an unedited video
      2. Asking students to read several articles written for medical professionals not medical students because the faculty member doesn’t have time to edit the content or doesn’t understand the knowledge level of med students leaves them confused and embarrassed by their lack of understanding. Worse it can mean avoidance of article reading once they graduate.
      3. Asking students to read articles without guiding questions so they know what to focus on
      4. Anything that takes more than 1 hour to complete (see Flipped Classroom for ideas)
  2. No Follow Through Between Homework and Class Time

      1. Asking students to do homework but not following up and helping students make the connection between the time spend studying and classroom activity
  3. Using Class Time for Lecturing

      1. The educational theory behind the flipped classroom is that content that must be memorized is best learned independently while higher order thinking is best done thru group activity. Flipping the classroom provides an opportunity for students to develop both factual and clinical reasoning. (see Using Classroom Time)
  4. Not Attending Faculty Development

      1. The underlying issue seems to be with faculty who I know have never attended a single workshop on how to flip a medical classroom. Students have positive stories about what active participants in faculty development are doing.

    image (C) Henry Fuselli

Why Guidelines are an Important Part of Medical Education

The Problem

Like women a year after childbirth who have fuzzy memories of the experience, preceptors don’t remember what it was like not to know X. Their fingers don’t remember the inability to tie knots and they are unable to list the steps in a procedure because it is performed automatically, both mentally and physically. Therefore guidelines seem too simplistic or obvious to experts. Even changes to guidelines are rapidly assimilated if they fit into the medical patterns that experts already have.

Medical Students Don’t Have Patterns

Medical students leave the university with vast chunks of information, but only practice in the real world forms those chunks into the patterns that denote medical expertise. Both their bodies and their minds are awkward participants in the new learning process that forms the clinical years.

Clinical Guidelines

Guidelines promote clinical learning for the following three reasons:

  1. memorizing steps is a familiar learning process for students, it’s concrete in an environment that may feel nebulous and unpredictable to recent graduates
  2. guidelines act as a bridge to pattern making, with increasing practice and confidence the student begins to understand the links to deeper knowledge and understanding
  3. guidelines are a concrete tool for feedback. Instead of the nebulous “great job”, preceptors can ask the clerk or resident how well they followed a particular guideline.

Just for fun, take a look at how one physician is encouraging the use of guidelines. How might you promote the use of guidelines?