Designing the Flipped Classroom: Part 3 – In class activities


Learning is viewed here as developing a way of thinking and acting that is characteristic of an expert community. Such a way of thinking consists of two important elements:

  1. the knowledge that represents phenomena in the subject domain
  2. the thinking activities that construe, modify and use this knowledge to interpret situations in that domain and to act in them.
Billet, 1996
Situated learning: bridging sociocultural and cognitive theorizing
Learning and Instruction, 6

Long Term MemoryIn Part 2, we looked at outside the classroom activities; in this article we will look at using the classroom to move information forward into long term memory.

Let’s start with the process outlined in the image to the right.

Input Interrogation

Input interrogation is a term originating in the electrical sciences which is used in education to mean using higher order questions to transform information into patterns. When groups of people do this interrogation together through discussion, cases and problem solving, the resulting patterns are better developed. Classrooms are an ideal location for input interrogation unlike memorization which is best done alone. Learning takes place when you have a teaching plan that includes both.


Patterns are the schema retained in long term memory that makes understanding and retrieval of knowledge easier. Experts have millions of patterns that make diagnostic reasoning and management planning easier.

Information Retrieval

We know that “practice makes perfect” in terms of skill development but it also improves development of patterns. The more time students spend checking  that what they believe to be true is true, the better their patterns therefore the better their retention will be.

Use these design elements to plan in class activity

  1. Look at your objectives again, verbs such as analyze, compare, manage, evaluate lend themselves to this design approach.
  2. Look at any questions you asked as part of the outside class activity, what is the best way to get answers for these questions (quiz/discussion)? This becomes your lead off activity. (Retrieval/Input Interrogation)
  3. Pick an activity that furthers your objective (Input Interrogation) (Pattern Making)
  4. Ask students to identify gaps in their knowledge and discuss how those gaps will be met in future classes or through self-directed learning. (Pattern Making)

Designing the Flipped Classroom: Part 2b Videos

KhanOne of the areas that is problematic for people who want to try flipping their classroom is the common idea that all you have to do is record your lecture and ask students to watch it ahead of time or as part of an online course. BIG MISTAKE promoted by lecture capture companies! Recorded lectures are not interactive, they are too long to meet peoples’ attention needs and they often focus on talking heads which is very poor input (unless your head illustrates the topic being discussed.) Cognitive overload is very common in this type of flipping and retention of content is poor.

Look at the beginning of this Behavioural Genetics lecture capture video of 1 hr 38 minutes. Three minutes in the instructor explains the basic concept using his voice only, combined with an image of the speaker pacing back and forth (a useful technique for engaging your live audience but distracting in a video). How much of the basic concept would the novice retain by lecture end? For the auditory learners in the class, he was probably a very entertaining speaker, but his brief use of the whiteboard is poorly shown by the capture technology. This lecture would have been better captured in a podcast without the visual distractions of his image.

Here are some tips for flipping videos to help people memorize:

  1. Keep them short -under 15 min.- and focused on one key concept (Attention)
  2. Chunk videos into no more than seven concepts per session (Cognitive Overload)
  3. Start with a story (Relevance)
  4. Use a graphic organizer at either beginning or end if there are important interconnections (Scaffolding)
  5. Use images of presenter at beginning and end if instructor presence is needed.
  6. Use clear, simple visual illustrations of all key concepts (input).

If you are teaching a skill:

  1. Demonstrate the complete procedure, including patient and team interaction
  2. Repeat the actual procedure progress by chunking videos into numbered steps (Cognitive overload and Scaffolding)
  3. Use still photos in the video to illustrate complex movements (Scaffolding).

Designing The Flipped Classroom: Part 2 Design the outside class activity

Working Memory

Prerequisite Learning Design Knowledge

In the previous section, you analyzed information about your students and your objective. Now we are going to look at how working memory (the brain’s immediate experience) can be best utilized to improve learning in a flipped classroom. As you can see from the image at the top of the page, there are 5 aspects of learning that you have to initially consider.

I. Attention
Obviously, in order to learn, people have to pay attention, however, there are many distractions that can take students’ attention away. There are three aspects of attention that you have control over:

  1. Because people can’t listen and read at the same time, they often find it annoying when presenters read the text on their slides.  If you are preparing a slide show as your flipped component, put key points and relevant images on your slides and write a script for uwhat you need to say. Don’t make your head the focus of the video unless you are using your image to teach a key point.
  2. People have trouble paying attention for more than 15 minutes. Flipping allows you to chunk content into more manageable pieces. If you are recording lectures, aim for 8-12 minutes per show and organize content around 1 objective at a time.
  3. Use questions. Our students have a Pavlovian response to being asked a question, so use questions to focus attention on what to look for in article and videos.

II. Relevance
The more relevant content is to student’s current lives, the more focused their attention will be. Information that can be incorporated into current schema (an organized pattern of thought or behavior) will be easier to retrieve from long term memory. This is why you analyzed who your students are in the previous section. Some of the ways to improve relevance in a flipped classroom are:

  1. Tell patient stories – There are some excellent online resources such as Stories from the Saskatchewan Health Region.
  2. Ask students to remember a relative or friend with health issues.
  3. Begin illness scripts that students will build on over time. Start with the common diagnoses.
  4.  Use graphic organizers that link what participants learned previously to keypoints they will learn next.

III. Scaffolding
Novice learners don’t have the patterns that you have, so they need structures that help them see relationships. Once they have created schema of their own, the scaffolding isn’t as useful or necessary. Some examples of scaffolding are:

  1. Guidelines
  2. Mnemonics
  3. Numbers
  4. Steps
  5. Concept maps/graphic organizers/illness scripts

IV. Inputs
Content primarily enters working memory in 4 forms: images, sounds, movement and emotions. Movement is the most poorly understood of the input tools but writing, typing, drawing and manipulating instruments are common examples. Smell is less useful in classroom settings, but can be very relevant in clinical settings. When planning your flipped classroom, try to include at least two of the inputs in every activity.

V. Cognitive Overload
Cognitive overload is the barrier that stops information from reaching memory. As a rule of thumb, about 7 items is the limit of how much information working memory can hold at any one time. Beyond that point, either earlier steps, ideas and facts will be lost in order to access the new learning or the brain will stop paying attention and new content will not be retained. Fatigue and hunger decrease the amount of material accessed, which is why you need to know about students’ overall work load. If information isn’t accessed by working memory, it can’t be stored in long term memory. If students cram information for exams, it often doesn’t get processed into long term memory and is lost post-exam.


Design The Outside Class Activity

  1. Start with an objective or learning step that you would like the students to learn before class which requires them to memorize X. Spend some time thinking about how this objective might be best learned. (There are some ideas here.) Pick three or four methods that fit the objective.
  2. Set some criteria the method has to meet, such as cost, time to construct, technology availability, availability of outside resources, etc. and narrow the choices to two. Pick one that appeals to you (start small).
  3. Create the resource, considering the 5 points in the prerequisite section.
  4. Ask someone else to look at the resource with fresh eyes and give you feedback.
  5. Pilot the content and ask for student feedback.

Stay tuned for next post on Creating Videos and on Designing the Flipped Classroom Time.


Is the End of Lecturing, the End of Teaching?

Lecturing humourOver and over for the last 10 years, I have heard people say online learning will kill the teaching profession, learning objects will kill the teaching profession and now flipped classrooms will kill the teaching profession. I think I bring a unique perspective to this argument because I came to teaching through an unusual teacher training program in the 1970’s. My teacher training was focused on small group learning, problem solving, discovery learning and individualized curriculum to bring up basic skills. Then, in my 30’s, I discovered computers as an individual teaching tool.
I wasn’t confronted with lecture based teaching methods until I went to graduate school in my 40’s. I deeply hated the experience, but I conformed to the university culture where every conference and every large classroom experience is exclusively lecture based.
To my deep shame, lecturing has now become a deeply ingrained habit, but I still hate it. If the job of teachers is to help students learn, then lecturing is an incredibly inefficient way of doing that. I feel like a horse buggy driver among spaceships. So let’s look at alternative definitions of teaching.

Teaching at a Distance – MOOC’s vs. Videoconferencing vs. Desktop Collaborative Learning

To date, I have participated in two Stanford MOOCS with over 500 people and been deeply disappointed. There was minimal interaction with teachers, poorly developed curriculum and mass chaos as 500 people tried to organize themselves into task groups. Clearly these course needed good teachers desperately.

My university has invested heavily in videoconferencing programs that project lectures to distant locations. I have participated in and observed many of these sessions and I have never seen an engaged audience at the other end. I see students eating, talking to their friends and engaging with their computers but I don’t see them engaging with the faculty or home-based students even when the instructor is interacting well with the f2f students.

I used to participate in online desktop sessions using a tool that allowed participants to communicate through audio, chat, small group rooms and whiteboard tools. I saw people deeply engaged. Contrary to the myth that you don’t need a teacher, it was the teacher presence and interaction with the audience that made these classes so engaging. I don’t understand why medicine is one of the only training programs not using this technology.

Flipped Classroom

The best examples of flipped classes in medicine that I have seen involve students using a variety of resources to learn the knowledge component of a course. Teachers create that content, teachers curate resources created elsewhere. Teachers decide what reasonable workloads outside the classroom are. Teachers have office hours to meet with students who are struggling with fuzzy concepts. Yes, it’s a different role from creating and reading PowerPoint slides, but it is clearly all about helping people learn.

The role of the teacher freed from listing facts in a lecture becomes a facilitator of Higher Order Thinking. Learning through cases, experiences, patient stories, problem solving, resource sharing and formative assessment will engage your brain as well as the students when you enter the flipped  classroom.

Curation as Social Learning

Curation means gathering, evaluating and providing access to X. One of the cutting edge roles of teachers is to curate knowledge resources online to share with students. Dr. A.M. Cunningham has one of the best examples of this here. The next level of curation is to make the students your curators by having them share resources with other students. This is called Social Curation and it still requires a teacher to facilitate, and assess the process.

Teaching is one of the oldest professions. It just needs a new wardrobe for the twenty first century. So medicine, let’s shed the 16th century lecture robes. Help me break a bad habit!

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