SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.
Recently, the flipped classroom — a model of instruction in which didactic content is delivered outside the classroom (usually online), and in-person class time is used for active learning — has infiltrated the educational landscape from kindergarten to professional school.
As a current medical student, I generally agree with advocates for using the approach in medical education. For example, Stanford’s Charles Prober, MD, senior associate dean of medical education, argues in a New England Journal of Medicine commentary that the opportunity for enhanced time-efficiency, student self-pacing, and classroom time freed up for more interactive learning make the flipped classroom a potentially attractive approach for educating physicians. I say “potentially” because, like anything else, the flipped classroom is a good approach only if it is done well. For me as a learner — even a modern, Millennial learner — I’d much rather attend an engaging lecture or study a well-written textbook than watch a lousy online video or struggle through a poorly facilitated interactive classroom session.
So I have to admit I harbored some skepticism when, about about a year ago, Prober invited me to become involved the Re-Imagining Undergraduate Medical Education Initiative, an ambitious project to create a new, flipped classroom-based microbiology and immunology curriculum in collaboration with four other U.S. medical schools, which Scope covered last year.
Although I was excited to have a role in such a large-scale project, I worried that the hype of the flipped classroom trend would overshadow what I thought should be the priority: training our future doctors with the highest quality education — not just the flashiest.
Happily, my worries have proved unfounded. I have seen the faculty and staff from the five schools work tirelessly to produce an impressively high-quality final product. In fact, I have even come to believe that the flipped classroom model intrinsically helps incentivize medical faculty members to prioritize teaching.
One of these incentives is that old favorite from middle school: peer pressure. Traditionally, in the world of academic medicine (most med students are trained in academic medical centers), peer opinion is almost exclusively based on a faculty member’s research accomplishments. Academic research involves constant accountability — faculty compete for prestigious grants, promotions, and awards, and routinely present their work at conferences to be directly critiqued by their peers.
By contrast, when a professor delivers a lecture to medical students, it is uncommon for any of her peers to be in the audience. They probably never even knew he or she was giving a lecture, much less whether it was any good. So it’s no mystery why many faculty, even those who say they enjoy and value teaching, hold themselves to a much less rigorous standard in teaching than in research. This isn’t to say that none of our med school faculty care about teaching — in fact, we have a wonderful contingent of faculty dedicated to educating med students. But in most cases, those who focus on teaching do so in spite of strong incentives to direct their energies elsewhere.
By contrast, the faculty working on our microbiology and immunology curriculum are subjected to the scrutiny of expert peers for every online lecture they create. As a student, it has been immensely satisfying to watch these educators strive to perfect their lecture videos before showing them to their peers, only to have the reviewing faculty member doggedly insist on making it clearer, more relevant, more concise, or more visually engaging. Even for educators who already tend to put considerable effort into their teaching, having peers appraise their work raises it to another level. This direct peer review of teaching (at least the online component) is made infinitely easier because online educational media can be readily accessed and reviewed by peer educators.
Another way that I have seen the flipped classroom motivate faculty educators is by giving them the opportunity for more meaningful in-person interaction with students.
Traditionally, “interaction” with students meant spending an hour behind a podium, flipping through a PowerPoint deck, while a handful of nameless medical students drowsily looked on. In the flipped model, the teacher instead spends that hour sharing his clinical or scientific expertise with a group of students who are engaged in problem solving with the concepts they are learning. After experiencing this more rewarding way of teaching through our microbiology curriculum at Stanford, our faculty (all busy clinicians and/or researchers) have been begging to come back again and again as facilitators. Several have even requested more faculty development activities to proactively improve their teaching skills in that setting.
As med schools across the country and worldwide transition to flipped classroom approaches, I hope that they'll leverage this opportunity, by implementing rigorous peer review of online material combined with meaningful student interactions in the classroom, to motivate their faculty to become better teachers.
Jennifer DeCoste-Lopez is a final-year Stanford medical student who will soon start a residency in pediatrics at Stanford. She was born and raised in Kentucky and went to college at Harvard. She currently splits her time between clinical rotations, developing a new curriculum in end-of-life care, and caring for her young daughter.
Photo by Pauline Becker