Flipping the Medical School Classroom

Flipping the Medical School Classroom

The high-tech future of medical education

Written & illustrated by Laura Maaske, MSc.BMC, Medical Illustrator & Medical Animator| e-Textbook Design

Was your medical training all you had hoped it to be? Did you learn as much as you expected or knew you could? Was learning effective, efficient, and fun? Technology is changing the practice of medicine. But it is also changing the way medical students learn, expectations of their potential, and the way they want to be learning.

A Changing World

AMA outlines a need for change in medical education

Medical education cannot remain the same, given the changing world. According to James L. Madara AMA EVP and CEO, there is gap between what students are learning, and the everyday reality of practicing as a physician[1]. In fact, the AMA is taking suggestions as models for this change, and has funded a number of schools to begin to reform standards in medical education.

To instigate practical change, he American Medical Association is granting $11 million in the course of five years to a list of winning medical schools that will explore teaching innovations. These schools must come up with better offerings for individual learning styles, methods to assess core competencies, improving patient outcomes and safety, and better efficiencies health care financing.

Grant recipients for this initiative, named Accelerating Change in Medical Education, include,

  • Indiana University School of Medicine
  • Mayo Medical School
  • NYU School of Medicine
  • Oregon Health & Science University School of Medicine
  • Penn State University College of Medicine
  • The Brody School of Medicine at East Carolina University
  • The Warren Alpert Medical School of Brown University
  • University of California ? Davis School of Medicine
  • University of California ? San Francisco School of Medicine
  • University of Michigan Medical School
  • Vanderbilt University School of Medicine

To read a summary of the proposal offered by each school, visit the AMA Grant Projects Webpage[2].

What Endures in Education?

Plato was right

We all know better than to say because a learning strategy is new, it is better. So how do we judge? Educators create exhaustive studies to answer this question. And their insights offer us a few points of focus as we look through the filter of new technology to see how education might be improved. Reading and collecting ideas about education, through my own effort to create good ebooks for students, I have gathered a list of keys to good education:

  1. Individualized learning. This seems like a new idea. But formal education is new in human history. Before the Egyptians introduced formal education, 3000-5000 BCE[3], people learned person-to-person. So all education was individualized. Formal education offered efficiency. But more recently, educators are making the effort to allow students options to learning, so that their individual needs and preferences might be addressed. In studies of medical students preferred learning styles, it was found that students prefer that instruction to be offered in all avaiable formats (visual, audio, reading/writing, and kinisthetic) rather than one or another[4].
  2. Socratic method. Perhaps the greatest innovation in education came from Socrates. The Socratic method is way of teaching so that the student systematically explores a question. Through active thinking, the student finds answers.
  3. The lecture. Plato did not believe the written word was the best form of transmitting knowledge, and he suggested the oral tradition as the best way to learn[5][6]. Certainly his students would have had to take notes in order to have any record of all as to what was taught. Socrates, as well, felt that the implementation of written texts would weaken the mental faculties of students, who would no longer be inclined to commit ideas to memory[7]. The word itself, ?lecture? is a 14th Century Latin word, which means, ?to read? from a text. But this is not what students need today, and the traditional 45 minute lecture has been shown to be too long for a student’s attention span. 20 minutes works best for adults[8]. It must be modified to be effective. And it is typical for most people, that their minds wander during a lecture[9].
  4. The textbook. Although the Greeks used texts for learning. And while Gutenberg printed a few Latin books on his presses. The use of textbooks in formal education did not begin until the 19th Century[10].
  5. Repetition. Repetition as a key to learning dates back to the earliest forms of edcuation. However, it takes on a new possibility in the classroom. More recently, as students are using the computer and ?flip the classroom? lectures as a way to review lecture materials, students find it extremely easy to review the materials that they find challenging. It has even reduced the need for students to ask professors questions outside class.This has been shown to be one of the most exciting innovations with technology, and it has freed time for professors to use in class to engage in less lecture-based and more Socratic forms of interaction with students.
  6. Practical Immersion. Apprenticeship is the traditional and enduring environment for hands-on learning. Many professions require internship. While many of these skills cannot be replicated in the digital environment, still many can be with simulated three-dimensional ?worlds?.
  7. Interactive design. This really follows fromt the Socratic Method, as an ideal which enourages students to think and solve problems as a way of gaining deeper knowledge and understanding. Interactive, active rather than passive engagemnt with information, is best form of learning that can be offered to students.
  8. Fun, engagement, and interest. Traditionally, these goals were considered a luxury or frivolity in education. But more recently, educators are offering these aims as objectives in learning. As we all know, when we enjoy our work, when we become absorbed and engaged, and whatever helps us to focus our efforts, will make learning possible. Global learning, offered int he digital age, offers not just interactivity, but the possibility for great and interesting educators who are fantastic at teaching to reach extremely wide audiences and experience world recognition in a way teachers and professors rarely have before.
  9. Tests or markers of knowledge. Controversial as tests may be as a tool to measure knowledge, they are nonetheless an eduring method for self- and outside-assessment. With technology, increasingly it is becoming possible to test student remorely. This brings education closer to a one-world classroom.

We’re working on apps, here at Medimagery. This is a layered hand app to reveal layers of anatomy with the touch of a finger.

Keeping education goals in mind

What do we want our new doctors to be capable of?

Among the suggestions for using technology to make education better, medical schools offer these goals to keep in mind:

  1. Possess strong foundation of science with ability to use scientific method to seek new knowledge, and to critically evaluate medical literature
  2. Know the human body: cell and organ structure and function, system function and integration
  3. Understand molecular, genetic, biochemical, and cellular processes as they relate to human body
  4. Know determinants of human health and disease: personal, social, or environmental impacts; apply principles of pharmacology and therapeutics
  5. Safely perform routine diagnostic and therapeutic procedures
  6. Interpret routine laboratory results, clinical tests, and image scans related to common conditions and illnesses
  7. Skillfully perform physical and psychiatric examinations
  8. Formulate appropriate management strategies for patients, suitable to that patient’s needs and values
  9. Curiosity and passion to address future needs of society from a health perspective
  10.  Learn in a self-directed way with lifelong commitment to learning
  11.  Capacity to collaborate well and communicate clearly
  12.  Capacity for reflective practice, to recognize one’s own limitations, to improve one’s own performance
  13.  Exercise sound clinical reasoning and decision-making skills; to perform critical evaluations of healthcare situation and systems
  14.  Professionalism and leadership skills
  15.  Capacity to interpret and apply evidence, to interpret clinical information
  16.  Creativity: to produce new discoveries, to assimilate new information, and to apply this information to patient care
  17.  High ethical standards; Recognize, anticipate and navigate ethical dilemmas in medical care.
  18.  Empathy towards others and understanding of others’ needs; advocate for the interests of their patients.
  19.  Ability to gather the necessary information from patient history, to understand socioeconomic and cultural impacts, to accurately write a patient history, and then to correctly interpret this information
  20. Understand and utilize the healthcare in context as a larger system

So what changes are taking place now?

New possibilities emerge as a result of technology

?Born-digital? textbooks and learning materials are those which have been originally created in a digital format. They offer a full range of necessary features to make learning all the objectives of the course possible. These include interactive features to test principles and formulas being described, video clips to augment learning, and an audio track of the book text.

Schools are still in an embryonic stage, to be taking full advantage of technology that is offered today. In a survey of 940 bookstores, run by the Follett Higher Education Group, roighly 2% of tge textbooks sold at college bookstores are in a born-digital format[11].

Among schools making the transition, Stanford School of Medicine is taking a lead. Its goals are to reinvigorate the classroom by offering online lectures in short segments. These lectures are offered my many instructors and specialists in the field, as needed. This allows textbooks to pull from primart sources for knowledge. Short lectures are followed up with quizzes.

The classroom time then is freed up. It becomes a place for discussions rather than lectures. Students take more initiative in asking questions so learning can be individuized. Time traditionally spent in lecture is now spent in real-world application, problem-solving, case studies, and team-based endevors.

The new paradigm offers a growing possibility for academic superstars. Stanford Medical School relies on input from Salman Khan[12], famous for his engaging style in teaching subjects from math to art history, to help faculty make their presentations more interesting and engaging. Khan says, ?I have a self-paced lecture to be seen at home? and what used to be homework, I now have students doing in the classroom.?

But medical schools cannot accomplish this alone. Textbook publishers play an enormous part in offering content. Innovative digital textbook company Kno has introduced, ?Kno Me.? It’s a personalized dashboard which allows students to mark their performance, time commitment, and engagement with materials, in mastering content.

Textbook publishing giant, McGraw Hill, recently announced a plan that offers a place for textbooks in the changing medical classroom. This Spring it has begun to offer a textbook suite with ?adaptive learning technology?, which means it collects data on individual student comprehension (knowledge, skill, and confidence). It uses this data to create algorithms for customized study. The program also offers ?before-the-course? materials to help students warm-up before difficult classes. It includes photo-realistic virtual labs to make preparation for labs more effective. The book ?talks? to students, offering instructions and suggestions on the most effective way to read, based on the student’s needs and performance. This textbook is not groundbreaking, but it is a good step forward.

The new changes put students in the powerful position to make critical suggestions, and of demanding that their educational content be effective. New materials should be available easily to all devices, probably Web-based. Content should be updated frequently and as soon as facts change. The books should be as interactive in teaching concepts and in testing them, encouraging critical thinking skills in the time-proven Socratic style.

Instructors should have greater impact as well, trusting that the material is peer-reviewed and authoritative. Instructors will have the freedom to choose which chapters and segments of material to be included in a course. Both students and faculty will be able to make use of the analytical capabilities of Smartbooks as a method of assessing their effectiveness in student learning.

[1] AMA pledges millions to jump-start innovation in medical education, By Kevin B. O’Reilly. Jan. 28, 2013http://www.amednews.com/article/20130128/profession/130129956/6/

[2] Proposals offered by each school can be viewed at http://www.ama-assn.org/sub/accelerating-change/grant-projects.shtml

[3] Formal education introduced by Egyptians. http://en.wikipedia.org/wiki/Education#History

[4] Heidi L. Lujan and Stephen E. DiCarlo. First-year medical students prefer multiple learning styles. 10 October 2005. http://advan.physiology.org/content/30/1/13.full

[5] Plato advising the oral tradition as the best: http://people.ucalgary.ca/~dabrent/webliteracies/platowr

[6] Plato’s Seventh Letter advising the oral tradition over written for passing significant knowledge, 360 BCE. http://classics.mit.edu/Plato/seventh_letter.html

[7] Socrates discourages written text as detrimental to learning. http://en.wikipedia.org/wiki/Textbook#History

[8] Joan Middendorf and Alan Kalish. The Change-up in Lectures. 1995. http://www.iub.edu/~tchsotl/part3/Middendorf%20&%20Kalish.pdf

[9] Rick Nauert. Short Lectures, Frequent Quizzes Maximize Online Learning. April 8, 2013. http://psychcentral.com/news/2013/04/08/short-lectures-frequent-quizzes-maximize-online-learning/53562.html

[10] Textbooks become standardized in formal education. http://en.wikipedia.org/wiki/Textbook#History

[11] Jeffrey R. Young. The Object Formerly Known as the Textbook. January 27, 2013.https://chronicle.com/article/Dont-Call-Them-Textbooks/136835/

[12] http://www.youtube.com/user/khanacademy


– See my full original article in Med Monthly Magazine at: http://medmonthly.com/research-technology/flipping-the-medical-classroom/#!

July 2013

Written & illustrated by Laura Maaske, MSc.BMC, Medical Illustrator & Medical Animator| e-Textbook Designr | e-Textbook Designer

Laura Maaske – Medimagery LLC
Medical Illustration & Design


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