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Roadblocks and Opportunities: The Flipped Classroom Is Emerging in Medical Ed

The EvoLLLution | Roadblocks and Opportunities: The Flipped Classroom Is Emerging in Medical Ed
AThe medical education space has been slow in adopting online learning opportunities, but their potential to transform the space is massive.

Across higher education, traditional approaches to teaching are being revisited and revised to meet the expectations of today’s students. In some disciplines these alternative options are widespread and common while in others, they are still largely ignored. The medical education space is in the latter group, but opinions are slowly changing. Leading that charge is Dr. Charles Prober, who is pioneering a set of entry-level medical education courses that use the “flipped classroom” pedagogical approach, which makes standard lecture material available online and reserves classroom time for more in-depth, discussion-based learning. In this interview, he sheds some light on the major roadblocks standing in the way of the wider adoption of online-supported flipped medical education and shares his thoughts on how this new approach could transform medical education worldwide.

The EvoLLLution (Evo): What have been some of the biggest roadblocks to the wider adoption of online learning in the medical education space?

Charles Prober (CP): The use of online learning in the medical education space is relatively new. We’re in the process of piloting several projects in online learning and then scaling those particular projects. Our roadblocks are to initiating and scaling the process rather than some broader roadblocks you’ll often hear about because we’re so early in the process.

The first barrier is gathering sufficient evidence that online learning is an effective strategy for a certain part of the medical education that is provided primarily in our medical schools. Before one can accrue evidence, one has to develop something to test, and for this one must have an enthusiastic explorer, somebody who is interested in attempting innovation and change to see if that innovation and change is for the better. You have to find someone who is an early experimenter or an early adopter who will create the online learning product and then use it in their particular course.

The first challenge I had was actually finding faculty who were interested—who recognized that we have a problem right now in the way that we teach much of our medical education, and then having them be willing to solve the problem through a different pedagogical strategy and to take the risk that that different strategy would work in terms of the learning outcomes.

After we have the faculty to develop and run the course, and then get feedback and evidence, the next challenge is finding more faculty to do the same thing with their courses.

Evo: What impact could a wider adoption of online learning—especially in early-stage medical education courses—have on medical schools?

CP: If one develops an online modular library of content that is of high quality and consistent quality, then by continuing to iterate that, one can get to a place of uniformly high quality. There’s the opportunity to engage many educators and to determine and define amongst those many educators, those that really excel at being able to create and distribute the content.

In addition, one can engage a group of other experts in education that can provide input to continually improve the product. There’s a greater opportunity to create consistently high-quality content. It can be created in a modular format—for example in short videos—that then can become part of a library that is used to vary the sequence of a course or curricular experience according to the needs and wants of the particular school or of the particular student. It can enhance the experience and ultimately enhance the efficiency and consistency of the production.

Evo: What has been the reaction from your colleagues across the industry, both at Stanford and outside of Stanford to the move to create and introduce more online programming in the medical education space?

CP: The response is variable. This is true of any new step or innovation in education or otherwise.

I have no specific data, but anecdotally it appears that about 20 percent of our faculty and other educators are keen and open to change and innovation, either because they see the need for one reason or another, or they see the opportunity. On the other end of the spectrum, there are probably about 20 percent of educators who do not see the need or opportunity and are reticent to consider change. The remaining 60 percent make up the majority. They are trying to see which way the pendulum is actually swinging to decide whether and when to get engaged.

Evo: What was the catalyst moment for you when you decided that online education needs to be available for medical education students?

CP: Medical education students have spoken with their feet in terms of their desire—or lack thereof—to receive material in a standard lecture format.

The attendance in lectures at our medical school, and at schools across the country, has typically been very low and getting lower. Having 20 percent of your class attend the lecture would be a high attendance rate. We’ve begun recording the lectures so that students have the opportunity to watch the lecture at any time of the day and they also have the opportunity to watch it at different speeds or to not watch it at all. Given that the majority of students did not seem particularly interested in the old model of education suggests that there needs to be something different if we believe we have important material to transmit.

Another thing that struck me was that there should be a core of medical education that can be agreed upon by a large number of schools. It’s our obligation as educators within medical schools in North America to identify that core and create it in a way that is accessible to the student. Why not share it and make it truly a collaborative effort so that the work of many reduces the work of a single individual or a group of individuals. If we do that, we’ve freed up a large amount of time to really work with the students to allow them to understand the relevance of the material, the compelling nature of the material, the fun of the material and then the lecture hall becomes abuzz with interaction and discussion, rather than just a single voice on stage.

Finally, there’s really a large discrepancy in access to medical educators around the world. We’re very fortunate in North America by having large faculties at many of our schools, but that’s not the case especially in the developing world where they may not have the faculty to create and teach the material. If one creates modular content that is exportable, one can export it to the developing world with language modification and make it more broadly accessible.

Technology is now at a place where it’s never been before in terms of global distribution. It’s available to really create compelling material and distribute it widely.

Evo: What do you think the future holds for online courses in the medical education arena and how can administrators that want to see more online programming get that course content from where it is today to where you see it in the future?

CP: I’m hoping for a future where this is a consensus on what represents the core of a medical education circa 2015 and moving forward. I’m looking forward to a future where with that knowledge of the core and there is a creation of material that is modular, flexible, portable and therefore sharable. Continuous quality improvement in that material would allow for different people contributing to the common good and each of the individual schools to develop the local flavor of the material in the context of the faculty at the schools interacting in person and with deep meaning with the particular students at the school.

The challenge is first of all proving what I just described as an ideal truly is ideal and then developing a way to create it together and share it broadly. We’ve dipped our toes into this by having a collaborative venture with four other medical schools to create a particular core content for one course in the pre-clinical space—microbiology and immunology. Early in this experiment, it appears that we can develop an agreement on the common core, we can develop a collaboration in the production and sharing of it and then use it at our schools in a way that maintains the individual identity of the school. It’s an extensive process, both in terms of time and resources. The challenge is to develop a strategy for paying for this development as well.

This interview has been edited for length.

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