By: Debra DaRosa, PhD, professor of surgery, Northwestern University Feinberg School of Medicine
Although it’s early morning, the energy in the classroom is palpable as the surgery residents assume their grouped seats in the classroom. Their mission is to dazzle the senior guide (formerly the faculty lecturer) by clicking in the correct answer to the first of several multiple choice questions (MCQs) reflected on the screen. The questions relate to their assignment, which they completed prior to this core curriculum session. The aim of the exercise is for the residents to correctly answer as many MCQs as possible within the hour-long session to show the senior guide that they understand the topic. Responses to the MCQs require the recall of critical facts, the analysis of images or data, comparisons, inferential thinking, or evaluation. If fewer than 80% click in the right answer, the guide takes the time to ask the residents to turn to their partners and convince them of the correct answer. A few minutes after this peer teaching exercise, the residents re-click their answers. Discussion as to why the other distractors were wrong ensues.
This brief synopsis describes the process we use at Northwestern University Feinberg School of Medicine in our surgery residency core curriculum. It has similar attributes to the new model for medical education proposed by Prober and Khan in their recent commentary (pre-assignments, the instructor serving as a coach/guide, and the interactivity of learners to embed knowledge). Two years ago, implementing this process required a major “flip” of our core curriculum. Yet it has been well received by residents and faculty.
I share our experience because Prober and Khan are suggesting a call to action to medical schools to apply a new model based on the flipped classroom design. I support their recommendations but feel that they excluded two variables that are critical to the successful adoption of this model.
Faculty development: As Prober and Khan state, the medical education curriculum remains primarily didactic, and faculty are accustomed to giving lectures. Some lectures are excellent, and I am not in favor of extinguishing all of them. But most, in my opinion, are not designed to promote deep learning, which is why the flipped classroom approach can serve as an excellent replacement. Faculty will need to be exposed to this model in a way that encourages their “buy in”, taught how and why it works, and coached during their first attempts to use it. A faculty development template or program could be developed for use by anyone interested in implementing the flipped classroom model. I can’t overstate the importance of this facet. People do things for three reasons: (1) they are forced to; (2) they think it is the right thing to do; and/or (3) they are good at it. Sustainable change in faculty teaching behavior will require #2 and #3. Prober and Khan’s call to action needs to include the development and delivery of a carefully constructed faculty development program to increase the likelihood that faculty will succeed in using this new model, which will reinforce their buy in and promote sustained behavior change.
Learners’ progression: One of the main benefits of the flipped classroom model is that it allows for learners’ individualized progression. As aptly noted by Prober and Khan, this model allows learners to view content as often as they need to master the knowledge/skill. A medical education system should be constructed that enables a learner to progress forward in the curriculum once she or he shows proficiency. Not all learners progress at the same rate, yet medical school and residency curricula require a lock step approach to graduation. Although constructing such a system requires additional scrutiny before it is implemented, it has a key benefit—the potential to shorten medical students’ pre-clinical years, and perhaps, depending on the scope of the proposed core curriculum, all of medical school.
Prober and Khan have called us to action to rethink how we conceive of and deliver medical education. The flipped classroom model described in their commentary, with the addition of the elements I have noted here (creating a faculty development program and adjusting for learners’ progression), represents a major paradigm shift. My hope is that eventually their proposal will move from a multi-institutional collaboration to a global collaboration. Khan Academy has touched the lives of learners all over the world. This innovation, applied to medical education, could do the same.