The flipped classroom concept is that the learners will acquire the basic information prior to coming to “class” and will work on knowledge application during conference time. We want to accomplish near transfer (thinking about problems similar to how they would in a clinical setting) as opposed to far transfer (learning something very differently then how it will be applied). Adults, especially the Millennial generation, do not learn well passively (sitting and listening). They need to be involved in active learning and interact with the material, apply their knowledge, make decisions, and see consequences of their actions to learn best, just as they do in the clinical setting.

Small Group Principles

You should strive to have “leaderless” small groups. Additionally, you almost always want to make time for the small groups to come together in the large group afterwards to discuss their findings, conclusions, and questions. You should plan 1/3 of the time for this large group debriefing (ie. if 30 minutes small group discussion, 10 minutes of large group debriefing) if you have not accounted for this in a different fashion.

Flipped Classroom Techniques

Some options of how to promote the application of knowledge during conference sessions are below. There should be minimal, if any, PowerPoint text slides. You may want to use some presentation media to show pictures, videos, algorithms, etc during your talk. You may also want to use presentation media for an introduction / attention grabber and/or to reiterate main take home points in the conclusion. You may find other uses for this such as a displaying a procedural skills checklists that you are having them practice during the session, or providing an overall structure for your talk. But, there should not be text slides with you talking very frequently. You should be “talking at” the large group < 50% of the time overall, and probably should generally have < 15 “slides” total.

In class problem solving

  1. Can distribute cases ahead of time with questions the learners will need to answer in class – for G1s questions could be more simplistic with answers that could come more from textbooks, and for G2s/3s answers could be more complicated and require literature search, nuances in management, etc. Having specific questions that they will need to discuss “in class” will hopefully motivate people to read about these topics ahead of time.
  2. Can distribute cases only “in class” and have them do real time problem solving but they may need computers / references easily available to do this depending on the questions. May get less covered this way than in (a) since some of their time would be spent searching for the answer.
  3. Can have each group solve different problems and then present their conclusions to the large group so they are teaching each other, with facilitator input when needed. Can tell people what topic or questions they will have ahead of time so they can focus their reading on that topic.
  4. These can occur in small groups or think-pair-share (groups of 2)
  5. Each small group can have a facilitator or be “leaderless”. If leaderless, the session facilitator must walk around to answer questions / check in with the groups.
  6. Caution: This must be problem solving – something that they need to think through – not simple questions that are regurgitation of facts read from a textbook. The objectives and topics of discussion must be worth having a discussion about; simple regurgitation of facts are not worth discussing.
  7. Recommendation: The residents who have done PBL in the past have suggested that we provide the materials we want them to review prior to class. Leaving them to find the resources on their own can seem nebulous and overwhelming to them. They have also suggested that compliance with pre-“class” reading / watching / listening will likely be higher if podcasts / audiocasts are assigned as opposed to readings. They are more able to listen to something (since they can do it while doing other things) than read something.

Point – counterpoint

  1. For controversial topics, can assign ½ of the class to argue one perspective during class, backed by evidence, and assign the other ½ of the class to argue the opposite viewpoint. Then the learners get into their groups and have a “debate” about the topic.
  2. Could also have the learners get into pairs with one person arguing point A and the other person arguing point B, and see how many people at the end come out on either side of the argument.

Skills practice

  1. Individual skills practice (ie. everyone practices certain type of suturing skill)
  2. Group skills practice (ie. people get in groups, have one person lay on ground, and have the group decide how to do a dislocated hip reduction then practice the skill. If multiple groups, after practice have groups all tell large group what technique they used and maybe show them – facilitator then discusses & demonstrates any techniques that weren’t discussed or used.)

Expanded cases

  1. Use a case presentation and have the groups go beyond MDM and management in their discussion. (ie. for a case where the diagnosis is new diagnosis of cancer, one could both discuss management of the medical aspect of the case, and also have learners discuss how they would deliver this bad news.) Could bring in any of the other competencies into the discussion beyond MK and PC: interpersonal and communication skills, professionalism, problem based learning and improvement, and systems based practice.

Oral boards style cases

  1. Each group has a facilitator that has the case in front of them. The facilitator can be a faculty or one member of the group that is given the case. They give some information and have the group decide what to do next. The case unfolds where they receive information sequentially and make decisions about case management. For advanced learners, this could involve a difficult consultant that is arguing with the EM doc, where the only way to convince them is to discuss the current evidence on the topic.
  2. This can be done with one person as the main decision maker with group support (or observation) OR this can be done where the group goes through the case as a team

Progressive Case Disclosure

  1. Similar to above where the learners get certain pieces of knowledge and make decisions on the case. Difference here is this: at each decision point, a discussion about why they decided what they did is had (can talk about data gathering, d