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
- 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.
- 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.
- 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.
- These can occur in small groups or think-pair-share (groups of 2)
- 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.
- 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.
- 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
- 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.
- 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.
- Individual skills practice (ie. everyone practices certain type of suturing skill)
- 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.)
- 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
- 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.
- 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
- 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, diagnosis, treatment, education, or follow up; can include evidence, practice variations, etc).
- This can also be done with a standardized patient or a facilitator / group member playing the role of the patient / consultant / other team member. For advanced learners, the patient could be a physican from a different specialty wanting to understand all of the evidence behind the decision being made.
- This can also be done where each person in the group plays a different role in the case
- Caution: this depends on the learners willingness to be imaginative. This requires very clear objectives as to keep people on task, and outcomes can be unpredictable.
- There are multiple stations with multiple facilitators (you will have to recruit them, but you do have a conference faculty who can help out) where the residents go from station to station to do skills, tasks, cases, etc.
- Can do quizzes, polls, audience response system questions at the start of each session to identify where you and the learners need to focus your efforts over the next hour. This will enable you to assess where they are and match your teaching with their knowledge gaps. This may also motivate them to read prior to “class”
- Previous versions of this have been very well received. This is where the facilitator just lets the audience ask any questions they want to know more about on the topic. Each question optimally generates a discussion amongst the audience (facilitated by the instructor – the instructor throws the question back to the audience if possible with a “what have you done with this sort of patient in the past”, gets their thoughts on it, and then provides them with any additional data or information to answer their question).
- If multiple less complex questions arise, the facilitator can just answer them
- CAUTION: when relying on the audience to generate the content of your talk, it is important to have a back up plan with questions that you will answer if the learners are not asking enough questions to fill the time.
- Jeopardy, The Price is Right, or any other game formats. People like competitions and these are often very interactive.
- Caution: these must be used sparingly or learner interest quickly wanes
- Caution: things like jeopardy often focus on lower levels of bloom’s taxonomy and simple facts (“know”, “understand”). We want to focus our learning on the upper levels of bloom’s taxonomy of “apply”, “analyze”, “evaluate”, and “create”.
- There are some topics that are perfect for jeopardy when you want to focus on those lower levels of Bloom’s taxonomy, such as remembering names of various fractures or identifying skin rashes / lesions. If that is your objective, jeopardy is fine.
“Find the Errors” in Podcasts or other non-peer reviewed media presentations
- Have the learners all listen to the same podcast with the assignment to find at least a certain number of errors in the presentation – this can generate a good discussion, and often different people find different errors.
- Learners reflect on an experience they’ve had either before class or in class based on a topic / assignment you’ve given them and do narrative writing (where they write from the point of view of a patient or other team member) or reflective writing (focusing on their own personal reaction or reflection of an event). They then share their reflections in a small group which promotes small group discussion of the issue. This works better for interpersonal communication / professionalism topics than for MDM topics.
Commitment to Act or to Change
- At the end of a session, you can have learners verbalize or write down what they plan to do differently as a result of what they learned in the session. People are more likely to remember and do things if they commit to it in this fashion.
This fantastic list of techniques for a flipped classroom was was put together by Dr. Danielle Hart. Associate Program Director, Department of Emergency Medicine, HCMC. Director of Simulation, HCMC Interdisciplinary Simulation and Education Center. Assistant Professor, Department of Emergency Medicine, University of Minnesota Medical School.