The combination of video material and the in-class activities provides students with a deeper understanding of the material and makes the course more relevant.
—Charles Prober, MD
Despite enormous advances in modern medicine and the explosion of biomedical information over the past century, the way medical education is taught in the United States is stuck in a format that does not optimize learning, according to Charles Prober, MD, Senior Associate Dean for Medical Education at Stanford School of Medicine in California.
The combination of the digitally empowered learner, the rapid expansion of biomedical knowledge, and the increasing specialization within the practice of medicine is driving the need to reimagine medical education, so lessons are more comprehensible and memorable, what Dr. Prober calls “stickier.” Dr. Prober believes that content should be more engaging, embrace a learning strategy that can be self-paced, and designed to make better use of the fixed amount of educational time available to train new doctors.
Rather than professors delivering a series of facts to students gathered in a lecture hall, in this “flipped classroom” model of education, students acquire basic knowledge on a specific subject through a series of short—10 minutes or less—videos presented online. The video sessions can be downloaded to a student’s computer or mobile device and viewed as often as necessary to master the content in preparation for in-depth interactive classroom discussions with the professors. In this flipping of the classroom model, lessons previously taught in class are learned at home, and “homework” is performed in the classroom, with small groups of students interacting with faculty.
The flipped classroom approach to teaching is part of the Stanford Medicine Interactive Learning Initiative (smili.stanford.edu), which was launched 2 years ago by the School of Medicine. One recently developed course using this model in microbiology/infectious diseases was created by Stanford in collaboration with four other medical schools, including the University of California, San Francisco; the University of Washington, Seattle; Duke University, Durham, North Carolina; and the University of Michigan, Ann Arbor.
According to Dr. Prober, several medical school courses at Stanford have seen improved student attendance and course ratings since they migrated from poorly attended lectures as the primary mode of delivery to the flipped classroom approach.
Dr. Prober first described the use of the flipped classroom in medical education in 2012 in an article called “Lecture Halls Without Lectures—A Proposal for Medical Education” published in The New England Journal of Medicine.1 The model was further detailed a year later in an article he coauthored with Salman Khan, founder of the Khan Academy, Mountain View, California, called “Medical Education Reimagined: A Call to Action,” published in Academic Medicine.2
The ASCO Post talked with Dr. Prober about this new concept in higher learning and its impact on the education of medical students.
Growing Popularity Among Students
Stanford first used the flipped classroom concept in its biochemistry classes. How has it changed the way students’ learn, and what has been the reaction from students?
The core biochemistry class here was redesigned 4 years ago to follow the flipped classroom model. Historically, the course had not been well received, as evidenced by very few students participating in organized lectures—only about 20% of students attended the lectures, and 80% found them not to be particularly compelling. Our faculty produced a series of short videos and, in parallel, designed richly interactive classroom sessions that became more patient-centered and problem-centered than the previous curriculum.
The students found the material much more relevant and compelling because it showed them why they needed to understand the information to take care of their future patients. The course immediately became more popular, with up to 90% of the students attending the optional interactive sessions.
So the students are more engaged, the material is being delivered in a more efficient fashion, the course ratings have gone up substantially, and we believe that the students are retaining the material.
I am not suggesting that there is no room in medical education for the more conventional lecture-hall settings, but to be successful, those kinds of lectures would have to be special learning opportunities for students.
The Sweet Spot for Delivering Videos
How did you determine that 10 minutes is the optimal amount of time for students to grasp the material in the videos?
There is a fair amount of emerging data showing that 10 minutes of material is about right for a typical learner’s attention span. Some people even suggest that reducing the information to less than 10 minutes is beneficial, but there is a limit to how short you want to make these videos. So 6 to 10 minutes is what we think is the sweet spot for delivering videos that have imbedded within them no more than two or three learning objectives as opposed to 20 learning objectives you might have in a conventional lecture.
Are you producing these videos in a variety of specialties, including medical oncology?
One of our faculty members who runs our introductory courses in molecular biology is an oncologist, and he has created videos for some of the more difficult to understand concepts. For example, he devised one on the Kaplan-Meier survivorship curves. So far, we have content in biochemistry, epidemiology, biostatistics, health policy, microbiology, immunology, infectious diseases, endocrinology, and cardiology. Our faculty is becoming more and more convinced that this is a strategy that may work for their students.
We are also producing videos for students in our clinical rotations. For example, one of our core clinical rotations is in surgery, and instead of presenting the information in a lecture format, members of the surgical team have created short videos of the information. After watching the videos, the students, who are in different hospitals doing their surgical rotations, then come together once a week in a central place to have an interactive classroom session about the material in the video.
Cultivating a Deeper Understanding
Why is the flipped classroom method effective in helping medical students retain knowledge?
There are several reasons. One is that the material is created to conform to a template, so there is consistency in the format regardless of the content. In a lecture situation, content can be delivered via a variety of formats, which may leave the learner confused. For example, if you have 50 minutes to deliver a lecture, some professors use up to 150 slides. This may drive a delivery pace that is difficult for many students to follow. So I think format consistency in the video presentations automatically facilitates learning.
Also, the short video format allows for efficient packaging of the information that the teacher wants to convey, and students can review the material as many times as they need to master the content. The videos allow students to learn at their own pace, on their own time. In a classroom setting, students have one shot at understanding the material being presented.
But what really allows the video material to be relevant and “to stick” is that the students can then put the principles they’ve learned online into practice in the classroom interacting with their peers and faculty. With this method, the combination of video material and the in-class activities provides students with a deeper understanding of the material and makes the course more relevant; therefore, the information is more likely to stick with students for a longer time.
One of the core elements of these videos are patient stories; students can learn some of the key concepts we are trying to teach about basic science and the pathogenesis of a specific disease. The patient stories are powerful and help students understand the importance of learning this material.
The real test of the flipped classroom method, and it’s too soon to tell at the moment, is whether presenting medical education in this new way provides students with a superior ability to deal with clinical experiences than the traditional method of learning. So we are interested in tracking long-term outcomes. ■
Disclosure: Dr. Prober reported no potential conflicts of interest.
1. Prober CG, Heath C: Lecture halls without lectures—A proposal for medical education. N Engl J Med 366:1657-1659, 2012.
2. Prober CG, Khan S: Medical education reimagined: A call to action. Acad Med 88:1407-1410, 2013.
Education in Oncology focuses on faculty development, medical education curricula, fellowship training, and communication skills. The column is guest edited by Leora Horn, MD, MSc, Associate Professor of Medicine, Assistant Director of the Educator Development Program, and Clinical Director of the Thoracic Oncology Program at Vanderbilt University School of Medicine, Nashville.