The 21st Century Medical School and the “Flipped” Classroom

Sep 30, 2014, 9:30 AM, Posted by Susan Dentzer

Pity the poor medical student...or at least many students now slogging away in medical schools across the nation.  

Most spend the first two years of medical school cramming their heads with facts about the functions of cells, organ systems, and other aspects of the human body. Having contact with real patients—the reason most students went to medical school in the first place—is quite limited until the third year, when clinical clerkships begin.

Meanwhile, medical knowledge is exploding, doubling every five years, and taxing the human brain’s capacity for processing and recall. Today’s medical students know that one day, they’ll be most likely to practice medicine with the aid of “cognitive computing” systems like IBM’s Watson, which has already “learned” as much as a second-year med student, and is helping clinicians at the Mayo Clinic, Memorial Sloan-Kettering Cancer Center, and other institutions process reams of medical information to make clinical decisions. 

So in this brave new world of medicine, what sense is there in making medical students cram down many facts that may already be in flux—or spend hours listening to lectures from the proverbial “sage on the stage?”  Why not “flip” the medical school classroom, by packaging much basic content in online form, and then creating richer pedagogical experiences for students that better equip them with critical thinking skills truly required for good doctoring?

Those are the goals of projects sponsored by the Robert Wood Johnson Foundation, and now under way at Khan Academy, Stanford Medical School and four other institutions. With RWJF’s support, for example, Khan Academy has developed dozens of online videos explaining everything from diseases of the heart and circulatory system to how to interpret blood lab test. And for the past two years, the foundation has collaborated with the Association of American Medical Colleges and Khan Academy to sponsor national contests encouraging medical school students to create video and online content for those preparing to take the revised Medical College Admission Test®, or  MCAT®, scheduled to debut in the spring of 2015.

Michael Painter, MD, JD, senior program officer at RWJF, says such efforts aren’t just intended for current or aspiring medical students. “Technology enables us to spread knowledge for free to anyone who is a curious learner,” and also to transmit it to others who may need it, including patients. He notes that video and other online content developed by Khan Academy is playing a growing role in educating people across the health professions—for example, nursing students preparing for the National Council Licensing Examination for Registered Nurses  (NYCLEX-RN).

Working with the Khan Academy, and building on its “flipped classroom” model, Stanford now leads an effort to “create educational products that are more valuable than individual medical schools are able to create on their own,” says Charles Prober, MD, professor of pediatrics, microbiology and immunology and senior associate dean for medical educations at the university’s medical school. Together with medical school faculty and students at the University of Washington, Duke, the University of California at San Francisco, and the University of Michigan, Prober and colleagues are creating a prototype online course on microbiology and immunology–in effect, about viruses, bacteria, and other bugs, and the body systems that fight them–that can be used across all medical schools.

“Right now, in North America, more than 140 medical schools each have their own idea of what a true core course in microbiology and immunology should be,” says Prober. Considering that all US students will ultimately take the same exam to get a medical license, “we’ve been doing them a disservice” not to come to a common agreement on core components of knowledge that students should acquire.

It took much discussion, but the five schools have now agreed on core content for at least the one course, on microbiology and immunology. It will be piloted beginning in October at UCSF, and roll out across the other four schools beginning next January. The course’s online videos feature compelling stories focused on fictional patients, scripted by medical content experts and artfully drawn by another Stanford educator, Maya Adam. One segment features a young Haitian boy, Philippe, who develops cholera after drinking from a local water tap. His fictional elder brother, a medical school student, tracks down the culprit: the bacterium Vibrio cholera, which is endemic in Philippe’s neighborhood.

The videos, which students can watch from home, are intended to serve as “springboards” into deeper, more interactive classroom discussions based on materials somewhat like classic business school case studies. Such sessions, guided by a facilitator, “focus us more on forming us as clinical decision makers, because they force us to interact more with the material,” says Jennifer DeCoste-Lopez, a Stanford medical student who leads a student group working on the project.

The prototype will be evaluated and undoubtedly tweaked—and, if ultimately deemed successful, used as a model for other courses for first- and second-year med students. And it may help to set the stage for similar innovations in educating tomorrow’s health professionals throughout their lifetimes.

Join an RWJF “First Friday” Google+Hangout on Flipping the Medical School Classroom, on Friday, October 3, from 12 pm to 1 pm ET.


Live Discussion: “Flipping” the Medical School Classroom

On Friday, October 3, the Foundation hosted a discussion focusing on a new approach to medical education in which much basic content is delivered online, thus freeing up classroom time for more interactive sessions and learning what really “sticks” with students.

Watch the video, below.