Medical education reimagined: a call to action.
TL;DR: The authors propose a new model for medical education based on the "flipped classroom" design that would enhance the relevance and retention of knowledge through rich interactive exercises, and facilitate in-depth learning fueled by individual students' aptitude and passion.
Abstract: The authors propose a new model for medical education based on the "flipped classroom" design. In this model, students would access brief (~10 minute) online videos to learn new concepts on their own time. The content could be viewed by the students as many times as necessary to master the knowledge in preparation for classroom time facilitated by expert faculty leading dynamic, interactive sessions where students can apply their newly mastered knowledge.The authors argue that the modern digitally empowered learner, the unremitting expansion of biomedical knowledge, and the increasing specialization within the practice of medicine drive the need to reimagine medical education. The changes that they propose emphasize the need to define a core curriculum that can meet learners where they are in a digitally oriented world, enhance the relevance and retention of knowledge through rich interactive exercises, and facilitate in-depth learning fueled by individual students' aptitude and passion. The creation and adoption of this model would be meaningfully enhanced by cooperative efforts across medical schools.
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TL;DR: The results indicate that there is much indirect evidence emerging of improved academic performance and student and staff satisfaction with the flipped approach but a paucity of conclusive evidence that it contributes to building lifelong learning and other 21st Century skills in under-graduate Education and post-graduate education.
Abstract: There is increasing pressure for Higher Education institutions to undergo transformation, with education being seen as needing to adapt in ways that meet the conceptual needs of our time. Reflecting this is the rise of the flipped or inverted classroom. The purpose of this scoping review was to provide a comprehensive overview of relevant research regarding the emergence of the flipped classroom and the links to pedagogy and educational outcomes, identifying any gaps in the literature which could inform future design and evaluation. The scoping review is underpinned by the five-stage framework Arksey and O'Malley. The results indicate that there is much indirect evidence emerging of improved academic performance and student and staff satisfaction with the flipped approach but a paucity of conclusive evidence that it contributes to building lifelong learning and other 21st Century skills in under-graduate education and post-graduate education.
1,491 citations
Cites background from "Medical education reimagined: a cal..."
...(5) Prober and Khan 2013 USA Proposal of a model for medical education based on “flipped classroom” approach....
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...Advocates in K-12 recommend a range of in-class activities including individual practice (e.g. completing maths problems) so that the teacher can then provide individualised help or large scale in inquiry projects (Prober & Khan, 2013)....
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TL;DR: The aims of this review are to examine the scope and quality of studies on the FC teaching approach in medical education and to assess the effects of FCs on medical learning.
Abstract: Context
There are inconsistent claims made about the effectiveness of the flipped classroom (FC) in medical education; however, the quality of the empirical evidence used to back up these claims is not evident. The aims of this review are to examine the scope and quality of studies on the FC teaching approach in medical education and to assess the effects of FCs on medical learning.
Methods
A literature search was conducted using the major electronic databases in 2016. Peer-reviewed papers were screened and reviewed according to explicit inclusion criteria. The scope and quality of all resultant studies were evaluated. Studies identified as using controlled designs were further synthesised to assess the effects of FCs on learning.
Results
A total of 118 articles were obtained. Full texts of 82 articles were reviewed. Nine of the included 46 articles used a controlled design when examining the effects of the FC. There were generally positive perceptions of the FC approach. However, the effects of FCs on changes in knowledge and skills were less conclusive as the effect sizes ranged from d = −0.27 to 1.21, with a median of 0.08. The varying direction and magnitude of the effect sizes, together with their 95% confidence interval, which contained zero, suggested the lack of strong evidence for the effectiveness of FCs in promoting knowledge acquisition above and beyond the traditional learning methods.
Conclusions
There has been a recent increase of research rigor and variety in measures of effectiveness in studies on the FC in medical education. The FC is a promising teaching approach to increase learners' motivation and engagement. More solid evidence on its effect on changes in knowledge and skills are warranted. Further studies should also examine the long-term effects of FCs with regard to knowledge retention and transfer of knowledge to professional practice and patient care.
456 citations
TL;DR: This paper illustrates the explosive growth of EMCC websites and provides a foundation that will anchor future research in this burgeoning field.
Abstract: Disruptive technologies are revolutionising continuing professional development in emergency medicine and critical care (EMCC) Data on EMCC blogs and podcasts were gathered prospectively from 2002 through November 2013 During this time there was a rapid expansion of EMCC websites, from two blogs and one podcast in 2002 to 141 blogs and 42 podcasts in 2013 This paper illustrates the explosive growth of EMCC websites and provides a foundation that will anchor future research in this burgeoning field
245 citations
TL;DR: Despite the increasing popularity of FL and similar active learning models, there has been limited attention devoted to understanding the reasons for why students may or may not engage in pre-class activities.
Abstract: Prior education studies have consistently emphasized the importance of sustained and active student engagement to aid academic performance and achievement of learning outcomes (e.g., Hockings, Cooke, Yamashita, McGinty, & Bowl, 2008; Michael, 2006). The positive impact of such active learning models on academic outcomes has been well established, particularly, in the STEM (Science, Technology, Engineering andMathematics) disciplines. For example, Freeman et al. (2014) demonstrated that students undertaking STEM courses incorporating active learning models received (on average) higher academic grades and were less likely to fail in comparison to peers in more traditional and lecture based modes of teaching. While active learning has clear benefits for student learning outcomes, the process of implementation is often more complex than first anticipated (Gillies & Boyle, 2010; Hung, 2011). For instance, student engagement in active learning does not occur spontaneously and educators must employ careful consideration of the curriculum design, activity sequencing and progression as well as the diversity of learners, including learners' prior experience and motivation, background and knowledge. Flipped learning (FL) is a form of blended learning that requires students' active participation in learning activities both before and during face-to-face sessions with the teacher (Lage, Platt, & Tregua, 2000). However, students frequently lack the necessary skills, time, and/ormotivation to fully participate in pre-class activities and therefore do not commit to the level of involvement in the learning process that effectively complements the intended design (Lai & Hwang, 2016; Mason, Shuman, & Cook, 2013). Clearly, the reasoning for why students may or may not engage in pre-class activities is complex and multi-dimensional. However, if provided with a deeper insight into the types of learning strategies students employ in such active learning models, teaching staff can make better informed decisions regarding student support and course design processes (Stief & Dollar, 2009). Despite the increasing popularity of FL and similar active learning models, there has been limited attention devoted to understanding
232 citations
Cites result from "Medical education reimagined: a cal..."
...Themajority of the reported studies confirmed the educational benefits associated with FL models, such as increased student satisfaction (e.g., Forsey, Low, & Glance, 2013), higher course grades (e.g., Pierce & Fox, 2012), and increased attendance (e.g., Prober & Khan, 2013)....
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TL;DR: Techniques that medical educators can use when leading teaching sessions to foster engagement and encourage self-directed learning are described, based on current literature and evidence about learning.
Abstract: Background Core content in Emergency Medicine Residency Programs is traditionally covered in didactic sessions, despite evidence suggesting that learners do not retain a significant portion of what is taught during lectures. Discussion We describe techniques that medical educators can use when leading teaching sessions to foster engagement and encourage self-directed learning, based on current literature and evidence about learning. Conclusions When these techniques are incorporated, sessions can be effective in delivering core knowledge, contextualizing content, and explaining difficult concepts, leading to increased learning.
180 citations
Cites methods from "Medical education reimagined: a cal..."
...These methods facilitate in-depth learning and dynamic in-class discussions (36)....
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References
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Journal Article•
TL;DR: For example, this paper pointed out that students are no longer the people our educational system was designed to teach, and that a really big discontinuity has taken place in the last decades of the 20th century.
Abstract: It is amazing to me how in all the hoopla and debate these days about the decline of education in the US we ignore the most fundamental of its causes. Our students have changed radically. Today’s students are no longer the people our educational system was designed to teach. Today’s students have not just changed incrementally from those of the past, nor simply changed their slang, clothes, body adornments, or styles, as has happened between generations previously. A really big discontinuity has taken place. One might even call it a “singularity” – an event which changes things so fundamentally that there is absolutely no going back. This so-called “singularity” is the arrival and rapid dissemination of digital technology in the last decades of the 20 th century.
7,973 citations
2,330 citations
TL;DR: Empirical evidence suggests that “medical reversals” may be quite common, and many medical reversals involve conditions for which the standard of care has been promoted over the years based primarily on pathophysiological considerations.
Abstract: IDEALLY, GOOD MEDICAL PRACTICES ARE REPLACED BY BETter ones, based on robust comparative trials in which new interventions outperform older ones and establish new standards of care. Often, however, established standards must be abandoned not because a better replacement has been identified but simply because what was thought to be beneficial was not. In these cases, it becomes apparent that clinicians, encouraged by professional societies and guidelines, have been using medications, procedures, or preventive measures in vain. For example, percutaneous coronary intervention performed for stable coronary artery disease and hormone therapy prescribed for postmenopausal women cost billions of dollars and supported the existence of entire specialties for many years. Stable coronary artery disease accounted for 85% of all stenting in the United States at the time of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial. Large, well-designed randomized trials that tested whether these practices improved major patient outcomes revealed that patients were not being helped. Defenders of these therapies and interventions wrote rebuttals and editorials and fought for their specialties, but the reality was that the best that could be done was to abandon ship. How many established standards of medical care are wrong? It is not known. Medical practice has evolved out of centuries of theorizing, personal experiences, bits of evidence, expert consensus, and diverse conflicts and biases. Rigorous questioning of long-established practices is difficult. There are thousands of clinical trials, but most deal with trivialities or efforts to buttress the sales of specific products. Given this conundrum, it is possible that some entire medical subspecialties are based on little evidence. Their disappearance probably would not harm patients and might help salvage derailed health budgets. However, it is unlikely that specialists would support trials testing practices that constitute their main source of income. Instead, the research community performs studies of modest incremental value without even knowing whether the basic standards of care are appropriate. Rarely, some investigators find the courage to test established “truths” with large, rigorous randomized trials. When this happens, empirical evidence suggests that “medical reversals” may be quite common. In an evaluation of 35 trials that were published in a major clinical journal in 2009 and that tested an established clinical practice, 16 (46%) reported results consistent with current beneficial practice, 16 (46%) reported evidence that contradicted current practice and constituted a reversal, and another 3 (9%) were inconclusive. Perhaps high-profile general medical journals are more prone to publish unusual results and less inclined to defend a clinical practice or specialized turf than specialty journals. However, it is unlikely that the selection filter in favor of reversal publications is stronger than the selection filter favoring the validation of standard of care. The mere testing of a standard of care generates interest because many standards of care are never tested. In another evaluation of trials published in 3 major general medical journals or high–impact factor specialty journals, of the 39 mostcited randomized trials published in 1990-2003 that found a significant benefit of a clinical intervention, 9 (23%) found effects stronger than those found in subsequent studies and 19 (49%) found results replicated in subsequent studies, but 11 (28%) remained largely unchallenged, with no large trial conducted on the same question. Many medical reversals involve conditions for which the standard of care has been promoted over the years based primarily on pathophysiological considerations. Often one or more trials exist, but they have not tested clinically relevant outcomes or have been biased. For example, vertebroplasty—the injection of polymethylmethacrylate cement into fractured bone—gained popularity in the early 2000s for the treatment of osteoporotic fractures. Initial studies addressed the pathophysiology of this therapy, delineated the technical skills required to optimally perform the procedure, and furthered the discussion about the benefits of vertebroplasty. Claims of benefit were strongly contradicted in 2 randomized trials that included a sham pro-
189 citations
Book•
01 Jan 2012
TL;DR: A free, world-class education for anyone, anywhere: this is the goal of the Khan Academy, a passion project that grew from an ex-engineer and hedge funder's online tutoring sessions with his niece, who was struggling with algebra, into a worldwide phenomenon as mentioned in this paper.
Abstract: A free, world-class education for anyone, anywhere: this is the goal of the Khan Academy, a passion project that grew from an ex-engineer and hedge funder's online tutoring sessions with his niece, who was struggling with algebra, into a worldwide phenomenon. Today millions of students, parents, and teachers use the Khan Academy's free videos and software, which have expanded to encompass nearly every conceivable subject; and Academy techniques are being employed with exciting results in a growing number of classrooms around the globe. Like many innovators, Khan rethinks existing assumptions and imagines what education could be if freed from them. And his core idea - liberating teachers from lecturing and state-mandated calendars and opening up class time for truly human interaction - has become his life's passion. Schools seek his advice about connecting to students in a digital age, and people of all ages and backgrounds flock to the site to utilise this fresh approach to learning. In THE ONE WORLD SCHOOLHOUSE, Khan presents his radical vision for the future of education, as well as his own remarkable story, for the first time. More than just a solution, THE ONE WORLD SCHOOLHOUSE serves as a call for free, universal, global education, and an explanation of how Khan's simple yet revolutionary thinking can help achieve this inspiring goal.
53 citations
TL;DR: The One World School House: Education Reimagined by Salman Khan as discussed by the authors leverages his popular status as the world's teacher to provide his own critique of the US education system.
Abstract: In Salman Khan’s new book, The One World School House: Education Reimagined, Khan leverages his popular status as the “world’s teacher” (Webley, 2012) to provide his own critique of the US educatio...
29 citations