"Flipped Classroom" for Pediatric Anesthesiology Rotation?

[Wakawaka123]

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Hey all,

Long time poster who created a new account for extra layer of anonymousness.....

I wanted to reach out to see if any other residents have been subjected to this 'flipped classroom thing' in Peds Anesthesia rotations for general anesthesia. My understanding is its a curiculum thats being piloted at multiple sites across the country.

I ask because we are really not liking it... just wanted to see if we were alone in this.

 

[urge]

Please explain for the old farts.

 

[It's lupus!]

Just a medical student, but half of my undergrad and all of my medical school curriculum has essentially been flipped classroom. From my experience, anyone entering flipped classroom for the first time hates it because it is entirely different from how they are used to learning which is obviously stressful. I would say it would be even more so for you since it is only for a brief period in the education process. There may be another layer of complexity given we are talking about GME, but I think the concept should still stick. After I adjusted to the flipped classroom, I found I preferred it, but it took a while to adjust to the difference because it is just so dramatically different. I am interested to hear more details on how the flipped classroom works at the GME level though.

 

[Lecithin5]

For the love of God, would someone explain what flipped classroom is?!

 

[It's lupus!]

For the love of God, would someone explain what flipped classroom is?!

Essentially, read, absorb, and digest the material at home then come to class/work/lab/whatever and learn how to apply the material. The whole idea was developed on the concept that we have resources at our fingertips that allow us to get content delivered in a myriad of ways. Facts can be learned without guidance, but application of those facts in a logical manner requires guidance. My professors will tell me what I need to read and review in advance. I'm expected to come with an at least broad understanding of that material. Then it is put into the context of an activity such as solving case studies. The time spent working through the case study is guided by someone who is ideally an expert on the topic that can take the student through the material and answer there questions as the case is parsed out. Often this is done in a Socratic method as well.

Flipped classroom - Wikipedia

 

[BigMAC3]

I prefer not to use the "flipped classroom" model to give didactics. Usually i see this approach come up when trainees are unhappy with didactic quality - so programs shift the preparation responsibilities to the trainees for a flipped classroom (Now if the trainees still complain about didactic quality, it's their own damn fault for their inadequate preparation 😉...) I agree that faciliting particiption and ditching the monologuing powerpoints is a good idea. It can take more prep work to lead a didactic session this way - but I prefer a white board, some conversation, and a cup of coffee.

 

[urge]

Hey all,

Long time poster who created a new account for extra layer of anonymousness.....

I wanted to reach out to see if any other residents have been subjected to this 'flipped classroom thing' in Peds Anesthesia rotations for general anesthesia. My understanding is its a curiculum thats being piloted at multiple sites across the country.

I ask because we are really not liking it... just wanted to see if we were alone in this.

Give us an example of a learning session so we can better understand what it is.

 

[urge]

Essentially, read, absorb, and digest the material at home then come to class/work/lab/whatever and learn how to apply the material. The whole idea was developed on the concept that we have resources at our fingertips that allow us to get content delivered in a myriad of ways. Facts can be learned without guidance, but application of those facts in a logical manner requires guidance. My professors will tell me what I need to read and review in advance. I'm expected to come with an at least broad understanding of that material. Then it is put into the context of an activity such as solving case studies. The time spent working through the case study is guided by someone who is ideally an expert on the topic that can take the student through the material and answer there questions as the case is parsed out. Often this is done in a Socratic method as well.

Flipped classroom - Wikipedia

Coming prepared doesn't sound like a bad idea.

If I'm understanding it correctly, basically learn new material at home and do the homework in class the next day. Would that be a fair statement?

How would that apply to anesthesia? PBLD discussions? Simulator?

 

[It's lupus!]

Coming prepared doesn't sound like a bad idea.

hahahah. Of course not. The major difference is that the discussions are higher order. There isn't any expectation that basic facts such as A leads to B are explained in class, but rather you are expected to know that A leads to B and have some understanding of why, and then be challenged to understand that concept with increasing complexity added to the A leads to B with the caveat that it doesn't always lead to B but rather C and why do you think that is? So on and so forth.

 

[deleted87051]

Essentially, read, absorb, and digest the material at home then come to class/work/lab/whatever and learn how to apply the material. The whole idea was developed on the concept that we have resources at our fingertips that allow us to get content delivered in a myriad of ways. Facts can be learned without guidance, but application of those facts in a logical manner requires guidance. My professors will tell me what I need to read and review in advance. I'm expected to come with an at least broad understanding of that material. Then it is put into the context of an activity such as solving case studies. The time spent working through the case study is guided by someone who is ideally an expert on the topic that can take the student through the material and answer there questions as the case is parsed out. Often this is done in a Socratic method as well.

Flipped classroom - Wikipedia

Isn’t this standard residency? That’s how mine was. Essentially no didactics. Read about cases the night before, do them the next day and ask the attending questions that come up. This was a long time ago.

 

[khrisskhoras]

Hey all,

Long time poster who created a new account for extra layer of anonymousness.....

I wanted to reach out to see if any other residents have been subjected to this 'flipped classroom thing' in Peds Anesthesia rotations for general anesthesia. My understanding is its a curiculum thats being piloted at multiple sites across the country.

I ask because we are really not liking it... just wanted to see if we were alone in this.

you are not alone....coming from a med student, seems like this plague is reaching medical schools too. it is worse than a root canal.

 

[deleted171991]

This post won't make me more popular either... 🙂

Disclaimer: I have never taught in a flipped classroom model, so maybe it's much worse than I imagine.

You are living in the US, surrounded by some of the best medical books in the world, many of them available for free, electronically. As long as you get directed to a good book to read before classes, it's absolutely more useful to spend your highly-paid teacher's time on applying and explaining your already existing knowledge, than on being spoon-fed the basic stuff.

Btw, that's exactly what you will have to do in the real world, when the buck will stop with you. If you won't know something, you'll find a book or a paper, read up, then go and ask one of your experienced colleagues about the little details.

As a teacher in the ICU, it's so frustrating to have to waste time on basic stuff that's in The ICU Book, which is beautifully written and my trainees have access to. Read the darn chapter first, and THEN let's talk about it, and you'll learn and remember much more, because we will have a conversation AT A DIFFERENT LEVEL. There are TONS of great video and printed materials on the Internet about critical care, much better than anything I (or many of my colleagues) can come up with. Why not read/watch the best first (and I'll be happy to direct you to them), then have your mentor explain to or show you the tricky stuff? Many of the most knowledgeable and clinically competent attendings are not the best teachers, and the other way round.

I know we have no MKSAP in anesthesia, but we have "Clinical Anesthesiology" and many other "learning" books (e.g. the entire series of Oxford Handbooks of *** Anesthesia, or Practical Approach to *** Anesthesia). Ask your highest-scoring seniors where THEY learn from. The textbooks (e.g. Miller and Barash) are not for learning. The traditional teaching method goes against the grain of real world medical practice, so, the sooner you'll learn where to go for independent learning, the better.

My guess is that the main problem with teaching in anesthesia is NOT the flipped classroom, it's the poor mentoring and way too little hand-holding, which are essential for it to work. Just like in the real world, Neo... When I had to learn a new block, I asked to have a mentor to watch/guide me for the first few times, the way a rep does. I was told this ain't residency, and to call for help if I couldn't get it.

 

[Mman]

"flipped classroom"? Isn't that how a normal residency has always worked? I don't ever recall walking in to do a case on the 1st day of a rotation and having an attending start telling me all about how it was going to go. I mean you read about the patient and the case and then maybe the attending lets you know the night before any particular stuff they want you to set up.

 

[deleted171991]

Mommy, they flipped the classroom!

 

[jonessoda1212]

Here's an example of how flipped classroom was used when I was a trainee. I'll even use a pediatric anesthesia example. Say the topic was Down syndrome and the total lecture time was to be around 30 minutes. The lecturer would create a 20 minute or so podcast (something fairly short and broad) that the trainees would listen to prior to the AM lecture (I usually listened on my drive home the day prior). Sometimes a review article on a given topic was assigned instead of the podcast.

The next morning the lecturer would present a case stem and the lecturers job would be to guide the discussion through the relative preoperative considerations, intraoperative considerations, and postoperative considerations with the learners providing most of the information on the relative considerations. Usually the occasional board question was thrown in to see how the material applies in that circumstance too since board exams are a large part of our medical training.

Overall the goal is in the actual AM lecture the trainees already have a general idea of the knowledge and the lecture itself is just cementing the lecture topic. The trainees should do most of the talking with the lecturer mostly used to push the discussion along in the appropriate direction. That said, it doesn't work that well when trainees don't do the required prep work. I will say when done right, I feel it's better than someone just sitting up there and going through the material quickly in powerpoint format.

 

[MoMoGesiologist]

So somehow reading and preparing beforehand is a novel concept? Can you imagine an attending surgeon's reaction if a surgery resident showed up to do a procedure and said "hey I haven't reviewed anything, show me everything"? They would get kicked out of the OR.

Tldr: you should be reading on your cases and patients before you show up to the OR, flipped classroom or not

 

[dhb]

hahahah. Of course not. The major difference is that the discussions are higher order. There isn't any expectation that basic facts such as A leads to B are explained in class, but rather you are expected to know that A leads to B and have some understanding of why, and then be challenged to understand that concept with increasing complexity added to the A leads to B with the caveat that it doesn't always lead to B but rather C and why do you think that is? So on and so forth.

Sounds like something smart people would like and that people with basic learning disability would dislike.

 

[T-burglar]

you'll never be a good doctor without being a solid autodidact so i don't see the problem.

 

[It's lupus!]

Sounds like something smart people would like and that people with basic learning disability would dislike.

Maybe? I can't speak to what truly defines a residency style flipped classroom, but in my medical school classes it has done well. I have two people with learning disabilities within my circle of friends and they do great, at least as far as I can tell. Learning styles are definitely different for everyone, but at least at my school the purpose was to have us immediately thinking critically and higher order rather than later on down the line. Essentially being told that the way we are learning now as the way we will be learning the rest of our career anyways, being efficient and effective at it now will keep us from a lag later. That's the theory anyways...

 

[dhb]

Maybe? I can't speak to what truly defines a residency style flipped classroom, but in my medical school classes it has done well. I have two people with learning disabilities within my circle of friends and they do great, at least as far as I can tell. Learning styles are definitely different for everyone, but at least at my school the purpose was to have us immediately thinking critically and higher order rather than later on down the line. Essentially being told that the way we are learning now as the way we will be learning the rest of our career anyways, being efficient and effective at it now will keep us from a lag later. That's the theory anyways...

I don't disagree, "learning disability" was used as an euphemism for stupid.

 

[pgg]

The whole "flipped classroom" idea pertains to didactics, not the in-OR daily cases. Of course you read about your cases and the anesthetic techniques you'll use for them ahead of time, and then have higher order discussions and hands-on training with your attending during the case. That's what 95% of residency is.

The idea is that residency didactics (academic lectures) can be switched over to this "flipped classroom" method, and there's probably some merit to it. I don't know about any of you, but when I was a resident and there was a lecture scheduled, I'd usually go in cold. Some of that was just being tired and having enough work already prepping for my cases. I just thought of lectures as a time when I could show up and be taught something. They were mostly passive with minimal pimping.

The point of a "flipped classroom" is that prior to a scheduled lecture, a brief piece of pre-reading (or a video, or audio something) is specifically assigned, and then the lecture itself is designed with the assumption that the learners were exposed to the knowledge, ideas, or techniques in the pre-reading.

What a flipped classroom isn't, is just a regular lecture with the addition of telling the learners to read the chapter the night before.

 

[pgg]

I don't disagree, "learning disability" was used as an euphemism for stupid.

Well - learning disabilities are real things.

Whether people with actual learning disabilities ought to choose so-called "lifelong learning" careers with extraordinary demands and life/death consequences like medicine is another question. In a perfect world, guidance counselors and other advisors would help these people with honest advice. In the real world, maybe we tell too many people that they can be astronauts if they want it bad enough.

And an even better question might be the degree to which we (the people who admit applicants to medical schools and residencies, design the curriculums, and teach) ought to offer these people special accommodations in training, understanding that those accommodations aren't going to be available later, when they're on their own and there's no attending safety net protecting patients.


Problem #1 is that it's usually hard to tell the difference between a learner with a genuine learning disability, and a learner who simply has poor study habits, if all you can see is some binary "yes he knows that" vs "nope he doesn't" ... and the truth is, that's usually all we can see.

Problem #2 is that virtually none of us have any formal training in education. This is (IMHO) one of the root causes of how revoltingly dysfunctional a lot of GME is. None of the teachers have been trained how to teach. I've had the benefit of maybe 10 hours worth of actual, formal instruction on how to be a teacher, and I'll be the first here to admit that I'm still basically winging it. So knowing that limitation, I'm reluctant to be too harshly critical of whatever reason I imagine a learner is struggling. Nobody stupid gets this far.

 

[dhb]

Nobody stupid gets this far.

There is a left end to the Bell curve.

 

[It's lupus!]

There is a left end to the Bell curve.

For poops and giggles... There is a left side of the curve but comparing populations between undergraduate students to medical students there is a right shift in the curve.

 

[Orin]

In my simple understanding, the flipped classroom is at its essence basically just asking the learner to prepare for class combined with the educator being prepared to do more than just read slides during class

In my dumb opinion, there are different purposes for didactics.

Many clinical learners just want the most efficient transfer of knowledge from expert A to novice B. Flipped classrooms can lose efficiency for many individuals and forces the education time into a learner's otherwise encumbered schedule rather than keeping it concentrated in that scheduled 30 minute slot.

Many clinical educators flip the classroom because it's what all the cool kids are doing, but that really isn't the best way for all topics to be taught or the best way for all educators to do things.

The pilot will likely show efficacy because they don't design those education trials to fail.

 

[Wakawaka123]

Hwey all, thanks for your insight and input.

The reason it has not been popular at our institution is the use of essentially 'homework' before each session. We are assigned 40 ish pages of text book reading then have to type out answers to questions. We are upset because we feel typing out answers is redundant. If we need to be prepared to discuss the questions, and we know them, then why do we have to waste time and type them?

Just wanted to see other people's experience. I agree with above post that often people are so busy that they want a more straight forward transfer of materials. We all read constantly, about our own interests, about cases. But mandating reading and typing up responses to questions is a bit much....