hat if instructional time was spent achieving more sophisticated learning objectives? What if learners came to the classroom—or meeting or bedside—having already achieved the most basic levels of learning and could then focus on building upon that foundation? That is precisely what the “flipped” classroom aims to do.

Why instruction has to change

Historically, classroom teaching has involved delivery of content in a traditional lecture format followed by a homework assignment in which the learners apply what they have learned. In the professional medical setting, this model extends to our traditional thought leader forums, such as Grand Rounds and many didactic continuing medical education methods. 

This educational approach involves little interaction between the educator and learners and leaves students to figure out the deeper meaning of what they have learned on their own after class. For practicing clinicians, this model must compete with busy schedules, entrenched processes and existing behaviors that often circumvent application of new concepts.

In education, there is a well-known hierarchy of learning objectives outlined by Benjamin Bloom.  

In the revised version shown here, the most basic levels of learning involve the ability to remember facts and understand concepts. Moving higher up the pyramid, you can find higher levels of learning such as being able to apply and analyze what you have learned. In traditional lectures and meetings, instructional time is typically spent at the lower levels. The flipped classroom blends pre-work and classroom time to achieve a meaningful learning experience.

What is the “flipped classroom?”

The “flipped classroom” is an instructional approach that has long been in existence, but is gaining momentum as more educators are becoming comfortable with technological advances. In this blended learning modelBlended learning integrates independent, often online methods of learning with supervised and collaborative approaches. learners are tasked with performing “pre-work” before their classroom time with the educator. Then, “live instruction” time is spent on the application of what they have previously learned. Active learning and engagement with the material that normally would have occurred as homework after class, has been “flipped” to now be an in-class activity.

In the professional setting, “flipped meetings” employ the same methods: providing “pre-work” via email or other modality that imparts greater context, can reduce meeting length and add depth to “live instruction” or team discussion.

What does it look like?

Here are some examples of pre-work and live instruction activities:

How do I do it? (Easy to use resources)

Here is some technology available to support the flipped instruction:

Before you begin, consider the pros and cons

There are advantages and disadvantages to consider when deciding if this is the best modality for your next teaching session. It is also important to remember that a curriculum does not have to flip 100%. For example, some sessions or lectures may be best in a traditional format whereas others are more conducive to trying “flipped” classroom.

The “flipped” classroom can work well in small or large groups and can be as high or low-tech as the educator is comfortable with. The main purpose is for the learner to be given the tools to prepare for a more interactive and engaging in-class experience that pushes their level of understanding. With deeper understanding of content, the hope is that their future patients will be better cared for.

Conclusion

Let’s return to our introduction case studies to see how Jamar and Sarah apply the flipped classroom technique.

Jamar’s teaching isn’t boring anymore.

Jamar uses the “flipped” classroom to restructure his previous teaching session on minimally invasive surgery. The week before his session, he sends out “pre-work” to learners which includes an article to read and a 20-minute video where he presents and discusses some of the background slides from his lecture last year. For the classroom time, he creates four cases based on real patients who had minimally invasive surgery. He develops a question guide for each case that encourages learners to decide how they would evaluate each patient, what intraoperative approaches would be best, and what to look for in the post-operative setting. Learners work in teams to answer the questions, while Jamar and the chief residents walk around to answer questions. For each case, he has video clips from the surgery that demonstrate key surgical techniques. After the group work, Jamar shows these video clips and goes through the answers to the questions. He receives excellent feedback for this session and learners appreciated the opportunity to ask questions and discuss real clinical scenarios.

Sarah has an actively learning and engaged team.

In some ways, the COVID-19 uncertainty has made staff more eager to learn. They are receptive to new information because they realize just how important it is. Sarah uses the “flipped” classroom approach by starting with why—she sends a meeting invitation that clearly and succinctly explains the rationale for the protocol change and provides a step-by-step visual 1-page visual summary of how to implement the protocol to be reviewed in advance. During staff meeting, she demonstrates the new procedure and allows staff to observe until they feel comfortable enough to try it. She leaves time for and encourages team discussion about the new procedure. In the following days she rounds on staff to check-in, identify concerns and answer questions, always making sure to validate emotions and concerns. Sarah will use their feedback to improve her method of instruction—she knows the protocol will change yet again.