Flipped Classrooms: Scrapping Lectures in Favor of Active Learning

More than a century ago, medical students often had to buy tickets to attend lectures. Some schools even relied on ticket revenues to pay faculty. Today, those tickets are curious relics from the past, while the lecture continues as a staple of medical education.

But the traditional classroom lecture is going the way of the lecture ticket at some medical schools. That’s because many schools are eliminating lectures in favor of a “flipped classroom” model in which students study lecture content on their own and use classroom time to interact with peers and apply their newly gained knowledge to real-life scenarios.

Class of 2019 medical students and faculty facilitators participate in a team-based learning session for the Cardiovascular, Respiratory, and Renal Systems course at the Larner College of Medicine at the University of Vermont. Photo credit: Andy Duback

“If you love teaching, there’s nothing quite like being in an active learning classroom,” said Bill Jeffries, PhD, senior associate dean for medical education at the University of Vermont Robert Larner College of Medicine.

Research on the effectiveness of the model—also known as “active learning”—is still emerging, but early indicators seem promising. For example, a large meta-analysis published in 2014 in the Proceedings of the National Academy of Sciences found that undergraduate students in science, technology, engineering, and math performed significantly better in active learning environments than with traditional lecturing.

“The room is alive. To me, as an educator, it’s something to behold because there is so much enthusiasm for learning. It really takes students to a deeper level of thinking.”

Charles Prober, MD
Stanford School of Medicine

“If you look at lecture halls in medical schools across the country, the percentage of students who actually attend those lectures is fairly small,” said Charles Prober, MD, senior associate dean for medical education at Stanford School of Medicine. “Even if we [have] the best lecturer in the world, the number of students who choose that [educational] delivery method is low.”

A few years ago, Prober helped usher in the active learning alternative at Stanford, where medical school faculty can choose whether to flip their classrooms. The first course to go “all in,” said Prober, was biochemistry. Before the change, he said biochemistry classes were among the most poorly rated and attended courses at the medical school. In response to input from students, faculty made short online videos for students to study before class and then engaged them as teams in problem-solving scenarios during class time. Biochemistry is now among the school’s most popular preclinical courses.

“The room is alive,” said Prober, also a professor of pediatrics, microbiology, and immunology. “To me, as an educator, it’s something to behold because there is so much enthusiasm for learning. It really takes students to a deeper level of thinking.”

Less than half of the required curriculum at Stanford’s medical school uses the flipped model, Prober said. However, interested faculty can get the knowledge and technical support to switch to active learning via the Stanford Medicine Interactive Learning Initiatives, which the medical school launched two years ago.

Victoria Bawel, a second-year student, said the innovative teaching style is part of what drew her to Stanford. She said she particularly likes using classroom time to talk with faculty about how they apply the learning materials when delivering medical care. “It’s forced me to think more deeply about how medicine is practiced,” she said.

A fully flipped medical school

The University of Vermont Robert Larner College of Medicine made headlines in the fall of 2016 when it became the first U.S. medical school to commit to flipping its entire required curriculum through all four years. The goal is to eliminate lectures throughout the school by the end of 2019, said Jeffries.

“Over the years, there’s been mounting evidence that lectures are not the best way to teach,” said Jeffries, also a professor of pharmacology. “We know the [traditional lecture] isn’t as good as other methods, we know [the lecture format] favors some students over others, and we know there are better ways to teach that promote better learning. So why wouldn’t we try a new way?”

Efforts to move toward more active learning began in 2011, but the decision to eliminate all lectures didn’t happen until 2015, Jeffries said. Currently, he said the school’s foundational courses are still 20 to 40 percent lecture based, while lectures have been removed from about half of clerkships. In the Vermont model, instructors create teaching videos or assign readings that students study before class. In the classroom, students often first go through “readiness assurance,” Jeffries said. In other words, they take a quiz to ensure they’ve completed the preclass work and won’t distract from other students’ learning during group exercises. Finally, students work in teams to apply their new knowledge.

With origins in team-based learning and peer teaching, Jeffries said the flipped model also allows teachers to serve as experts who can moderate discussions, answer questions, and ensure learning objectives are met.

“Get students to be the driving force. At the end of the day, it’s about getting them ready for the real world. If students get engaged, then everything starts working.”

Ranga Krishnan, MBChB
Rush Medical College

Like Stanford’s Interactive Learning Initiatives, the Larner school’s Teaching Academy, launched in 2015, helps educators make the switch. This summer, the medical school will open Larner Learning Commons, which will house the academy, along with IT staff who can help faculty flip their classrooms.

Active learning is in at Rush Medical College in Chicago too, where 2017–2018 will be the first official year of a flipped curriculum. Ranga Krishnan, MBChB, the college’s dean, said medical students helped faculty redesign the curriculum, with a goal of ensuring students achieve the AAMC’s core entrustable professional activities, or skills they should master before residency. Currently, Krishnan said, the first two years of schooling have been flipped, and work is under way to flip the entire four-year program.

Faculty and students are so excited about the change that the curriculum transformation is already a year ahead of schedule. “Get students to be the driving force,” Krishnan said of launching flipped classroom efforts. “At the end of the day, it’s about getting them ready for the real world. If students get engaged, then everything starts working.”