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Clerkship Corner The Flipped Classroom: An Engaging Alternative to Lecture-Based Instruction
By Ambika Anand, MD; John Schneider, MD; and Nathan Lewis, MD on behalf of the SAEM Clerkship Directors in Emergency Medicine academy
A flipped classroom is a teaching technique that involves using pre-class assignments to introduce content followed by using classroom time to engage with learners and explore topics in more depth. This reverses the standard model of classroom instruction in which topics are introduced in class followed by at-home assignments to reinforce concepts (Figure 1). Preclass assignments may consist of a variety of activities including but not limited to videos, reading assignments, or interactive modules. The flipped classroom has been increasingly used and studied as an alternative to traditional lecture methods.
Advantages & Disadvantages
The principal advantage of the flipped classroom model is that more time is spent exploring material using an active rather than a passive learning strategy. Students can review preclass content as many times as they need before class and then practice applying principles and deepening their understanding while in class under the guidance of an instructor. Studies of this teaching technique show increased student participation and increased instructor engagement. Additionally, this technique can lead to higher student satisfaction and favorable instructor evaluation of the learning experience. Kraut et al. (2019) suggest that a flipped
Figure 1. Traditional classroom instruction (top) compared to the flipped classroom (bottom).
classroom can be particularly effective in enhancing procedural learning, discussion of critical thinking, and higher order medical decision making.
Disadvantages of the flipped classroom lie in the increased time requirement for both instructors and students. There is additional work for instructors to create or curate pre-class materials as well as to prepare for moderation of in-class activities. Students need to allot time to complete pre-class assignments in order to participate effectively in class. Also, learners may have different levels of understanding of the material that can lead to imbalanced participation during in-class discussions. Lastly, there is no clear consensus that the flipped classroom improves student learning, rather, studies have concluded that it is not inferior to traditional lecture methods when evaluating student retention of knowledge.
How to Create a Flipped Classroom
Define session-specific learning objectives.
The learning objectives will drive the rest of the session components and discussion. While the main goal for the class may be broad, such as understanding a common chief complaint or a procedure, these objectives should be designed to answer specific questions or clarify specific points. Objectives should also be attainable within the available pre-class and in-class time.
Create pre-class components.
These can be sourced from existing FOAMed resources, published flipped classroom activities, or created from the ground up using instructor curated resources such as articles, book chapters, videos, blog posts, etc. Keep in mind the amount of time required to complete pre-class activities, and ideally time them to be less than 25 minutes for maximal student participation. Make sure to send out materials with ample time for completion before the session.
Create in-class components.
Decide how to structure the in-class activities in a way that promotes interaction and discussion. Examples include oral board examination style cases, simulations, problem-based learning or team-based learning, and small group discussions to name a few. Consider the number of instructors or facilitators needed for the session. The bulk of learning through the flipped classroom comes from the application of pre-class content, so there should also be adequate time allotted for generating questions and exploring solutions to problems.
Use assessment tools.
Consider using assessments to gauge understanding of topics covered during the session. For example, this could consist of pre- and post-tests to evaluate students’ knowledge growth. Alternatively, students could be surveyed on how effective the session was in achieving the learning objectives.
Figure 2. An example of a flipped classroom design. Pre-class assignments curated by the instructor may include articles, videos, or other resources that students may work through at their own pace. In-class components can be designed to be simulations, small group discussions, or other facilitator-guided methods. Post-class assessments may be used to further reinforce concepts or evaluate overall efficacy.
Conclusion
The flipped classroom is an alternative to traditional lecture-based instruction that allows students to apply knowledge and explore concepts in the classroom after completing pre-class assignments. Sessions are designed to facilitate interaction and discussion rather than passive learning and may be particularly effective in teaching procedures and developing clinical reasoning skills. While adequate preparation time is a must for both instructors and students, the flipped classroom can be an engaging method to use with learners to diversify and enhance their learning.
ABOUT THE AUTHORS
Dr. Anand is a first-year medical education fellow and clinical instructor in the Virginia Commonwealth University Department of Emergency Medicine.
Dr. Schneider is a second-year medical education fellow and clinical instructor in the Virginia Commonwealth University Department of Emergency Medicine.
Dr. Lewis is an associate professor at the Virginia Commonwealth University School of Medicine where he serves as the emergency medicine clerkship director and assistant residency program director.
About CDEM
Clerkship Directors in Emergency Medicine (CDEM) represents the interests of undergraduate medical educators in emergency medicine. It serves as a unified voice for EM clerkship directors and medical student educators and provides a forum for them to communicate, share ideas, and generate solutions to common problems. For more information, visit the CDEM webpage. Membership in SAEM's academies and interest groups is free. To participate in one more groups: 1.) log into SAEM.org; 2.) click “My Participation” in the upper navigation bar; and 3) click “Update (+/-) Academies or Interest Groups.”
