Recently, the university I attend switched from the traditional didactic format to a “flipped classroom.” A flipped classroom shifts class time away from a lecture format to a more discussion based, allowing exchange between students and professor, as well among students. Ideally, the flipped classroom format allows students to come to lecture with a broad knowledge of the subject at hand, and during the lecture hour, the professor helps to hone this knowledge and contextualize the information in a way that will make the students understand it better. However, in its practice, it can become a shifting of responsibility teaching from the professors to the students alone.
When I heard that we were switching to a flipped classroom format, I was excited. The college I attended was a big proponent of the flipped classroom. In my experience, I felt that coming to class prepared and ready to discuss the day’s material was a good way to stay engaged, build a rapport with professors, and to understand the subject from different viewpoints by listening and discussing with my classmates. The most excited amongst us were the deans, building their model off of those used at other institutions that had since seen double digit increases in board scores. Obviously, everyone was excited to jump into this new format in the hopes that we would see the same success, but we did not expect how difficult it would be to make the transition.
The practicality of bringing this format to our medical school had a few barriers to breach, not the least of which being the class size. In my experience (in undergraduate college), the flipped classroom tends to work best in a class of roughly 10-20. Our class has 165 students. Within the single 50 minute lecture period, it would be almost impossible for everyone – or even a meaningfully large proportion – to have their voice heard and give feedback. As it is now, class time interaction mainly consists of professors posing a question relating to the class, calling on a random person from the audience, and that student answering the question. There isn’t any meaningful discussion and there isn’t any significant dialogue. To add to the frustration, roughly five minutes per lecture hour are spent silently waiting for a microphone to pass to the selected student and waiting for the student to organize his or her thoughts. Almost daily, we sit through a painfully uncomfortable interaction with a student who sincerely does not know the answer to the question and a professor who sincerely wants to get an answer out of them.
Really, I can’t blame them. I am a relatively confident speaker, but even when I am called on to speak in front of an audience of 165 on a subject that I barely understand, I find it nerve-racking. The faculty wants to ensure that there is sufficient student contribution in class, so the professors have had to reduce their in-class teaching time significantly.
Additionally, to convert their lectures to this new format, professors have had to adapt to new technologies, such as in-class polling systems and quizzes, and must integrate them into their lectures. Although this comes naturally for some professors, others who have been giving the same lectures for years have had great difficulty using and incorporating new systems. What makes this even more difficult is that this shift was only announced at the beginning of the school year. Instead of having a summer to convert their lectures and learn to use the new technology, many professors have had to learn as they go by trial and error. What limited instructional time we have is even further limited by technical inadequacies. The students have been caught in a perfect storm of excessive pre-study, poor class direction and inefficient use of class time. In the past months, the on campus atmosphere has become increasingly tense and the student-professor relationship has become increasingly strained. In our own limited case, it seems that the flipped classroom is an ideal that is destined to fail.
All this being said, a flipped classroom is not an inherently bad idea. In my undergraduate classes, I felt like I learned more and learned faster in flipped classroom environments. However, there are some key differences between the ideal flipped classroom format and the traditional medical school didactic format that must be overcome to make the conversion successful. The issues of technology and re-education of faculty are important and can be relatively simply addressed. Even something as simple as having professors training during the summer and giving professors the time and assistance they may need to adopt the new format should be sufficient. However, the most paramount issue is, unfortunately, also the most difficult; medical schools that would attempt to employ the flipped classroom must address class size. With an national average total class size of 125, it would take a complete overhaul of how classes are taught to reach a class size manageable for a truly interactive flipped classroom. To reach an ideal class size of roughly 15-25 (maybe up to 30), I would recommend that participating schools reorganize classes into blocks of students rotating through organ systems and basic science classes such that a single professor or a small core of professors is responsible for teaching a subject year round. I recognize that it is simply not economical for most medical schools to have full time professors and that most medical schools prefer to have practicing physicians on staff. The complicated and variable commitments of practicing physicians, as well as the cost of keeping professors on staff full time, is a rather significant upheaval of the traditional didactic format. If an institution is looking to successfully employ a flipped classroom, the classroom may not be the only thing that has to be flipped.
I am certain that the flipped classroom could be a great opportunity for us as medical students. We had a right to be excited about the idea of the flipped classroom. To give first and second year medical student the opportunity to engage and immerse themselves in new material from the first few days of their education could change how they interact with others and practice medicine for the rest of their careers. However, if your institution decides to attempt to employ a flipped classroom, I recommend you to be wary and to ensure that the students, faculty and everyone involved are prepared for the challenges ahead.