This past Christmas, I bought my wife a Fitbit Charge (She asked for one). Among other things, Fitbit counts the number of steps you take in a day. If you accomplish 10000 steps, you complete your goal for that day. Compare that step quota with what the 60 steps some elderly people average each day. We know the sedentary life is unhealthy, but it gets worse as you age. It is also understood that if you stay healthy and keep your weight down as you get older; you’ll live longer because being more mobile enables you to bounce back quicker if you have an accident.
Where is all of this coming from? Recently, I met a doctor of geriatric medicine from one of the top universities in America. He also has a master’s in education, which I thought was interesting. As it turns out, he is also in charge of training the doctors and staff in the university’s health network. When he is not seeing patients, he is developing training. His mission is to keep patients as healthy as possible to slow their decline in function. To do this, he trains doctors and staff members about the resources and services available to their aging patients such as in-home physical therapy, convalescent nursing, weight and nutrition assistance, and psychiatric services. Providing training also allows him to make an assessment of what other types of care should be offered.
His love of training began when he noticed a gap between the care patients get after they see their primary care doctor and when they have medical emergencies and have to go to the hospital between doctor visits. Emergency rooms are mainly designed to quickly triage, diagnosis, care for, and stabilize patients. Elderly patients, on the other hand, are more likely to start out with complex, comorbid conditions that make it impossible for ER staff to work quickly to treat them. As a result, elderly patients often become worse after their visits (Gray, et al., 2013). This is because ER doctors don’t have the kind of information on patients that the primary physician has and may prescribe medicine or perform procedures that is often different and potentially harmful to the patient’s ongoing care. He recognized this and set out along with other doctors to find a solution. His job was to develop training that would familiarize ER staff about social services available to elderly patients such as those mentioned above as well as the availability of special transportation and how to inform patients about getting prescriptions filled and how to take them properly. He knew the task would be daunting, so he procured a grant that would allow him to take the time he needed.
Because he had to train both experienced doctors as well as interns, he suspected that there would be a knowledge gap. He needed to keep the entire class engaged and knew that if he had to stop to answer questions for the less experienced staff he would lose everyone. He concluded that using a traditional lecture format would not work. His solution was to flip the classroom.
The Flipped Classroom
The flipped classroom is a type of blended learning strategy where “students engage with lectures or other materials outside of class to prepare for an active learning experience in the classroom” (University of Waterloo). Flipping the classroom is not a new idea, but it is relatively new in the health industry. Flipping the classroom was first proposed by Barbara Walvoord and Virginia Johnson Anderson in their book, Effective Grading in 1998. Recently it has gained buzz word status with the release of Salman Khan’s TED talk, Let’s Use Video to Reinvent Education in 2011. A flipped classroom targets the lower levels of Bloom’s taxonomy (Remembering and Understanding) outside of class, which enables the instructor to focus on the more cognitively demanding levels (Applying, Analyzing, Evaluating, and Creating) in class through collaboration and engaging activities.
There are four steps to instituting a flipped classroom:
- Introduce students to the lesson
This step has two purposes. The first is to introduce the students to the new module. Instructors should explain what they will be doing and why it is important. Instructors should also clearly articulate their expectations so students are prepared for the activities that they will be doing independently and in class. Secondly, instructors must provide an incentive for students to come to class prepared. If students are being graded, this is often done using a point system. The out of class assignments are weighted heavier because of their importance to the activities done in class. Adult learners, such as the doctors, don’t need this kind of incentive usually, because they are internally motivated and understand the importance of these assignments.
- Students Complete Independent Work
Assignments given outside of class can be anything from tutorials, lecture videos, screencasts, reading assignments, to PowerPoints. However, the choice of media should be carefully considered. Videos can be created by the instructor or found on YouTube, the Khan Academy, MIT’s OpenCourseWare, Coursera, or other similar sources (Brame, 2013). Quizzes or short writing assignments or summaries of the readings or lecture videos they watch should be given to ensure assignments are completed. The doctor in the above example created an online e-Learning course that the students would take before class. It combined both video and screencasts with text and animations. Most independent work doesn’t have to be this high-tech.
- Learning is Assessed
Assessing what the students have learned is one of the most important tasks in a flipped classroom. It enables the instructor to quantify the knowledge a student has gained before in-class learning activities take place. It is beneficial for the instructor as well as the students to know how well they have understood the content they complete outside of class. It’s important for the students to know where they need to focus their efforts. More importantly, the instructor can adjust the in-class learning activities to target students requiring extra help (University of Waterloo). Assessments can be taken online or as in-class assignments prior to the activities.
- Engage in In-class Activities
In-class activities are done to promote a deeper understanding of the material. Activities should correspond with the objectives of the module as well as the subject. For example, doctors may spend time in class analyzing data or performing critical medical procedures, or the class may be held in the emergency room or clinic using scenarios or simulations. The key is that students are using class time to deepen their understanding and increase their skills at using their new knowledge (Brame, 2013). Students are also able to get real-time assistance from their instructors.
Flipping the classroom works even better for adult learners. Adult learning theory, also known as andragogy, suggests that adults are self-directed and expect to take responsibility for their decisions (Knowles, 1990). Andragogy emphasizes learning that is problem-based and collaborative where the process of learning is more important than the content. It’s not that content is not important, especially when we are talking about saving or extending life as doctors do, but if the process of learning doesn’t make the content stick, then it’s of no use. Research has shown that flipping the classroom leads to higher test scores, better retention, and increased performance when compared to a traditional classroom setting, which is crucial in the healthcare industry where doctors have to perform what they learn immediately.
While the data is still being collected on the doctor’s training, initial findings show marked improvement in the care patients are getting. But I know it’s working, because I’ve seen it in action. Although my 76 year old mother is not one of his direct patients, she is in his health network. Over the past 18 months, she has been going through cancer treatments and has all sorts of issues as a result. I’ve seen the nurses come to her house to check her meds, and I’ve been there when the physical therapists show her how to use her walker or perform different strengthening exercises. That’s how I know it’s working.
- Bates, C. (n.d.). Malcolm Knowles (1913 – 1997). Retrieved January 28, 2015, from University of Tennessee-Knoxville: http://web.utk.edu/~start6/knowles/malcolm_knowles.html
- Brame, C. J. (2013). Flipping the Classroom. Retrieved January 20, 2015, from Vanderbilt University Center for Teaching: http://cft.vanderbilt.edu/guides-sub-pages/flipping-the-classroom/.
- Chase, D. (2012, March 18). Doctors Flip of Patient Visit Inspired by Khan Academy. Forbes, pp. http://www.forbes.com/sites/davechase/2012/03/18/khan-academy-inspired-flip-of-doctor-patient-visit/.
- Goodwin, B., & Miller, K. (2013). Research Says / Evidence on Flipped Classrooms Is Still Coming In. Educational Leadership, 78-80.
- Gray, L. C., Peel, N. M., Costa, A. P., Burkett, E., Dey, A. B., Jonsson, P. V., et al. (2013). Profiles of Older Patients in the Emergency Department: Findings From the interRAI Multinational Emergency Department Study. Annals of Emergency Medicine, Volume 62, Issue 5, 467–474.
- Knowles, M. (1980). The modern practice of adult education: from pedagogy to andragogy (Rev. and Updated Ed.). Chicago: Follet Publishing Company.
- Knowles, M. (1990). The Adult Learner: a neglected species (4th edition). Houston: Gulf Publishing.
- Medina, J. (2008). Brain Rules. Seattle: Pear Press.
- Stutzmann, B., & Colebeck, D. (2014). Flipped Classroom Pedagogy Research & Retention . Marietta, GA: Southern Polytechnic State University .
- University of Waterloo. (n.d.). Course Design: planning a flipped class. Retrieved January 20, 2015, from Centre for Teaching Excellence: https://uwaterloo.ca/centre-for-teaching-excellence/teaching-resources/teaching-tips/planning-courses-and-assignments/course-design/course-design-planning-flipped-class