Flipping the Medical Classroom

How we learn medicine has changed little since the last great reform in medical education that took place in North America in the early 1900s. Since then, teaching and learning in medicine has centered on the didactic lecture, supplemented by hefty tomes and musty journal articles.

It’s time for a change.

We need to be able to teach and learn more efficiently, given the ever growing and ever more complex body of knowledge we are expected to command.

One way this may be achieved is by flipping the classroom, as advocated in a recent NEJM article written by Prober and Heath.

The idea is that with the rise of online educational media (most of which is freely available, you know the stuff — some of us like to call it FOAM) and individual interactive instruction  there is often no need for a didactic ‘one way’ lecture held within the confines of a lecture hall. A better way to learn and teach is for the student to watch the video, listen to the podcast and read the blogpost even before the teaching session begins. Don’t get me wrong, this does not mean that we can dispense with teachers and simply let Scott Weingart, Amal Mattu and HQMEDED do all the didactic stuff.


Instead of the teacher holding a one way conversation, time in the medical classroom can be better spent. The teacher could lead an open discussion where students clarify issues raised from the assigned asynchronous learning resources (Socrates was onto something I reckon), or the time could be dedicated to supervised simulation sessions, or debates, or quizzes, or case-based discussions… or whatever your imagination can dream up to facilitate active contextual learning that actually works.

In some subjects such as physics, researchers have found that this flipped classroom model works better than the standard approach — even when the traditional model features lectures by a Nobel Prize-winning physicist. Interestingly, TED.com has developed a tool for teachers in schools to create customised contextualised versions of their videos so that teachers can use them for flipped learning. The flipped classroom model certainly has some enthusiastic proponents among school teachers who have tried it, such as the writer of this Edudemic article titled To Flip or Not Flip?.

Will medicine be the last to widely adopt this approach?

Perhaps it is time for us to put some velcro on the soles of our shoes and tip medical classrooms upside down?

If you’re using a flipped classroom model for medical education be sure to leave us a comment about your experience.


  • Prober CG, Heath C. Lecture halls without lectures – a proposal for medical education. N Engl J Med. 2012 May 3;366(18):1657-9. PubMed PMID: 22551125.

Addendum 16th August 2012

The most recent edition of the NEJM featured correspondence to the paper by Prober and Heath. There were calls for education to be prioritised and valued by institutions to decrease the gap between evidence and educational practice, a recognition of some of the barriers to innovation, also commentary that flipping the classroom may be even more important for graduate students, and a call for a Khan Academy for medical education…

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  1. Hi Chris
    I love the flipped teach…. Um er learning style. Always try and make sessions open, interactive forums, debates and discussions. Cases are good as they put it in real terms where no true right or wrong.

    Problem I face – entrenched old school learning styles the kids bring with them from Med School etc. some feel uncomfortable with open discussion, nowhere to hide their uncertainty etc. it can be confronting for the

    Tried student-led discussions on topics – but tend to gt regurgitated textbook answers which don’t reflect reality or actual practice today!

    I am trying to come up with new games, quests and challenges for the JMOs so they stay interested and awake, and learn to rethink their practice and beliefs.


  2. This is very interesting idea. I have come across, new to me, a concept about online learning coined as MOOC (massive online open courses). It is not supposed to replace academics, you don’t get grades, or a diploma from it. What you do get is to learn about the stuff that interests you, connect with other people (connectivism http://en.wikipedia.org/wiki/Connectivism), and create your own version of the information. What #FOAM needs to do now is organize itself and create timed events where we can have a more structured discussion about a specific topic. Maybe these videos will help better elucidate this idea:

    What is MOOC? : http://www.youtube.com/watch?v=eW3gMGqcZQc

    Success in MOOC: http://www.youtube.com/watch?v=r8avYQ5ZqM0&feature=player_embedded#!

    Born to learn: http://www.youtube.com/watch?v=falHoOEUFz0&feature=related


      • That’s definitely a disadvantage, but at the same time the platform still allows you to participate by watching a video of the discussion, asking questions in the forum, responding a blog, listening to the podcast. People will also benefit from your responses as well. Just like we do now after we listen to podcast or follow a blog, except that this will have a “curriculum” that’s run for a short amount of time.

        Can you imagine a few people who have expertise in a field putting together something like this? For example: In the next three weeks we’ll discuss the ventilator management of the critically ill patient. These are the articles that will be discussed, theses are podcasts that cover part of the material (freeemergencytalks.net). After the session people go back to their blog, podcasts, forums and write about it and create more discussions from that point on.

        It’s a bit like what Scott Weingart is doing with Dr. Marik this Monday. He tweeted that he will have a discussion with Dr. Marik about his latest paper on central lines. He chose to do it on Google+ hangout, so a few will be able to join and I think it can be broadcast on youtube. After the session people can go back to their preferred mode of online communication and post their impression. This in turn will cause more connections and more learning.


  3. I think in one of his podcasts Scott Weingart says that he tells his residents to listen to his podcasts for a specific topic, and when they come to lecture they just work out clinical problems. So, I think he already flips the classroom.


  4. Chris,
    I’ve had the good fortune to be involved in a novel educational “experiment” for the last 5 years. When our residency started, there weren’t enough teachers to go around while keeping the department staffed so we “flipped” our didactic program before the term “flipped” was even coined. One thing to remember about flipping is that it isn’t all about the tech. Low tech flipped classrooms utilize reading or similar assignments and then bring the learners together to discuss, work on problems, etc. We mainly use a low tech approach. We’ve divided our “content” into 82 modules (down from 92 original models) and have faculty “experts” select readings from the medical literature. The residents read the articles and then on our didactic day, we sit and have a discussion. We’ve used quizzes, cases, whiteboard talks, mini-lecture, you name it to promote small group learning. We follow these sessions with an hour of lecture (often M&M, guest lectures, or administrative/wellness topics) and then an hour of sim.

    The whole setup works amazing. We’ve begun incorporating more podcasts and video based learning too. We host everything on a wiki so that the residents can always access it and we can easily make changes, etc. The whole thing is very, VERY time consuming as a teacher (hence why my blog has languished on the “to do” list) but the learning is just completely refreshing. The level of questions that learners bring to the table as they mature through the process just keeps us coming back for more. I wouldn’t want to go back to the old death by powerpoint ever again. Perhaps its time to consider the lecture “dead?”

    • Thanks for sharing your ‘experiment’ Robert.
      Amazing what can happen out of necessity. The way your sessions work sounds great – though I can imagine the work that goes into getting it off the ground.
      It is also tough for a teacher to take those first steps into the unknown – there is security in the structured lecture.
      I agree – the lecture is moribund. A great talk can serve well as as inspirational pep talk but does little to aid retention (the exception being if it is recorded and can be revisited) or deeper understanding.
      PS. Hope you find to time to kickstart the ‘Better in EM’ blog soon!

  5. I think this concept of flipping the classroom will continue to grow deeper roots in education in general. I already use this with my kids. My 11 year old son will watch a Khan video on a particular math topic and then go to class with a great understanding of how to apply it. His math teacher this year had all the kids watch Khan Academy videos at home and then class could be much more productive with examples, interactions. The cool thing about the Khan videos is that many are relatively short. So, in 4 minutes my son got the concept and off he went. People in education are slowly realizing that we need to change the way we teach…

    • A great example of limiting cognitive load. There is only so much we can comprehend or remember at any one time. Keep the message simple and promoting task practice allows the learner to retain so much more. Another reason why our typical 50 minute lectures are really wasting our time and our learners time.

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  7. I tried an experiment with our trainees where I posed a series of hypothetical clinical scenarios and posed some clinical questions a week ahead of an education session normally led by the trainees themselves. This was to give everybody some time to think about the problems and read around the issues, to guide the presentation and possibly stimulate some discussion. Unfortunately, it turned into a flop – the trainees never did the reading and the presenter often just gave an unimaginative didactic power-point talk. Meh – Gen Y.

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