Tom Fowlks/Getty Pictures
Throughout my first two years as a medical scholar, I nearly by no means went to lectures. Neither did my friends. In truth, I estimate that not even 1 / 4 of medical college students in my class constantly attended courses in individual. One among my professors, Dr. Philip Gruppuso, says in his 40 years of instructing, in-person lecture attendance is the bottom he is seen. Even earlier than the COVID-19 pandemic, first- and second-year medical college students frequently skipped lectures. As an alternative, they opted to look at the recordings at residence on their very own time. The pandemic accelerated the shift. This absence from the classroom has lots of people within the medical schooling system questioning how this can have an effect on future medical doctors, and has precipitated large dialogue amongst medical establishments. Medical schooling is altering quickly, and the change is being pushed by college students — so how do faculties incorporate the fact of digital studying whereas coaching them adequately for the massive duty of affected person care?
“Flip” the classroom for the primary two years
The primary half of medical schooling (historically the primary one to 2 years, that are additionally generally known as the preclerkship years) prepares college students to succeed in the course of the second half of medical faculty, clerkships, the place college students work instantly with affected person care groups. Preclerkship medical schooling is the place college students study the technical components of being a health care provider earlier than seeing sufferers. It contains lectures in medical science — anatomy, embryology, physiology, pathology, and pharmacology — and well being system science – ethics, professionalism and public well being. And it goes past lectures. It contains dissecting a human physique in anatomy lab, training find out how to interview a affected person and conduct a bodily examination (sometimes utilizing affected person actors) and quite a few small group dialogue periods linked to particular lectures.
Digital studying throughout these essential first two years for me had some vital downsides. I used to be unable to ask questions of a prerecorded lecturer. Scholar-teacher relationships, one of many components of medical schooling I used to be most wanting ahead to, grew to become a lot more durable to domesticate. It was isolating at instances.
Dr. Gruppuso and I began speaking and we have now a number of ideas on find out how to change the medical schooling system to mitigate these downsides whereas supporting college students in a call they’ve already made to study on their very own time.
Our proposal is that this: make use of the “flipped classroom” mannequin extensively for preclerkship medical faculty lectures. On this mannequin, the in-person lecture all however disappears, and college students study many of the classroom-type materials on their very own earlier than in-person time — therefore the flip. We propose beginning with a collection of digital modules to arrange for case-based small group periods held in individual. Actions corresponding to anatomy lab, affected person interviewing and bodily examination observe and particular visitor lectures would stay in-person. This, in essence, embraces the digital lecture trajectory however requires precise attendance for small group hands-on studying.
A medical scholar’s perspective — Alexander Philips
Let me begin by saying, I did take pleasure in benefits of digital lectures. Pausing, rewinding, re-watching, and rushing up the talks was an effective way to give attention to my weak areas and save time, and time was my most precious useful resource as a medical scholar, given the sheer quantity of data to be discovered. Digital studying made it a lot simpler for me to include non-lecture sources into my examine plan, too, corresponding to flash playing cards, internet tutorials or lectures by third events.
Within the flipped classroom situation, my typical day may contain a morning of watching brief, focused medical science modules, with pauses in between so I may draw diagrams, examine on-line flash playing cards, and skim and watch different sources. Then, I might have an hour or two of required in-person case-based small group dialogue with my professors and classmates the place we give attention to the scientific purposes of that medical science by discussing hypothetical affected person instances. Different days could be dedicated to anatomy lab, scientific abilities observe with standardized sufferers (affected person actors) beneath the direct supervision of school, shadowing within the hospital, and non-structured time for different actions like analysis, advocacy and group service.
Along with permitting for discussions and attending to know professors and fellow college students, it could give some regularity to my schedule. Within the present system, with the comfort of recorded lectures, I used to be by myself to maintain on observe with the fabric and it was simpler to fall behind.
A professor’s perspective — Dr. Philip Gruppuso
I’ve taught medical college students for practically 40 years in lots of contexts – on hospital rounds, throughout affected person appointments, operating small group discussions, and instructing giant courses. I’ve lectured on subjects that vary from biochemical pathways to life-style illnesses (these linked to issues like bodily inactivity) to vitamin science and the biology of growing old.
Essentially the most gratifying a part of instructing is passing alongside the much less tangible facets of being a doctor — find out how to present respect for all sufferers and be a real caregiver. I do that by telling tales about my scientific expertise throughout lectures and the payoff for me is engagement with college students. The pandemic and its attendant shift in how college students discovered modified all of that.
Totally digital studying for the primary two years of faculty might have been vital in the course of the pandemic, however persevering with to do that would in poor health put together younger adults to be physicians.
The intrinsically private nature of drugs taught in scientific abilities curricula or human physique dissection can’t be captured in a studying format that’s intrinsically impersonal. There’s additionally extra to preclerkship schooling; different facilitators of holistic doctor coaching like analysis, specialty exploration, and volunteer work, are nearly unimaginable with digital studying.
Lastly, there’s a very actual menace to the medical schooling enterprise in altering the position of the doctor college member. Medical doctors are uncommon amongst professions within the expectation that they are going to educate no matter the place and what specialty they observe. Take away the gratification that comes with face-to-face instructing and we danger dropping the dedication of school, a lot of which is usually completed on a wholly voluntary foundation.
Medical schooling at an inflection level — our joint take
Within the dialogue of what post-pandemic medical schooling may seem like, some have known as for the preclerkship years to be completely digital. Development to clerkships could be decided by competency (ie. have you ever mastered the coursework) relatively than time. However we favor a much less excessive incorporation of digital studying that depends on this flipped classroom.
The Warren Alpert Medical College of Brown College, amongst different faculties, is more and more implementing this method. The worth of interplay with friends, asking questions, and constructing relationships with lecturers is best and most time-efficient when college students have an intensive understanding of the elemental frameworks and key ideas of the underlying science. That framework can typically be constructed extra effectively in a tailor-made digital setting the place college students can actually work on their weaknesses, permitting faculty college to give attention to serving to college students apply that information to caring for sufferers. Lecturers might also complement these discussions by sharing experiences about how they recognized and handled particular sufferers working in organizations and communities through which medical college students will serve throughout their clerkships. Putting off the bigger in-person medical science lectures and specializing in growing or sourcing high-quality digital content material attracts on the strengths of digital studying; diverting saved time and sources in the direction of optimizing common in-person case-based small group periods with college and different college students mitigates the drawbacks of digital studying.
Medical schooling is at an inflection level. A standard vs. flipped preclerkship medical science classroom is only one of a number of choices we face when fascinated with find out how to practice the following era of physicians. For instance, the next questions are intimately intertwined with the position of digital studying in medical schooling, and are concurrently being debated in faculties throughout the nation.
What’s the position of medical science coursework in medical schooling? The USMLE Step 1 Examination is the primary licensing examination to changing into a doctor and primarily checks medical science ideas. The transfer in the direction of a shortened preclerkship schooling time period will solely be accelerated by a latest shift of the examination to move/fail. Encouraging college students to start viewing medication from a scientific lens earlier of their coaching is an effective, however much less time spent constructing a deep understanding of mechanisms of illness and remedy can undermine the inspiration for scientific schooling. To what extent can or ought to preclerkship medical science schooling combine exterior sources to effectively educate content material? Medical college students have already been embracing a shift in the direction of exterior sources for years through a self-directed curriculum to both complement or substitute medical faculty lectures. This has been occurring largely impartial of enter from college or administration. If the price of offering lectures decreases in gentle of reusable or simply updatable digital content material, presumably standardized throughout faculties, the ensuing efficiencies may conceivably decrease the price of schooling. If that may be achieved, ought to medical tuition lower to mirror this? If that’s the case, this will likely imply broader entry to medical schooling, much less scholar mortgage burden, and fewer boundaries to pursuing careers in lower-paying specialties, together with main care. Conversely, the time and school intensive nature of extra small group periods might enhance value burden to varsities. Will the advantages of those academic reforms be accessible to all? For college students who enter medical faculty from much less advantaged academic backgrounds, together with college students with neurodivergence or these from teams underrepresented in medication (URiM), on-line coursework might lead to poorer academic outcomes. Conversely, neurodivergent learners might profit from customized studying modules; URiM college students and people who historically have much less entry to college might have extra face-to-face studying time. As schooling shifts to a digital format, it’s essential that its results throughout the whole scholar inhabitants be evaluated.
These questions are a lot more durable to reply than a query of whether or not flipped school rooms deserve an elevated position in preclerkship medical schooling. However these selections should not all or nothing. Change ought to be made with an understanding of the tradeoffs, and with the foresight to mitigate the damaging penalties of these modifications.
Medical faculties must get preclerkship medical schooling proper. The robust basis from my (Alexander Philips’) first two years of medical faculty was what helped me diagnose, admit, deal with, and discharge my first affected person only a few weeks in the past as a 3rd 12 months medical scholar on my first clerkship. We consider the speedy subsequent step for preclerkship medical science medical schooling is evident. A flipped classroom, and thus an elevated position for digital studying within the preclerkship years of medical faculty, is a promising mannequin. Can we protect the broad targets of preclerkship medical schooling whereas supporting medical college students in a call they’ve already made to study on their very own time? We consider the reply is sure.
Alexander P. Philips is a third-year medical scholar at Brown College and Tweets @AlexPPhilips. Dr. Philip Gruppuso is the previous Affiliate Dean for Medical Schooling and presently teaches at Brown. This piece solely represents the angle of the 2 authors, who want to thank Dr. B. Star Hampton and Dr. Sarita Warrier with Brown College, for his or her enter.