Many medical college students don’t attend lectures within the first two years, as a substitute opting to observe recorded courses on their very own time.
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Tom Fowlks/Getty Images
Many medical college students don’t attend lectures within the first two years, as a substitute opting to observe recorded courses on their very own time.
Tom Fowlks/Getty Images
During my first two years as a medical pupil, 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 persistently attended courses in individual. One of my professors, Dr. Philip Gruppuso, says in his 40 years of educating, in-person lecture attendance is the bottom he is seen. Even earlier than the COVID-19 pandemic, first- and second-year medical college students repeatedly skipped lectures. Instead, they opted to observe 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 it will have an effect on future docs, and has precipitated vast 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 large duty of affected person care?
“Flip” the classroom for the primary two years
The first half of medical schooling (traditionally the primary one to 2 years, that are additionally generally known as the preclerkship years) prepares college students to succeed through the second half of medical faculty, clerkships, the place college students work straight with affected person care groups. Preclerkship medical schooling is the place college students be taught the technical components of being a physician 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, working towards easy methods to interview a affected person and conduct a bodily examination (usually utilizing affected person actors) and quite a few small group dialogue periods linked to particular lectures.
Virtual studying throughout these vital first two years for me had some important downsides. I used to be unable to ask questions of a prerecorded lecturer. Student-teacher relationships, one of many components of medical schooling I used to be most trying ahead to, turned a lot more durable to domesticate. It was isolating at occasions.
Dr. Gruppuso and I began speaking and we now have a couple of ideas on easy methods to change the medical schooling system to mitigate these downsides whereas supporting college students in a call they’ve already made to be taught on their very own time.
Our proposal is that this: make use of the “flipped classroom” mannequin extensively for preclerkship medical faculty lectures. In this mannequin, the in-person lecture all however disappears, and college students be taught many of the classroom-type materials on their very own earlier than in-person time — therefore the flip. We counsel beginning with a collection of digital modules to organize for case-based small group periods held in individual. Activities reminiscent of anatomy lab, affected person interviewing and bodily examination apply 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 pupil’s perspective — Alexander Philips
Let me begin by saying, I did take pleasure in benefits of digital lectures. Pausing, rewinding, re-watching, and dashing up the talks was an effective way to deal with my weak areas and save time, and time was my most dear useful resource as a medical pupil, given the sheer quantity of data to be realized. Virtual studying made it a lot simpler for me to include non-lecture assets into my research plan, too, reminiscent of flash playing cards, internet tutorials or lectures by third events.
In the flipped classroom situation, my typical day would possibly contain a morning of watching brief, focused medical science modules, with pauses in between so I might draw diagrams, research on-line flash playing cards, and skim and watch different assets. 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 deal with the medical purposes of that medical science by discussing hypothetical affected person circumstances. Other days could be dedicated to anatomy lab, medical expertise apply 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.
In addition to permitting for discussions and attending to know professors and fellow college students, it might give some regularity to my schedule. In the present system, with the comfort of recorded lectures, I used to be alone 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, working small group discussions, and educating massive courses. I’ve lectured on subjects that vary from biochemical pathways to way of life ailments (these linked to issues like bodily inactivity) to diet science and the biology of getting old.
The most gratifying a part of educating is passing alongside the much less tangible points of being a doctor — easy methods to present respect for all sufferers and be a real caregiver. I do that by telling tales about my medical expertise throughout lectures and the payoff for me is engagement with college students. The pandemic and its attendant shift in how college students realized modified all of that.
Fully digital studying for the primary two years of faculty might have been obligatory through the pandemic, however persevering with to do that would in poor health put together younger adults to be physicians.
The intrinsically private nature of medication taught in medical expertise 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 inconceivable with digital studying.
Finally, there’s a very actual menace to the medical schooling enterprise in altering the position of the doctor school member. Doctors are uncommon amongst professions within the expectation that they are going to train no matter the place and what specialty they apply. Remove the gratification that comes with face-to-face educating and we threat dropping the dedication of school, a lot of which is commonly achieved on a wholly voluntary foundation.
Medical schooling at an inflection level — our joint take
In the dialogue of what post-pandemic medical schooling would possibly appear to be, some have known as for the preclerkship years to be totally digital. Advancement to clerkships could be decided by competency (ie. have you ever mastered the coursework) reasonably than time. But we favor a much less excessive incorporation of digital studying that depends on this flipped classroom.
The Warren Alpert Medical School of Brown University, amongst different faculties, is more and more implementing this method. The worth of interplay with friends, asking questions, and constructing relationships with academics is biggest and most time-efficient when college students have a radical understanding of the basic frameworks and key ideas of the underlying science. That framework can usually be constructed extra effectively in a tailor-made digital setting the place college students can actually work on their weaknesses, permitting faculty school to deal with serving to college students apply that data to caring for sufferers. Teachers may complement these discussions by sharing experiences about how they identified and handled particular sufferers working in organizations and communities during which medical college students will serve throughout their clerkships. Doing away with 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 assets in direction of optimizing common in-person case-based small group periods with school and different college students mitigates the drawbacks of digital studying.
Medical schooling is at an inflection level. A conventional vs. flipped preclerkship medical science classroom is only one of a number of selections we face when excited about easy methods 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 is the position of medical science coursework in medical schooling? The USMLE Step 1 Exam is the primary licensing examination to turning into a doctor and primarily exams medical science ideas. The transfer in 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 drugs from a medical 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 medical schooling.
- To what extent can or ought to preclerkship medical science schooling combine exterior assets to effectively train content material? Medical college students have already been embracing a shift in direction of exterior assets for years through a self-directed curriculum to both complement or substitute medical faculty lectures. This has been occurring principally impartial of enter from school 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 might conceivably decrease the price of schooling. If that may be achieved, ought to medical tuition lower to mirror this? If so, this will likely imply broader entry to medical schooling, much less pupil mortgage burden, and fewer boundaries to pursuing careers in lower-paying specialties, together with major care. Conversely, the time and school intensive nature of extra small group periods might improve price burden to colleges.
- Will the advantages of those academic reforms be obtainable 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 drugs (URiM), on-line coursework might lead to poorer academic outcomes. Conversely, neurodivergent learners might profit from personalised studying modules; URiM college students and those who historically have much less entry to school might have extra face-to-face studying time. As schooling shifts to a digital format, it’s vital that its results throughout your complete pupil inhabitants be evaluated.
These questions are a lot more durable to reply than a query of whether or not flipped lecture rooms deserve an elevated position in preclerkship medical schooling. But these decisions usually are not all or nothing. Change ought to be made with an understanding of the tradeoffs, and with the foresight to mitigate the unfavorable penalties of these modifications.
Medical faculties have to 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 just some weeks in the past as a 3rd yr medical pupil on my first clerkship. We imagine the rapid subsequent step for preclerkship medical science medical schooling is obvious. 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 be taught on their very own time? We imagine the reply is sure.
Alexander P. Philips is a third-year medical pupil at Brown University and Tweets @AlexPPhilips. Dr. Philip Gruppuso is the previous Associate Dean for Medical Education and at the moment teaches at Brown. This piece solely represents the attitude of the 2 authors, who wish to thank Dr. B. Star Hampton and Dr. Sarita Warrier with Brown University, for his or her enter.