B E G I N N I N G W I T H T H E E N D I N M I N D T H E F L I P P E D C L A S S R O O M

David A. Morton, Ph.D. Associate Professor, Neurobiology and Anatomy

Adjunct Professor, Department of Family and Preventive Medicine, Physical Therapy University of Utah School of Medicine

Mark A. Munger, Pharm.D., F.C.C.P., F.A.C.C. Professor, Pharmacotherapy

Adjunct Professor, Internal Medicine Senior Associate Dean, College Affairs

College of Pharmacy

Learning activity

Study time

PP Lecture

Test the objectives

B E G I N N I N G W I T H T H E E N D I N M I N D T H E F L I P P E D C L A S S R O O M

Measurable

learning objectives

Synthesis

Test

Does this look familiar?

Learning activity

PP Lecture

B E G I N N I N G W I T H T H E E N D I N M I N D T H E F L I P P E D C L A S S R O O M

Measurable

learning objectives

F2F time with professor is first time student has looked at

material

Challenges with this model

• Students capture as it is said

• Little time for reflection

• Miss points because …

• Data transfer

Educational point

Learning is not so much about

consuming information but of

active processing of the

information by the student

Educ Psychol. 1988;13(3):191-205

Learning activity

PP Lecture

B E G I N N I N G W I T H T H E E N D I N M I N D T H E F L I P P E D C L A S S R O O M

Measurable

learning objectives

F2F time with professor is first time student has looked at

material

Challenges with this model

• “Please no more questions…”

• Discussion?

• Passive learning

Educational point

Students learn best when they

actually participate in the

educational process with guided

supervision.

Med Educ. 2007;41(8):763-770

Learning activity

PP Lecture

B E G I N N I N G W I T H T H E E N D I N M I N D T H E F L I P P E D C L A S S R O O M

Measurable

learning objectives

F2F time with professor is first time student has looked at

material

Challenges with this model

• Discuss problems with

classmates?

Educational point

Learning in cooperation with

others is much more effective than

learning alone.

In later professional life virtually all

work is team based.

Educ Psychol. 2007;(19):15-29

Learning activity

PP Lecture

B E G I N N I N G W I T H T H E E N D I N M I N D T H E F L I P P E D C L A S S R O O M

Measurable

learning objectives

F2F time with professor is first time student has looked at

material

Challenges with this model

• Who is responsible for

learning?

Educational point

Too much effort is given to

instruction which is not effective

Perspect Med Educ. 2014;(3):222-232

“College is a place where a professor’s

PP slides go straight to the students’

laptops/iPads, without passing through the

brains of either.”

~ Edwin E. Slosson

Study time

PP Lecture

Test the objectives

B E G I N N I N G W I T H T H E E N D I N M I N D T H E F L I P P E D C L A S S R O O M

Test

Professors role in synthesis?

Synthesis

Challenges with this model

• Can students synthesis content?

• Detecting errors in thinking?

Educational point

Good education provides

strategies to facilitate synthesis of

information but we leave a lot of

this up to the student without

support.

Perspect Med Educ. 2014;(3):222-232

Study time

F2F Synthesis

Test the objectives

B E G I N N I N G W I T H T H E E N D I N M I N D T H E F L I P P E D C L A S S R O O M

Test

Measurable learning

objectives Synthesis

Videos or… Tutorials or … Readings or

…

Active learning and student engagement

B E G I N N I N G W I T H T H E E N D I N M I N D T H E F L I P P E D C L A S S R O O M

Mark A. Munger, Pharm.D., F.C.C.P., F.A.C.C. Professor, Pharmacotherapy

Adjunct Professor, Internal Medicine Senior Associate Dean, College Affairs

College of Pharmacy

Example 1 - Pharmacy

Pharmacy Higher Education Delivery •Rejecting the Use of Classroom Time

for simple Transmission of Facts; •Challenging Students to think critically,

communicate lucidly, and synthesize broadly to solve problems; and

•Adopt a philosophy of “evidence-based education.

Core Constructs of Education Innovation and Reform

•PCTH 7322 Drug and Diseases III

•Cardiology Module

•HTN, Hyperlipidemia, SIHD, ACS, AMI, Heart Failure, Arrhythmias

•2011-2013

University of Utah College of Pharmacy Flipping the Classroom Experiment

Triple Aim of Education Delivery P3 Students

• 1. Pre-Class Learning • Handouts/Reading Materials/Guidelines • 2 weeks before Module Section

• Quiz: 20 Questions • 2 attempts/Question • Qualtrics® or CANVAS

• Pathophysiology, Pharmacology, and Therapeutics • Must pass before coming to class • Score recorded for Module Grade

• 2. In-Class Learning • Case-Based • Group/Class-Interactions • Pre-determined Questions • Assessment/Problem List • Treatment Plan • Monitoring Plan

• Ready for Alternative Discussions • 3. Evaluation Methodology

Diseases and Drug Therapy III PHPRC 7322 Cardiology Examination

Prepare the following case for oral presentation of your assessment, treatment plan and monitoring plan. You will have 1 hour in which to prepare your presentation. Please return to testing room one hour after receiving your exam. You will have 45 minutes in which to present your plan. Only material presented during the 45 minute exam period will count towards your exam grade. Review the cases carefully. All data presented is applicable to the case and should be considered in preparing your presentation. Acute Case Reason for admission: JH is a 62 year-old male admitted for shortness of breath, profound weakness, and diaphoresis. History of present illness: The patient was working in his garage making a cabinet when he became weak, short of breath, and started sweating profusely. The symptoms came on suddenly about 2 hours ago and JH collapsed onto the floor and could not get back up due to the profound weakness. He called for his wife who immediately called 911. JH was brought to the ED by ambulance. He denies pain, nausea, or loss of consciousness. An IV was started by the paramedic on route to the hospital and NS infusion was started. No other therapies were given. Past medical history: Hypertension, Hyperlipidemia, Coronary artery disease (STEMI in May 2007 with placement of 3 drug eluting stents), Diabetes mellitus type 2 (diet controlled), and Hypothyroidism Allergies: Penicillin (rash) Medications: Lisinopril 20 mg po daily Hydrochlorothiazide 12.5 mg po daily Fish oil 1 g po TID Aspirin 81 mg po daily Levothyroxine 75 mcg po daily Tylenol PM 1-2 tablets as needed for sleep Family history: Father died of a myocardial infarction at age 45. Mother died at age 78 of stroke. Both parents had diabetes. Social history: Smokes 1 pack per day for the last 42 years, drinks alcohol occasionally, no illicit drug use. JH lives with wife. He has 5 children, none living at home. Employed as carpenter. Review of systems: Unremarkable except as noted

Physical Exam VS: HR 96 bpm, BP 152/90 mmHg, RR 18 bpm, Temp 37.5C, denies pain, Weight 120 kg, Height 183 cm. General: White male in no apparent distress. Alert & oriented x 3. Skin: Pink and diaphoretic. HEENT: Unremarkable Chest: Full, symmetrical chest expansion on inspiration. Lungs clear to auscultation, heart sounds regular w/o rubs, murmurs or gal Abdomen: Soft, non-tender, bowel sounds present. Extremities: Unremarkable Neurological: Cranial nerves II-VIII grossly intact. No focal neurological deficits noted. Current labs: Na+ 142 mEq/L (136-145 mEq/L) K+ 3.9 mEq/L (3.5-5 mEq/L) Cl- 98 mEq/L (96-106 mEq/L) CO2 24 mEq/L (24-30 mEq/L) BUN16 mEq/L (8-20 mEq/L) Cr 1.2 mg/dL (0.7-1.2 mg/dL) Random Glucose 137 mg/dL (60-120 mg/dL) ALT 52 U/L (15-45 U/L) AST 49 U/L (15-45 U/L) LDH 115 U/L (100-190 U/L) AlkP 85 U/L (30-120 U/L) CK 129 U/L (40-150 U/L) WBC 8.6 x 103 cells/mm3 (4.8-10.8 x 103 cells/mm3) Hgb 13 g/dL (12-16 g/dL) Hct 39% (37-47%) Platelet count 360,000/µL (140,000-440,000/uL) Total cholesterol 220 mg/dL (<240 mg/dL) HDL cholesterol 32 mg/dL (>40 mg/dL) TG 195 mg/dL (≥ 150 mg/dL) LDL (calculated) 149 mg/dL BP: 148/92 mmHg (mean x 3 measurements) (These values were obtained 3 weeks prior to this episode) Cardiac troponin I 4.7 ng/mL (<0.04 ng/mL: negative, 0.04-0.10 ng/mL: suspicious for cardiac injury, >0.10 ng/mL: consistent with my

B E G I N N I N G W I T H T H E E N D I N M I N D T H E F L I P P E D C L A S S R O O M

David A. Morton, Ph.D. Associate Professor, Neurobiology and Anatomy

Adjunct Professor, Department of Family and Preventive Medicine, Physical Therapy University of Utah School of Medicine

Example 2 - Anatomy

• Introduced Flipped Classroom in 3 courses:

• Skin, Muscle, Bone and Joint (MS II Course)

• Physician Assistants Anatomy Course

• Foundations of Medicine - Anatomy content

B E G I N N I N G W I T H T H E E N D I N M I N D T H E F L I P P E D C L A S S R O O M

HSEB 1700

F2F 2. Problem

sets Study time

1. Complete tutorials and Workbook

B E G I N N I N G W I T H T H E E N D I N M I N D T H E F L I P P E D C L A S S R O O M

Objectives

Synthesis

Practice Problems Test

1 . C O M P L E T E T U T O R I A L & W O R K B O O K

1 . C O M P L E T E T U T O R I A L & W O R K B O O K

Tutorials (Key Note converted to QT movie)

Workbook (PDF-Print to Paper or Digital)

Educational point

Learning is not so much about

consuming information but of

active processing of the

information by the student

Educational point

Students learn best when they

actually participate in the educational

process with guided supervision.

2 . C L I N I C A L P R O B L E M S O L V I N G

• Workbook used to answer Q’s

• Rigor of Q’s

• Q’s match objectives and tutorials

• “Think-Pair-Share”

• Environment for student interaction

Educational point

Good education provides strategies to facilitate

synthesis of information.

2 . C L I N I C A L P R O B L E M S O L V I N G

• Workbook used to answer Q’s

• Rigor of Q’s

• Q’s match objectives and tutorials

• “Think-Pair-Share”

• Environment for student interaction

Educational point

Learning in cooperation with others is much

more effective than learning alone.

3 . C O M P L E T E P R A C T I C E P R O B L E M S

• Problem set from lecture (F2F)

• 30-40 practice questions

Educational point

Good education provides strategies to facilitate

synthesis of information.

4 . T A K E T H E T E S T

L E S S O N S L E A R N E D

• Medical students are ninja smart at slurping up content given to them

L E S S O N S L E A R N E D

• Students can study when they are ready to learn

L E S S O N S L E A R N E D

• Students can review the lecture/tutorial as often as needed (or just the part they are struggling with)

• Whereas they are only in lecture for 1 hour

“I like being able to learn the material on my own time at my speed. With your videos I can rewind and rewatch until I get it.”

L E S S O N S L E A R N E D

• We can focus during class time at synthesizing infor

“I really like being able to then come to class and apply what I learned by working through thought provoking problems on the material while having teaching points clarified.”

L E S S O N S L E A R N E D

• Encourage students to seek/find information (FDP; scoliosis)

L E S S O N S L E A R N E D

• Students with disabilities

L E S S O N S L E A R N E D

• Tutorials take time to produce/create

L E S S O N S L E A R N E D

• Getting images is sometimes challenging

Q & A