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An instructor at the U. of Vermont Robert Larner, M.D. College of Medicine teaches in an 'active classroom.'

Erin Post

Four years after two senior academics at Stanford University challenged medical schools to stop lecturing and start flipping their classrooms, major reforms at underway at a handful of colleges to change the way they teach medicine.

The University of Vermont last week became the most recent institution to join the trend, announcing a pedagogical reform in its College of Medicine that observers say is the most sweeping yet. The college will over the next several years remove all lecture courses, replacing them with videos students watch on their own time. And instead of sitting through lectures, students will meet in “active learning” classrooms, led by faculty members, working with their classmates in small groups.

“We teach evidence-based medicine all the time,” William Jeffries, senior associate dean for medical education at UVM, said in an interview. “If you have the evidence to show one treatment is better than the other, you would naturally use that treatment. So if we know that there are methods superior to lecturing, why are we lecturing at all?”

The approach builds on experiments at Stanford, which has worked with Khan Academy to test a flipped classroom model in certain medicine courses. Other institutions have taken that model a step further. The Touro College of Osteopathic Medicine in New York, for example, has since the 2012-13 academic offered an entirely flipped curriculum.

UVM’s announcement, however, marks the first time a member of the Association of American Medical Colleges has declared it will abolish lectures across all its programs, Lisa Howley, the organization’s senior director of educational affairs, said in an interview.

“What we know about learning in general is different than it was decades ago,” Howley said. “Our medical students are of a generation that has grown up differently when it comes to technology and the impact that has on their ability to receive and retain information.”

But moving away from how medical schools have trained new physicians for centuries is no easy task. Major curricular changes could jeopardize the schools’ regional and professional accreditation statuses, repel prospective students, offend alumni donors and alienate some faculty members, to mention just a few.

The most pressing concern, Jeffries said, is also the simplest: money. “Most schools do not have the resources to ‘turn the battleship around,’’ he said.

UVM will put a $66 million gift, announced Friday, toward building renovating classrooms and retraining faculty members. It has also renamed its College of Medicine in honor of the donor, alumnus and retired physician Robert Larner.

The college will spend part of the gift on expanding its Teaching Academy, founded last year. Faculty members in the College of Medicine join the academy for three- to five-year periods, during which they are mentored by more experienced instructors, attend conferences and workshops, and complete self-paced courses, among other activities.

The overarching goal of the academy, Jeffries said, is to help faculty members discover teaching methods that can be as rewarding -- if not more so -- than lecturing.

“That internal oomph or dopamine release that you get when you lecture and are the center of attention is a barrier to converting faculty over,” Jeffries said. “What we need to do is ensure they have the time and support to develop alternative ways of teaching.”

The most powerful tool the med school has to win faculty members over is that they are “scientists at heart” and “understand the evidence” suggesting students in flipped classrooms perform better than students in lecture courses, Jeffries said. At Touro, for example, the pass rate on an important licensing exam has climbed to above 95 percent -- higher than the national average -- since the college flipped its curriculum.

About 80 faculty members joined the Vermont academy when it first opened, but the College of Medicine has a long way to go before the faculty is prepared to teach in the new classrooms. The med school has more than 700 faculty members in total.

The transition to an all-flipped model at UVM has already begun, and the university plans to complete it by 2022, Jeffries said. Lecture courses now make up a minority of the college’s foundational curriculum -- about 40 percent, down from 50 percent two years ago. The first semester courses have already been redesigned into a series of connected components, and the college plans to pour over data collected from them during a curricular retreat in February, where administrators and faculty members will produce a strategic five-year plan.

There are some major unanswered questions facing UVM, including what an education at the college will look like in 2022, how much time students will spend in the classroom and how faculty members will respond to their roles changing from lecturing to facilitating. Jeffries said he expects some of those details will be settled during the February retreat, while other pieces will fall into place as the medical school transitions away from lectures.

“A lot of this is a great unknown to us,” Jeffries said. “We are starting an evolutionary process in making this initial commitment ... to formulate a new model.”


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