Is it time to shift to flipped classrooms?: Dr Anshu

One oft-heard complaint from teachers in medical schools in India is that students don’t attend lectures. The woes of low attendance in theory classes are a repeated refrain from administrators. And this isn’t a problem just restricted to India. Worldwide, schools are beginning to realize that even the best lecturers are not always successful in attracting students to lectures. Clearly, the traditional lecture isn’t doing too much to engage students. Teachers need to think of newer ways to capture the attention of this digital generation of learners. Is it time then to shift to flipped classrooms?

In a traditional model, teachers deliver didactic content to students in the classroom, and give them homework to hone their skills. The flipped classroom reverses the manner in which time is spent inside and outside the classroom. The flipped classroom is an educational model where students are assigned didactic study content before a class, and the classroom time is utilized for more engaging and active learning strategies. With the availability of technology, such asynchronous and distributed learning formats are possible in our settings. To give you an example, teaching videos or assigned readings are uploaded on an online platform before the scheduled class. Students are expected to study and come prepared. Once students are in the classroom, they are given a short quiz or assessment to ensure that they are ready with the basics. This helps in ensuring that unprepared students will not distract learning of other prepared students during the group exercises. Students then work in teams to apply their knowledge to assigned tasks.

The concept of the flipped classroom comes from time-tested educational theories. Teaching and learning do not occur in closed systems. Learning often happens outside the formal boundaries of time and space, and learners need meaningful enriching experiences. In the flipped classroom format, students can metacognitively manage the pace of their own learning, identify their learning gaps, and formulate their plans of moving ahead with the guidance of their teachers. The role of classroom activities is to scaffold student learning and facilitate learner-centred collaborative environments.

How can you design flipped classrooms in your setting?

The key to designing flipped classrooms is organizing how you will teach. The first step is to have a look at your learning outcomes and plan backwards. Make learning outcomes explicitly clear to learners. Think about the assessment and learning activities that your students must undertake actively to achieve those outcomes. Write down a clear schedule of what you expect learners to do and share it with them. Remember to sort the material based on difficulty level. Difficult and advanced concepts need to be taught in class, while easier instructional material that might be easy to assimilate by learners can be given as pre-reading assignments. While doing this, do not forget the cognitive load on the learners, and estimate the time they will require to study on their own. In the classroom, develop small formative assessments to determine the learning gaps. You can also use technological advances like audience response systems or online assessments to determine learning gaps. Use active learning strategies like group work and hands-on skill training.

Clearly, using the flipped classroom approach needs organizational changes such as altered arrangements of the classrooms, and availability of resources such as books, audio-visual aids, computers and the internet. This also requires much more preparation from faculty than the traditional lecture, due to the unpredictability of what learners may need. Creation of web-based content like online lectures, videos and assessment may take time to prepare, but once done, they can be re-used easily for future batches of learners. Learning material must be easy to access. Proper sequencing of tasks from easy to difficult is essential. Flipped classrooms can free up time for interactive activities and hands-on training. Collaborative strategies such as brainstorming, concept-mapping, team-based learning and problem-based learning are suitable for medical students. The role of the teacher will be to facilitate learning as subject experts by moderating discussions, resolving doubts, providing feedback and ensuring that learning objectives are met.

How do flipped classrooms help?

Flipped classrooms make students responsible for their own learning. They can use the face-to-face time to interact with teachers and peers, ask specific questions, obtain guidance, receive feedback, and apply their newly learnt knowledge to real-life scenarios. Students seem to love this kind of active learning as it allows them the freedom to think and discover things for themselves. Use of formative assessments helps students in identifying their own learning gaps. This format takes students to a deeper level of learning instead of merely cramming the subject.

In a systematic review, Chen et al (2017) have shown that the flipped classroom is a promising approach to improve learner motivation and engagement. They were found to be at least as effective as traditional lectures. There is not enough evidence yet to suggest that this method helps in better knowledge retention or transfer of knowledge to professional practice.

As with any other major curricular change, transitions to flipped classrooms will require drastic alterations in organizational culture. It is important to create an environment of inquiry and open questioning. This transition must be facilitated by good administrative coordination and communication between faculty and students. Additionally, technological support will be critical to sustaining this model. Faculty training is essential to understand how redesigning of face-to-face classroom time can be best done. If used well, the flipped classroom model allows efficient use of time and technology. Watching student enthusiasm towards learning can be very fulfilling.

(Dr Anshu is Secretary, AHPE. She is Professor in the Department of Pathology at the Mahatma Gandhi Institute of Medical Sciences Sevagram, Maharashtra)

The different shades of social obligation and medical colleges in India: Dr Sucheta Dandekar

The ultimate goal of medical colleges in India or anywhere else in the world is to improve the health of people, be it physical, mental or social. This is invariably attempted by juggling the three-pronged approach of educating the future health professionals; conducting relevant clinical research; and delivering comprehensive patient care. To make this possible, amalgamation of the social determinants such as behaviour, environment and social conditions and the values associated with social obligation (quality, equity, relevance and effectiveness) need to be adhered to.

Quality in health care has the community in mind and where treatment is person- and situation-specific and should be coordinated to serve the complete needs of a patient or a citizen. Equity implies that all persons from the community have equal access to the health services. Relevance is adhered to, when the most important health problem is identified and treated on priority such that the person, groups, society and community benefits. Effectiveness is achieved when all the available resources and infrastructure are put to optimal use to benefit individuals and the population. Establishing these values are the key towards social accountability.

It is nearly 22 years since WHO defined social accountability of medical schools as, “the obligation of medical schools to direct their education, research and service activities towards addressing the priority health needs of the community, region, and/or nation they have a mandate to serve. The priority health needs are to be identified jointly by stakeholders namely, governments, healthcare organizations, health administrators, health professionals and the public” (Boelen and Heck, 1995).

The terms ‘social obligation’, ‘social responsibility’, ‘social responsiveness’, and ‘social accountability’ are often used interchangeably.  At the moment, students from our medical schools are ‘being taught’ ‘social responsibility’ by sending them to the rural health centres and making them work as per the Medical Council of India (MCI) norms. When some of our students take part in blood donation camps, when they visit the community during floods, when they respond to the epidemics, they are being ‘socially responsive’. Most of the times, this is tackled on a voluntary basis. The more the students from a medical school come forward, the more it is a reflection of the effectiveness of our teaching. However, how prepared are we for all the principles to be tested remains debatable. This shall lead us to becoming ‘socially accountable’, when we are ready for an evaluation and accreditation process. Sensitizing of the stakeholders regarding issues of social accountability and accreditation is important. This, perhaps, shall be the much-needed step in making a positive impact on the society.

Medical educationists have acknowledged the challenges faced by Indian medical schools and suggested that if progress has to be made, it should be based on contextual planning of the curriculum, such that it incorporates the health needs of the community and encourages sound educational research, with the governmental agencies also seeing eye-to-eye. Researchers have suggested the identification of current and prospective social needs and challenges, adaptation of education programs to meet these needs and, evaluation to show that the society has benefitted from the interventions.

We realize that there is a need to work collaboratively by advocating changes to the health system. Faculty of our medical schools have a large responsibility of inculcating this into the system by taking into confidence the governing bodies, community, institutional administrators and students. The understanding of the importance of this symbiotic relationship cannot be denied. Some medical schools are no doubt, closer to implementing a model of social obligation as compared to others.

 

(Dr Sucheta Dandekar is a FAIMER Institute Fellow (2010) and an IFME Fellow (2014). She has completed her MHPE from the University of Keele in 2018. She is Professor and Head of the Dept. of Biochemistry & Clinical Nutrition at Seth GS Medical College & KEM Hospital, Mumbai)

Message from President, AHPE 2018: Dr Himanshu V Pandya

Very warm greetings!

I write this message with immense sense of honour and pleasure. I take this opportunity to thank the members for reposing faith in me and bestowing the responsibility of leading this Academy.

India’s health system is facing a crisis of grave magnitude due to rising incidences of violence against health care staff. Over the past few years, articles have appeared in lay press and medical journals on this issue. Authors of these articles have cited various factors responsible behind this problem. They also propose various strategies including curricular changes to handle and prevent such situations. However messages on physicians’ groups on social media suggest that there is growing sense of cynicism in the medical community. This is indeed a worrying sign for the profession.

 

In a time when medicine in general and medical education in particular, finds itself under great stress, the profession needs to respond constructively through a new focus on professional identity of physicians. Over the last decade, experts in the field of medical education have made a strong case that professional identify formation needs to become the central focus in educating tomorrow’s doctors. This Academy can take a lead in supporting and spreading the growing movement for teaching of professionalism to ensure that members of the profession develop the identity that the public expects and the ideals of medicine demand. I wish you all the best in your endeavours to enhance the image of health professionals as it should be.

 

Dr Himanshu V Pandya

Educational innovations and ethical dilemmas: Dr Avinash Supe

Innovations pave the way for most of the progress that has occurred in the field of medicine. This holds equally true for medical education. Various innovative approaches in the field of education have significantly increased student’s engagement and improved understanding, leading to improved outcomes of education.

While innovation is motivated by teachers’ expectations that a new approach will benefit students, the reality is that not all innovations will result in improved learning. The ethical dilemma of implementing any educational innovation is knowing whether a particular innovation will prove to be good for students.  This uncertainty creates challenges for teachers, students, and the education system.

By its very nature, an innovation introduces a potential risk to the process of student learning- a risk that may not be fully anticipated at the outset. At the same time, it fosters an optimism bias too. Ideally, informed consent of the students involved in educational innovations must be obtained along with permission from the authorities for using it. Innovative procedures and their associated educational technology raise issues of cost and resource distribution in the contemporary, financially conscious, healthcare educational environment.

Teachers and institutions need to identify and address conflicts of interest created by the development and application of an innovation, always giving priority to students’ interests over and above academic scholarship or institutional gains. Potential strategies to address the challenges inherent in educational innovation include collecting and reporting data of objective outcomes, expediting the informed consent process, and adhering to the principles of disclosure and professionalism. As teachers, we must encourage creativity and innovation keeping our ethical awareness and responsibility to students in mind.

In India, examination patterns are set by Universities and the Medical Council. However, teachers can still try and introduce innovative practices during their teaching learning sessions and formative assessments, keeping within the framework of Council guidelines.

The magnitude and urgency of the challenges to be faced in a developing country such as India are enormous. Funds are required to avail of the services of available experts. Educational planners, administrators and teachers have to work in a situation plagued with the continuing dilemma of requirement of change and development on the one hand, and the severe restraints imposed by traditions and shortage of resources, on the other. Despite this predicament they race against time to keep pace with better educational provisions elsewhere in the world. The strain is great- a few individuals and organizations perceive the urgency of finding unconventional ways of conducting different aspects of the educational system, but more often than not they are outnumbered by those keen to hold fast to traditions. In the ensuing conflict of what should be done, innovations might arise and take shape swiftly, but their careful piloting and systematic diffusion present many difficulties. From this standpoint, the struggle which Indian educationists have put up with since independence, appears to have been fairly rewarding.

Each educational project is not necessarily based on entirely new ideas, but often comprises of the pragmatic adaptation of an earlier idea in the light of the present situation. For instance, the new graduate medical curriculum incorporates the best aspects of the basic education system as well as those progressive facets of such programmes prevalent in advanced countries.

Most of the innovations attempted so far in India focuses on greater input of human effort than on availability of financial support with strong administrative leadership. Structural changes made are plenty because new programmes cannot be planned and implemented through outdated systems.  The most striking finding is that administrators have discarded their authoritative mantles and now welcome the entry of the teaching profession and the community into the traditionally holy precincts of the educational system. Yet, one must ensure that while introducing newer techniques of education, students consent must be taken along with institutional review boards permissions.  No innovation should hamper achievement of the learning outcomes. If two methods are used, students should get benefit of best system, even if it means additional effort on part of teacher. Ultimate beneficiary of any innovation should be the students!

(Dr Avinash Supe is Past-President, AHPE. He is Director, GSMC FAIMER Regional Institute; Director, Medical Education Mumbai, Dean & Professor, G I Surgery, GS Medical College KEM Hospital, Mumbai)

Message from President AHPE 2017: Dr Thomas V Chacko

Warm Greetings from the President, AHPE!

It gives me great pleasure and I feel honoured by the trust you have reposed on me to be your President for the year 2017.

Being a voluntary Non-Government Organization, the success of the organization depends on the full-hearted support and contributions by members and the esteemed Executive Committee members of the AHPE to further the cause of improving the quality of Health Professions Education in India.

For this purpose a ‘Needs Assessment’ exercise was conducted to find out what the expectations of the HPE faculty are that they expect AHPE to deliver. Thanks to Dr. Anshu’s efforts at doing a qualitative analysis of the responses, the primary areas of focus were identified as Capacity building through Faculty Development Programs (including through the NCHPE and formation of Regional centers), making available a repository of evidence-based good practices through website and newsletters/ journal, producing guidelines and standards for measuring and improving quality of education through accreditation of master trainers, Faculty Development/ CPD programs etc. as well as development of criteria for recognizing efforts of teachers and rewarding them within institutions and across the regions/ country (Scholarship of Teaching and other types of educational scholarships).

Through leadership in these fields and generating the evidence, we can influence policy and do advocacy with regulatory and accrediting agencies related to HPE.  Various suggestions were also received as to how we can achieve this through formation of Special Interest Groups (SIG) in areas like competency based approach to education, distance/blended learning using IT resources, inter-professional education, educational research, program evaluation, student assessment including exit / licensing exams etc. When these SIGs come out with authoritative evidence-based recommendations that are content and context specific responding to local needs and get peer reviewed and approved by AHPE, it will serve as an authoritative resource for decision makers to arrive at policy decisions within the country.

I also encourage you to register for the NCHPE 2017 at Jorhat, Assam to enlarge your network of friends within the community of practice in India. Best wishes for success in all your academic endeavors in the coming months.

Dr Thomas V Chacko