Throughout my first two years as a medical pupil, I virtually by no means went to lectures. Neither did my friends. Actually, I estimate that not even 1 / 4 of medical college students in my class constantly attended lessons in particular person. One in all 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 frequently skipped lectures. As an alternative, they opted to look at the recordings at house on their very own time. The pandemic accelerated the shift. This absence from the classroom has lots of people within the medical training system questioning how this can have an effect on future medical doctors, and has precipitated extensive dialogue amongst medical establishments. Medical training is altering quickly, and the change is being pushed by college students — so how do colleges incorporate the truth of digital studying whereas coaching them adequately for the large duty of affected person care?

“Flip” the classroom for the primary two years

The primary half of medical training (historically the primary one to 2 years, that are additionally typically 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 training is the place college students be taught the technical parts 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, working towards how one can 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.

Digital studying throughout these important 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 training I used to be most trying ahead to, grew to become a lot tougher to domesticate. It was isolating at instances.

Dr. Gruppuso and I began speaking and we’ve got a number of ideas on how one can change the medical training 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. On 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 recommend beginning with a collection of digital modules to arrange for case-based small group periods held in particular person. Actions similar to anatomy lab, affected person interviewing and bodily examination follow 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 a good 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 knowledge to be discovered. Digital studying made it a lot simpler for me to include non-lecture assets into my research plan, too, similar to flash playing cards, net tutorials or lectures by third events.

Within the flipped classroom state of affairs, 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 instances. Different days could be dedicated to anatomy lab, medical expertise follow with standardized sufferers (affected person actors) beneath the direct supervision of college, 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 might 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 educating massive lessons. I’ve lectured on matters that vary from biochemical pathways to life-style illnesses (these linked to issues like bodily inactivity) to vitamin science and the biology of growing older.

Probably the most gratifying a part of educating is passing alongside the much less tangible points of being a doctor — how one can 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 discovered modified all of that.

Absolutely digital studying for the primary two years of faculty could have been mandatory in the course of the pandemic, however persevering with to do that would ailing put together younger adults to be physicians.

The intrinsically private nature of drugs 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 training; different facilitators of holistic doctor coaching like analysis, specialty exploration, and volunteer work, are virtually unattainable with digital studying.

Lastly, there’s a very actual menace to the medical training enterprise in altering the function of the doctor college member. Docs are uncommon amongst professions within the expectation that they may educate no matter the place and what specialty they follow. Take away the gratification that comes with face-to-face educating and we threat shedding the dedication of college, a lot of which is usually performed on a wholly voluntary foundation.

Medical training at an inflection level — our joint take

Within the dialogue of what post-pandemic medical training would possibly appear to be, some have known as for the preclerkship years to be totally digital. Development to clerkships could be decided by competency (ie. have you ever mastered the coursework) somewhat than time. However we favor a much less excessive incorporation of digital studying that depends on this flipped classroom.

The Warren Alpert Medical Faculty of Brown College, amongst different colleges, is more and more implementing this method. The worth of interplay with friends, asking questions, and constructing relationships with lecturers 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 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 deal with serving to college students apply that data to caring for sufferers. Academics 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. Taking away the bigger in-person medical science lectures and specializing in creating 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 college and different college students mitigates the drawbacks of digital studying.

Medical training is at an inflection level. A conventional vs. flipped preclerkship medical science classroom is only one of a number of selections we face when fascinated with how one can practice the following era of physicians. For instance, the next questions are intimately intertwined with the function of digital studying in medical training, and are concurrently being debated in colleges throughout the nation.

1. What’s the function of medical science coursework in medical training? The USMLE Step 1 Examination is the primary licensing examination to changing into a doctor and primarily checks medical science ideas. The transfer in direction of a shortened preclerkship training time period will solely be accelerated by a latest shift of the examination to go/fail. Encouraging college students to start viewing medication 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 therapy can undermine the muse for medical training.
2. To what extent can or ought to preclerkship medical science training combine exterior assets to effectively educate 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 change medical faculty lectures. This has been taking place principally unbiased of enter from college or administration.
3. If the price of offering lectures decreases in mild of reusable or simply updatable digital content material, probably standardized throughout colleges, the ensuing efficiencies might conceivably decrease the price of training. If that may be completed, ought to medical tuition lower to mirror this? In that case, this may occasionally imply broader entry to medical training, much less pupil mortgage burden, and fewer obstacles to pursuing careers in lower-paying specialties, together with main care. Conversely, the time and college intensive nature of extra small group periods could improve price burden to varsities.
4. Will the advantages of those academic reforms be obtainable to all? For college kids 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 could end in poorer academic outcomes. Conversely, neurodivergent learners could profit from personalised studying modules; URiM college students and those who historically have much less entry to school could have extra face-to-face studying time. As training shifts to a digital format, it’s important that its results throughout your entire pupil inhabitants be evaluated.

These questions are a lot tougher to reply than a query of whether or not flipped lecture rooms deserve an elevated function in preclerkship medical training. However these selections aren’t all or nothing. Change ought to be made with an understanding of the tradeoffs, and with the foresight to mitigate the unfavourable penalties of these modifications.

Medical colleges have to get preclerkship medical training proper. The sturdy 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 yr medical pupil on my first clerkship. We consider the speedy subsequent step for preclerkship medical science medical training is obvious. A flipped classroom, and thus an elevated function for digital studying within the preclerkship years of medical faculty, is a promising mannequin. Can we protect the broad targets of preclerkship medical training whereas supporting medical college students in a call they’ve already made to be taught on their very own time? We consider the reply is sure.

Alexander P. Philips is a third-year medical pupil at Brown College and Tweets @AlexPPhilips. Dr. Philip Gruppuso is the previous Affiliate Dean for Medical Training and at present 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 College, for his or her enter.