Flipping Out: Using Principles of Inverted Teaching in Medical Education Leigh Patterson, MD LaToya Griffin, PhD

Learning Goals 1.Define the modality of inverted teaching commonly called the “Flipped Classroom”. 2.Explore the advantages, challenges, and costs of inverting your teaching. 3.Develop plans to teach a lesson using an inverted approach.

Counting Vowels in 45 seconds How accurate are you? Count all of the vowels in the words on the next slide. Slides from Sandra McGuire, Louisiana State University

Dollar Bill Dice Tricycle Four-leaf Clover Hand Six-Pack Seven-Up Octopus Cat Lives Bowling Pins Football Team Dozen Eggs Unlucky Friday Valentine’s Day Quarter Hour

NOW LIST ALL OF THE WORDS FROM THE PREVIOUS SLIDE IN 2 MINUTES. HOW SUCCESSFUL WERE YOU?

How Do We Learn? As teachers, we must: – provide learners with clear instructions and expectations. – frame the content in a way that students understand its relevance. – assess their learning in a manner that is consistent with the content delivered (e.g. exam material should match lecture/slide content) – give them multiple no/low-stakes opportunities to develop and demonstrate mastery of material. What could I have done differently in your pop quiz? What could you have done differently to help you better retain the words? – Read the words out loud – Rewrite the words – Split the words with your neighbor, look for trends and explain how your words represent a number.

Dollar Bill Dice Tricycle Four-leaf Clover Hand Six-Pack Seven-Up Octopus Cat Lives Bowling Pins Football Team Dozen Eggs Unlucky Friday Valentine’s Day Quarter Hour

Mastery Level LOWEST HIGHEST How Do We Learn? Average Retention Rate

Why the Flipped Classroom? Strengthens team-based skills. Encourages engagement AND attendance. Promotes higher level classroom discussion.

What Does The Flipped Classroom Look Like? Get familiar with basic concepts and definitions by doing background reading and/or viewing brief videos. Before Class During Class After Class Creat e Evaluate Analyze Apply Understand Remember Creat e Evaluate Analyze Apply Understand Remember Projects, problem- solving, small-group discussions, case studies, clicker questions. Study, review key concepts, additional readings, practice tests/quizzes. Creat e Evaluate Analyze Apply Understand Remember

A Case Study: Basic Pharmaceutics (PHCY 411) UNC Eshelman School of Pharmacy

Key Findings: 1.Students felt that active student engagement was encouraged by the instructor. 2.90% of students indicated that they found the course material to be helpful. 3.93% of students indicated that the inverted classroom promoted their understanding of key concepts. 4.Attendance was higher. 5.Students felt that the out-of-class assignments improved their learning.

Pros and Cons of Inverting the Classroom Advantages Promotes attendance. Keeps students and instructors engaged and focused. Gives instructors the ability to check learners’ understanding at multiple steps. Helps instructors develop relationships with students, even in large settings. Promotes collaborative learning and deters unhealthy competition. Disadvantages May exacerbate isolation of students who don’t attend class. Student success depends heavily on their intrinsic motivation. May pose a challenge in team- taught course. May not be suitable across an entire curriculum. Costly upfront with respect to time and money.

2011 Traditional 2012 Flipped 2013 Flipped Continued 1 TA time Instructor Time Cost$5,965$14,728$8,622 Estimated Costs of Flipping PHCY McLaughlin JE, Roth MT, Glatt DM, et al. The flipped classroom: A course redesign to foster learning and engagement in a health professions school. Supplemental digital content. Acad Med. 2014;89 2.John Spangler, MD, MPH; Department of Family and Community Medicine, Wake Forest School of Medicine (Letter to the Editor of Acad Med)

Inverting Your Class Assess your Lecture Pre-work assignment – Knowledge Acquisition Classroom Transition – Measure Understanding Engaging Assignment – Application/Analysis Follow-up

1. Assess your Lecture What are the goals and objectives? What are the key points – definitions, dates, ideas, concepts, formulas? Can you sort the points by complexity? Do any of the concepts build on each other?

2. Create Pre-work What definitions, ideas, concepts can your learners grasp on their own? What will they need help understanding? Are their existing resources you can use or do you need to create something new? – Articles, chapters, podcasts, blogs, case reports, mini-lectures

3. Transition to the Classroom How can you ensure that your students are ready to engage in an interactive assignment? – Measure pre-work knowledge Pretest? Questioning in Pairs? 60 second paper? – Facilitate comprehension of more complicated topics Discussion? Guided Q&A session? Poll-discuss-repoll? Muddy points?

Interactive Group Assignment What should your students be able to DO with the key concepts you are trying to teach? – Problem Solving Cases Clinical Decision Protocols – Illness Scripts – Critique alternatives

Follow up How will you circle back with your learners to monitor understanding, retention and creativity? – Muddy Points – Portfolios – Standardized Exams – Outcomes

Debriefing