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RUSH MEDICAL COLLEGE

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What is the Flipped Classroom?

September 30, 2015

711 AACRSVP with Judith Busse in OMSP

RUSH MEDICAL COLLEGE

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Anatomy of a Flipped Class

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Trad

In Class

At Home

Invert

Watch ischemic stroke video lectures

Review stroke simulation scenarios

Assessment on key topics

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The Flipped Classroom doesn’t have to involve technology

Review this...

...and we’ll talk about it tomorrow

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but technology certainly can help

AT HOME

IN CLASS

high fidelity simulation

online video

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There is a lot of content out there already

but this is only half of a flipped classroom (the rest is still up to us)

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Dr. Stephanie Velegol’s Four Rules (NEWS)

Environmental Engineering Professor @ Penn State University

No additional workload

Experiential learning in class

Weekly Assessments

Short video segments

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Is there evidence for flipping?

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U of BC Physics Class

Louis Deslauriers, Ellen Schelew and Carl Wieman, 'Improved Learning in a Large-Enrollment Physics Class', Science 13 May 2011: Vol. 332 no. 6031 pp. 862-864

traditional lecture, celebrated professor

problem sets at home

flipped class, taught by TA’s

read at home

problem sets in small groups in class

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Each arm was similar

in testing, attendance and enthusiasm

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Attendance & Enthusiasm Increased

in flipped group compared to traditional

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Test scores went up

despite not covering all the material

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What about in health care?

The literature is a bit weaker here

PubMed

July 2015

Healthcare, Flipped Classroom, Education

59 articles

Student Perceptions (20)

Better (16)

Same or Worse (4)

Review or Innovation (29)

Test Scores (16)

Better (14)

one was pretest vs postest,

another was strawman argument

Same or Worse (2)

Costs (1)

cost prohibitive to flip

Didn’t describe flip (8)

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Writing Objectives for the Flipped Classroom

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We will need to design objectives for both pieces

Krathwohl / Anderson 2001 revision

REMEMBER

UNDERSTAND

APPLY

ANALYZE

EVALUATE

CREATE

List, Name, Identify, Show, Define, Recognize, Recall, State, Visualize

Summarize, Explain, Interpret, Describe, Compare, Paraphrase, Differentiate, Demonstrate, Classify

Solve, Illustrate, Calculate, Use, Interpret, Relate, Create, Manipulate, Apply, Modify

Analyze, Organize, Deduce, Contrast, Compare, Distinguish, Discuss, Plan, Devise

Evaluate, Choose, Estimate, Judge, Defend, Criticize

Design, Hypothesize, Support, Schematize, Write, Report, Justify

lecture, visuals, video, audio, examples, illustrations, analogies

questions, discussion, review, test, learner presentation, writing

exercises, practice, demos, projects, sketches, simulation, role play

problems, exercises, case studies, critical incidents, discussion

case studies, critiques, appraisals

projects, develop plans, construct simulations, creative exercises

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Luckily, Bloom’s taxonomy splits well into 2 pieces

Krathwohl / Anderson 2001 revision

REMEMBER

UNDERSTAND

APPLY

ANALYZE

EVALUATE

CREATE

List, Name, Identify, Show, Define, Recognize, Recall, State, Visualize

Summarize, Explain, Interpret, Describe, Compare, Paraphrase, Differentiate, Demonstrate, Classify

Solve, Illustrate, Calculate, Use, Interpret, Relate, Create, Manipulate, Apply, Modify

Analyze, Organize, Deduce, Contrast, Compare, Distinguish, Discuss, Plan, Devise

Evaluate, Choose, Estimate, Judge, Defend, Criticize

Design, Hypothesize, Support, Schematize, Write, Report, Justify

lecture, visuals, video, audio, examples, illustrations, analogies

questions, discussion, review, test, learner presentation, writing

exercises, practice, demos, projects, sketches, simulation, role play

problems, exercises, case studies, critical incidents, discussion

case studies, critiques, appraisals

projects, develop plans, construct simulations, creative exercises

AT HOME: lower order objectives

recall & recognition

IN CLASS: higher order objectives

application & problem solving

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Other taxonomies split well, too

COGNITIVE

(BLOOM)

PSYCHOMOTOR

(SIMPSON)

AFFECTIVE

(KRAFTWOHL)

RECALL / RECOGNITION

Remembering

Understanding

Observing

Imitating

Receiving

Responding

APPLICATION & PROBLEM SOLVING

Applying

Analyzing

Evaluating

Creating

Practicing

Adapting

Originating

Valuing

Organizing

Characterizing

AT HOME

IN CLASS

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Example from Emergency Medicine

Apply the concepts of the trauma primary survey

COGNITIVE

(BLOOM)

OBJECTIVE

RECALL / RECOGNITION

Remembering

Understanding

List the components of the primary survey

APPLICATION & PROBLEM SOLVING

Applying

Analyzing

Evaluating

Creating

Perform a primary survey in a trauma simulation

Evaluate the completeness of the primary survey performed by the other group.

AT HOME

IN CLASS

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Then design activities

based on those objectives

AT HOME

IN CLASS

List the components of the primary survey

Perform a primary survey in a trauma simulation

Evaluate the completeness of the primary survey performed by the other group.

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Pre-workshop activity

write objectives: session, lower and higher order

Session Objective(s)

Lower Order Objectives (at home)

Higher Order Objectives (in class)

REMEMBER

UNDERSTAND

APPLY

ANALYZE

EVALUATE

CREATE

List, Name, Identify, Show, Define, Recognize, Recall, State, Visualize

Summarize, Explain, Interpret, Describe, Compare, Paraphrase, Differentiate, Demonstrate, Classify

Solve, Illustrate, Calculate, Use, Interpret, Relate, Create, Manipulate, Apply, Modify

Analyze, Organize, Deduce, Contrast, Compare, Distinguish, Discuss, Plan, Devise

Evaluate, Choose, Estimate, Judge, Defend, Criticize

Design, Hypothesize, Support, Schematize, Write, Report, Justify

lecture, visuals, video, audio, examples, illustrations, analogies

questions, discussion, review, test, learner presentation, writing

exercises, practice, demos, projects, sketches, simulation, role play

problems, exercises, case studies, critical incidents, discussion

case studies, critiques, appraisals

projects, develop plans, construct simulations, creative exercises

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Multimedia Design Principles

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Photo by Tama Leaver - Creative Commons Attribution-NonCommercial-ShareAlike License http://www.flickr.com/photos/75815807@N00

Created with Haiku Deck

Modules are NOT taped lectures

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Richard Mayer’s multimedia learning principles

Multimedia

pictures and words > words alone

Modality

spoken text and images > written words and images

Redundancy

don’t read your slides

Contiguity

keep like things together (in time and space)

Coherence

remove irrelevant images and words

Segmenting

break lessons down into chunks

Image

narrator’s face only distracts from the lesson

Personalization

conversational > formal speech

Voice

human > robot voice

Pre-training

introduce names of concepts before details

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Comparable Global Epidemiology

  • 95 cases per 100,000
    • 2 week surveillance
    • 206 French ICUs
  • 95 cases per 100,000
    • 3 month survey
    • 23 Australian/New Zealand ICUs
  • 51 cases per 100,000
    • England, Wales and Northern Ireland.

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Comparable Global Epidemiology

  • 95 cases per 100,000
    • 2 week surveillance
    • 206 French ICUs
  • 95 cases per 100,000
    • 3 month survey
    • 23 Australian/New Zealand ICUs
  • 51 cases per 100,000
    • England, Wales and Northern Ireland.

MULTIMEDIA

words and pictures work better than words alone

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Comparable Global Epidemiology

  • 95 cases per 100,000
    • 2 week surveillance
    • 206 French ICUs
  • 95 cases per 100,000
    • 3 month survey
    • 23 Australian/New Zealand ICUs
  • 51 cases per 100,000
    • England, Wales and Northern Ireland.

COHERENCE

remove irrelevant images

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Comparable Global Epidemiology

  • 95 cases per 100,000
    • 2 week surveillance
    • 206 French ICUs
  • 95 cases per 100,000
    • 3 month survey
    • 23 Australian/New Zealand ICUs
  • 51 cases per 100,000
    • England, Wales and Northern Ireland.

COHERENCE

and use only relevant images

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Comparable Global Epidemiology

  • 95 cases per 100,000
    • 2 week surveillance
    • 206 French ICUs
  • 95 cases per 100,000
    • 3 month survey
    • 23 Australian/New Zealand ICUs
  • 51 cases per 100,000
    • England, Wales and Northern Ireland.

CONTIGUITY

put related things next to each other (in space and time)

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Comparable Global Epidemiology

95 cases per 100,000

2 week surveillance

206 French ICUs

51 cases per 100,000

England, Wales and Northern Ireland.

95 cases per 100,000

3 month survey

23 Australian/New Zealand ICUs

CONTIGUITY

put related things next to each other (in space and time)

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Comparable Global Epidemiology

95 cases per 100,000

2 week surveillance

206 French ICUs

51 cases per 100,000

England, Wales and Northern Ireland.

95 cases per 100,000

3 month survey

23 Australian/New Zealand ICUs

SIGNALING

highlight keywords in the text

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Comparable Global Epidemiology

95 cases per 100,000

51 cases per 100,000

95 cases per 100,000

REDUNDANCY

don’t read your slides

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Comparable Global Epidemiology

95 cases per 100,000

51 cases per 100,000

95 cases per 100,000

IMAGE

the narrator’s face only serves as a distraction

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Approach to the CXR: Technical Aspects

  • Projection – PA or AP
  • Position – Upright or Supine (Supine folks are sick)
  • Inspiratory effort
    • 9-10 posterior ribs
  • Penetration
    • thoracic intervertebral disc space just visible
  • Positioning/rotation
    • medial clavicle heads equidistant to spinous process

How would you redesign this slide?

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Projection – PA or AP

Position – Upright or Supine (Supine folks are sick)

Inspiratory effort

  • 9-10 posterior ribs

Penetration

  • thoracic intervertebral disc space just visible

Positioning/rotation

  • medial clavicle heads equidistant to spinous process

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Care with images

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There are two main problems with images

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Keep Patient Information private - never online

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Get Consent

but consent can be revoked

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Be wary of hidden & meta-data

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Be wary of the cloud

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Don’t run afoul of lawyers

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Get open source images

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Make your own images

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Making video home modules

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many ways to record content

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Use PowerPoint to record movies

Narrate and record your slides

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Use PowerPoint to record movies

When done, time to save it as a movie

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Use PowerPoint to record movies

When done, time to save it as a movie

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Why not the public domain?

Fear of criticism

I’m not an exhibitionist

Don’t want to share my secrets

Another reason for students not to come to class

Any other reasons?

Why the public domain?

Share with the world

Ease of access

any device / anywhere

let YouTube do the heavy lifting

Any other reasons?

WHERE

Videos

YouTube or Vimeo, Panopto

Websites

Wordpress, Square Space, Blackboard

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Share your work with the world

Participate in free, open-access medical education

#FOAMed

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COSFAP promotions guidelines

helps with promotions

Evidence that an educational exercise developed by the candidate serves as a model for other institutions (i.e., letters from colleagues stating this point, published teaching tutorials, novel teaching approaches and/or courses/lectures developed by the candidate adapted by other institutions, etc).

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Create international impact

which is easily quantified

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Get testimonials from learners and instructors

frequent and worldwide extending the impact of your teaching.

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Designing classroom activities

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Average Student Retention Rates

learning pyramid

90%

75%

50%

30%

20%

10%

5%

Teaching others

Practice doing

Discussion

Demonstration

Audiovisual

Reading

Lecture

http://acrlog.org/2014/01/13/tales-of-the-undead-learning-theories-the-learning-pyramid/

We remember

  • 10% of what we read
  • 20% of what we hear
  • 30% of what we see
  • 50% of what we see and hear
  • 70% of what we say
  • 90% of what we say and do

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Average Student Retention Rates

learning pyramid / cone of experience

90%

75%

50%

30%

20%

10%

5%

Teaching others

Practice doing

Discussion

Demonstration

Audiovisual

Reading

Lecture

http://acrlog.org/2014/01/13/tales-of-the-undead-learning-theories-the-learning-pyramid/

We remember

  • 10% of what we read
  • 20% of what we hear
  • 30% of what we see
  • 50% of what we see and hear
  • 70% of what we say
  • 90% of what we say and do

of course, none of this is true

but...

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Actively engage students in class

Krathwohl / Anderson 2001 revision

REMEMBER

UNDERSTAND

APPLY

ANALYZE

EVALUATE

CREATE

List, Name, Identify, Show, Define, Recognize, Recall, State, Visualize

Summarize, Explain, Interpret, Describe, Compare, Paraphrase, Differentiate, Demonstrate, Classify

Solve, Illustrate, Calculate, Use, Interpret, Relate, Create, Manipulate, Apply, Modify

Analyze, Organize, Deduce, Contrast, Compare, Distinguish, Discuss, Plan, Devise

Evaluate, Choose, Estimate, Judge, Defend, Criticize

Design, Hypothesize, Support, Schematize, Write, Report, Justify

lecture, visuals, video, audio, examples, illustrations, analogies

questions, discussion, review, test, learner presentation, writing

exercises, practice, demos, projects, sketches, simulation, role play

problems, exercises, case studies, critical incidents, discussion

case studies, critiques, appraisals

projects, develop plans, construct simulations, creative exercises

AT HOME: lower order objectives

recall & recognition

IN CLASS: higher order objectives

application & problem solving

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One way to structure a flipped week

PRIMING

VIDEOS

PRE-SESSION ASSESSMENT

IN CLASS EXERCISES

WEEKLY QUIZ

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One way to structure a flipped week

PRIMING

VIDEOS

PRE-SESSION ASSESSMENT

IN CLASS EXERCISES

WEEKLY QUIZ

Try to solve a problem with the knowledge you have

“Write down everything you know about trauma”

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One way to structure a flipped week

PRIMING

VIDEOS

PRE-SESSION ASSESSMENT

IN CLASS EXERCISES

WEEKLY QUIZ

Supports a diverse group of learners

The danger of false fluency

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One way to structure a flipped week

PRIMING

VIDEOS

PRE-SESSION ASSESSMENT

IN CLASS EXERCISES

WEEKLY QUIZ

Not a “quiz”

Worth only a few points (motivation to complete)

Few questions including

“what was the muddiest point?”

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One way to structure a flipped week

PRIMING

VIDEOS

PRE-SESSION ASSESSMENT

IN CLASS EXERCISES

WEEKLY QUIZ

Homework in class

No additional workload (class time to complete it)

Challenging, complete together as a group

Eric Mazur’s peer-instruction

Mandatory attendance? Maybe not.

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One way to structure a flipped week

PRIMING

VIDEOS

PRE-SESSION ASSESSMENT

IN CLASS EXERCISES

WEEKLY QUIZ

This is a quiz

Worth more points than the pre-session assessment

More challenging than the homework problems

Mastery learning: Must achieve a score of 80%?

No penalty for failing. Review. Re-engage. Re-take.

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Dr. Eric Mazur

Peer Instruction & Confessions of a Converted Lecturer

Teach a Concept, then pose a question

Students answer questions on their own via audience response system

Then discuss in groups

(peer instruction)

Reviews the answer

https://www.youtube.com/watch?v=wont2v_LZ1E

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Be The Guide On The Side

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Learner Motivation

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Student complaints:

“It takes too much time”

“I like sitting in lecture”

“I’m not used to learning in this way” (introverts)

“You’re just trying to make us teach ourselves!”

Instructor complaints:

“Does it take more time?”

“What about mistakes in videos?”

“What if students show up unprepared?”

“Should I make my own material or use what’s out there?”

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Susan Ambrose “How Learning Works”

Belief they can do well

See the value in what they are doing

Feel supported

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Self Determination Theory

Competence

Relatedness

Autonomy

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U of C / Carnegie Mellon / MIT

Mastery

Purpose

Autonomy

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What determines motivation?

Belief they can do well

See the value in what they are doing

Feel supported

Competence

Relatedness

Autonomy

Mastery

Purpose

Autonomy

Mastery / Competence

Purpose

Relatedness / Support

Autonomy

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What determines motivation?

Mastery / Competence

Mastery learning

Pause the lecturer

Muddiest Points

Mastery / Competence

Purpose

Relatedness / Support

Autonomy

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What determines motivation?

Purpose

Genuine experiential exercises

“Field trips”

Mastery / Competence

Purpose

Relatedness / Support

Autonomy

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What determines motivation?

Relatedness / Support

Students interact with each other

Instructor provides focused, individualized teaching

Mastery / Competence

Purpose

Relatedness / Support

Autonomy

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What determines motivation?

Autonomy

Students pick HOW to learn (fast / slow / skip)

WHERE to learn (home / class / mobile)

WHEN to learn (binge watch / space it out)

Mastery / Competence

Purpose

Relatedness / Support

Autonomy

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How about a little extrinsic motivation?

Medical students respond to it:

Quiz scores

Homework scores

Test scores

Board prep

But not attendance?

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