Don't flip out over flipped classrooms- Anna Ryan

We’ve all been in those classes where we phone it in. Someone is going to stand in front of the class, power point slides glowing behind them, and preach about a topic we haven’t heard about since our initial classes. The slides will be lightly animated, maybe there will be a video clip that highlights the point of the lecture (like salt makes sugar taste a little sweeter but in a weird way), and the bullet points will be read out word for word. You don’t even have to make the effort to read. Someone in the back of the room is balancing a checkbook, the co-worker who has been there for 20+ years is knitting a baby blanket, the rest are on their phones in a group chat trying to figure out where to go and get a drink at lunch. The class is required, and man does it feel that way. 

Most of us are so used to this method of instruction, the idea that there may be other methods is a little scary. It’s fine, we’re going to do this together. 

The answer for some is to introduce a hybrid program. Sending the students out to sit in their living rooms and dedicate some of the required hours of a class is fine, as long as the rest of the time they spend in the classroom is dedicated to skills or clarification. In my own experience, we tend to fall back into the “sage on the stage” mentality. Students do the work, come in and receive a lecture on the same topic where they can snuggle in to a dark corner and get their stitching done or their budgets in order. 

Well, that doesn’t change much either, now does it? 

So what else is there? We can’t preach off a power point, we can’t have a hybrid class without bringing them back in to preach and call it “reinforcement”…where does that leave us as educators andstudents? 

Here it is folks: FLIP. YOUR. CLASSROOMS

The concept of a flipped classroom is not new to medical education. Medical colleges have hosted entire flipped classrooms and found that they are able to focus on an aspiring doctor’s skill set instead of cracking open their skulls, aiming a firehose of knowledge at their grey matter and hoping they make it through. In EMS, the concept is very much the same and it affords us the ability to focus on the hard skills we are required to teach and the soft skills we want to see in an ideal provider. 

There’s controversy (of course there is) about what that means for the educator. The model that we are commonly using now says that the people preaching in front of the warming glow of power point’s warming glow are the experts and they should be able to elaborate off the material provided by the text book company. In reality though, these instructors are often left with a printed syllabus of the lesson, a chance to look over the material and a high five as they strut into the room to deliver the prescribed material. There’s no training, there’s not a whole lot of philosophy, and in the end of it we are dictating material that could easily be taken care of outside of a classroom. What’s lacking here is not that the people in the front of the room don’t have experience in the field, its that we have tied their hands when it comes to using it. 

Flipped classroom takes the initial exposure of material and makes it the student’s responsibility to obtain it. The onus for comprehension then falls on the instructor, to access their own knowledge and experience and make sure the student understands what it is they dealt with before class. It also takes apart the notion that everyone learns the same way. Anyone who has sat in a classroom for more than five minutes knows what kind of a learner they are; kinetic, visual, auditory. If in the course of the sage preaching the power point you get lost in the sauce because you can’t feel what they’re talking about then your kinetic disposition is not going to allow you to process what’s being said. If all you’re seeing on the screen is words but no pictures or videos, your visual disposition is not going to allow those concepts to sink in. 

Auditory learners have it easy. So, kudos if that’s you. 

A flipped classroom allows you to involve all three kinds of students! I’ll elaborate. Say you’re working with the cardiac module of your initial EMT class. The students have assignments and readings they must complete before they show up to the classroom. A well rounded flipped model means those assignments encompass all learning aspects; they’ll do some readings on the heart, they’ll watch a video on how the circulation works in the body, they’ll do an activity where they have to drag and drop terms to their definitions. When they come to class, it’s the instructor’s job to create an activity that solidifies those concepts; have the students place plush likenesses of the organs in the circulatory system on their teammates with Velcro, have them act out how a drop of blood flows through the body from the feet to the aorta, make the medical assessment on a cardiac patient into a game like a round robin that allows all students to participate. At then end of class, the students are given a final assignment to expand on the concepts; a pod cast (like maybe The Overrun?), a JEMS article, a JAMA study. Those assignments are to be addressed at the beginning of the following session to finalize the concepts. 

Here’s another concept: Flipped classroom allows for critical thinking practice in an easier format than our traditional model. The sessions in the classroom has the opportunity to be dynamic, and the opportunity to introduce troublesome aspects of healthcare present themselves nicely. Stress inoculation, high fidelity simulation, mental health in first responders. Tie them all in to the lessons you’re providing at the classroom level because you’re no longer wasting your time on the initial information exposure. 

I get that those concepts, run up against one another, makes this an intense course but ask yourself the question: In the current medical climate, are you producing technicians or clinicians? Are you refreshing certificates or providers? Are you enhancing your staff or your crews, or are you simply keeping them legal? Ask yourself this too: Are you utilizing your staff’s experience and expertise the best way you can by having them preach the good word to students who aren’t always paying attention? 

Sounds good? Great. It’s not easy. It’s not cheap. Sorry. 

In my shop, we initiated our flip a year ago. In January 2019 we will finally be ready to implement it. We took the whole curriculum and wrote it to NREMT standards (NJ is moving to the national standard where it was previously a state standard in the last decade or so), we extended the class from a 3 months to a 6 months, we have initiated training for our instructors that includes teaching methods and philosophy, we hired additional staff to make sure that our instructors are supported and that we have another generation of instructors, we incorporated provider mental health assessments into our patient assessments, high fidelity simulations, MCI experience, self-defense, tactical medicine and bleeding control and so on. Between reimbursement, cost of salary, materials and so on, we aren’t going to roll in the money BUT we will be turning out a candidate that will test well AND be ready to enter the field. 

There’s studies linked at the bottom of this article, I’d love to cite each one individually but I tend to be wordy in these posts so I’ll let the results speak for themselves. My point in this post is this: If you haven’t considered flipping your classroom, a full on committed flip, you are doing your students and staff a disservice. In almost 2019, google can do the same thing for a student as the staff instructor pontificating on airway management can do for them. The things we offer these students is insight, experience, guidance and support. A lecture does not make a clinician, we do, and if you’re committed to producing people who can perform admirably in the line of duty then this is should be in your crosshairs. Do. Better. 

https://www.emsworld.com/article/12028217/flipping-the-classroom

https://www.emsworld.com/article/12035823/ems-education-flipping-the-classroom

https://www.emsworld.com/article/12043387/how-to-flip-the-ems-classroom

https://www.edutopia.org/blog/flipped-classroom-best-practices-andrew-miller

https://www.cae.net/why-flipped-classroom-works/

https://www.physiology.org/doi/full/10.1152/advan.00033.2016