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Auscultation

Listening in on medical education

TURN OVERS: Medical schools turn to the flipped classroom to help students learn <br/>Photo: comodclassics.com


As I sat in the lecture hall in the Tosteson Medical Education Center to take the last exam of my first year of medical school, I couldn’t stop staring at the sea of faces. I whispered to the person next to me, “Are there really this many people in our class?”

When it comes to preclinical education, it’s becoming clear that there’s no longer a one-size-fits-all method of teaching and learning. With a growing number of online resources, it’s possible to never set foot in a lecture hall until exam day. As major curricular reforms are being discussed at HMS and other medical schools across the country, it’s not unreasonable to consider whether there are alternatives or modifications to the traditional lecture format that may better help students integrate the high volume of information presented in the preclinical years.

I was reflecting on this situation last spring when an e-mail message caught my eye. Khan Academy, an online nonprofit educational organization, was announcing that, together with the Robert Wood Johnson Foundation and the Association of American Medical Colleges, it was sponsoring a competition to seek individuals who could create free online educational videos for students preparing for the 2015 MCAT. As someone who is passionate about teaching, I was immediately sold. But its appeal was greater than that: This opportunity struck me as a way to better learn how technology outside of the classroom might be used to enhance medical education, including my own.

I had glimpsed the potential of educational videos during my first year at HMS. Richard Schwartzstein ’79, the Ellen and Melvin Gordon Professor of Medical Education and course director of my class’s physiology block, had recorded Khan Academy–style “chalk-talk” videos, 20 to 30 minutes in length, on several fundamental concepts in pulmonary physiology. In an inversion of the traditional lecture format—an approach he described as a flipped classroom when he introduced it to us during our first day of class—these videos were assigned as homework. We were to use them to prepare for the critical-thinking sessions of clinical vignettes in lecture. I considered this format to be better than the traditional lecture format: A well-structured 20-minute educational video can often transmit information far more effectively than 60 text-heavy PowerPoint slides.

I do not think we medical students should be spoon-fed our education. Learning how to adapt to different learning styles and to take ownership of how we incorporate new information are valuable lifelong skills. Grappling with uncertainty can be a good thing. Grappling with information overload, however, is not. Solving the latter is, I think, where good teaching outside the classroom comes in.

Technology has given us the tools to become self-learners. But how do we make individualized learning more productive? I was about to find out: I had been accepted into the Khan Academy training session.

Equipped with my laptop, a microphone attachment, and a writing tablet, I flew to San Francisco for the weeklong session. I and the 13 other participants from across the country—the majority of whom, not surprisingly, were medical students—met Rishi Desai, Khan Academy’s medical fellow. Desai has made countless medical and health care educational videos for Khan Academy on topics ranging from the alveolar gas equation to atherosclerosis. I had, in fact, discovered many of his videos on YouTube and had benefited from their content during my first-year courses.

Our training week focused on making—and critiquing—videos. Conversations about preparing content for the MCAT flowed into discussions about our own educational experiences. Throughout the week, one question kept coming up: could this model for creating a structured online classroom be the next step in medical education?

One night over dinner, a participant who had just finished his first year in medical school told us how he had made Khan Academy–style videos for his classmates. He had realized that the Khan Academy approach would suit a lot of topics in medical education, so he bought a writing tablet for his computer and started fooling around with it.

“I made videos on whatever we were learning at the moment and shared them with my classmates,” he explained. “People liked them, as they like any well-digested presentation of what we need to know. I think they liked the clarity, because a lot of the lectures we receive are difficult to follow.”

Many of us around the table shared similar sentiments about our preclinical education. As we discovered, however, making effective educational videos isn’t easy. In a classroom, facial expressions and gestures add rich layers of engagement. But in a chalk-talk video, there is only a voice in the background and a pen marking a virtual blackboard. Sound quality, engaging color choices, pacing, and clarity are all important considerations in video production. Despite the challenges, it was powerful to discover that making an educational video is not above anyone’s head—at a minimum, all it requires is a laptop, a writing tablet, and practice.

In retrospect, the training session gave me a greater understanding of the positive role that technology can have in the evolving student-teacher relationship. By producing clear, focused, bite-sized chalk talks that begin with the big picture and then slowly bring in the details, Khan Academy’s videos allow individuals to tackle and master concepts at their own pace.

The chalk talk model may be especially useful for medical students, considering the information overload challenge we face. Students in my class at HMS, for example, come from diverse academic backgrounds— business, cell biology, economics, math, political science, and public health, to name a few—and, consequently, have vastly different aptitudes for the subjects required in medical school. Given the quantity of knowledge medical students must absorb and understand, it is not unreasonable for them to want to build individualized learning plans that accommodate different baseline levels of understanding the material.

Pursuing a path of self-learning, however, has its pitfalls. Midway through several courses this past year, I found myself surrounded with more textbooks and online resources than I had time to use. Instead of complaining about a lack of resources, I most often found myself complaining of too many. Sorting through all the noise was the biggest hurdle. A guiding framework that organizes all the information is often lacking or difficult to glean from material presented in a large lecture hall. Bite-sized educational videos may be just the sort of engaging framework for content that students could use outside the classroom. I do hope, however, that such videos would enhance, rather than replace, peer-to-peer and peer-to-educator interactions inside the classroom.

Jasmine Rana ’16, a second-year student at Harvard Medical School, participated in the Khan Academy video development workshop during the summer of 2013.

The opinions presented are those of the contributor and do not necessarily reflect those of the President and Fellows of Harvard College or the publishers of Harvard Medicine magazine.

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