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Not Another Lecture

A bold new model at the Robert Larner, M.D. College of Medicine at the University of Vermont aims to reinvent medical education

Flipped classroom in action: first-year medical students work in small groups during an “Attacks & Defenses” course at the University of Vermont’s Larner College of Medicine. [photo credit: Caleb Kenna]
Flipped classroom in action: first-year medical students work in small groups during an “Attacks & Defenses” course at the University of Vermont’s Larner College of Medicine. [photo credit: Caleb Kenna]

It’s the archetypal image of a higher ed classroom – an expert holding forth at the front of a room.

But mounting evidence suggests that active learning methods, those that feature collaboration, simulation, small-group sessions and “flipped classrooms,” actually produce better results for students, both in terms of test scores and information retention.

Nowhere are the stakes higher for better training than in the medical classroom.

That’s why the University of Vermont’s Larner College of Medicine has a goal to replace traditional lectures with active learning within three years. According to the Association of American Medical Colleges, it’s the most aggressive push of any medical school toward that format.

“We know that these efforts improve outcomes,” says William Jeffries, Ph.D., senior associate dean for medical education at the college, “and that’s what we’re really focusing on.”

A 2014 study in the Proceedings of the National Academy of Sciences determined that active learning reduced course failure rates by about one-third.

The college is accomplishing this shift thanks to the support of Robert Larner, M.D., a 1942 alumnus and longtime donor to the college. Even though the traditional lecture was a hallmark of his training, when he heard about the college’s plans to increase active learning, he pledged several major gifts – including the largest endowment in the school’s history – to help meet that ambition. His support over the past 30-plus years, worth about $100 million, has supported new and retooled classrooms, technology and faculty training.

“Dr. Larner fell in love with that idea,” Jeffries says. “He was essentially willing to give us a huge legacy to support that endeavor.”

With active learning, students spend class time working in teams on exercises or case studies that require them to apply their knowledge. Lectures don’t really vanish, but instead become homework.

“The engagement takes place in the classroom,” says William Raszka, M.D., professor of pediatrics and director of the Attacks and Defenses course. “When the students are engaged, they do a terrific job.”

The University of Vermont’s Clinical Simulation Laboratory gives students the opportunity to practice hands-on skills in a team environment. Here, respiratory therapist Major Munson (far left), medical resident Julia Powelson, medical student Matthew Shear, and ICU nurse Jodi Hart participate in an Interprofessional Clinical Care ICU session. [photo credit: Caleb Kenna]
The University of Vermont’s Clinical Simulation Laboratory gives students the opportunity to practice hands-on skills in a team environment. Here, respiratory therapist Major Munson (far left), medical resident Julia Powelson, medical student Matthew Shear, and ICU nurse Jodi Hart participate in an Interprofessional Clinical Care ICU session. [photo credit: Caleb Kenna]

“Team-based learning” is another active learning format. After preparing at home, students come to class and take a quiz, which is graded. Then, they gather in pre-arranged teams and take the same quiz, collaborating on the answers. Individual test scores average 60 to 70 percent and rise to an average of 94 percent for the groups, Raszka says.

For the remainder of class, students answer detailed questions that test their knowledge, encourage critical thinking and prompt them to work together.

“The trick is applying it in a complicated way,” says Laurie Leclair, M.D., professor of medicine and director of the Cardiovascular, Respiratory and Renal Systems course. “We’ve got to make sure we’re preparing students to function highly in an increasingly complex world.”

Faculty must learn this new way of teaching, record their lectures and organize other preparatory materials, and develop ideal application exercises. Their job doesn’t diminish with the removal of the in-class lecture, says Kathryn Huggett, Ph.D., director of the Teaching Academy, a faculty development initiative that emphasizes a scholarly approach to medical education.

“They’re the facilitators, and their job is to curate the information,” she says.

Most of the factual content in medical school curriculum is easily retrievable on smartphones, Raszka says, noting that he keeps two drug databases in his iPhone for reference. “Just memorizing the facts is not the key to learning,” he says. “Being able to use the knowledge is really the exciting part. It’s all about clinical decision-making.”

Collaboration with peers mirrors the experience students will have in practice, Huggett adds. “Especially when active learning requires team work, it more closely represents a real work experience.”

Students agree that the give-and-take exposes them to different ways of approaching the material, deepening their understanding of a subject – just the training we’d hope for our future physicians.

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