No Flipping Way in MedEd

“Flipping the classroom” is a trendy educational technique that has entered the lexicon of almost every medical school that I know. I have even moderated sessions on “flipping the classroom” at conferences and meetings. The problem is that in medical education, we do not flip the classroom and to pretend we do is a great disservice to our learners.

The initial concept of “flipping the classroom” starts with the idea that in K-12, students are taught specific concepts in the classroom and then go home and do assignments (homework) to solidify those concepts. When one “flips” the classroom, the students work on learning specific concepts on their own at home and then solidifies these concepts by practices in the classroom setting where a faculty member is available and can mentor the student working on the concepts that they are supposed to learn.

Technology has been cited as a key factor in the “flipped classroom.” I disagree. When I was in school, we often had quizzes at the beginning of class on material we were supposed to have learned on our own so that we could participate in the discussion of the subject at hand. In team-based learning (TBL), learners are expected to prepare before coming to the session and are assessed with the readiness assurance tests (RAT; iRAT; tRAT). This is fundamentally part of the concept of having “reusable learning objects” that learners use to prepare themselves for classes.

Now, we use pre-made, special, short videos for flipping classrooms. Technology has made flipping the classroom easier – especially for those faculty who just “show last year’s lecture.” But, it does not fundamentally alter the idea that learners prepare for class by reviewing resources ahead of time.

What the flipped classroom does provide is time for learners to learn skills associated with thinking through the subject at hand. It is an opportunity to be active in the learning process. Depending on how the session is developed, learners can develop skills such as identifying what they need to learn, research the topic, and evaluate the resources to come to an understanding of the information about the topic. Without question, this is a valuable model for education, regardless of educational level.

However, in the typical setting, flipped classrooms presuppose several things:

  1. There is a finite amount of material that is introduced and for which the learner achieves a level of mastery in the classroom setting.
  2. Learner assessment is based on their achievement of mastery of the introduced concepts – and they are not expected to learn additional related material to do well on their assessments.
  3. There is a defined timeframe for the material to be introduced (classroom) and assignment (homework) that can be flipped. Consequently, the total time involved between “classic” and “flipped” models is the same.

None of the above presumptions are true in medical education. And using the term “flipped classroom” with our learners is thus misleading.

There is no predefined finite amount of material that is adequate for mastery in medical school. Medical school material is about the application of fundamental scientific knowledge and thinking processes for clinical application. Thus, in a preclinical active “flipped classroom” environment, one approach would be for students to study the fundamental scientific knowledge at home prior to the class and then have the class session as a time to apply the material to clinical issues. The challenge is that the learners do not have the depth of knowledge to develop more than the most rudimentary components of mastery. So, in medical education, the best we can do is to have learners develop skills toward their mastery, but mastery is accomplished outside this setting.

However much we want to reduce the amount of information medical students are required to know in our courses and programs, we are constrained in that they must know enough to pass their licensure exams (USMLE; COMLEX). Thus, we have no choice but to teach the information and assess the learners or else leave them to their own devices to make sure they pass the licensure exams. Now, I think we have an obligation to prepare the learners for their licensure exams, but not all medical educators agree with me. We cannot ensure that the learners master everything they need in a topic from each flipped classroom experience. In my experience, we usually have to limit the amount of information provided to learners for a “flipped” experience as compared to a lecture on the same topic. Thus, they are exposed to even less than we might expect of them in our own course assessment, much less the licensure exams.

Almost no faculty member in medical schools assigns homework in the classical sense. Traditionally, we give a lecture (an hour?) – which often is optional, suggest some readings, and expect learners to be able to figure out what they need to know for the exam. Thus, the time commitment for the session is the class session time and then whatever is needed for the learner to achieve the appropriate level of mastery of the subject at hand.

In the typical “flipped classroom” model in medical education, we ask learners to prepare by viewing a required video ahead of time (an hour?), require attendance at the flipped session (another hour?), and still expect the learner to commit whatever is needed to achieve the appropriate level of mastery not only for the material covered, but for everything else they need to know to pass the course and/or licensure exams.

From the learner’s perspective, we have moved from one optional hour to two required hours and no change in what is expected of the learner. Thus, from the learner’s perspective, we have simply increased their load by a minimum of two additional hours. This seems to be unfair to them and, quite frankly, I can’t argue with that perspective.

From the perspective of a medical education administrator, we have added an hour of required curriculum time. In most of our medical schools, we are “hour neutral,” meaning that we cannot add an hour without taking it away from somewhere else in the curriculum. Depending on what the defined outcome is, it is not clear what we have gained besides being able to use a buzzword.

Am I arguing that we should not require learners to prepare before the educational session and to devote the educational session to an active participatory exercise? No, most emphatically not. What I am saying is don’t call it a “flipped classroom.” Even more importantly, don’t use it as an underhanded way to add curricular hours. Rather, use this opportunity to instill in the learners the skills that are being addressed and to test the development of those skills in our assessments.

We do not teach “flipped classrooms” in medical education. What we do is ask learners to start developing specific cognitive skills that aid in their clinical training. In our courses/clerkships, we need to tell the students of the specific skills that they should be developing. We should call the session by what it is – developing specific skills – than what it is not – a “flipped classroom.”

In summary, the term “flipped classroom” in medical education is a misnomer; it leads to confusion and resentment in students. I argue that we should be working with students to learn techniques of thinking through clinical applications of knowledge gained and acquired outside the classroom – and show them through assessments how those skills can be used.

Note: The views in this commentary are my own and not necessarily those of my institution, employer, or colleagues.

Building the Strategic Plan: Part 1

Now comes the fun part of the strategic planning process, building the plan.

A strategic plan should contain elements of “want to do’s” but must contain the “need to do’s.” So how do we figure this out?

The most important tool we can use is the SWOT analysis. As I described in a previous Reflection, the SWOT analysis gives us a true and real description of what is going on with our organization.

When I get started with the building process, I like to take time to revel in the successes of our Strengths. As we review our strengths, I like to look at growth trajectories of our successes and truly understand what we do well. As part of this step, it is time to build some strategic goals that address these strengths. That is, what are some short- to intermediate-term objectives that improves what we already do well or actions to maintain strengths?

As I described previously, a strategic goal should have a time frame and some quantification of what needs to be done. That is, a strategic goal is an objective that should take 2-5 years to accomplish. However, it should not be a description of a specific task or a specific list of identified tasks. Identified tasks, in my framework, are tactical measures. At this stage, I like to have everything developed as strategic goals. And, the more strategic goals that are written, the better. It doesn’t matter if the goals are similar or address the same issue. Go ahead and write them down. In a later part of the process, we will talk about how to whittle down the strategic goals. The main thing is to get them all down for now.

It is typical for most of us to develop tactical measures instead of developing strategic goals. Tactical measures describe things we do. What I like to do is to keep the tactical measures and associate them with strategic goals that have been already developed. However, it is essential that the primary task at this stage is to develop strategic goals.

The next thing to do is to review the Threats. Threats are the external forces that can negatively impact our organization. For all threats, I like to address each with three questions:

  1. Can one of our Strengths address this threat?
  2. Can improvement of one of our Weaknesses address this threat?
  3. Can action on an Opportunity address this threat?

If the answer to any of these three questions includes a “yes,” then we can do something about it.

If all three answers are “no,” then the question is whether or not the threat addresses the fundamental mission of the organization. If it does, then we have to ask the question of why we are not doing something to address this threat. Can we do something and what would it entail? How would it mesh with our Strengths, Weaknesses, and Opportunities? Was it something we had missed in the SWOT analysis?

If we are absolutely sure that there is nothing we can do about this external threat, then we should monitor the threat and otherwise ignore it. It is a waste of time, energy, and emotional strength to focus on that about which we can do nothing. I must admit that I have come across very few threats in this category.

Threats are best addressed by identified Strengths and Weaknesses (“yes” to above question 1 or 2). The reason is simple; we are already doing something that addresses the threat. We may be doing something well (Strength) or not-so-well (Weakness), but we are already doing something. At this point, we should be writing out strategic goals that address the threats.

Next, we should address the Weaknesses:

  1. Can one of the Strengths address this weakness?
  2. Can we improve what we currently do to address this weakness?
  3. Can action on an Opportunity address this weakness?

If the answer to question 4 is “yes,” that is terrific. What we need to do is to develop strategic goals that amplify the Strengths to address the Weakness. If the answer to question 5 is “yes,” then this is also terrific. What it says is that we can develop some strategic goals that involve work we are already doing. Again, I think it is perfectly appropriate to write out strategic goals that may be similar to ones developed previously. The key is to get the strategic goal written.

If the answers to question 6 is a “yes” or if the answers to questions 4, 5, and 6 are “no,” then we need to develop strategic goals about things we currently do not do. This can be challenging in that it asks us to look beyond our current scope. At the same time, it can be exciting to look at new opportunities and actions. Regardless, as the mantra goes, write down the strategic goals.

Now, we should look at Opportunities. There are two components for analyzing Opportunities. First, does this opportunity fit with our mission? If the Opportunity fits our mission, then, what are the strategic goals that address this Opportunity? If the Opportunity does not fit out current mission, but is part of the vision of what we do, then we need to ask the questions (a) do we need to revise our mission and (b) should we incorporate some “nice-to-have” strategic goals that address this Opportunity.

Lastly, we should ask ourselves, are there new strategic initiatives that we want to achieve that was not addressed in the SWOT analysis? In my experience, many of the most exciting ideas can come from this discussion. As far as Opportunities and new initiatives are concerned, I believe that we should document them and include them in the discussion. The more ideas, the richer the strategic aims will be when we develop them.

At this stage, what we should have is a list of many strategic goals. In some cases, it is not unusual to have lists of a couple hundred strategic goals. Many of these goals have associated tactical measures as well.

The next question is how to take this huge list and pare it down to a Strategic Plan. This will be the topic of a subsequent Reflection.

Note: The views in this commentary are my own and not necessarily those of my institution, employer, or colleagues.


The Terms in Strategic Planning

This week, I will step back into the discussion of strategic planning. To date, we have discussed my view of mission/vision statements and how they guide the process of developing a strategic plan. The next step was to do a SWOT analysis, one based on reality and data. The next step is to develop a Strategic Plan. There are steps after creating a strategic plan which are also essential. They are developing the tactical plans, implementation, and review. We will address those points later.

I must admit that I am an advocate of the Rule of Threes. In writing, rhetoric, and public speaking, it is alleged that people remember things in threes better than in any number combination. When I do planning, I tend to revert to using three items as the default number of items in a category. So, for each strategic plan, I start out with three main strategic aims, three strategic goals for each aim, and three tactical measures for each aim. It is critical that we are not bound into three items. Sometimes there are more; sometimes there are less. But, it is a good place to start.

But, before we start, let us define some terms – at least the way I use them. In a later Reflection, I will describe how I build a Strategic Plan using these terms.

Strategy vs. tactics

There is an abundance of literature regarding the differences between strategy and tactics. This is a crucial difference that must be understood. In the way I look at the world, a strategy is a long-term, broad-based objective. It is a description of what we want to achieve in the long-run. A tactic is a short-term focused action designed to achieve a specific goal.

Strategic aim

When developing a strategic plan, I like to have three (remember, Rule of Threes) Strategic Aims. These are the three main long-term objectives we want to reach. Sometimes there are more Strategic Aims; sometimes there are fewer. The key is that the Strategic Aim is the broad description of the direction in which we want to go. In my view, there should be minimal overlap between Strategic Aims. The combination of all the strategic aims is the compilation of the Strategic Plan.

I like to have strategic aims that are broad, action based, and aggressive. For example, “Increase diversity within the medical school” or “Enrich technology-based education within the medical school.”

Strategic goal

For each strategic aim, I start thinking about having three Strategic Goals. Again, the actual, final number of strategic goals will vary, but I like to start out with three. Strategic goals are subsets of a strategic aim. These are more focused and directed in the short- and intermediate-term. The combination of all the strategic goals should lead to the strategic aim coming about.

In my experience, it is useful to put a time frame and quantification on some (not all) strategic goals. The time frame tells you “how long” and the quantification tells you “by how much.” For example, “Increase enrollment of Hispanic, Latino, and Spanish-origin students by 100% in the next five years” or “Create technology-enhanced small group sessions in all first year courses within five years.”

Tactical measure

Tactical measures are activities we do to make strategic goals come about. These are designed for the immediate- and short-term. Thus, a group of tactical measures are the things we do to accomplish our strategic goals. By accomplishing our strategic goals, we achieve a strategic aim. By addressing all our strategic aims, we succeed with a strategic plan.

Tactical measures must have timelines and specific objectives. For example, “Triple recruitment trips to undergraduate institutions with large populations of Hispanic, Latino, and Spanish-origin students next academic year” or “Ensure all classrooms in which small group sessions are conducted have the same technology.”

When developing tactical measures, there are five components that must exist for each tactical measure:

  1. Timeline: What is the timeline is which this tactical measure is to be completed? In my opinion, tactical timelines should be never be longer than five years for full implementation and typically should be about 2-3 years maximum. Timelines of one year are appropriate for most tactical measures. It doesn’t mean that the tactical measure needs to be done now; it can be done a year from now. But the duration and time it takes to accomplish should be limited.
  2. Action: What is the specific action that is going to be taken? The details need to be developed within the tactical measure, but doesn’t need to be listed in the title of the measure.
  3. Implementation Process: Who is responsible for getting it done? Who is responsible for evaluating it? And what steps are needed to make this tactical measure happen?
  4. Resource Requirement: What resources (financial, personnel, space, transportation, etc.) are needed? Is this going to require a budget (New? Reallocation of finances?) If you need personnel, are these new slots? If they are not new slots, then who is going to do the work that they otherwise would have done?
  5. Evaluation Parameter: How often does the status of this activity need to be reported and to whom? What is the measure of success?


I like to think of four timelines for strategic plans. They are:

  • Immediate-term: Within the next 12 months.
  • Short-term: Within 2-3 years.
  • Intermediate-term: Within 5 years.
  • Long-term: A horizon of about 10 years.

I don’t know about other industries, but higher education is rapidly changing and there is simply no good way for me to predict or know what is happening in the next few years, much less in the next decade. Therefore, I like to keep timelines relatively short and with goals that I can achieve within those timelines. I admit that some things do not change and are more amenable to longer timelines, but that is atypical of my experiences.


You could think of an outline for a strategic plan as follows:

Strategic Plan

A.  Strategic Aim A

  1. Strategic Goal A.1
    1. Tactical Measure A.1.a
    2. Tactical Measure A.1.b
    3. Tactical Measure A.1.c
  2. Strategic Goal A.2
    1. Tactical Measure A.2.a
    2. Tactical Measure A.2.b
    3. Tactical Measure A.2.c

B.  Strategic Aim B

  1. Strategic Goal B.1
  2. Strategic Goal B.2
  3. Strategic Goal B.3

Using the examples we have above:

Strategic Plan

A. Increase diversity within the medical school.

  1. Increase enrollment of Hispanic, Latino, and Spanish-origin students by 100% in the next five years.
    1. Triple recruitment trips to undergraduate institutions with large populations of Hispanic, Latino, and Spanish-origin students next academic year.
    2. Increase participation of Hispanic, Latino, and Spanish origin students in recruiting trips.
  2. Increase enrollment of non-Hispanic Black students by 200% in the next five years.
    1. Refocus recruitment trips of non-Hispanic Black students to schools that have students that apply to our institution.
    2. Develop on-campus activities that highlight achievements of non-Hispanic Black students.
  3. Increase unrepresented minority faculty by 100% in the next ten years.
    1. Increase recruitment of underrepresented minority postdoctoral fellows into faculty positions

B. Enrich technology-based education within the medical school.

  1. Create technology-enhanced small group sessions in all first year courses within five years.
    1. Ensure all classrooms in which small group sessions are conducted have the same technology.
    2. Recruit six course directors to use technology-enhanced small group sessions in the next academic year.
    3. Provide technical support to faculty doing small group sessions before and during all sessions.

This Reflection is focused on developing the basic definitions that underlie a Strategic Plan. In the next Reflection, I will describe the process I have used to actually put a Plan together using the elements described here.

Note: The views in this commentary are my own and not necessarily those of my institution, employer, or colleagues.

MedEd’s Role in Diversity

At my institution, recent events in the world around us led to students asking for an open forum on diversity issues at our school. This event was led by our Office of Diversity Enhancement (in the Office of Medical Education). Deans from the Office of Medical Education, the Office of Student Affairs, and Office of Admissions participated. The auditorium was packed with a standing room only crowd consisting of students, faculty, staff, and administrators.

As noted on the History web page of the Albert Einstein College of Medicine, “From the beginning, it has been the University’s policy that there be no discrimination in regard to race, religion, creed, color, national origin, sex, age, disability, veteran or disabled veteran status, marital status, sexual orientation, or citizenship status” (1).

Moreover, we are located in the Bronx, a racially diverse and low-income borough of the City of New York. In 2013 data from the U. S. Census bureau (2), the majority population (54.6%) was Hispanic, Latino, or Spanish origin and the largest minority population (43.3%) was Black or African American (most of whom are Black of non-Hispanic or Latino origin). The non-Hispanic or non-Latino White population represents only 10.5% of the population in the Bronx. The per capita income in 2013 was $18,171 and a median household income of $34,388. The percentage of persons below poverty level (2009-2013) was 29.8%.

The faculty (especially the clinical faculty) choose to work in this environment where their patients are challenged with numerous disparities and where compliance with medical care is not necessarily based on life style but a choice based on financial necessity.

Taken together, one would think that bias is minimal and diversity is maximal at Einstein. This, regrettably, is not the case. Let me be clear, it is not Einstein that is at fault; it is a systemic problem. However, we – medical educators – need to look ourselves in the mirror and ask how we have addressed the issue.

Diversity is challenging for all institutions. The Liaison Committee for Medical Education (LCME), the accrediting body for MD schools in the US and Canada, allows each institution to define their areas of focus for diversity in students and in faculty. The two categories need not be the same. Thus, medical schools can address diversity issues such as “GLBTI,” “veterans,” “economically challenged,” and “first college student in family” as areas of diversity. These areas are very important and need to be addressed.

While I have a very highly developed gaydar, I cannot reliably predict who is straight or GLBTI. Similarly, I cannot look at someone and know whether or not they are a veteran, economically challenged, first college student, etc. However, I can tell when their skin color is different from mine. However, the bottom line is that when I think of diversity, my first thought is of people who look different from me. These are the people who are “traditionally underrepresented minorities” in medical education, such as those of Black or African descent and those of Hispanic, Latino, or Spanish origin.

A disclaimer: I am a gay Asian of Chinese descent. However, most people tell me that I look “Hawaiian” or look like some exotic blend of non-Hispanic white. So, while white is a minority to me (globally-speaking), they are not a minority in medicine. And as a Chinese male, I am not a minority in the field of medicine. But most people don’t know (or care) that I am gay.

The AAMC website contains many tidbits of interest. In the US (data from 2011), the number of practicing physicians is approximately 816,000 of whom 68.5% are non-Hispanic white, 19.0% are non-Hispanic Asian, 5.8% are Hispanic, 4.9% are non-Hispanic Black, and 1.8% are “Other” (including multiracial) (3). Thus, the potential pool of clinical faculty who are persons of color is very small. Those who enter academic medicine are highly recruited to help “diversify” the faculty at all medical schools. I will assert that these numbers are equally challenging among basic science faculty.

Faculty are not the only ones who need to be recruited. It is difficult to find medical students of color. Here is a brief summary of data from the AAMC website (4, 5, 6). For brevity, a few other categories are not included in the table. The “Applicant” category includes all prospective medical students who applied for MD medical schools. The “Matriculants” are those who were accepted and entered into medical school that year (from the Applicant pool). The “Total Enrollment” represents the total number of students enrolled in MD medical schools (all years) in each category.


With a class of 183 students at Einstein, it would be difficult, if not impossible, to create a population of students with proportions that look like the community around us (the Bronx) with the pool of students that are in the mix.

So, why is it an issue that medical educators need to address? After all, many of us do not participate in the decision to accept medical students.

First and foremost, many of us do not pay attention to this issue. Of my many colleagues in the basic science professoriate, most pay attention to the status of their research, graduate students, and the material they need to “teach” to medical students. However, many do not think about diversity issues. And we ought to be. I wonder how many of our faculty talk about how race and other diversity affect the sciences we teach (and do). How many are actively engaged in recruiting and developing basic science faculty who are persons of color? How many of us think about issues that would help our students confront diversity (colleagues and patients) when they go to their clinics?

This is an obligation not only of basic science faculty, but also of our clinical faculty. And how do they handle these issues?

Secondly, we know from numerous studies that many potential students of color are discouraged from medical careers for a number of reasons. Most are told they “cannot make it” and should not set themselves up for failure. This abominable practice is meant well, but flies in the face of logic and reason.

Why do people think people of color cannot make it?

We know it isn’t intelligence. Traditionally underrepresented minorities in medicine demonstrably are as capable, smart, and intelligent as any other student. All I need to do is look around me here at Einstein and at my previous schools and see that skin color has nothing to do with the ability to achieve and excel in medical school.

So, what does affect how well these students do?

I believe (don’t have data, but this is my perception based on the students I have taught over the years) that there are two major barriers for success for many of our underrepresented minority students: language and culture.

Many of the students that I have had who are unrepresented minorities have difficulty with English as used in medical school. This is a generalization and certainly does not apply to everyone. However, regardless the color of the skin or any other status, the ability to comprehend and master material in technical, medical English is critical to success in medical school.

This is true for two reasons. First, there is a tremendous amount of information that is provided to the student in a short amount of time. There is no time in a traditional curriculum to translate the information from the format in which it was presented into a more comprehensive form. Second, the English used in medical school is complex. It is a form of jargon that has a large number of unfamiliar vocabulary terms and concepts. These two facts alone make medical school challenging. To add another dimension of needing to learn the English context multiplies the difficulty that some students face.

Compounding the issue of English that is used differently, there is a cultural issue. AAMC data of matriculating medical students show that approximately half of all medical students come from families in the top quintile of income in the United States (7). Moreover, parents of Black and Hispanic medical students have less college education and fewer graduate degrees than White and Asian students (8).

Taken together, this means that the Black and Hispanic students who do make it into medical school generally come from less affluent and less educated family backgrounds. My experience is that this means that many of these students have a different mindset vis-à-vis what expectations they have of achievement and what it takes to support themselves through college. The bar for achievement is more often survival and not necessarily success.

I believe that there is something to this “learning by osmosis” concept (or perhaps immersion learning). That is, being around a more English-oriented and more highly educated environment gives persons who grow up in these circumstances an advantage when placed in an environment where high level of English capability is expected. The data would indicate that many Black and Hispanic students would not have grown up in these types of environment.

In conclusion, I assert that underrepresented minorities experience an exacerbation of the cultural and language gaps.

So, what can we – as medical educators – do?

We must recognize that slow or poor performance in the traditional lecture/lab/exam formats does not mean that the individual is less capable, less intelligent, or less eager to accomplish their career and educational goals. Rather, we must provide the supportive educational systems that will enable students to become successful. We do not need remedial programs; we need programs that enable students to break down the language and cultural barriers to success. No remediation is needed; students are intelligent and capable enough on their own. What they need is the opportunity to succeed.

Medical education needs to be based on educational competencies that students are expected to meet. Students need to be given the opportunity to follow a developmental pathway that is clearly defined where they can demonstrate achievement along the way. Medicine is dependent on having and finding knowledge and the art of being able to use that knowledge. What we need to provide as medical educators are programs that promote educational opportunities and encourage students to excel. It is not the role of medical educators to serve as gatekeepers to the profession. Students need to succeed or fail based on their ability to meet the educational milestones to fulfill the defined competencies.

It is our role as medical educators to help our schools achieve diversity goals. It is also our role as medical educators to give students the opportunity to succeed. And this has to be a cultural norm in medical education.

I have further thoughts about biases and competency education, but I will wait for another day, another time to reflect on those topics.

(3) Table 2 of Section IV in the Diversity in the Physician Workforce: Facts and Figures 2014.
(4) Table 8: Applicants to U.S. Medical Schools.
(5) Table 9: Matriculants to U.S. Medical Schools.
(6) Table 28: Total U.S. Medical School Enrollment

Note: The views in this commentary are my own and not necessarily those of my institution, employer, or colleagues.



Anyone who has gone through the semblance of a strategic planning process will likely have participating in (or at least read about) a SWOT analysis. A Google search on the term “SWOT analysis” yields just about 5.5 million results. Wikipedia (not usually my “go to” resource) has a rather lengthy discussion of the utility and description of SWOT. So, I am not going to review material that is easily found elsewhere. Rather, I am going to reflect upon some of the concepts I have learned in doing many SWOT analyses.

SWOT – Strengths, Weaknesses, Opportunities, and Threats.

Strengths and weaknesses are internal to the organization. That is, strengths are those things we do well; weaknesses are things that we need to do better (to meet our mission).

Opportunities and threats are external to the organization. That is, opportunities are those things that we can leverage to enhance what we do (to meet our mission) and threats are those things external to the organization that can prevent us from accomplishing our mission.

There are many things that one can do with the SWOT analyses and they can be used to manage projects. I will focus on some issues which have guided the best SWOT analyses on which I have worked.

Many analyses go awry because they deal with peripheral issues and not those that are central to the organization. The SWOT must deal with the mission of the organization as guided by the vision. That is, the factors are issues related to what it is that we are and do (mission) as driven by our core values (vision). We may do many things and some of them we may do very well. But, if those things are not part of the mission, we should acknowledge them but they should not make it into the SWOT.

And yes, it depends on how we define our mission.

Let’s take an example of a medical school which has a program that successfully provides food to children in their local area who are in need of food. I think we can all agree that this is a humanitarian exemplary and should be acknowledged.

School A has nutrition and child health as its mission. School B has a humanitarian mission. In School C, the mission is to produce community physicians. School D has primary care as its mission. School E has research physicians as its mission. All of these schools could (theoretically) claim this program as a strength, depending on how it fits within the mission.

It would be clear how such a program fits within the mission of School A. For School B, providing food to children in need is a humanitarian function, thus, it fits within their mission. School C is producing community physicians and if the program teaches its students the importance of being involved in the community to benefit patients, then it is indeed a strength. For School D, if they are teaching primary care/family medicine physicians, it is important for the students to be looking toward the whole health picture of their patients, including nutrition and health. For School E, their strength must be that the program allows participants to collect and analyze data and publish their results regarding health benefits of the food provided to the children. Hence, it meets their research mission.

While the program in and of itself is a strength – and it may help in the accreditation of the school – the key is that is must be framed within the context of the mission of the school.

If it is not possible to relate a SWOT component to the mission of the institution, then it really shouldn’t matter to the institution, even if it is a wonderful program and gets lots of rave reviews. On the other hand, maybe the mission of the institution needs to be reviewed and modified – but that is a whole different kettle of fish.

A common strength cited in many SWOT analyses is that the organization has “strong leadership.” That’s great. What is the leadership to this organization? Is it just the top person? Is it the “leadership team”? What qualities make the leadership “strong”? I am actually uncertain why “strong leadership” is a strength. What happens if the leadership team breaks apart? What happens if key people leave the organization?

I recognize that many use SWOT analyses as dynamic structures and thus strengths such as these represent one of the variables that are tracked. In my experience, this happens in a minority of academic settings and thus this is not truly a construct that is useful to many of us.

Rather, I think that SWOT statements should be based on two factors, (1) actions and (2) data. While it is sometimes useful to describe attributes of specific individuals, I think that a SWOT is much more useful when it focuses on the institution and not individuals within the institution, regardless of how important that person is to the institution.

I would argue that actions – the things we or others do – are the factors which should be outlined in the SWOT. Here are some alternatives to “strong leadership.”

  • The institution is committed to having a Dean with a strong international reputation. This statement indicates that it is a commitment of the institution to have a Dean with a strong international reputation. This is an on-going process. It does not rely on the individual who is the Dean (who happens to have a strong international reputation), but there is a commitment to the continuity of that particular quality in the Dean.
  • The institution is committed to a strong, diverse faculty. Again, this is an institutional commitment. The commitment is to a strong faculty (however it is defined by the institution and those doing the SWOT) and a diverse faculty (however it is defined by the institution and those doing the SWOT).
  • The institution strongly supports mission-based programs. This statement can be interpreted as the institution supports that programs that are mission-based on a higher priority than those that are not mission-based. That is, the mission is more important than the “nice-to-haves.” Again, this is an institutional direction and not just that of an individual.

The SWOT is an analysis. To do this analysis, the appropriate questions must be asked. Is the strength a commitment and does that commitment match reality? If the commitment is a reality, then it is a true strength; if the commitment is real, but does not match reality, then it is a weakness. Similarly, if there is no commitment, but the words match reality, then it is also a weakness.

In developing the SWOT, the group needs to analyze the commitments, whether or not they match reality, and on that basis designate their strengths and weaknesses.

One almost never sees the data behind the statements in the SWOT analysis. Often, the way we generate a SWOT matrix is to sit down and verbalize what we think are the strengths, weaknesses, opportunities, and threats, but we don’t examine the data that underlie what we verbalized. This is a common error. The only way a SWOT analysis reflects reality is if data underlie each statement. The data need not be published; the data need not be public. But, the data must exist.

Let’s look at the three examples above, does the Dean have an international reputation? What is that reputation in? Does that reputation qualify him to be Dean? For example, does a reputation as an Olympic gold medalist (international reputation) necessarily qualify someone to be Dean of a medical school? Is that the level of international reputation that we are looking for?

When we look at diversity of the institution’s faculty, does it have an equitable distribution of faculty ranks (instructor, assistant professor, associate professor, professor)? Or is it heavily weighted one way or another? What does the succession planning for teaching look like? If part of the definition is research strength, what does the research strength look like? Is that a separate variable? And these are parameters that need to be reviewed along with those regarding diversity in race, sex, sexual orientation, etc.

With respect to the mission of the institution, is it focused on Leadership? Research? Teaching? What types of things does the institution do to support these programs that are part of its mission? What are the non-mission-based programs of the institution and how are they prioritized? For example, in an institution with a research mission, are there adequate resources to support faculty and student research? Are there adequate opportunities to engage in research?

It is remarkable how often the SWOT analyses do not reflect reality. I have read some analyses that make firecrackers into space rockets and muscle cars into rickshaws. Often, this distortion of reality has to do with the audience at whom the SWOT analysis is directed. Some institutions are wary of putting their reality out in the public where accreditors or competitors can access the information. Thus, some folks have chosen to deliberately withhold a complete picture for political purposes. I do not ascribe to this philosophy, but I have seen it in several organizations.

Regardless, somewhere, a truthful representation must exist. And that representation needs to be the basis of the strategic plan implemented by the organization.

Many SWOT analyses list the same thing as both strengths and weaknesses or an opportunity is also listed as a threat. I have never come across a situation where that was the true. I have seen strengths that are threatened by external circumstances and weaknesses for which there are opportunities. When looking at the internal characteristics of the organization, strengths are strengths and weaknesses are weaknesses. A strength is not a weakness. If it appears so, then there has not been sufficient analysis or characterization of the attributes to segregate strength from weakness.

Similarly, opportunities cannot be threats. Opportunities can become threats if the appropriate actions do not take place, but in and of themselves, they cannot be both. So, similar to strengths/weaknesses, it is crucial that we analyze what attributes make something an opportunity and what are the attributes that can threaten the organization.

Failure to do a proper analysis only dooms the SWOT to uselessness as a planning tool.

A SWOT analysis is probably one of the most important tools that is part of strategic planning. The reason is that a deep analysis, based on data, of the attributes of the organization gives us a realistic view of who we are, where we are, and allows us to define where we want to go.

Note: The views in this commentary are my own and not necessarily those of my institution, employer, or colleagues.


Vision and Mission Statements

Welcome to the New Year!

In my reflections at the end of last year, I emphasized was the importance of having strategic and tactical plans in the implementation of technology in medical education. I would suggest that such plans are useful in every aspect of education.

Over the years, I have participated in the process of developing strategic plans for a health sciences university, medical schools, departments within educational institutions, not-for-profit groups, and entrepreneurial enterprises. Some of these processes have been successes; some have been disasters. The ones that are successful have had common elements; those that failed are ones that eschewed those elements.

Much has been written about these processes and how they should be implemented. I have not read most of that literature but have been influenced most by the information on developing plans for small businesses. I am going to reflect on the experiences I have had that were most successful. Generally speaking, there are five steps in the process:

  • Developing vision and mission statements
  • Doing a SWOT analysis.
  • Developing the strategic plan.
  • Developing and implementing tactical plans.
  • Doing reviews and continuous quality improvement.

All five steps are essential elements in developing the strategic plan that is successful. In the next few reflections, I will describe these steps and what I found worked and that which failed.

Vision and Mission Statements

When I started in these processes, we always talked about mission statements but rarely talked about a vision statement. However, both are essential. They are related; but there are clear differences. Here are my definitions of the two types of statements.

Vision statement: A vision statement is a short description of the “who we are” as an organization.

Mission statement: A mission statement is a short description of “what we are” as an organization.

Thus, a vision statement defines “us” as an organization and a mission statement defines what we do.

The Vision Statement

The vision statement drives the direction of the organization. It is what we want to be and what we want to be able to do. While there are aspirational components to the statement, it is focused on the core values and purposes of the organization (1). From my perspective, this statement is a short, succinct sentence which encompasses the “who” we are the “what” we want to be. The theoretical horizon for a vision statement is forever. It should be the immutable core of what the group is and should be not only now, not only in five or ten years, but forever. Thus, developing a vision statement requires an understanding of who we are within the framework of the world around us.

If, indeed, the vision statement is an immutable core of values and goals, then to reach the understanding of that statement, everyone has to “buy in” and everyone has to participate. If this vision is not shared by all, then it will not be successful. What this means is that those who are in place developing the vision need to understand and agree, and those who join later must understand and comply.

I would argue that it is possible to develop vision statements for individual units within an organization. This is an important exercise. For example, a core value for an IT (or medical education) unit could be to “enhance the national and international reputation of the organization.” This core value implies that the unit does things to enhance reputation: new and novel implementations of technology, be leaders in outside organizations, participate in building the national and international consensus on best practices, etc. Another reasonable core value could be “enhance technology services within the institution.” (This one is tricky. It can be a core value or it can be a mission. The implications are different, as we will discuss below.) By adopting this vision, the core value is focused on internal provision of technology services.

The vision statement must be used as a guide to decision-making within the organization. Fundamentally stated, does doing “x” advance the organization toward the articulated vision? The decision is mostly binary: if yes, then it needs to be done; if no, then it doesn’t matter and should be removed from consideration. For example, if a core value is to enhance reputation of the organization, then the organization is committed to supporting its members to become leaders of national and international groups. If the core value is directed internally (for example, enhance technology services within the institution), then there is little or no commitment to supporting its members to become leaders of national and international groups.

The Mission Statement

This differs from the mission statement. The mission statement is the articulation of what we do here and now. This is how we define ourselves. There may be gaps, but this is what we do. For the most part, it sets the parameters of our daily operations.

For example, the Microsoft mission statement is “our mission is to enable people and businesses throughout the world to realize their full potential” (2). This statement is supplemented by some explanatory sentences, but it is a declaration that this is what Microsoft does. The key words in the mission statement are “enable” and “realize … full potential.” I interpret this to mean that they make it possible for their market segments (people and businesses) to achieve (realize) the goals and objectives that the market segments want to achieve. This does not limit them to hardware or software or services. What it says is that Microsoft sees as its mission the ability to provide resources to individuals and businesses to get where they want to go.

At Google, it is “to organize the world’s information and make it universally accessible and useful” (3). So, Google says that their mission is to organize the world’s information (thus both digital and non-digital facts and combinations of facts) and to make it available for people to obtain (accessible) and useful (can be used by the person seeking the information). It is interesting that they use the word information as information is much more than just data or facts. Thus part of Google’s mission is to help collate and interpret data.

Both of these are excellent examples of corporate mission statements. They are short, succinct, and inspirational descriptions of what these companies do. In contrast, the Apple mission statement (“Apple designs Macs, the best personal computers in the world, along with OS X, iLife, iWork and professional software. Apple leads the digital music revolution with its iPods and iTunes online store. Apple has reinvented the mobile phone with its revolutionary iPhone and App Store, and is defining the future of mobile media and computing devices with iPad”; 4) is neither inspirational nor short. It is a catalog of what they do now (more like a sales catalog). It contrasts poorly with Steve Job’s description of the mission of Apple as “to make a contribution to the world by making tools for the mind that advance humankind.” (5)

What about examples from medical schools?

Harvard Medical School has clear mission, “to create and nurture a diverse community of the best people committed to leadership in alleviating human suffering caused by disease” (6). The key phrases at Harvard are “create and nurture,” “diverse community,” “best people,” “leadership,” and “alleviating human suffering.” The phrase “caused by disease” acknowledges the other facts causing human suffering but indicates that it is not within the realm of the medical school’s mission to alleviate those causes.

My current institution also has a well-defined and clear mission, “The Albert Einstein College of Medicine of Yeshiva University is a premier, research-intensive medical school dedicated to innovative biomedical investigation and to the development of ethical and compassionate physicians and scientists” (7). At Einstein, the key phrases are “premier, research-intensive,” “innovative biomedical investigation,” “development of ethical and compassionate physicians and scientists.”

In contrast to Harvard’s declaration of creating a diverse community of leaders, Einstein is focused on research. In reading the two mission statements, it would be reasonable to interpret that Harvard is primarily interested in creating leaders whereas Einstein creates ethical and compassionate physicians and scientists (who could be leaders, but are more in the trenches).

As a disclaimer (though it should be obvious), I had and have no role in writing or the official interpretation of these statements. What I have written above is just how I have read and interpreted them.

I helped develop an IT mission elsewhere that read, “the mission of the IT organization is to provide outstanding service and technical support within the organization.” This is similar to the vision statement above. But, the implications are different. In a vision statement, we make decisions based on that core value – enhanced technology services. In a mission statement, it says that we do “outstanding” (anything less is not good enough) “service” (not just technology, but service is what we provide first) and “technology support” (restricting the types of support to technology) within the organization.

It is an important exercise to develop a vision statement and a mission statement. Regardless of size or whether the group is a part of a larger organization. When developing a strategic plan, it is crucial that the team undergoes this exercise. In the process of developing (or re-affirming) a vision statement, the team identifies what they believe are the core value and core aspirations of the group. This defines how decisions should be made. The mission statement identifies what it is that we do. This defines the direction of activities of the group.

By developing or reaffirming vision and mission statements at the beginning of a strategic planning process, it helps the team come to an identity that can be used to drive the next steps. That is, once we have a vision (our core values) and mission (what we do), we need to look at our organization to see where we excel and fail at our vision and mission (SWOT analysis), what are the themes of future activities to realize our mission (strategic plan), what are the things we can do to make those themes reality (tactical plans and implementation), and how we determine if we have met our goals (review and continuous quality improvement). Those I will touch on in future reflections.


(1) See Building Your Company’s Vision. J.C. Collins and J.I. Porras, Harvard Business Review. September 1996.

Note: The views in this commentary are my own and not necessarily those of my institution, employer, or colleagues.

(Originally published on LinkedIn Pulse on January 6, 2015 at

Evolution of EdTech: Three Examples

As the calendar year comes to a close, I have been reflecting back on some technologies that are critical in my life. As an educator, they are essential elements in what I need and use on a daily basis; as an administrator, these have been significant headaches.

The three I will focus on in this post are PowerPoint, course websites, and wireless.

PowerPoint did not exist in 1984; today, a lecture without PowerPoint is rare and unsettling. Course websites were novel and exciting in 1996; today, course websites are de rigeur and content is expected to be updated and relevant. Whereas we calculated wireless access on the basis of (less than) one device per person in 2006, most learners now carry three or more wireless devices on a regular basis.

Before PowerPoint, we had blackboards and overheads. I used both. Some of my lecture halls used lantern slides (large glass slides). However, most of the rooms had 2×2 slide projectors with the slides carefully placed into carousels (so they would not be inverted, upside down, or otherwise unreadable). (I still have nightmares about the first time I tried to process my own color slides.) I now use PowerPoint to project the images (and wonder whether the slide is meaningful or useful). The software and file were originally located on a computer deployed in the classroom; now I can use any device we can connect to a projector (physical or wireless) and, more often than not, the file is located somewhere in the cloud.

In the days of blackboards and overheads, we needed to make sure that the faculty member had access to the scribing instrument (chalk and/or markers of different colors) and perhaps the plastic overlays needed for the overhead projector. In those classrooms, no technical assistance was needed. As we have upgraded to contemporary classrooms, now we need to have a way for the faculty member to show their PowerPoint slides regardless of device and location of the files. The room and what we need in it have evolved into a complex system and require support capabilities that are different from having housekeeping staff clean the blackboards every so often.

For those who worked with lantern slides and then 2×2 slides, getting the slides into a carousel and onto the projector was difficult. In most cases, the complexity of making sure all the slides were handled correctly necessitated a technician being in the room the entire time of the lecture. Now, with the ability of individual faculty member to bring in a laptop with all their slides preloaded and ready-to-go, the need for a technician to stay in the room for the duration of a lecture is a luxury, not a necessity.

When I first created course websites, I programmed it in HTML 2.0 on a Sun SparcStation 1+ running SunOS 4.1.3 with Apache 1.0. Most of the behind-the-scenes scripting was done using Perl. We introduced a course website (in the late 1990s) that contained uploaded (and downloadable) course materials, resources, and syllabi, course grades, discussion boards, and interactive practice questions. Changes were not trivial and required significant time and energy. Subsequently, I migrated to Dreamweaver, but that was not exactly easy-to-use software and I still had to update customized software.

Actually, the term course website is an anachronism itself. My first course websites were self-built and maintained. Now, most course websites are incorporated into learning management systems. In the most primitive course websites, it was often enough to be able to post materials and have a discussion board. Now, the ability for students to post assignments and give/get feedback from faculty and peers, to have discussion boards, blogs, wikis, practice exam questions, quizzes and tests, and access to grades is a minimum. The emphasis really is not on what capability the course website has anymore, but on the content. It is expected that the quality of the content is high and that the materials are provided in a way that can meet the educational needs of the learner and the instructional objectives of the faculty member.

The need of someone who can manage a computer and program a home-grown website for each course has mostly disappeared. The technical requirements to run and maintain learning management systems are much more sophisticated – and arguably, mission-critical. The expectation now is that the students have a stable and consistent experience from the institution. The focus is on the instructional design of the on-line materials; on-line education is not the same as face-to-face education in a bricks-and-mortar environment. Even the combination of the two (hybrid model) requires significant rethinking of what we do.

The wireless example is an evolution of student expectations over time. In 2004, wireless devices operated on the slow IEEE standard 802.11b. We were lucky to plan implementation of a wireless system using 802.11a/b/g. Luckily, since we did most of our deployment closer to 2009, we were able to incorporate using the faster and more capable 802.11n standard. The concept of providing ubiquitous wireless access on campus was relatively new in 2009 and I certainly got a lot of push-back. However, the opportunity to access the wireless network is only one variable. Other variables we had to consider included density of users, how are they affiliated with the institution, and what devices can be used to access material on the local campus network and the greater Internet at-large.

This example is one that migrated from a relatively simple network nice-to-have option (since almost everything was hardwired) to a much wider operation that required consideration of engineering, networking, security, legal, and other issues. What is challenging is that students expect the type of service that they experience at home and in the public space. What is most critical is that wireless is now expected to be ubiquitous and operate flawlessly for faculty to deliver their instruction and learners to experience the educational activity.

Throughout these evolutions, in academia we followed and tried to adjust and meet the needs of the teachers and expectations of the learners.

In all three examples, there are some basic themes:

  1. The difficulty of using the technology has dramatically declined for the end user.
  2. The difficulty of managing the technology has grown exponentially for the provider.
  3. The allocation of resources needed to provide the technology shifted.

While we can talk about all three themes in great detail, I want to focus briefly on the issue of resource allocation.

Resources needed for the different technologies changed. Things that were relatively inexpensive are now very expensive. Software that was custom built and managed (thus relatively “cheap”) is now provided by vendors with a financial agenda. Personnel needs have simply shifted from easy-to-find and inexpensive to highly specialized professionals. Support needs have grown from a simple phone call to a colleague to massive help desk systems.

The cost of implementing technology is huge. This includes both direct costs of the technology (hardware, software, services, support) and indirect (personnel, facilities). Moreover, the more capabilities that exist with the technology, the more a faculty member can do with it. This means that we need more personnel to support the pedagogy as well as train the faculty in the use of the technology.

It is simple to conclude that technology is a giant black hole into which one throws resources. But that conclusion would be wrong.

In line with the concept of “evidence-based education,” we must look to the outcomes of implementing the technology to determine its worth.

The outcomes will differ for everyone – individually and institutionally. However, I would suggest that this is where the largest failure of technology implementation has occurred. All too many technology projects have been implemented without defined outcomes. We do the change or implement technology because we feel we need to, but do not define the parameters of what we want to do, why we want to do it, and how we know we have succeeded.

It is critical for the institution to understand the outcomes it needs to view and measure. Is the outcome student performance? If so, what criteria are used to measure student performance? Is the outcome student recruitment and retention? If so, what criteria are used to measure recruitment and retention? Is the outcome to increase revenue? If so, what criteria are used to define the sources of income and expense?

As technologists and educators, we often do not define the outcomes we want and, equally important, define the strategic and tactical plans by which those outcomes will be achieved. Without a clear strategic plan, we simply hope that what we are doing will not be deleterious. Without good tactics, the way is haphazard.

As we review the evolution of the three technologies described above, it is simple to say that we simply had to stay up with the times. My question is why? What did we achieve by doing so? Those of us who are educators, technologists, and administrators should be able to answer these questions. Without that effort, we cannot justify supporting expansion of technology at our institutions. And working on answering that challenge has been the cause of my headaches.

Happy New Year!

Note: The views in this commentary are my own and not necessarily those of my institution, employer, or colleagues.

(Originally published on LinkedIn Pulse on December 31, 2014 at

Why I Lecture

Short answer: because I am lazy.

Well, maybe that’s not the whole story, but that is really what it boils down to. Teaching is hard work; lecturing is hard work. However, lecturing is the most efficient way to convey information to 100+ people at the same time.

When I started in medical education, we had lectures and labs. That was what we did. In lecture, we stood up and spoke for 50 minutes per hour (if we were “good”). We started on time and ended on time. I taught, but I am not sure they learned.

In the first decade or so of teaching medical school, my idea was to convey information from the textbooks in a somewhat more distilled manner. What I wanted to do was to take information that was available in the textbook, repackage it in a way that made sense to me, and present it to the class. I would color in diagrams of the various layers of muscles in the arm; I would repeat (but reword) the textbook and atlases.

But did I teach or engage the students? Some, maybe. My lectures got good to great student evaluations, for the most part; students mostly passed the course. But there were 5-10 students in the back of the room reading newspapers.

In my second decade of teaching, what I did in my lectures certainly changed. I was no longer repackaging easily accessible and understandable materials. The content of the lectures migrated toward focusing more on challenging concepts that the students need to understand and linking structures and concepts that were not obvious from the textbook.

For example, in neuroscience, the concept of feedback inhibition and disinhibition are extremely difficult concepts for most students, especially in the basal nuclei (ganglia). So, I focused on those concepts. In gross anatomy, textbooks would describe the seventh cranial nerve (facial nerve) in multiple different regions of the head and neck separated sometimes by tens of pages of text and diagrams. I took it as my mission to bring the disparate parts of the nerve and put it together into a comprehensive whole.

The goal was not so much to teach material but to put context around the information that the student was to learn. In these efforts, I increased my discussions about the functional correlates of what I was describing and clinical consequences of maladies associated with the structures I was describing. Consequently, students told me my lectures were more “relevant.”

But did I teach or engage the students? Some, maybe. My lectures got good to great student evaluations, for the most part; students mostly passed the course and I had strong attendance at my lectures. But was that because I was more entertaining?

Now in my third decade in medical education, I don’t teach much anymore as I am mostly an administrator. But I still think about lectures and how to do them. I now think of them more as stories and how I can use that story to prick at the interests of the student. And then to use that story to frame the dialogue of what the learner should be able to do with the content.

In the earliest days, a lecture would take about 2-3 hours to prepare; in the latter days of my second decade, a lecture would take 8-12 hours to prepare (for the first time) and 3-4 hours to update the following year. Now, simply putting together a framework for a lecture takes several days to a week – and that is before I even think about selecting images and putting together the PowerPoint.

But, no matter what I do or did, regardless of whether I used an audience response system, “raise your hand” system, or more Socratic dialogue during the lecture, in every case, it was a matter of my being on a stage, feeling that the lecture was a performance, and delivering material to a group of people that I hoped would get something out of what I was doing.

But I have no evidence that the students who just attended my lectures benefitted at all from my work.

If I had been smarter or had more appreciation for educational theory over the decades, I would have tried to engage the learners more in activities that are more meaningful to them. I would have tried to assess their level of comprehension and learning as I went along. I would have given them opportunities – during the formative sessions – to test their thinking.

Sessions that engage learners in cognitive, attitudinal, and behavioral activities are difficult to develop; lectures are easy. And lectures take me a long time to develop.

So, I have hewed to the easy for now. However, I must challenge myself to work more effectively with learners rather than simply teach students. That should be the keystone of what I do in my third decade.

Note: The views in this commentary are my own and not necessarily those of my institution, employer, or colleagues.

(Originally published on LinkedIn Pulse on December 23, 2014 at

Don’t confuse delivery with consumption

“Oh, piffle,” I thought.

Over the weekend, I had responded to a question about lecture capture with some data showing that students use the lecture capture system at my institution. It evoked responses about the demise of lectures and encouraging bad behavior of contemporary students.

Oh, piffle.

In the highly sophisticated, elite, and insular environment in which I work, we pride ourselves as the pinnacle of educators and education. Medical education is one of the most expensive enterprises both for the institution and the learner. Hence, we better be the best.

So, the raging controversy isn’t that students use lecture capture; they use it and use it extensively.

The controversy is that the student is not there live to enjoy my performance as a lecturer and the time I devoted to making special features (videos? audience response system questions? in-class activities? discussion questions? pearls of wisdom?) which make my lecture especially worthwhile. It doesn’t matter that the student views my lectures after the fact. It doesn’t matter that at some institutions, students can view my lectures ahead of the fact. And it doesn’t even matter that the students perform just as well on my exams or their licensing exams. The issue is that they were not there when I lectured, or when my special guest lectured, or …

While I will focus on other facets of the issues in future posts, here, I make one assertion. Lectures are a method of content delivery to which we want our learners to be exposed. Other methods of content delivery include reading materials (assigned or optional), class notes, prerecorded learning objects (including Khan Academy-like videos), recordings, other types of videos, web modules, or whatever.

Delivery of content in medical education does not equate to the consumption of that content.

How a learner wants to consume the content should be up to them. If they want to view the lecture at 3x speed, why not? It they think they benefit as much by reading a textbook, why not? If they think they learn best by watching a video from another institution, why not? It seems to me that my role as a faculty member is to guide the learners (sometimes more vigorously than others) to the appropriate resources and then allow them – as adults – to choose the most appropriate way of consuming that content.

What we should concern ourselves about are the following:

Do learners learn what we want them to learn? What objective outcomes measures can we use to determine that the learner has achieved what we want?

Here, we must declare the intent of our curriculum – hidden or otherwise – in order to look critically at the outcomes. If the intent of the curriculum is to focus on content, then fine, tell the learners that and guide them on how to consume the content. Then assess whether they have acquired the requisite content.

If the intent of the curriculum is to focus on social interactions, team building, and team activities, then fine, tell the learners that and show them how the in-class activity meets those objectives. And if it is important enough, require the learners to show up. And then, assess how those skills are exhibited and/or enhanced by the activity.

So, piffle. Let us control that which we can and trust our learners to do that which we cannot.

Note: The views in this commentary are my own and not necessarily those of my institution, employer, or colleagues.

(Originally published on LinkedIn Pulse on December 16, 2014 at

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