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.


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.


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

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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