really good stuff

Lessons learned with a ipped classroom

Saman Nematollahi, Paul A St John & William J
Adamas-Rappaport
What problem was addressed? There has been a
decline in the time devoted to instruction on anatomy in medical schools, especially with the introduction of system-based learning. This lack of teaching
has been cited as having negative implications with
regard to patient safety.1 In response to the challenge of integrating anatomy into a system-based
curriculum, we introduced a flipped classroom
(FCR) format with videos for the musculoskeletal
block (MSB) of the curriculum, with the goals of:
(i) making anatomy clinically relevant, (ii) using
classroom time for group problem solving and investigation of clinical vignettes, and (iii) promoting
understanding rather than rote memory of anatomy.
Below, we discuss our mistakes, successes and
insights when implementing the FCR in the MSB.
What was tried? We constructed videos with an
average length of 3540 minutes for each anatomical region (upper extremity and lower extremity),
describing each muscle, its function and its clinical
correlation. Students viewed the videos prior to the
class and completed a quiz at the beginning of each
classroom session to assess their knowledge of the
basic information contained in the video. We measured student satisfaction in a post-FCR session
questionnaire at the end of the MSB, in which students compared the standard lecture format with
the FCR and provided suggestions for improvement.
What lessons were learned? Student responses to
our questionnaire noted that the video sessions were
too long, showing a preference for 20-minute videos
instead. Initially, we presented all the muscles,
which took time away from teaching. To ameliorate
this issue, we now focus on muscle groups rather
than individual muscles, allowing for a better understanding of functional anatomy. Moreover, originally
we attempted to use clinical correlations in the
video to illustrate key points. We used similar correlations during the classroom sessions and many students viewed the video and classroom sessions as
redundant; presently, we include clinical correlations only in classroom discussions. We learned that
it was more useful to focus on fewer clinical cases
than to cover many superficially and equally important to separate distinct anatomical areas into different FCR sessions. For example, at first we
incorporated the topic of the brachial plexus in the
upper extremity video, but now we have a separate
session for the brachial plexus itself.

In the early stages of the FCR we asked students

open-ended questions, but we often received
responses from the same few students. To address
this problem, we transitioned to using board-like
questions to simulate USMLE Step 1 and promote
discussion of correct and incorrect answers. To
encourage more participation, we will use an electronic polling system. This system will give us feedback with regard to areas of weakness that require
more attention.
Additionally, students received 2 points (out of a
possible 200 in the course) if they achieved 75% in
the in-class quiz. Students asserted that this gave
them enough incentive to watch the video. In conclusion, we found that incorporating FCRs into the
integrated anatomy discipline makes anatomy more
clinically relevant and increases student understanding of the important relationship of anatomy to clinical medicine.
REFERENCE
1 Yammine K. The current status of anatomy knowledge:
where are we now? Where do we need to go and
how do we get there? Teach Learn Med 2014;26 (2):
1848.
Correspondence: William Joaquin Adamas-Rappaport, Department of
Surgery, The University of Arizona College of Medicine, 1501 N.
Campbell Avenue, PO Box 245058, Tucson, AZ 85724-5058, USA.
Tel: +1 520 626 3972; E-mail: rappaport@surgery.arizona.edu
doi: 10.1111/medu.12845

Breakfast club: a simple, reproducible, student

education initiative
Reshad Khodabocus, Katherine Tran, Terasa Broom
& Adris Razaq
What problems were addressed? Final-year
medical students need to develop core knowledge
domains, practical skills and professional behaviours
to prepare for exams and transition to foundation
training. Achieving this consistently is challenging as
learning opportunities vary widely between allocated
clinical placements. Seizing an opportunity to
collectively educate final-year students before the
official start of their clinical placement day can
increase the consistency of curriculum delivery and
augment students placement experiences.
What was tried? The Pinderfields breakfast club
was introduced in 2010, with senior doctors
teaching final-year students on placement at this
hospital each weekday from 08.00 to 08.45 hours.

2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 11391167

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