Carrick Institute

New Research: Randomized Control Study of a Remote Flipped Classroom


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We are just over the moon excited about our new study that was published in Frontier Neurology, in the Neurology Education section.  Frontier Neurology is a great journal that has an impact fact by 3.552 and is the second most cited journal in clinical neurology. We are so pleased to have had the paper accepted we have been working on this for a couple of years.

We developed a randomized control study over a remote flipped classroom Neurotology curriculum.  The randomized control study is when we take a group of subjects, and we divided them into two groups randomly, so no one knows what group they are going to be in. We had one group which was the control group that studied using a traditional classroom that all of us know about. Then we developed a new novel teaching environment where we did an online synchronous program using interacting polling and so things that are really current.

We did this with my team at Harvard Medical School’s Harvard Macy Institute and the Massachusetts General Hospital Institute as well the University of Cambridge at the Bedfordshire Centre for Mental Health Research. My colleagues that are involved in this research are all specialist in this area and medical educators. Now when we look at doing this study the first thing is “why would you do such a study?”  Well, the answer is fairly easy.  Society needs well-trained doctors. The training of doctors has been under questions because there is so much to learn and only so little time to learn it.

So that the entrustable practitioner achievements that people will get is such that there is a hard time for people to study, do their jobs, take care of patients, and learn more material. Especially when material complex as it is in neurology.

So there is definitive need to develop new medical education strategies that will allow physicians to master the very complex activities of the brain, especially those things that are used with traumatic brain injury treatments and neurodegenerative diseases such as Alzheimer, Parkinson’s, and more. So what we were able to do is develop an interactive program were people out a distant or in the classroom can have the same experience, which means they can talk to the professor, they can do a variety of different things. We did the study and we had a world wide contribution. We had people in Thailand; we had people in Dubai at the Department of Medical Education in the United Arab Emirates, people in London, people in Egypt, people in Canada and of course, in the United States. So it was really a very exciting thing for us to do. Then we had to develop different types of question that allowed us to know for sure whether people actually learned what we were teaching them.  These questions were not simple questions like ‘yes or no’ or  ‘all of the above.’ These questions were designed to test mastery. We used a modern type of strategy that allowed us to do this at a superior level to anything that has been done before.

So what did we find? What we found was that everybody learned like they never learned before and as a consequence of this learning they were able to take this strategy specific to neurology and put their education into practice at a level that is superior to anything that we have seen before.

We have found some very interesting things. We found that generally man and women both do well in the classroom and at a distance but woman actually do better in the classroom than the males. There has been a lot of information that been talked about in regards to genders bias.  Women do better in OSCE testing or practical testing then do man, and some men do better in different things. Now we know that in the classroom women do better than men. The most important take-home point is that we were able to demonstrate similar outcome at a distance to that in a traditional classroom.

Now, what does that mean for us as practitioners?  What does it mean for society? What it means is that doctors do not have to travel across the world to listen to the best people and experts anymore, they can do it at a distance as long as that distance learning is associated it with is a modern methodology of educational training or something that we call pedagogy. There has been a growing availability of learning online that has been very popular however there has been pretty scant research to say whether that online learning works. Most online learning is really like a talking head, and the experience has been questionable.  In other words, are the people engaged? We used a Kolb’s learning cycle in our learning mechanism that we developed that demands that people have previous experience and as a consequence our research team develop a flipped classroom where individuals will be able to review scientific papers, listen to different podcasts, different interactions and put that to the task so when they are learning with us they can interact. We used small and large group learning where even the group at a distance were divided it into viable live learning group so that a doctor from Italy can be talking with a doctor from Thailand or a doctor from the United States at the same time live and can look at all of the different problems that we utilize. We incorporated the use of live patient scenarios so the patients can be seen during examinations and people can contribute, and they can problem solve and onwards they go.

In order to this we needed to develop a platform of software and hardware that would allow us to be able to stream the live courses to a mobile phone, tablet, or to a computer, even in areas of the world where connections are very poor.  So we have a learner in Africa that it is on a 4G Network. We have got the technology to make that vibrant for then without skipping, without lag time. It is much better than just Skype or FaceTime or anything that you could ever imagine.  Then the people are able to answer, interact and speak to us and we can speak to them.  So we wanted to be able to improve the efficiency and our delivery of this educational model but we also wanna to make sure that the implementation of this model was such that it would give us a better outcome than any models that we were able to use before. We found that the personal productivity and the ability to do things better was enhanced by this individual research type of activity.

The educational model of using a flipped classroom has a great potential to improve the learning environment so that our learners or scholars will gain exposure to new material outside of the classroom, on their own time. Then they are able to use that classroom time to grab the knowledge through problem-solving exercises or discussions. This really
that really helps us a lot so that the valued time that we have in the formal part of our practicum training has become very rich, richer that we ever could have imagined it because we do not have to spend time going over very difficult material that it may take hours or weeks on their own. That time would take way from really the nuts and bolts as to what you are going to do with this individual patient. We are really pleased that were were able to solve this dilemma.

This research was also presented at the Harvard Medical School academy on Medical Education Day.  We had such great results that we went full bore with the actual experiment. We then developed a long term component that has materials being delivered to the scholar a couple of times a week, that gives them explanations, video, and interaction and all sorts of things to keep the material fresh in their mind. This was done with no extra cost to the student.  It is a very expensive endeavor. We are able to do it with a program developed at Harvard Medical School and that we use at the Carrick Institute and other institutes throughout the world.

The literature was very scant specific to the outcome measures of medical education that was given at a distance. It was also very scant on the best methods to promote maximized learning. We were able to crack that nut and we hope that our study is going to encourage other medical educators at different universities to not only test their outcomes, but to embrace the pedagogical model that we have developed. We are super thankful. We expect decreased need for brick and mortal facilities, decreased aspect of travel and expense for students. We know there is a danger when people implement technology without the benefit and experience of a good qualified evaluation of what that consequence is.  We see this all the time. You will get email and spam messages that say ‘study with us, online!’  But realistically, does that online material meet the necessity of society and the necessity of the doctor. Is it good? We developed a model that is at the top of the medical education pyramid.  We are super happy about it. Hopefully you will read this paper and see what we did. The paper will explain it in fairly good detail. It shows how we measured the activity, the stastical outomes.  We are just really happy to participate in it!

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