Out of the Wilderness: Flipping the Classroom to Advance Scholarship in an Internal Medicine Residency Program Dale S. Vincent MD Abstract
Residents in an internal medicine residency program “flipped the classroom” in a series of learner-centered activities which included the creation of a medical student interest group, a continuing medical education symposium, and a journal supplement focused on wilderness medicine topics in Hawai‘i and Asia Pacific. The project encompassed both scholarly activities (discovery, integration, application, and teaching) as well as scholarship (writing for publication). The project advanced the professional formation of residents by developing competencies and producing outcomes that are key features of the ACGME Next Accreditation System.
Introduction This Wilderness Medicine Supplement started with a brainstorming session with residents just before the start of the academic year. How do we encourage scholarly activity and also produce more tangible scholarship? Indeed, the Next Accreditation System (NAS) of the Accreditation Council for Graduate Medical Education (ACGME) has begun to shift from emphasizing structure and process (scholarly activities) to outcomes (peerreviewed publications).1 Here was the idea: focus on activities that the residents have learned to love by living in Hawai‘i, and create a collection of scholarly reviews of common and not-so-common wilderness medicine topics for the community. Several residents had already established a popular Wilderness Medicine Interest Group at the University of Hawai‘i John A. Burns School of Medicine. The supplement would be a natural fit in the truest sense. Professor Ernest Boyer reimagined the range of scholarly activities in medicine to encompass the elements of discovery, integration, application, and teaching.2 By discovery, he meant a disciplined, methodical pursuit of new knowledge. Integration refers to the reworking of isolated facts to present a coherent, illuminating narrative. The scholarship of application applies knowledge to important social and institutional problems. Teaching transmits knowledge, and also transforms knowledge in creative and stimulating ways. Medical professional organizations such as the Association of Professors of Medicine have embraced this broad definition of scholarly activity.3 and participation in scholarly activities has been an integral feature of residency training. The ACGME has recently begun to ask residencies to report the outcomes of scholarship in residency programs.1 By scholarship, the ACGME means the creation of published works in the peer-reviewed medical literature. Internal medicine and other primary care residents already have grueling schedules and a daunting body of knowledge to master during their short, threeyear residencies, so this new expectation represents a special challenge.4
In order to overcome barriers to participation in this project, we identified and leveraged several sources of motivation for the residents. Some residents are motivated to publish by a desire to be more competitive for employment and fellowship applications, an extrinsic source of motivation. We believed that we could also harness powerful internal motivation by having the residents choose fun and interesting subjects with which they were already familiar. Thus, the supplement became an example of a “flipped classroom.” The “flipped classroom” has been described as a “disruptive” educational model in which learners acquire knowledge outside of the classroom, and consolidate that knowledge during mentoring that takes place inside the classroom.5 The characteristics of the flipped classroom have been succinctly summarized as: a flexible learning environment, a learner-centered culture, intentional content, and guidance from a professional educator.6 This Wilderness Medicine Supplement exemplifies all of these characteristics. Residents developed new skills and consolidated their learning during the supplement’s preparation. All of the papers were written online using Google collaboration tools. Residents with publishing experience mentored more junior residents. Many of the authors reached out to experts in the Hawai‘i medical and public health communities, anchoring their papers in local tradition and experience. They had regular meetings with deadlines and updates throughout the academic year, and gained experience with the peer review process. The residents also presented a six hour Wilderness Medicine Symposium with Continuing Medical Education credit. They wrote learning objectives using Bloom’s taxonomy, completed nondisclosure forms, and engaged in other activities that are an integral part of the CME accreditation process. For many, participation in this project represented a sentinel event in their personal professional formation. We hope you sense their enthusiasm, and enjoy their papers. Disclosures The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. provided financial support for this supplement. Dr. Vincent reported no conflicts of interest. Disclaimer The views expressed in this abstract/manuscript are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
HAWAI‘I JOURNAL OF MEDICINE & PUBLIC HEALTH, NOVEMBER 2014, VOL 73, NO 11, SUPPLEMENT 2 2
References
Author’s Affiliation: Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859 Correspondence to: Dale S. Vincent MD; Program Director; Internal Medicine Residency Program Tripler Army Medical Center, Honolulu, HI 96859; Ph: (808) 433-6793; Email: [email protected]
1. Philibert I, Leih-Lai M, Miller R, Potts JR, Brigham T, Nasca TJ. Scholarly activity in the Next Accreditation System: moving from structure and process to outcomes. J Grad Med Educ. 2013;5(4):714. 2. Boyer EL. Scholarship reconsidered: priorities of the professoriate. The Carnegie Foundation for the Advancement of Teaching. San Francisco: Jossey-Bass, 1990. 3. Gerachi SA, Hollander H, Babbott SF, Buranosky R, Devine DR, Kovach RA, Berkowitz. AAIM report on master teachers and clinician educators part 4: faculty role and scholarship. Am J Med. 2010 (November);123(11):1065-1069. 4. Ledford CJW, Seehusen DA, Villagran MM, Cafferty LA, Childress MA. Resident scholarship expectations and experiences: sources of uncertainty as barriers to success. J Grad Med Educ. 2013;5(4):564. 5. Mehta NB, Hull AL, Young JB, Stoller JK. Just imagine: new paradigms for medical education. Acad Med. 2013;88(10):1418-1423. 6. Kharbach, M.The four pillars of flipped learning. Educational Technology and Mobile Learning. Found at http://www.educatorstechnology.com/2014/05/the-four-pillars-of-flipped-learning.html. Accessed June 5, 2014.
Wilderness Medicine in Hawai‘i and the Pacific Guest Editors Seth L. Cornell MD William A. Londeree MD Gregory M. Sprowl MD Dale S. Vincent MD
Nu‘uanu from Pali Notches (Photo: William Harner MD) HAWAI‘I JOURNAL OF MEDICINE & PUBLIC HEALTH, NOVEMBER 2014, VOL 73, NO 11, SUPPLEMENT 2 3
Residents in an internal medicine residency program “flipped the classroom” in a series of learner-centered activities which included the creation of a medical student interest group, a continuing medical education symposium, and a journal supplement focused on wilderness medicine topics in Hawai‘i and Asia Pacific. The project encompassed both scholarly activities (discovery, integration, application, and teaching) as well as scholarship (writing for publication). The project advanced the professional formation of residents by developing competencies and producing outcomes that are key features of the ACGME Next Accreditation System.
Introduction This Wilderness Medicine Supplement started with a brainstorming session with residents just before the start of the academic year. How do we encourage scholarly activity and also produce more tangible scholarship? Indeed, the Next Accreditation System (NAS) of the Accreditation Council for Graduate Medical Education (ACGME) has begun to shift from emphasizing structure and process (scholarly activities) to outcomes (peerreviewed publications).1 Here was the idea: focus on activities that the residents have learned to love by living in Hawai‘i, and create a collection of scholarly reviews of common and not-so-common wilderness medicine topics for the community. Several residents had already established a popular Wilderness Medicine Interest Group at the University of Hawai‘i John A. Burns School of Medicine. The supplement would be a natural fit in the truest sense. Professor Ernest Boyer reimagined the range of scholarly activities in medicine to encompass the elements of discovery, integration, application, and teaching.2 By discovery, he meant a disciplined, methodical pursuit of new knowledge. Integration refers to the reworking of isolated facts to present a coherent, illuminating narrative. The scholarship of application applies knowledge to important social and institutional problems. Teaching transmits knowledge, and also transforms knowledge in creative and stimulating ways. Medical professional organizations such as the Association of Professors of Medicine have embraced this broad definition of scholarly activity.3 and participation in scholarly activities has been an integral feature of residency training. The ACGME has recently begun to ask residencies to report the outcomes of scholarship in residency programs.1 By scholarship, the ACGME means the creation of published works in the peer-reviewed medical literature. Internal medicine and other primary care residents already have grueling schedules and a daunting body of knowledge to master during their short, threeyear residencies, so this new expectation represents a special challenge.4
In order to overcome barriers to participation in this project, we identified and leveraged several sources of motivation for the residents. Some residents are motivated to publish by a desire to be more competitive for employment and fellowship applications, an extrinsic source of motivation. We believed that we could also harness powerful internal motivation by having the residents choose fun and interesting subjects with which they were already familiar. Thus, the supplement became an example of a “flipped classroom.” The “flipped classroom” has been described as a “disruptive” educational model in which learners acquire knowledge outside of the classroom, and consolidate that knowledge during mentoring that takes place inside the classroom.5 The characteristics of the flipped classroom have been succinctly summarized as: a flexible learning environment, a learner-centered culture, intentional content, and guidance from a professional educator.6 This Wilderness Medicine Supplement exemplifies all of these characteristics. Residents developed new skills and consolidated their learning during the supplement’s preparation. All of the papers were written online using Google collaboration tools. Residents with publishing experience mentored more junior residents. Many of the authors reached out to experts in the Hawai‘i medical and public health communities, anchoring their papers in local tradition and experience. They had regular meetings with deadlines and updates throughout the academic year, and gained experience with the peer review process. The residents also presented a six hour Wilderness Medicine Symposium with Continuing Medical Education credit. They wrote learning objectives using Bloom’s taxonomy, completed nondisclosure forms, and engaged in other activities that are an integral part of the CME accreditation process. For many, participation in this project represented a sentinel event in their personal professional formation. We hope you sense their enthusiasm, and enjoy their papers. Disclosures The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. provided financial support for this supplement. Dr. Vincent reported no conflicts of interest. Disclaimer The views expressed in this abstract/manuscript are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
HAWAI‘I JOURNAL OF MEDICINE & PUBLIC HEALTH, NOVEMBER 2014, VOL 73, NO 11, SUPPLEMENT 2 2
References
Author’s Affiliation: Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859 Correspondence to: Dale S. Vincent MD; Program Director; Internal Medicine Residency Program Tripler Army Medical Center, Honolulu, HI 96859; Ph: (808) 433-6793; Email: [email protected]
1. Philibert I, Leih-Lai M, Miller R, Potts JR, Brigham T, Nasca TJ. Scholarly activity in the Next Accreditation System: moving from structure and process to outcomes. J Grad Med Educ. 2013;5(4):714. 2. Boyer EL. Scholarship reconsidered: priorities of the professoriate. The Carnegie Foundation for the Advancement of Teaching. San Francisco: Jossey-Bass, 1990. 3. Gerachi SA, Hollander H, Babbott SF, Buranosky R, Devine DR, Kovach RA, Berkowitz. AAIM report on master teachers and clinician educators part 4: faculty role and scholarship. Am J Med. 2010 (November);123(11):1065-1069. 4. Ledford CJW, Seehusen DA, Villagran MM, Cafferty LA, Childress MA. Resident scholarship expectations and experiences: sources of uncertainty as barriers to success. J Grad Med Educ. 2013;5(4):564. 5. Mehta NB, Hull AL, Young JB, Stoller JK. Just imagine: new paradigms for medical education. Acad Med. 2013;88(10):1418-1423. 6. Kharbach, M.The four pillars of flipped learning. Educational Technology and Mobile Learning. Found at http://www.educatorstechnology.com/2014/05/the-four-pillars-of-flipped-learning.html. Accessed June 5, 2014.
Wilderness Medicine in Hawai‘i and the Pacific Guest Editors Seth L. Cornell MD William A. Londeree MD Gregory M. Sprowl MD Dale S. Vincent MD
Nu‘uanu from Pali Notches (Photo: William Harner MD) HAWAI‘I JOURNAL OF MEDICINE & PUBLIC HEALTH, NOVEMBER 2014, VOL 73, NO 11, SUPPLEMENT 2 3
