Letters to the Editor
Senior consultant, Office of Medical Education, and clinical professor, Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC; Lgreenbe@gwu.edu.
Dr. Kalmey’s response to my letter and to Dr. Kanter’s comments about medical student attendance at lectures is in synch with my attitude towards this issue. He describes a “flipped-classroom” approach to lectures, in which the teacher empowers learners to prepare for class remotely using prerecorded podcasts in addition to key journal articles, book chapters, or handouts.1 The teacher can then devote class time to learner questions based on their readings, clinical applications of knowledge (such as having a patient describe to students in a physiology class what it is like to have congestive heart failure), ethical dilemmas, and communication principles, all topics not easily found in classic textbooks or other materials. This approach has several advantages over the traditional lecture format. First, it represents the value-added piece I mentioned in my original letter. That is, focusing classroom time on “critical incidents” encourages student attendance.2 Second, it lends itself to a discussion (versus a lights-off, PowerPoint session) in which learners are activated, learning in more depth and breadth.3 Finally, it encourages faculty to be facilitators rather than autocratic teachers to assist learners in their quest to master necessary information, skills, or attitudes.4
This paradigm shift does not just happen. It takes buy-in from the faculty and continuing professional development to shift from the “sage on the stage” mentality to one that favors the “scribe on the side.” Whatever process one chooses, the less talking the teacher does, the more learning occurs.5
Larrie Greenberg, MD
Senior consultant, Office of Medical Education, and
clinical professor, Pediatrics, George Washington
University School of Medicine and Health Sciences,
Washington, DC; Lgreenbe@gwu.edu.
2. Brookfield SDBrookfield SD. Classroom dynamics: The critical incident questionnaire. Becoming a Critically Reflective Teacher. 1995 San Francisco, Calif Jossey-Bass
3. Bloom BS. Thought processes in lectures and discussions. J Gen Educ. 1953;7:160–169
4. Grow G. Teaching learners to be self-directed. Adult Educ Q. 1991;41:125–149
5. Harvey J. Learning to not teach. Organ Behav Teach J. 1978;111:11–17