Flipped Learning: “Turning learning on its head”

Here’s a scenario of an innovative educational method that is sweeping through the halls of academia:  Imagine…students are hard at work at home accessing captured lectures, PowerPoint slides, audio or video casts, reference books, or other resources to learn about foundational factual material.  They then go to class to spend the teaching/learning time on applied cases, projects, or problems where they can question the teacher, and work with their classmates on solutions and discoveries.  Sound familiar?  This is an example of “Flipped Learning”.  I’d like to show you that we at Queen’s Meds are way ahead of the curve—we’re practicing “flipped learning” in “flipped classrooms already!”

A brief history of the Flip:

In 2000, J.W. Baker presented on a “Classroom Flip” where he used technology to allow students to read and learn at home, and became the “guide on the side” for them in class.

Formally defined in the literature by Lage, Platt and Treglia (2000) as the “Inverted Classroom”, the authors, from the Economics Department at Miami University, outlined a multimedia strategy for teaching that “appeals to a broad range of learning styles, without violating the constraints faced by instructors at most institutions.” (p. 31). By inverting the teaching and learning that took place inside and outside their economics classroom, the teachers gained more time to address diverse learning styles and challenges.  They allowed groups and individual students to do their “homework” in the classroom, and reserved traditional lectures for outside the classroom.

In 2007, two high school chemistry teachers, Bergmann and Sams, recorded their PowerPoint lecture presentations using then newly developed screen capture software. Bergmann and Sams had built the videos for absent students to catch up, but found that students who had been present accessed the material to study and review.  This left them time to spend in a classroom, on inquiry, and “deeper learning.”  According to Bergmann, the Flipped Classroom “took off like a rocket!”  (Bergmann, 2012.)

In March 2011, at Ted Talk, Salman Khan, spoke about flipping the homework/lecture equation.  A hedge fund manager with multiple degrees in math and science from MIT Khan created the  Khan Academy (www.khanacademy.org/), from his original math tutorials for his niece, to a very successful and free source of over 2,600 online tutorials covering everything from math, chemistry and even medicine. (Kahn, 2011). “Khan asserts that teachers in a traditional classroom spend five percent of their time actually working with students, while spending the other 95 percent lecturing, creating lectures or grading. Using Khan’s free online math tutorials, teachers flipped this equation, using technology to “humanize the classroom.”   (Huston and Lin, 2012).

The growth in acceptance of this method is evidenced by, among many things, the best selling Bergman and Sams (2012) ISTE publication “Flip Your Classroom: Reach Every Student in Every Class Every Day.”

So, that’s what the “flip” is all about.  What are we doing here in Queen’s Meds and what are some of the challenges we have to overcome in our use of “flipping”?

If you’re teaching in Undergraduate Medical Education (UGME), chances are you’ve come across our “SGL’s” or “Small Group Learning” sessions.  With Dr. Lindsay Davidson’s example to guide us, we in UGME have adapted Team Based Learning (TBL) for these sessions.  Here, we provide students with what had previously been the purview of the lecture: foundational facts through readings or other resources, from textbook chapters with reading guides, to online modules, complete with interactive quizzes, videos, etc.  Students are provided with some “homework” time in our Directed Independent Learning sessions and are expected to come to class prepared to engage in inquiry through group work, with cases, or problems where they can apply their learning.  The faculty member, often with a colleague, (other faculty, residents or fellows), facilitates the session, but notes that if he/she is talking more than 25% of the time, he/she is straying into the other side of the flip and not focusing on the student learning.

Why did we do this?  For the same reasons that the flipped classroom is reaching so many teachers and students.

Here’s what Jon Bergmann has to say about this type of learning:

  • Flipped Learning transfers the ownership of the learning to the students.
  • Flipped Learning personalizes learning for all students
  • Flipped Learning gives teachers time to explore deeper learning opportunities and pedagogies with their students (PBL, CBL, UDL, Mastery, Inquiry, etc)
  • Flipped Learning makes learning (not teaching) the center of the classroom.
  • Flipped Learning maximizes the face to face time in the classroom. (Bermann, 2012)

Now, what are some of the challenges? And how can we address them?

  1.  It’s important that the students have prepared before coming to class.  We do this by a.  appealing to students’ sense of responsibility and professionalism, b.  appealing to students’ common educational sense (they have to prepare if they are going to work on the applications) c.  tying the preparation to assessment and grades into the preparation, d.  using Readiness Assessment Process (lovingly known as RATs) which allow for enhanced group learning of concepts.
  2. Flipped Classrooms came about through innovations in technology that allowed for Lecture Capture, Narrated PowerPoint, and other technological tools.  The key is not to get carried away with the technology but focus on the value of what is being offered to students:  on guiding them through the learning and then inextricably weaving it with what is going to happen in class.  One indispensible factor is quality:  the captured lecture, online module, or even textbook chapter must have been carefully selected and/or crafted the way any good teaching tool would be.
  3. There really isn’t anything revolutionary about a video lecture.  A recorded lecture is still just a lecture.  What’s critical here is guiding of the learning.  We are advocating Reading Guides for chapters or articles, quizzes and interactive questions for online modules, and short (5 minute) captured lecture bursts to guide readings, etc.  Can the students learn from a captured lecture?  Yes.  Can they learn better with additional or with other tools?  Absolutely.  Bergmann cautions that flipped learning is NOT “a synonym for online videos. When most people hear about the flipped class all they think about are the videos. It is the interaction and the meaningful learning activities that occur during the face-to-face time that is most important.”(Bergmann et al, 2011.)
  4. Are lectures “bad”?  Absolutely not!  Flipping makes room for another teaching method, or several of them.  But lectures have a place in medical education, especially for introducing a concept, generating excitement in a topic, providing a framework for learning, and other suitable purposes.
  5. It’s still about what happens in the classroom.  I used the word “inextricably” above—the independent student learning must be closely linked to what happens in class.  The class time is used to check on the student learning, clear up any questions, and work through well-thought-out and well-crafted group activities.  Student intra-group discussion, student inquiry, students debriefing to the whole class, and instructors providing feedback to students about their learning are important activities.  There is still a lot for an instructor to do in helping students to learn; it’s just been “flipped.”

Do you have questions or comments about “flipping”?  Write back to the blog.


Baker, J.W. (2000).  The Classroom Flip’: Using Web Course Management Tools to Become the Guide by the Side. Selected Papers from the 11th International Conference on College Teaching and Learning (11th, Jacksonville, Florida, April 12-15, 2000). Chambers, J.A., ed.

Bergmann, J. (2011). The history of the flipped class: How the flipped class was born [Web log post]. Retrieved March 24, 2013, from http://blendedclassroom.blogspot.com/

Bergmann, J. (2012).  The Flipped Class as a Way TO the Answers. Flipped Learning.  Retrieved March 24, 2013 from http://flipped-learning.com/

Bergmann, J. (2012). Flip your classroom : reach every student in every class every day. Eugene, Or. Alexandria, Va: International Society for Technology in Education ASCD.

Bergmann, J., Overmyer, J. & Willie, B. (2011). The Flipped Class:
What it is and What it is Not.  Retrieved March 24, 2013 from http://www.thedailyriff.com/articles/the-flipped-class-conversation-689.php

Houston, M. & Lin, L. (2012). Humanizing the Classroom by Flipping the Homework versus Lecture Equation. In P. Resta (Ed.), Proceedings of Society for Information Technology & Teacher Education International Conference 2012 (pp. 1177-1182). Chesapeake, VA: AACE. Retrieved from http://www.editlib.org/p/39738.

Kahn, S. (2011). Let’s use video to reinvent education. Speech presented at TED2011. Retrieved March 24, 2013, from http://www.ted.com/talks/salman_khan_let_s_use_video_to_reinvent_education.html

Lage, M.J., Platt, G. J., Treglia, M. (2000). Inverting the classroom: a gateway to creating an inclusive learning environment. Journal of Economic Education.

Team Based Learning Collaborative.  Getting Started.  .  Retrieved March 24, 2013 from http://www.teambasedlearning.org/starting.

Thompson, C.  (2011, August.). How Khan Academy Is Changing the Rules of Education. Wired. Last retrieved on March 24, 2013 from http://www.wired.com/magazine/2011/07/ff_khan/

Zappe, S., Leicht, R., Messner, J., Litzinger, T., Lee, H., (2009). “Flipping” the Classroom to Explore Active Learning in a Large Undergraduate Course. American Society for Engineering Education.


6 Responses to Flipped Learning: “Turning learning on its head”

  1. This is a collaborative post from Eve Purdy and Michael Chaikof:

    I am a big fan of the flipped classroom. I absolutely do not need to be converted. The idea of meaningful discourse about concepts already learned, the opportunity to massage information and work through problems under the guidance of peers and professors is my idea of learning. So what’s the problem?

    The problem is that most high stakes assessments in our curriculum do not accurately reflect the flipped model. There is the occasional team-graded exercise but they don’t seem play a prominent role in our overall assessment. Students (and professors) seem far more concerned with midterms and final exams. As nicely outlined in this article by Peter Nonancs http://www.popsci.com/science/article/2013-04/why-i-let-my-students-cheat-their-game-theory-exam … maybe flipping the classroom isn’t good enough. Maybe we need to flip the exam.

    We have wonderfully facilitated SGL sessions but inevitably the question always comes up, “what part of this is on the exam” or “will we have to know this for the exam”. Rumblings of “I doubt this is testable” can often be heard walking around one of these flipped classroom sessions. Our understandable focus on succeeding in assessments created around a traditional classroom model in many ways undermines the flipped classroom’s place in the curriculum.

    I keep hearing the phrase “assessment drives learning”. Though I’m not convinced this is entirely true, since I am no expert in medical education I will trust those that are with this principle. When we assume that “assessment drives learning” then the way we are assessed governs the way that we learn.

    If the flipped classroom model is a great way for medical students to learn to become excellent physicians, and if assessment drives learning, then maybe the exams need to be flipped too.

    • Eve and Michael, this is a very thoughtful response! (Dare I say “reflection”? 🙂

      I love the idea of flipping the exam as well as the classroom to align with what is the major focus of our teaching in flipped learning.

      Let’s see if faculty will weigh in here!

      • Michelle Gibson says:

        (As we say in the Twitterverse – my thoughts are my own, and not representative of any official position/body/committee, etc.!)

        First – voila, http://bit.ly/125GArp, a poster presented last week at CCME about Graded Team Assignments in the Clerkship “back to class” courses. I’ve now done GTAs in all 3 courses, so I’ve had a lot of time to think about them (marking them all does that to you). They are often good, I think, at modelling what we try and do in SGL sessions, and I have them all “open-book/laptop/etc”, also to mimic what clinical practice is like.

        However, they are not perfect, and there is one crucial difference in medicine than in game theory courses – patient safety – another big theme at CCME. Ultimately, in a medical program, we are charged with the responsibility to ensure that our students are ready for residency, and, if you take that back 2 years, ready to start clerkship. This focus is both on the learner (having them feel prepared, or something like it, to start the next phase of training), but also, importantly, on the patients we care for.

        GTAs can, as you might imagine, turn into “divide and conquer” exercises, so it’s not that every student is participating in the activity. Even if I design the assignments better (and I’m getting better at them … purposeful practice and all…) there is, as you know, no way to guarantee that every student is participating and thus is being assessed on important (or I hope it’s important) material. Worst case scenario, a student shows up, unprepared, doesn’t participate at all, and then starts clerkship with significant deficits. While clerks are supervised, they are involved in patient care, and we do care about ensuring that students are “ready” for clerkship.

        Now, I don’t think this means we should abandon GTAs (they are one of my “babies”, so it’s just possible I’m biased…), but what this speaks to is alignment, and appropriateness of assessment for learning objectives. There will, I am afraid, always be a need for some form of exams, and at least for now, the Medical Council of Canada agrees with me! However, we need to strive to improve exams (and they have improved dramatically over the 10 years I’ve been involved in UGME), and to ensure that we’re assessing what we say is important. For example, we are looking to introduce key features questions (again, an MCC technique), to enhance our assessment of clinical reasoning and essential medical knowledge and skills.

        Other skills need to be assessed in other ways (your OSCEs aren’t going away any time soon, either – sorry!) but again, this comes back to alignment.

        Long story short? I do believe that assessment in large part drives learning, but more importantly, we need to move towards assessment FOR learning. However, in contrast to some other disciplines, at some point, the public expects us to assess learning in order to ensure patient safety. If you want (and you don’t!), you can read the portions of my M.Ed thesis that addressed this tension… and, you’re also right – even if the faculty are interested in promoting learning, students are still, for many complex and valid reasons, concerned about exams – in my experience, even a 10% midterm evokes as much angst and stress as a 70% final – and that’s a story for another time, as they say.

        Thx, Eve and Michael, for a thought provoking response.

  2. Lindsay Davidson says:

    Larry Michaelsen, the father of TBL, recommends grading all of the classroom ‘application exercises’. Frankly I tried this early on, and it nearly killed me. However, as my experience has grown with TBL I’ve moved in that direction and this year the first year class will have 3 ‘graded’ team assessments worth 6% of the course grade. Yes, this is still a token amount, but I think that students will find this helps them understand what is expected in case problem solving – largely tested right now in final short answer questions (well constructed ones which as students to do more than list). As we move towards key features questions (this is what the MCC) uses, I also think that the skills honed in SGL team problem solving will help individual student success.

    Anyway, Eve and Michael, I completely agree that assessment needs to align with our objectives and teaching methods. However I hope that students will also understand that the active, social learning that characterizes classroom SGL is actually much more likely to “stick” with you thereby making all forms of testing easier.

  3. Pingback: Geriatrics, Twitter and Flipping the Distraction - Manu et Corde

    • I saw the twitter feed from your class, Eve–what a terrific idea to have all of you commenting on what you learned during your geriatric psychiatry class with Dr. Gibson through twitter!

Leave a Reply

Post Timeline

Students striving to make a difference in our community
Published Mon, October 23, 2017

One of the attributes that our Admissions Committee works very hard to identify in applicants is a commitment to service. This has multiple dimensions, involving service to both individual patients and communities. It’s therefore always very gratifying to learn of efforts such as that described below in todays guest article provided by students Lauren Wilson, Katherine Rabicki and Melissa Lorenzo. … Continue reading

Mentorship isn’t rocket science – or is it?
Published Mon, October 16, 2017

One of the most consequential communications in modern history took the form a letter sent by Albert Einstein to American President Franklin Roosevelt on August 2, 1939. “Sir: Some recent work by E. Fermi and L. Szilard, which has been communicated to me in manuscript, leads me to expect that the element uranium may be turned into a new and … Continue reading

Meet Jenna Healey, the new Hannah Chair in the History of Medicine
Published Mon, October 9, 2017

The new Jason A. Hannah Chair in the History of Medicine knows most Queen’s medical students aren’t going to memorize historical dates and events as a matter of routine, and that’s perfectly okay. Dr. Jenna Healey notes that instead focusing on dry facts – that these days can readily be looked up — one excellent use of history is “to … Continue reading

Curriculum Committee Information – July 27, 2017
Published Mon, October 2, 2017

Faculty and staff interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller (umecc@queensu.ca), for information relating to agenda items and meeting schedules. A meeting of the Curriculum Committee was held on July 27, 2017.  To review the topics discussed at this meeting, please click HERE to view the agenda. Faculty interested in reviewing the minutes of the July … Continue reading

From campus to community: the Loving Spoonful Service Learning Project
Published Mon, October 2, 2017

By Steven Bae and Lauren Wilson, MEDS 2019 “Let food be thy medicine, and medicine be thy food” – Hippocrates Food. It is a vital part of our existence, and is a focal point in many cultures. Over the course of one year, a person who eats three meals a day consumes 1092 meals. It plays such a large role … Continue reading