Surgical Video and JoMI in the World of Flipped-Classroom Education

BlogPicFinal1The flipped-classroom model is making waves in medical school education. In the past two years, the medical schools of Stanford, Duke, UCSF, University of Washington and University of Michigan have been working together to develop a revolutionary flipped classroom course in immunology and microbiology. Rather than learning from textbooks and lectures, students are to study these topics outside of class through specially designed video case studies. In the classroom, students will practice clinical decision-making as a team, even during the first two years of medical school.

A flipped classroom is so called because it inverts the traditional classroom structure of in-class lectures and out-of-class problem solving. The model requires students to watch video lectures in preparation for class so that class time can be used for personal interactions with teachers and other students. While such an arrangement may seem feasible for non-surgical higher medical education, as in the cases of immunology and microbiology, we might ask if, why, and how the flipped-classroom model is appropriate for surgical education.

If: Surgical residency education has long maintained a flipped component. A young resident in orthopedic surgery may have the chance to see and complete a total knee arthroplasty once in the hospital, but she is expected to have learned about the procedure – its mechanics, purpose, outcomes – outside of the hospital. Her surgical problem-solving, be it coping with complications or learning how to operate efficiently, should be curated within the operating room; much, however, must be developed without.

Why: The correlation between high-volume surgeons and the superiority of their outcomes to those of low-volume surgeons is strong. It is so strong, in fact, that some hospitals are limiting surgeons’ ability to practice low-volume surgeries. High quality video can serve to familiarize a surgeon with a procedure and may help bridge the low volume-high volume outcomes gap. A student of surgery can boost his skills by supplementing direct exposure with select indirect exposure on a visual, intellectual, or even emotional level. Furthermore, residents have little choice of what procedures they are exposed to during their training and may only participate in a limited number of cases. Even recalling information from surgeries may be difficult for stressed and exhausted residents. Clear video demonstrations can supplement these deficiencies by giving residents the opportunity to both watch new cases and review cases they have previously observed.

How: In the process of creating video content for the flipped classroom, Stanford Medical School faculty worked together to refine their teaching methods for the new medium. The collaborative process encouraged professors to review and improve one another’s teaching, resulting in a higher quality of instruction. While textbooks and written articles are factually informative, they lack the visual and spatial aspects so integral to the practice of surgery. This is where video enters. The recent decades saw tremendous change in the creation, distribution, and availability of surgical video content. These resources have begun to fill a gap in surgical education.

JoMI’s Role in the Ecosystem: While surgical video content proliferates, didactic and visual quality are far from uniform. JoMI hopes to be the next step in surgical education by providing a consistently high quality, peer-reviewed educational experience. Our virtual operating theater aims to deliver an overdue surgical tool that will make in and out-of-hospital learning and practice more effective for medical students, residents, fellows and attendings, alike.

Co-Authored by Gabriela Mizrahi and Alexander Dagi 

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