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Flip it! Maximizing longitudinal learning experiences

By Allison Naso posted 09-13-2016 13:12

  

My residency rotation was in dire need of a change.

As a primary preceptor for a PGY1 residency rotation titled “Pharmacy Administration/Medication Safety,” I had my hands full. Because the subject matter seemed insurmountable – how much could I possibly teach on these subjects in one month? – the rotation was set up to involve a one-month intensive early in the residency year, with a corresponding longitudinal component spanning the three to six months following the rotation.

In my first year as a residency preceptor, my hospital was starting a brand new PGY1 residency program. Everything was new, unchartered territory for the residency advisory team. I had a co-preceptor for the administration rotation in that first year. While we took turns working with the resident to provide as many administrative experiences as possible in the designated rotation month, admittedly there was little structure, and many opportunities to teach were missed. (This fact was not missed by the keen eyes of our ASHP accreditation surveyors.)

In the second year I assumed full preceptorship of the rotation. On the advice of our surveyors, I worked feverishly to create a structured outline of topics and learning activities for the residents (many of which, in retrospect, involved my active teaching and the residents’ passive learning). The longitudinal, then, became a short “touch base” time frame with the resident to close projects that were not completed in the assigned month.

This went on for a couple of years, yet nothing seemed to be getting easier, especially after we added more residents to our program. The rotation month was an intense whirlwind of activity for me as the preceptor, but it was “hit or miss” for producing real-time learning experiences for the residents depending on the ebb and flow of department demands. And when it was over, I was one exhausted preceptor, but the residents seemed unimpressed and unchanged by the passive nature of their involvement. Likewise, the residents voiced dissatisfaction with the longitudinal component, which tended to fall to the wayside as new rotations took the residents off campus. Inevitably, the longitudinal became a last-minute frenzy of activity as we scrambled to fulfill learning objectives before the close of the residency year.

As we were preparing to welcome our fourth class of residents, I knew something had to change. What if I flipped the learning experiences?

You may be wondering what I mean by “flipped.” Let me set it up for you.

When I was in graduate school, I had an accounting professor who used a flipped learning approach for her class sessions. For these sessions, the professor would require the students to complete a text reading or view a video lecture at home prior to class. Once we arrived at class, we would use the entirety of the class session to work through problems in small groups. In essence, we would do our “homework” in the classroom, with the benefit of having the professor on hand to guide us and respond to our questions.

According to the Flipped Learning Network (www.flippedlearning.org), “flipped learning is a pedagogical approach in which direct instruction moves from the group learning space to the individual learning space, and the resulting learning space is transformed into a dynamic, interactive learning environment where the educator guides students as they apply concepts and engage creatively in the subject matter.” In essence, the flipped learning experience makes the study of the material independent and the application of the material an engaged, active learning process under the guidance of the educator.

Now, for a traditional student like me, this was a major shake-up and not at all within my realm of expectations. I was definitely “old school” – one glance at my ball-point pen and college-ruled spiral notebook amongst the sea of iPads and laptops in class was evidence of that. I was accustomed to passive learning in the classroom as I listened to the one-way flow of information from my professors’ lectures. This was followed by sweating out the homework problems at home and pouring over my lecture notes and text to find something I had missed, only to learn from my (numerous) mistakes in the next class session… sometimes days later, and usually after I had already forgotten my logic for the mistake in the first place.

Wait a minute… it seems my professor was on to something with this flipped learning idea.

It was only natural that my "old school" educational roots had shaped my style of preceptorship, but I had finally learned that, in an experiential setting, it wasn’t working. So how could I apply the concepts of flipped learning to my residency rotations?

I pitched the idea to my residency program director, and he agreed to my proposal to flip the learning experiences for my Pharmacy Administration/Medication Safety rotation. This year, I have structured the focus on administrative and safety topics into a true, year-long longitudinal rotation, with a one-month intensive near the end of the residency year.

Beginning in July, I scheduled one-hour topic discussions with the residents once every week for the full duration of the residency year. The topics are the same that I once squeezed into an overwhelming one-month intensive, but given the luxury of time, we have the opportunity to touch on so much more during these sessions. Further, the residents and I now have more time to review and prepare materials prior to our meetings using this “flipped” approach; as a result, the residents are far more engaged in the process. And while the one-month intensive is still scheduled, it is positioned at the end of the residency year rather than the beginning; our hope is that, by the time the rotation rolls around, the residents will have ample opportunity to actively apply the administrative principles that they have learned throughout the year rather than passively trudge through the required rotation.

I am pleased to report that in the first quarter, my residents have read one popular business text in its entirety – and we are on track to read at least four texts in the year (something we would never have achieved in the past!). In addition, we have reviewed a number of principles for pharmacy administration, and each resident has completed a medication use evaluation – all before the one-month intensive rotation even begins. More importantly, the residents seem to be very receptive to the flipped learning structure, which is reflected in the high quality of their work.

The cherry on top? The flipped learning structure is contributing to my own professional development. I am routinely afforded the role of active learner given the high level of the residents’ engagement and the breadth of topics we are able to review under this new format.  (And yes, I still use my pen and notebook to take notes.)

Oh, and through it all, this preceptor is far less exhausted. That’s a major win.

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