Palo Alto Weekly

Cover Story - May 10, 2013

Flipping the university classroom

Stanford tests the power of stories and technology to boost learning

by Chris Kenrick

Despite an explosion in biomedical knowledge, the method of teaching medical students through lectures has changed little since the Wright brothers were tinkering at Kitty Hawk over a century ago, says Stanford University pediatric infectious disease specialist Charles Prober.

Prober, who also is associate dean for medical education at the School of Medicine, aims to improve on that.

By making lessons "stickier" — more memorable and comprehensible — and embracing self-paced and mastery-based approaches, he hopes to make better use of students' time in their task of absorbing the ever-expanding medical canon.

Ultimately, he aspires to make better doctors.

Prober's emerging reform efforts at the School of Medicine, combining face-to-face and online teaching, are part of a larger and systematic initiative across Stanford to test the uses of technology in search of better ways to teach and learn.

The global onslaught of education technology — described variously as a "tsunami" and an "avalanche" — has colleges and universities around the world scrambling to position for a future that is sure to be different.

Online learning — including the newly famous "MOOCs" (massive, open online courses, in which tens of thousands of students around the world have enrolled in some Stanford-taught courses) — promises to remake 21st-century higher education in ways nobody can predict.

Stanford aims to blaze a trail and remain standing in that brave new world, leveraging its entrepreneurial culture, star-studded faculty, depth in computer science and broad resources to test online approaches to figure out what works.

Last year, about 60 professors across the university experimented with new, technology-assisted teaching methods — probably the highest level of participation on any university campus, computer science professor John Mitchell said.

Chief among the new approaches is the so-called "flipped classroom," in which faculty members convert lectures into online video modules to be absorbed by students before they come to class. Class time then becomes available to build on the academic content with interactive discussion, hands-on activities or guest speakers.

Stanford President John Hennessy last summer created a new Vice-Provost's Office for Online Learning, appointing Mitchell to head it.

In turn, the schools of business, engineering and medicine appointed deans to lead their respective online-learning efforts.

"It really hasn't been my job to get people interested in it," Mitchell said. "I'm just trying to help everyone follow through on the ideas that they have."

Twice a quarter Mitchell gathers the professors from across departments who are experimenting with online teaching to let them hear one another's stories and advice.

"These have been thought-provoking for faculty," he said. "If you sit through that and are thinking about your own course you get several different ideas."

The early adopters remain a small but growing subset of Stanford's nearly 2,000-strong faculty. Flipping a class requires a professor to commit substantial upfront time to creating online content — and then come up with ingenious ways to use the freed-up class period.

"There's no reason for the most popular lecturer on campus to necessarily change what they're doing, although most of us are not spellbinding for every second of every lecture," Mitchell said.

"It's part of our culture that everyone is autonomous to a reasonable degree."

But sensing the future — and the potential of technology to scale their classroom lectures to global audiences — faculty and graduate students from business to psychology to statistics are piling on to the ed-tech initiatives.

For professors, Stanford offers the incentive of seed grants for proposals that "challenge our understanding of what's possible in online learning, leveraging innovative technologies and teaching strategies to promote deep learning experiences for learners at Stanford and beyond."

Mitchell and Graduate School of Education Professor Roy Pea established Stanford's "Lytics Lab" for design and research into online learning.

"There are 10 to 15 graduate students there — from education, computer science, engineering, statistics, communications, business and psychology — who've realized that this is the future, and if they're going to have a career in education, this is an exciting topic to do your Ph.D. thesis on," Mitchell said.

At the school of education, Pea and sociologist Mitchell Stevens organized a group called Education's Digital Future "to catalyze a transnational conversation about digital learning."

Ed tech, Stevens said, "is the beginning of a wholesale reorganization of teaching and learning in higher education. It will very soon be an un-ignorable phenomenon.

"This is not a sort of fringe activity of Cambridge and Silicon Valley. This is something that's going to be reorganizing the entire sector."

Jennifer Widom, head of Stanford's Computer Science Department, was among the earliest adopters.

Widom grew tired of "delivering the same lectures year after year," often to a half-empty classroom because lectures were videotaped and available to students on the web.

So in 2011 she flipped her introductory database course.

She created "better" videos for students to watch before class — shorter, topic-specific segments, punctuated with in-video quizzes to let watchers check their understanding.

With that material covered in advance, she made class time more enticing with "interactive activities, advanced or exotic topics and guest speakers.

"In my course evaluations, I think I got 100 positive comments to two negative comments — something like that — so the students really enjoyed it," she said.

Student reviews aren't uniformly positive for professors, especially those who assign students to watch their lectures in advance, then require them to come to class where they repeat the same lecture.

But trial and error is tolerated as part of the learning process.

"Students are now seeing many courses that are taught in this style, and so I think we're starting to refine what we do," Widom said.

After preparing video lectures for her database students at Stanford, Widom made the presentations publicly accessible online and soon realized that she could offer the entire course to anyone — and her "Database @ World" class was born.

But when students from around the globe flocked to her open, online course she realized there was much more she had to do.

"For 10 weeks I worked nearly full-time on the course — never mind my other job as department chair, much less my research program — in part because there was a lot to do but most because there was a lot I could do to make it even better, and I was having a grand time," she said.

Widom said her global students — a varied assortment but many of them software professionals looking to sharpen their skills — were "unabashedly, genuinely, deeply appreciative" for the opportunity to take the class.

"Many said the course was a gift they could scarcely believe had come their way," she wrote in a blog posted with the Association for Computing Machinery.

Widom reciprocated the good feeling by posting weekly "screenside-chat" videos, covering logistical issues, technical clarifications and full-on cheerleading for those who were struggling.

The online class was machine-graded and offered a "statement of accomplishment" — but no Stanford credit — for completion. By July 2012 it had garnered 115,000 accounts, 480,000 assignment submissions and 6,500 course completions.

In the fall of 2012 Widom offered the same "introduction to databases" course to 240 students at Stanford — and 48,000 around the world signed up as well. Of the global enrollees, 21,000 submitted more than one assignment, 4,900 completed the entire course and 1,900 completed it "with distinction."

In one poll Widom learned that her global students were from 130 countries, with the U.S. best represented, followed by India and Russia (China blocked some of the content, but a few students found workarounds). Males outnumbered females four to one, a little better than the ratio among U.S. college computer-science majors, Widom said.

Many of the global students said they had been programming databases for years without really knowing what they were doing.

The Stanford students in Widom's flipped classroom worked through the same material but got more: hand-graded written problems with more depth than the automated exercises, a programming project, traditional written exams, and classroom activities ranging from interactive problem-solving to presentations by data architects at Facebook and Twitter.

And rather than a "statement of accomplishment," they gained Stanford recognition and credit.

"There's no question that the Stanford students were satisfied," Widom said. "I've taught the course enough times to know that the uptick in my teaching ratings was statistically significant."

Stanford junior Perth Charernwattanagul, a math major, took Widom's flipped database course last fall.

"At first I didn't think it would work because I thought going to lectures was a necessary part of learning, but it fit that class really well," Charernwattanagul said.

"One of the major advantages is you can actually go through all the videos at your own speed, and you don't have to go at the professor's pace.

"You can pause and go back. You can't really do that in an actual lecture, and I do that a lot."

Charernwattanagul thinks he learned more from Widom's flipped classroom than he would have in a traditional delivery of the same course because the professor used class time to discuss her own research and bring in speakers from industry.

But he questions whether every subject or class size would lend itself to the flipped model.

"It makes sense in a class with a lot of students that's not a discussion classroom, but with only 10 or 20 students, people might not like it. Or I'm not sure how it would work in a humanities class," he said.

The time-honored tradition of teaching medical students at the bedsides of hospital patients is, in many ways, the original flipped classroom, observed Prober of the School of Medicine.

"It's what we've tried to do in medical education for a long time — teach medical students about medicine through the lens of the patients they're seeing. The material is familiar but reframed in a way."

But Prober also aims to improve the effectiveness of students' pre-clinical education — the first two years of medical school, when most spend their days in traditional classrooms cramming their heads with dense content.

"You come in fresh and ready to save the world, and you get thrown into classrooms with lecture material, facts coming at you.

"You have them coming at you and coming at you so strongly that you sometimes wonder, 'What's the relevance of this? I want to be a doctor. What's the relevance?'

"So the more you can start flipping the classroom into the relevance, and underscoring the relevance through patient stories and simulation," the more the learning will stick, he said.

Last year Prober called for major reforms to medical education — including use of the flipped-classroom model — in a New England Journal of Medicine article he co-authored with Stanford Graduate School of Business Professor Chip Heath.

"Since the hours available in a day have not increased to accommodate the expanded medical canon, we have only one realistic alternative: make better use of our students' time," they wrote.

The School of Medicine has redesigned its core biochemistry course, discarding the standard lecture-based format in favor of short, online presentations. Class time is used for interactive discussions of clinical vignettes highlighting the biochemical bases of various diseases.

Student reviews have been positive, and class attendance — which is optional — jumped from 30 percent to 80 percent, Prober and Heath said in the May 2012 New England Journal article.

The flipped format also has been used in some courses in endocrinology, women's health, genetics, microbiology and immunology, Prober said.

Another faculty member is designing a "mix and match" course — some standard lecture, some interactive — in cardiovascular physiology for Stanford medical students.

Part of that project will be "taking the cardiovascular content that's created in the video part and exporting it to Rwanda to see if it's equally relevant to students there," Prober said.

But change is hard and requires departure from comfortable and familiar routines for something unknown.

"And of course the looming question in every educator's mind is, 'Does this work? Is it really going to make a difference?'" he said.

Success can be measured in things like examination results and student and faculty satisfaction levels.

But ultimately the question is whether it will produce better doctors, and that is a long-term proposition.

A 2010 U.S. Department of Education analysis of online-learning studies concluded that hybrid courses — partly face-to-face and partly online — were at least as good if not marginally better and more engaging than the standard model.

In his quest to make the medical curriculum more compelling and memorable, Prober reached out to Heath, whose research centers on how to design messages to make them stick. Heath is co-author with his brother, Dan Heath, of the 2007 New York Times best-selling book "Made to Stick: Why Some Ideas Survive and Others Die."

Prober also has initiated projects with Sal Khan, whose online Khan Academy offers 4,100 online videos, each about 10 minutes long, on topics from arithmetic to venture capital.

"Sal Khan is intriguing in the simplicity with which he delivers the message and the effectiveness with which it is delivered," Prober said.

Delivering dense medical content in compelling segments that are shorter than the traditional 50-minute lecture also makes them easier for a professor to update — and readily searchable later on by students and doctors for a just-in-time refresher when needed, he said.

"Every major university is involved in this space," he said. Last year he brought a few major medical schools together for a summit on the topic.

"There was a lot of enthusiasm for this and the question of whether we should be doing something together."

Though many expect online learning to radically reshape higher education, neither Prober nor Widom think it will change the core experience of Stanford students.

"The residential college is not going to go away," Prober said.

"We need to have students of like age, of like mind and of broad diversity mixing it up with each other as they learn together, but I think we can create a balance with online structuring," Prober said, adding that online approaches also potentially could address cost issues in higher education.

Said Widom: "I don't expect it to compromise a university like Stanford. I think the experience of students coming to Stanford, being residential, interacting with the faculty and with the other students, working in labs and so on, is not going to be replaced."

And yet Stanford's online initiatives are opening a Pandora's Box of big questions, suggested by Widom in her blog.

Who owns the course content, the university or the professor? What about money and teaching credit for putting courses online?

Is it the university's mission to educate the world?

And if everything is online, what are people getting, exactly, for the $40,000-plus tuition at Stanford?

Mitchell, the vice-provost for online learning, said he expects to see "a lot of different approaches online.

"Maybe it will settle down in 20 years, but 20 years is a long time. I think for the next five or 10 years we'll see lots of changes and new developments."

Online education, Widom told her colleagues, is "exploding, yet nobody knows where this is going.

"I think that's really important to say. It could be going just about anywhere."

Staff Writer Chris Kenrick can be emailed at ckenrick@paweekly.com.

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