Looking at the pattern on the electrocardiogram, my own heart rate started to climb after I heard, “so what’s the rhythm?” My attending sat down next to me and quickly walked me through every step of reading an EKG, giving me a framework that I still use to this day. Despite the responsibilities of managing a busy inpatient service, he still made medical student education a priority. Later, as an internal medicine intern in New York City during the onset of the COVID-19 pandemic in 2020, I found my clinical responsibilities all-consuming. However, my passion for medical education remained. As the surge passed, I started to plan a medical education project to teach clinical problem solving on high-yield cardiology topics to third- and fourth-year medical students, while keeping in mind both my time limitations as a resident and the students’ rigorous schedule.1 This is when I was presented with the challenge faced by all clinician-educators: how could a physician with significant clinical responsibilities create a time-efficient intervention to contribute to medical student education?
Tip #1: Use the Flipped Classroom Model
While the bulk of medical education traditionally involves large group lectures, poor attendance reflects an important limitation of this modality. The Association of American Medical Colleges 2021 survey of second year medical students revealed that fewer than 30% of respondents attended in-person pre-clerkship lectures most of the time, and only 43.1% attended virtual lectures most of the time.2 Novel educational techniques, such as the flipped classroom model (FCM), have been developed to improve learner engagement.3 In an FCM, students prepare for an educational session on their own time. Time with the instructor is reserved for problem solving using higher-order thinking. I utilized the FCM to teach cardiology topics to maximize the time in group sessions that was spent on clinical problem solving. The medical students who participated in my course proficiently acquired basic knowledge on their own by reviewing pre-selected materials. This allowed us to focus our in-person session on the complex nuances of clinical cases.
Tip #2: Teach Small Groups
Small group sessions are essential to engaging your learners. While teaching smaller groups may seem less time efficient, as it involves less learners per session, it can increase learner engagement and result in a greater impact on each student. When teaching over an online videoconferencing platform, commonplace during the pandemic, participation is more difficult as groups of students are often unable to focus on the presented material.
My FCM cardiology sessions were conducted via videoconference, with roughly four medical students per session. I set the expectation at the beginning of each session that everyone should have their video on and that we would participate in a fixed rotation. This allowed everyone in the group to be continuously involved and engaged.
Smaller group sessions have many advantages—for example, they are more flexible to schedule and provide the opportunity to connect with your learners on an individual basis. This enables you to diagnose your learners and teach to their level. Further, students are provided with more airtime to actively participate, helping them build communication and teamwork skills and providing them with the individualized attention needed when teaching complex topics.
Tip #3: Recycle Existing Resources
It can be exciting to think about creating a new resource for trainees, whether it be an instructional video series, a question set, or an interactive app. However, there are already a plethora of high-quality learning resources available to medical trainees. To save time, I recommend searching for existing guides, reviews, apps, online videos, or question sets to provide to your learners. MedEdPORTAL can be a great resource for identifying successful educational interventions.4 I provided my medical students with snippets of review articles, descriptive graphics, and links to helpful YouTube videos.
Tip #4: Stick to High Yield Topics
I recommend sticking to high yield topics when teaching medical students. It can be tempting to discuss a rare and exciting condition. However, common topics are more likely to be tested and employed in clinical practice. Therefore, a session teaching common topics will result in a greater impact for the time invested. Management of rare conditions can be addressed during specialty training. Using my own experiences as an internal medicine resident on the wards, I knew that heart failure, acute coronary syndrome, and tachyarrhythmias were common medical conditions that students could expect to encounter during their rotations. I focused only on these three topics for my flipped classroom sessions.
A key role for physicians is to provide education to new trainees to help sustain the field and improve the size and skill of our workforce. As our population ages, the demand for skilled physician labor will increase significantly; but, with busier clinical practices, our supply of time to teach will become more limited. As a result, we must plan our educational interventions carefully to maximize the impact of our time. Keys to time efficiency include utilizing the flipped classroom model to increase the value of time in the classroom, teaching small groups to increase learner engagement, focusing on high yield topics, and making use of pre-created resources instead of starting from scratch. With these techniques, we can focus our time to coach our learners through activities that require higher-order thinking and will have a greater impact.
Acknowledgements: We thank Dr. Alfred Burger for useful discussions and helpful feedback.