Tuesday, 16 December 2014

The Flipped patient?

Move over flipped classrooms ... medical students could now be using flipped patients.

A viewpoint article (paywalled I'm afraid) in JAMA (1) explores the concept of 'flipping' the experience of medical students meeting patients - presenting them with an electronic health record derived construct before seeing the real thing.

The flipped patient model might be described as seeing an electronic patient presentation first (the iPatient). In this article a virtual construct of the patient is described, generated from the electronic health record. After reviewing this construct the students then head off to see the real patient in the emergency room to better understand how the history, examination, and investigations relate to a real-world presentation.

The authors describe the reality of 'unflipped' classrooms in their introduction. "A common sight in the first 2 years of US medical education is that of a professor speaking in a lecture hall that is only half full. An hour later, in the library or elsewhere, students who did not attend the lecture can be seen wearing headsets, watching the recorded lecture at 2× to 4× speed on a desktop, while looking up reference material on their laptop. This trend should not be surprising, because the much-talked-about “millennial” generation has many distinguishing characteristics—but it is their facility with technology and their attitudes toward learning that stand out and that have changed the educational landscape."


This flipped patient is an interesting way of separating the cognitive skills required in learning the complex task of taking a history, examining a patient, reviewing the results, and considering the differential diagnoses. Whether this semi-automated method of constructing a brief from the electronic health record is any better than a good introduction to the case by a clinical teacher is yet to be seen. Certainly it also adds the experience of the workplace reality of making sense of electronic records.

1 Chi J, Verghese A. Clinical education and the electronic health record: The flipped patient. JAMA 2014;312:2331–2. doi:10.1001/jama.2014.12820

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