I was flying to join my wife in San Diego, California while she was attending a conference on ocean planning. For those of you not familiar with ocean planning, it is the process of analyzing ocean resources and ocean use. The most important thing about it is that the people who do it usually have conferences in beautiful, often warm and always ocean-adjacent locations. I sat in my seat and reached for the airline magazine. The first article was about medical education and how many medical schools were switching to this new concept of the “flipped classroom.” It highlighted the University of Vermont as well as Harvard Medical School, and how they changed the old model of sitting in a large auditorium, listening for hours on end to someone who had incredible amounts of expertise and information, because they had found learners had trouble committing this information to long-term memory and applying it to new settings. How could this be? The lecture format is the tried and true educational experience. The idea of the “sage in the stage” started with the very advent of universities as far back as 1050 AD. This was the “way it was done.” Why then were these medical colleges completing overhauling the way they teach medicine?

I’ve long since lost the article that I admit to tearing out and stuffing in my carry-on but it definitely made an impact on me. I am an educator, I teach at Northeastern University in the School of Nursing, and I often teach the courses many students dread like pathophysiology. I always strive to make my courses interesting so this was really compelling. It made me start to think about my own classroom experience and what I could do to engage my learners.

On average, most student’s attention span is only 10-15 minutes. Think about how long most lectures are; 60, 90 or even 120 minutes. Even if learners are paying attention, the passive learning from lectures has been shown to be far less optimal than more active learning strategies. At best most learners will recall only about 10% of what they hear from the podium. This leads many to drop out or fail courses under the current “regime” of the classroom lecture.

Many sources on active learner encourage doing something new every 10 minutes to keep learners learning. If you change it up, then re-engage, you keep your learners interested. Your learners are also using critical thinking skills and problem solving, working as teams and exploring - all things that help with learning and retention. “Hitting Pause” by Harvard Macy Alumna Gail Taylor Rice offers an array of ideas for learners to reflect, share information and engage in active learning. The concept is to allow the learner some time to digest what they have learned, and allow learning to transition from short to long-term memory. 

Active learning takes the stage

So how do we embrace this change? We engage learners in the process of active learning. Whatever terms you chose to use, “flipped classroom,” “problem based learning,” or “case based learning,” each model asks learners do a lot of the legwork prior to class, and then the class empowers them to use that knowledge.

The educator is now the facilitator, helping guide the learner and letting them explore and learn in a more dynamic way. The outcomes have been in favor of this transition. On average, 55% more learners will fail a standard lecture course than they will one that involves active learning. Early evidence suggests improvements in overall retention and test scores as well.

My foray into the flipped classroom:

I implemented this concept the next semester for my pathophysiology course. They still had recorded lectures and readings to help guide my learners towards key concepts. The in-class experience however was in the true spirit of the flipped classroom. When they walked in, they were given a case and in small groups they worked through it, answering questions and exploring the concepts. After about an hour, we would then revisit the case and talk about it. After class they had a take-home quiz to help reinforce the material. So how did it go?

Are learners ready for active learning?

Some learners looked shocked when on our first day I described the learning environment of the course. They had their laptops open and were ready for me to drone. As the semester went on though, people seemed more engaged in learning. They were tackling difficult concepts and working as teams. Attendance was always high. So, how did the learners really feel about it? That answer came with the course evaluations. Thankfully, most of these were great. I have paraphrased these to make them more general but here are a few examples:

“Listening to the recorded lectures followed by in-class cases was very helpful.”


“The assignments outside of class helped us to engage in class. Centering of the patient experience is fundamental to nursing practice and this class was appreciated.”


These were the first two! I was on a roll. Many more followed suit. A lot of learners loved the concept and felt they really were able to learn something. But there were also a few responses like this:

“Lectures and assigned readings were all interesting but the lectures were long and arduous to complete before class.”


“I feel like a have a lot of information about some very specific diseases, but less general knowledge.”


“More in-class lecture would have been helpful for me.”


Lessons Learned:

Active learning is exciting! It offers an opportunity to help learners better engage with the material and to improve retention. The learners learn critical thinking skills and how to perform better in teams. These are all great things. We as educators are embracing the need to employ different learning strategies that are based on the evidence. We need to consider attention span, methods of retention and ways to encourage higher-level learning.  It does take a lot of work, and there will be trial and error. With time however, we can all learn from each other and help to build a learning system that truly involves the educator and the learner. 

The caveat to that however is that we have to make sure our learners are ready for this. For learners who have parked themselves in chairs and listened to lectures, studied from their notes in order to pass a test may be a little shell-shocked by all of this. It takes a really great educator to foster this new learning environment and there is very little data on how learners perceive this change. I think while the effort is noble, and I am embracing it, we need to remember that are learners are a heterogenous group.

Overall, it has really changed the way I teach and I think the learners benefit from it. I am fresh out of the Harvard Macy Program for Educators in the Health Professions and have a cadre of new tools and ideas to implement. I am going to allow for more reflection, integrate other learning tools and infuse some art and storytelling into my teaching. I believe active learning is the way to go! I just caution that we as educators need to ensure that the learners really understand it and are engaged in it as well. We need good qualitative data on this experience so that we can further develop, define and refine the active classroom.



Did you know that the Harvard Macy Institute Community Blog has had more than 170 posts? Previous blog posts have explored topics including deploying team science principles to mend “silos” in academic medicine, and supporting students and faculty through the application of learning sciences and the use of a board game in emergency medicine.



Stephen P Wood

Stephen P. Wood, MS, ACNP-BC (Educators, ’19) is a nurse practitioner, working in the field of emergency medicine as well as an instructor at Northeastern University in the Bouvé College of Health Sciences Graduate School of Nursing. He is a fellow at the Harvard Medical School Center for Bioethics and a regular blogger for the Harvard Law School’s Petrie-Flom Center “Bill of Health”. His areas of interest include the flipped classroom, experiential learning and simulation. Stephen can be followed on Twitter or contacted via email.