**1. Introduction**

Medical students have become increasingly apathetic to traditional lecture-based teaching methods, particularly as they fail to engage the attention of the learners and have been described as an inferior pedagogy with respect to the development of critical thinking skills [1–3]. Indeed, student concentration is well known to shortly dissipate during lecture time [4]. As a result, non-compulsory lecture-based curricula receive poor classroom attendance and overreliance on third-party educational or other external resources. Further, as compelling evidence with respect to important factors such as failure rates has been put forward, the inferior nature of lecture-based teaching pedagogies in the science, technology, engineering, and math (STEM) fields of study relative to active learning pedagogies has been revealed [5, 6]. Active learning methods emphasize the application of information during class time. Such

problem-solving skills promote higher-order thinking in the Bloom's taxonomy. In fact, evidence show that lecture-based delivery of information is outdated and inefficient. Active learning is a superior method for delivering content in the STEM fields [5]. Further, it may no longer be appropriate to use lecture-based teaching as the comparative standard for teaching efficacy, but rather that different active learning modalities should be compared to each other [6].

Active learning models such as cooperative, team-based learning (TBL), and flipped classroom (FC) pedagogies have been developed to address the inadequacies of lecture-based teaching as they strive to eliminate the ineffectiveness of passive learning [7, 8]. Indeed, many medical schools have revised their curriculum to emphasize active learning pedagogies [9, 10]. TBL is a small group format that highlights knowledge application. FC settings reverse the traditional lecture-homework learning model that has dominated education for years and promotes student engagement and learning [11, 12].

Cooperative learning is an active strategy that has been shown to promote student engagement and learner satisfaction [8, 13, 14]. Its successful implementation requires strong interpersonal skills and peer teaching. One type of cooperative learning pedagogy called think-pair-share (TPS) was developed by Lyman and colleagues [15] and has been successfully implemented in healthcare education [16]. TPS is a 3-pronged approach that promotes individual, cooperative, and full class input.

Although these active learning platforms represent promising teaching pedagogies for increasing medical student engagement and acquisition of higher order learning skills some challenges remain. This includes variations in the degrees of improvement of learning outcomes relative to traditional lectures as well as continued student engagement and in-person attendance [10, 17–19]. Thus, in and by itself, the active learning is not necessarily sufficient to address issues such as engagement and attendance.

This chapter will discuss and describe TBL, FC, and TPS as active and progressive educational pedagogies. Descriptions of practical application of each of these strategies will be followed by specific pandemic-stimulated remote learning lessons learned. The technology required to use these techniques will be discussed and specific challenges of special populations and unique education delivery challenges will be reviewed and examined.
