Medical Schools Trend Away from Traditional Lecture

Imagine working with a partner who graduated from medical school without ever sitting through a lecture. It may seem sacrilegious—enduring lengthy sermons in anatomy, immunology, and cell biology has always been a rite of passage for med students. But, it turns out, being a passive recipient of information is not an optimal way to absorb or retain information.

“If information delivery is your goal, the lecture is a bad way to do it,” said William Jeffries, PhD, senior associate dean for medical education at University of Vermont’s Larner College of Medicine (UVM) in Burlington. “Attention span wanes within the first 15 minutes.”

Studies have consistently shown that active learning methods are the best way for students to understand, absorb, retain, and utilize information as they work their way through selecting key ideas, organizing how those ideas relate to each other, and integrating how the new ideas relate to other things they already know.

Medical schools are also trying to maximize a student’s attention using interactive activities alongside short videos or podcasts that are not easily interrupted by the vibration of an incoming text message in a lecture hall. “Texting while you’re driving is the same as being drunk and driving,” said Dr. Jeffries. “It’s the same in the classroom. Texting while learning is the same as being drunk while learning.”

Active Learning

Case Western Reserve University’s medical school in Cleveland, Ohio, has had a no-lecture curriculum since it opened in 2004. By the summer of 2019, UVM will have eliminated all of its lecture-style courses, moving to an entirely active learning environment in which students won’t be able to snooze or text their way through the parts of a lecture that don’t hold their attention.

“We’ve used the principles of neuroscience of learning to try to figure out how best to convey the information,” Dr. Jeffries said, “how to make it sticky and more meaningful to the practice of medicine. Students can then apply knowledge at a higher level and synthesize new information and paradigms to make higher-level connections when they encounter other clinical problems.

The way UVM achieves that goal is to put the information that would have been in a lecture into the cloud, assigning it as homework for students to read before class. Class time then is spent applying that information as students solve problems by going through a number of different types of exercises in group-based activities.

Not all medical schools are going completely lecture-free, but many are trending toward offering fewer lectures. “What this mostly refers to is a learning environment that is problem based with regard to disease, and small group versus large lecture-style format,” said Joseph E. Kerschner, MD, dean of the school of medicine, provost, and executive vice president of the Medical College of Wisconsin (MCW) in Milwaukee. Dr. Kerschner is also professor of otolaryngology, microbiology, and immunology. MCW also has completely digitized their content so that students can access the materials both before and after class.

It is much more important to teach concepts and ways to continue to learn and access data than ever before. The old style of just lectures has less room to reinforce these concepts. Small group and problem-based learning is more conducive. —Joseph E. Kerschner, MD

In an active learning environment at MCW, said Dr. Kerschner, students might be presented with a patient who has head and neck cancer, learning the appropriate anatomy, cell and molecular biology, physiology, pathology, pharmacology, and clinical correlates as they discuss this patient in a small group setting. “It’s a hands-on learning situation that is more memorable than passively receiving information,” said Dr. Kerschner.

The University of Kansas Medical Center’s new curriculum, Active, Competency-based, Excellence-directed (ACE), has changed the legacy curriculum of 15 lecture hours per week to only five lecture hours per week, with the goal of making learning more active and learner-centric. “Many transformed curricula like ours introduce students earlier to clinical areas, including subspecialties. This early exposure may identify students headed to otolaryngology who might have been lost otherwise,” said Robert Simari, MD, executive dean of the University of Kansas Medical Center in Kansas City.

Twenty-five years ago, medical knowledge doubled about every five years, but currently, it’s doubling about every 100 days. “It’s no longer possible to teach everything we know in medicine to our medical students and residents without it being obsolete by the time they graduate,” said Dr. Kerschner. “Therefore, it is much more important to teach concepts and ways to continue to learn and access data than ever before. The old style of just lectures has less room to reinforce these concepts. Small group and problem-based learning is more conducive to this.”

Challenges

The challenges to medical school students in lecture-free learning environments are not insignificant; students must be mature enough to take responsibility for their education and be prepared to participate actively in class. “There is no place to hide in these curricula,” said Dr. Simari.

Students may also balk about being forced to attend class, being pressured by their peers so that group performance is up to snuff, and, since lectures tend to be a guide to what’s on the test, being potentially responsible for even more information than they would have been in a lecture. “The advantage is, when you look at the data, students report that it’s actually easier to study for the test when there’s active learning involved, because they remember more material,” Dr. Jeffries said.

Medical schools face challenges, too; active learning curricula can be significantly more expensive due to the additional costs of technology as well as faculty development.

The cost of implementing new teaching methods at medical schools is also a major consideration. The University of Vermont has applied a $66 million gift toward building and renovating classrooms and retraining faculty members. Part of the gift will go to expand its Teaching Academy, which provides faculty with mentors, conferences and workshops, and self-paced courses, all in the name of helping faculty discover teaching methods that can be more impactful than a lecture.

But not all faculty members embrace the overhaul. “Right now, we hire faculty without regard to what type of teacher they are or what they would contribute in that respect to the learning environment,” said Dr. Jeffries. “We’re going to have to focus more on faculty who want to teach, who are good teachers, and who are willing to work in these different ways. That’s crucial.”

As medical schools begin to see the positive effects of active learning, Dr. Jeffries predicts that lecture-style learning will fade away as active learning modalities become standard.

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Renée Bacher is a freelance medical writer based in Louisiana.