Be it resolved that in-person lecture should be discontinued as a delivery method for undergraduate medicine education.
Sarenna Lalani Meds '23 - NAY!
Mike Christie, Meds '21 - YAY!
Does it make sense to continue doing something a certain way simply because that’s how it’s always been done? Lecture requiring in-person attendance has undeniably been the longstanding workhorse of medical education, however in modern times its utility has faced increasing criticism. A brief consideration of its pitfalls makes it clear that in-person lecture should be discontinued as a delivery method for undergraduate medical education.
While the average attention span is a source of debate among academics, it is generally accepted to be between 10 and 20 minutes. This means that during a standard 50-minute lecture, the average student is likely only paying attention forty percent of the time! Extrapolating this forward, the retention of the knowledge and concepts covered suffers because they are not learned in the first place. The driver behind these limitations is the reality that lecture does not engage students in critical thought. The reason? There simply is no time for it. The voluminous nature of medical education does not permit time for more effective lecture styles where questioning of the audience to spur critical thought can occur simultaneously with the dissemination of information. From the student’s perspective, the goal of lecture is to somehow pay attention to the continuous relay of information, rather than to interpret, apply, or question it. Consequently, while lecture may claim to disseminate information, it is woefully ineffective for having students actually learn it.
With a lack of student engagement, the didactic relay of content makes lecture attendance akin to data-mining. In a world where distribution of educational content is possible through online modalities, attending lectures to collect information is completely unnecessary. Furthermore, this teaching method forces a universal learning pace and style upon students with a wide variety of individual knowledge bases and learning preferences. Consider that in comparison to a recorded session, a student seated in a lecture hall cannot rewind or fast forward a presentation. If a point is missed, or a quick read up on a topic is necessary to contextualize content, keeping up with the relay of information becomes impossible. Having the option to select which lectures to spend more or less time on would optimize individual learning. Students spending self-determined time on a recorded session as opposed to re-teaching themselves a lecture means that overall less time is spent on the subject and there is more time to cover additional material.
Medical students, however, are only part of the equation. A critical component of medical education is the presence of passionate, experienced, highly qualified experts to organize and deliver it. It is important to consider that having these individuals provide in-person teaching removes them from clinical activity. Although this is necessary to facilitate certain sessions, it is unreasonable to pull physicians from patient care to teach didactically what students could otherwise learn themselves. It would be sensible to instead have content sessions be self-taught and then followed by interactive, engaging, case-based sessions facilitated by these physicians. Further considerations with this model include increased ease of scheduling for all parties involved, as well as a decreased need for a physical space to host lectures, thereby freeing up this resource for other learners.
In summary, the fundamental problem with didactic in-person lecture is that it is an ineffective method of education. Lecture, in and of itself, does not teach students. The reasons for this are that it disregards limitations of attention span, results in poor retention of content, and lacks engagement via critical thought. Supporters of lecture must come to acknowledge both the constraints on lecture style inherent in medical school and that the dissemination of information is not synonymous with quality, functional learning. Building upon this argument, because the learning method of didactic in-person lecture is ineffective, it is also intrinsically an inefficient use of both students’ and educators’ time. Compounding this inefficiency is that other easily accessible alternatives exist that would optimize learning.
In a system without in-person lectures, the medical school still exists. Fears surrounding loss of community or a trend towards completely removing in person attendance from schooling are hyperbolic and discount the continued need for attendance at both case-based and clinical skills sessions. Indeed, constructing delivery of medical school curriculum around practical, modern, and effective educational methods has the capacity to help the physicians of today more optimally train the physicians of tomorrow. School is in session, and lecture is cancelled!
With the past month’s unprecedented circumstances, #ZoomUniversity has become all-the-rage. As it stands, it is our best option to fill our brains with something beyond the murder, mayhem and madness of Netflix and YouTube’s seemingly endless depths. In a world where most of our lives have been reduced to containment within four walls, (which I admit, we are very privileged to have) I find myself wondering about the pros and cons of this avant-garde style of teaching. For me, video-conferenced learning doesn’t quite hit the spot, at least not in the same way in-class lectures do, but let’s unpack that a little more…
1. From people, for people:
Fundamentally, e-learning methods lack the humanity that defines our educational experience. Your peers are reduced to abstract concepts, nothing more than their initials (or if you’re lucky, their photo) in an icon on your screen. Funnily enough though, if you ask most of your colleagues “why medicine?”, I am certain that human interaction owns some prime real estate in those top slots. Human interaction in medicine is far from restricted to patients; medicine is a team sport – you work with other physicians and healthcare professionals, seek inspiration from those who came before you and provide mentorship for those to follow. Our profession is a social and personal one, but those facets of our education are lost with the ousting of in-person lectures. As far as I’m concerned, good social skills are not inherent in a med school admission. Sure, we’d all like to think that our EQ is above-average – maybe it is, but that doesn’t mean we have nothing more to learn in the realm of teamwork. The non-verbal language in SGL, the process of forming a differential with your tutor, being able to both observe a patient and generate ideas synchronously – these are all skills that flourish as we interact with others. We are always told that our patients will remember us for how we make them feel, but if we haven’t had the chance to hone our interpersonal skills, there is no reason to believe that we will be good at it once residency comes around the corner.
2. Log-in, check out
I buy that learning online forces people to manage their time well and practice exceptional self-discipline. With the availability of recordings, one can work at their own pace, work from the couch and in their pj’s and channel major #WFH vibes. While this is an A+ in comfort, I would argue that this doesn’t necessarily enrich the educational process. There’s an article in the Harvard Business Review on the daily routines of geniuses; the piece references many successful writers – Austen, Twain, and Hemingway to name a few – and how their cultivated daily routines ultimately resulted in their success. Through notions as simple as a clean workspace with minimal distractions (nudge nudge, 032A) to accountability metrics, these extraordinary minds were able to unlock their potential. I would argue that this is much easier to do in a classroom, which is designed explicitly for your learning success and tailored to make your experience one of ease. With a schedule parsed out to maximize your hours in a day, you are inherently given a routine – all you have to do is show up! Coming to class is a system of checks and balances in itself. The sheer setting and the added bonus of your partners-in-knowledge hold you accountable and keep you honest, because goodness knows we are phenomenal at making excuses for ourselves. The temptation to pull out your phone, open a new tab, or just excuse yourself for a mid-lecture snack is much stronger when no one else is watching, making online learning that much more dangerous than its in-person counterparts.
3. It takes two to tango!
Let us appreciate that there is a whole other population besides ourselves affected by the advent of online lecturing – our professors. Intelligent, wise, generous with their time, and confident, they are now thrown into Zoom University alongside us, unsettled by lectures delivered into the abyss. Gone are the times when profs could appreciate the moment of satisfaction when realization washed over students’ faces as they finally grasped that complex concept. Gone is their ability to read the room and explain things when 216 (or so) befuddled eyes stared blankly back at them. Gone are the experiences of genetic escape rooms, class jeopardy, randomizer-induced palm sweat and red blood cell piñatas, as teaching is reduced to a mere video call… or worse, an online module. In removing in-person lectures from our curricula, we effectively suck dry the joy of teaching (and potentially the joy of learning too… I mean who didn’t love hemolyzing the RBC?). We risk putting our lecturers in uncomfortable positions and depriving them of the delight of influencing students. More, we miss out on the wealth of knowledge and personalities of our profs outside of lecture; be it a discussion in the ten minute break, a walk to the SMB entrance after class or a run-in in the atrium. A loss of lecture is a loss of the valuable little moments that inspire us too.
In an era where technology is not the future but the present, we are at risk of losing the mortality of medicine more than ever before. We are fortunately given access to a fountain of knowledge through our medical education, but a transition to online or alternate delivery methods jeopardizes our ability to absorb and process that knowledge. Without human context, we risk reverting to the memorization tactics of undergraduate education – the rote learning that we so greatly despised in our past lives. We aren’t learning for a test; we are learning for our patients. By not refining our social skills and optimizing our educational experiences, we not only cheat ourselves, but risk harming our patients. Zoom University is the best solution we have for now, but I cannot wait to be back in class with 107 diverse, intelligent, eager and similarly caffeinated classmates by my side.
Carmichael, S. G. (2014, March 19). The Daily Routines of Geniuses. Retrieved from https://hbr.org/2014/03/the-daily-routines-of-geniuses
Sarenna Lalani, Meds '23
Full disclosure: I never thought I would be someone who went to see a shrink. Therapy was for people who had something wrong with them, and I was hell-bent on the fact that there was nothing wrong with me. Sure, I can be a little bit of a perfectionist at times and sure, I probably operate at a higher basal level of stress than the average person, but that’s normal…right? That’s just part of your regularly scheduled med school programming, isn’t it?
Over the past couple of years, I’ve toyed with the idea of seeing someone. I paid lip-service to the benefits of therapy, especially when friends needed help beyond what my words could offer them. I’ve casually referred friends to resources on campus, and whenever I was met with hesitation, I would always throw in the fact that I’d been considering making an appointment too. I didn’t feel the stigma – the cloud of judgement never lurked over my head – and I wasn’t ashamed to share my truth – I had indeed considered making an appointment – but when push came to shove, something would prevent me from taking that first step. I was too busy to call or didn’t have time that week or had other things outside of school that were taking up my time. I was nothing if not consistent at making excuses.
When this year started, I could sense that I was struggling with striking a balance. My stress levels, while still contained, were certainly higher than usual. I can recall a handful of weeks where I really didn’t think I would make it through – there was too much on my plate for me to even begin to tackle, and I had absolutely no idea where to start. I became reliant on my schedule to get me through, but my set-up was unstable at best. If I didn’t check off one of today’s boxes, the rest of my week and weekend would be thrown off, and feelings of guilt would wash over me. I began cutting myself less and less slack; I was less forgiving if I worked slowly because I was tired. While I wasn’t a ruthless dictator of my own life, I certainly wasn’t being kind to myself either. Of course, I didn’t realize this on my own – these are some of the findings Anna and I came through after sifting through my psyche. I just knew something was off, and come December, I knew that I needed to make an appointment to preserve my well-being. I was ready to admit that I might need a teensy-weensy bit of outside help.
I recall sitting nervously in the little waiting corridor (it really does not have the structure to be considered a room) of Student Wellness Services, eagerly awaiting Anna’s arrival. I remember wondering what would she look like: was she tall or short? Young or old? Would she be a nice person? How would I know that I could trust her? Anna, a small-statured and peppy woman with a soothing voice eventually appeared in the waiting corridor and guided me down the hallway towards her office. It was dimly lit with a warm-shaded lamp, had a desk in the corner and one sofa and one armchair. It was small, but cozy. She beckoned towards the sofa, and as I sat down, I could feel the tension dissolve across my shoulders. So, this was therapy, eh? Not so scary after all.
An hour later we had talked about all kinds of things. We shared funny stories from our lives, talked about the stress of med school, shared our favorite spots in Kingston and so much more. Anna, more than a therapist, was a friend. She didn’t judge and she certainly normalized and validated everything I was feeling. She gave me some homework, which was really more of a mantra to use when I felt myself spiraling. Instead of feeling guilt when I couldn’t get everything on my to-do list done in a day, I needed to accept that I was doing my best and that that was enough. I only have a certain bandwidth, all of us do, and we can only do so much. She said not making it to the gym one day, or not finishing all of the notes I had hoped to do was “fact, not failure.”
Fact, not failure – three simple words that have, in many ways, changed my life. Every one of us could probably benefit from being a little kinder to ourselves, and thanks to Anna I was able to see that. Med school can be hard, life can be hard, and you’re doing yourself dirty if you pretend otherwise. Some days, you will be your own superhero; you will dot every “i” and cross every “t” that you intend to, but if one day you don’t, remember it’s fact, not failure.
Illustration by Amanda Mills, Meds '23
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