Is Skipping Med School Lectures Making Inferior Doctors?

Emily Kahoud

Disclosures

November 14, 2018

Passive Learning and Misperceptions

Michael Lea, PhD, professor at Rutgers New Jersey Medical School in the Department of Biochemistry and Molecular Biology, is worried about what's lost by only listening to or watching lectures at home. He explained that without actually being present, "You may not get the facial expression or the subtle ways we communicate with each other."

Lea is also worried about things that won't show up on tests. "My concern is that the lack of attendance in-person will create more isolated individuals, and therefore we potentially lose some of those other things we're trying to teach, [such as] professional identity formation, the transfer to patient care, and the ability to communicate well with peers as well as patients."

Regardless of feelings on attendance, Lea admits that "traditional lecture is a very low-tech way of transmitting information, because everyone has to go at the same pace." Furthermore, Lea is worried that attending lectures moved from an active to a passive experience. As he described, "If not provided handouts of the material in any form, you had to listen very carefully and take notes—and that made learning very active." With lecture slides and handouts readily available online, Lea has observed an increased frequency of student "multitasking." He doesn't use the term to refer to additional simultaneous learning; "multitasking" is Lea's euphemism for students' tendency to tune into Facebook or Instagram during the lecture.

What can't be disputed is that the back-and-forth nature of discussions or questions asked in class is superior to corresponding via email. Instead of active participation, passive exchanges have become the norm. Beyond her role as a researcher, when considering the passive nature of lectures based on PowerPoint slides in her role as a professor, Kauffman asked, "Are we using our time as optimally as we could?"

Other things may be lost by not attending lectures as well. Kauffman identified the inability to recognize misconceptions as a potential danger. If two different students have wildly different interpretation of the facts, as Kauffman explained, "[t]hey may still be able to get the answer right on a multiple choice exam...but they wouldn't necessarily be able to do it on a different question...or they may not be able to transfer it to patient care because of that huge misconception." The worrying part is not the misinterpretation, as Kauffman clarified "We won't be able to [remediate] if there isn't some kind of person-to-person interaction."

Learning Is Changing, but What About the Outcomes?

If students are no longer learning in the same way, why are we being tested in the same way? Multiple-choice questions have never captured nuance, but without the same classroom interactions as before, are the gaps in assessment even more dangerous? "Our patients don't read the textbook," Kauffman explained. "They don't have the stereotypical presentation." With more passive learning and a failure to correct misperceptions, Kauffman stressed the importance of being able to "recognize the limitations of what we're assessing with those exams."

In a piece for the Washington Post , Brenda Sirovich, MD, professor of medicine at Dartmouth Geisel School of Medicine, argues that students are quick to figure out how to maximize test scores. She put out her frustrated take on her student's "to-do" lists:

  1. Do not attend class, unless attendance is specifically required.

  2. Complain about the (modest) number of class hours requiring attendance.

  3. Resist discretionary learning opportunities, no matter how interesting.

Sirovich points out that this does often produce a good board score. However, is that score the sole desired outcome of medical education? Are professors increasingly "teaching to the test," toward the achievement of good board scores, the holy grail of medical education? Has the focus shifted from the outcome of students actually becoming good physicians?

Kauffman suggests that professors should consider their role in medical education beyond just imparting information. "Is that truly our most important role? Was it ever our most important role?" Board scores are essential, but so is the molding of students into mature physicians capable of the depth of insight complex patients require. Professors are our greatest asset, our guides toward adopting the doctorly demeanor. As Kauffman put it, "Do we need to consider that our more important role might be in the dimensions of professional identity formation; in the dimensions of clinical reasoning; in the dimensions of patient care, rather than just the ability to put information on a slide, or say the information out loud?"

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