
Vermont Medical School Says Goodbye to Lectures - happy-go-lucky
http://www.npr.org/sections/health-shots/2017/08/03/541411275/vermont-medical-school-says-goodbye-to-lectures
======
pixelmonkey
Another one bites the dust. This is a trend/fad that will likely be reversed
once properly studied.

My wife went to a medical school that had recently adopted so-called "active
learning" techniques. All the students secretly hated them, but wouldn't share
this feedback with higher-ups (academic administrators) because med students,
as a group, are generally rule-following, adaptable students.

The "non-lecture" format was frequently derided by students, in private
settings, as "Dr. Wikipedia". That is, they were learning medicine by using
Google and visiting Wikipedia pages. Because they had to collaborate on their
own learning materials, even though they had no background in medicine.

About 50% of students I knew (secretly) spent thousands of dollars on recorded
medical lectures to supplement the completely ineffective class "group
activities", and thus did well on the tests (and USMLEs) anyway. They never
reported this to professors or administrators. Again, they were "working
around" the broken "active learning" system. One of the hilarious side effects
of this: the supposedly "objective peer-reviewed studies" of this learning
style won't show score/testing degradation -- because the students are so
self-sufficient that they work around the failing format with supplemental
lecture materials purchased online! Thus, they still achieve the grades they
hope, and the administrators think the system is "working"!

There was, however, a very small subset of students who preferred the "active
learning" format. Most of the time, these were students who came into med
school with a stronger science background than others (e.g. had basically
started studying medicine before they got there). One reason they particularly
enjoyed the format: they could skip class with little effect on their grades.

~~~
mahyarm
Why do you even need a med school with these types of students

~~~
epmaybe
To be completely honest, as someone in medical school right now you definitely
don't "need" the structure and materials that medical school lecturers and
courses provide for those first two years. I however needed the structure and
did not have the work ethic to do it on my own. Additionally the next two
years of clinical learning most definitely require you to be at the hospital.

~~~
fifteenforty
A professor of medical education once said to us something along the lines of
'The half life of the facts we tell you is about 6 years, so the actual
content isn't necessarily that important. What is important is the language
and that you learn to understand what you hear and read after you graduate.

5 years after graduation, I feel like I am only starting to truly appreciate
that comment. I started medical training 11 years ago, and half of the stuff I
read in books during first year was probably already known to be wrong.

The lectures we received were biased and incomplete, but they provided a
largely up-to-date picture and, more importantly, a story.

~~~
epmaybe
The story definitely matters, I agree. But if you're good at making that story
up as you read the book, why bother coming to class? I'd also argue that not
everything is completely out of date. Only things like cytology or genetics
and autoimmune disorders from what I can gather. Pathology is largely the
same, as in the manifestations don't really change. You can get by studying a
First Aid board review book from a few years ago and still pass step 1.
Physiology doesn't really change, only treatments targeting the
pathophysiology.

Medical Schools largely understand that everyone studies and learns
differently and that's why they don't mandate you come to lectures. They're
recorded for your own benefit as well. My professors would also provide
several different learning methods throughout the preclinical courses to
really hammer in those mainstay concepts regardless of how you learn. Be it
quizzes, or team based learning, or straight lecture.

------
mncharity
> "Well this method of teaching is actually not as good as other methods.
> Would you do that?"

A university did a trial. Lecture with active learning vs traditional lecture
and sections. Simultaneous versions of the same class; random assignment of
students; pre-written exams. Inexperienced postdoc vs highly-respected well-
rated experienced prof. Mid-term results came in. The comment was that if it
had been a _medical_ trail, they would have had to stop immediately, rather
than finish the term. It would have been clearly unethical to continue to deny
the control group the intervention.

~~~
watty
Sounds interesting, source?

~~~
mncharity
Story told by Edward Prather (Arizona)[1] at MIT[2]. I failed to quickly find
an obvious publication.

My recollection is the course was elsewhere, he was invited to lecture
(astronomy education improvement is his thing), and said let's instead set it
up as a trial, and use this student instead of me.

[1]
[https://profiles.arizona.edu/person/eprather](https://profiles.arizona.edu/person/eprather)
[2]
[http://web.mit.edu/physics/events/colloquia.html](http://web.mit.edu/physics/events/colloquia.html)
May 11, 2017, but this link may rot soon.

EDIT: I should amend "inexperienced postdoc" with "who was trained in active
learning instruction, and prepared the course with a highly-experienced
astronomy education researcher". Because a key issue with active learning is
that doing it well, and thus deploying it rapidly, is hard.

------
noddy1
MD here - I remember leaving a lecture theatre after 8 hours of didactic
lectures, and I could not remember the topic of any of the lectures other than
the one i'd just seen, and I could not remember a single fact from any of
them. I persisted with the lectures as that seemed to be what was expected of
us, however it generally seemed like lectures are there to suit faculty rather
than students.

When it came to actual hardcore study for board and specialty exams, I used
100% active recall testing with flashcards with variable repetition based on
performance (Anki mainly). I never had any problems passing anything.

I believe an excellent, underutilized way medicine could be taught would be
computer based simulation of emergency dept patient presentations, with the
player taking a history, performing an investigation and labs, and making
decisions +/\- referring patient as appropriate.

------
medymed
Minimum viable US medical school (in theory):

Prerequisites: High school AP bio/Chem/physics/stats. College biochemistry.

Standard interview process.

Preclinical: 1.5 years of online instruction and drilling (UsmleWORLD,
firecracker, Pathoma etc) for USMLE 1. Cost ~$500 per year.

1.5-2 years clinical rotations. Cost: at current yearly tuition.

Then graduate, residency.

~~~
pmiller2
That's a reasonable approximation of PA school:
publichealth.tufts.edu/Academics/Physician-Assistant-Program/Curriculum

~~~
tbihl
Only when looked at from the craziness of medical school. Tuition: $42k/year
(similar to most PA schools, though a few have better in-state pricing)
[http://publichealth.tufts.edu/Admissions/Financing-Your-
Educ...](http://publichealth.tufts.edu/Admissions/Financing-Your-
Education/Program-Costs/PA-Program-Total-Annual-Estimated-Costs)

Also, "All academic coursework AND a bachelor's degree from an accredited
university/college must be completed before submitting an application to the
PA Program". A bachelor's degree is such a painful gatekeeper: four years of
opportunity cost in addition to steep tuition. I'm not going to argue that
undergrad is strictly vocational in purpose, but many students view it as such
and thus get nothing further from it.

------
MengerSponge
Good! Lectures are terrible for students. It's fun and pretty easy to give a
lecture though, which is why they persist.

This is a great example of a "flipped classroom", which is gaining traction
across American higher-ed. A lot of research went into developing the SCALE-UP
paradigm, which is a great place to start if you're curious:

[https://en.wikipedia.org/wiki/SCALE-UP](https://en.wikipedia.org/wiki/SCALE-
UP)

~~~
maxxxxx
I am glad I didn't have to study that way. I am notoriously bad at
"collaborative learning" in team settings. I probably wouldn't have learned
anything in school.

~~~
watwut
Collaborative learning means less individual problem solving. The moment there
is someone a bit faster then you in the group, the less occasion to think you
have.

~~~
maxxxxx
It's not even about someone being faster but just different. That together
with some people being dominant I would probably contribute nothing to the
group because my approach is often different.

------
roceasta
[http://compleatlecturer.blogspot.co.uk/2017/06/the-
compleat-...](http://compleatlecturer.blogspot.co.uk/2017/06/the-compleat-
lecturer.html)

Historically the original mode of lecturing was simply the transcription by
the students of the manuscript the lecturer was reading.

------
whatupmd
At the University I attended most of the lecturers did not know how to teach.

So yea, you'd probably get better results from some system designed by good
teachers that could then be replicated without requiring the talent that
produced it on a regular basis.

But I'm sure that same training/workshop would be a much better experience
when delivered by the minds that created it than a robot that is just
repeating the steps.

When I went to University what I wanted was knowledge-sharing by subject
matter experts with a passion for teaching. What I got in most cases was
researchers that were reading from a script and essentially ticking the boxes
of the course outline.

A well designed 'active learning' session is going to have value to students
for the same reason a well designed lecture will, it was created by someone
with the ability to teach.

------
edtechdev
It's always interesting how many commentors' intuitions about education are
completely opposite of what research shows.

Active learning has been shown in hundreds of studies to be superior to
traditional lecture-based instruction. Here's a recent meta-analysis:
[http://www.sciencemag.org/news/2014/05/lectures-arent-
just-b...](http://www.sciencemag.org/news/2014/05/lectures-arent-just-boring-
theyre-ineffective-too-study-finds)
[http://www.pnas.org/content/111/23/8410](http://www.pnas.org/content/111/23/8410)

And you don't need to learn from lecture 'first' to 'prepare' you for
subsequent group learning or real-world learning. In fact, the opposite has
been shown in research studies. Let students get their hands dirty with some
field experience or try out a simulation even though they aren't quite ready
for it yet or try to figure out some data, etc., and then when they receive a
lecture on a related topic afterward, they will learn much more from it,
because they can relate it back to their previous experience. They have a
_reason_ to listen to the lecture, rather than just trying to listen and
memorize for a some future test or experience they know or care little about.
Several studies have compared for example giving a lecture first followed by a
simulation or other experience, vs. the other way around. And lecture-first is
always inferior. See for example research on productive failure. Here are some
examples: [http://ideas.time.com/2012/04/25/why-floundering-is-
good/](http://ideas.time.com/2012/04/25/why-floundering-is-good/)
[https://ww2.kqed.org/mindshift/2016/04/19/how-productive-
fai...](https://ww2.kqed.org/mindshift/2016/04/19/how-productive-failure-for-
students-can-help-lessons-stick/) [https://bulletproofmusician.com/productive-
failure-how-strat...](https://bulletproofmusician.com/productive-failure-how-
strategic-failure-in-the-short-term-can-lead-to-greater-success-and-learning-
down-the-road/) [http://manukapur.com/productive-
failure/](http://manukapur.com/productive-failure/)

------
manbearpigg
It depends what you're studying.

I did part of my computer science degree on campus with lectures that I didn't
find useful. In one ear out the other. I have to slow down at some parts but
can zip through other parts, but a lecture is steady paced. Huge number of
hours wasted.

I did part of my degree at distance. The profs chose great textbooks and it
was much better. It's always there as a reference and I can go at my exact
pace.

I can imagine though that history or something might require lectures. You
don't just give the kids obscure books with no context. For computer science
though, an intro to algorithms textbook is pretty straight forward.

------
jonbarker
In my own experience learning and teaching Go and Bridge, two very complex
subjects, a combination of lectures and interactive examples is best.

------
ajarmst
This is interesting, but it depends on the proposition that "active learning"
is clearly better than more traditional education methods. That's not nearly
as plain or uncontroversial as the article implies.

One issue is that when educational techniques are compared, it is troublingly
common for the comparison to be between simplistic and homogenous definitions
that are only rarely encountered in real classrooms. Educators and non-trivial
courses that depend entirely on lectures or entirely on active exercises are
so rare they statistically don't exist. Every class I've taken, taught or
observed was a blend of multiple types of learning and instruction,
distinctions being ones of emphasis, not of type.

The article also seems to assume that there is a best, or at least better, way
to teach that is independant of how individual students learn or what
particular topic or discipline is being taught. That's, to be frank,
ludicrous. It's been clear for a very long time that appropriate and effective
educational approaches depend a great deal on what is being taught and who
it's being taught to. For example, imagine teaching history without lectures,
or programming without hands-on activities.

Good educators tailor the mix of approaches to their particular students and
topics. I'm baffled why any educator would support the idea that lectures
should be completely eradicated. Why not, instead, take a hard look at the
curriculum and mode of instruction with an interest in determining the best
approach for the most students and then trust your faculty to make appropriate
choices on how to tailor it to a class---with the odd lecture once in a while
if it's useful. If they've got a problem with some courses or educators
depending on lectures to the detriment of students, the solution is to
redevelop the curriculum and train the educator on different techniques---not
to just outright ban one approach.

Medical students are generally top students that are highly motivated.
Further, cohorts tend to be in all the same classes with each other,
encouraging mutual support. Those traits, along with medical education being
task focussed, argue for active learning approaches. But that isn't true of,
say, freshman English.

Finally, there has always been a circular definition problem with new
educational approaches. For example, "active learning" often seems to have an
implicit definition along the lines of "self-directed exploration that _is
sucessful_ ". If you tried it and it wasn't effective, then what you were
doing wasn't active learning, QED.

~~~
ajarmst
Addendum: there's also a definition problem with "lecture". Pretty much any
educator will tell you that they encourage---actively wish for---questions
from and conversations with students during a lecture. Passive lectures
without interaction tend to happen mostly in giant lecture theatres. In that
case, the problem isn't lectures: it's class size.

------
plg
hasn't McMaster (in Hamilton Ont. Canada) done this for ... decades?

~~~
pragone
Yes, they invented the "problem-based learning" method/style, I do believe.

------
gaius
Note to self: don't get sick in Vermont.

------
HillaryBriss
> _" OK, if you like doing appendectomies using an old method because you like
> it, and you're really good at it, but it's really not the best method for
> the patient, would you do it?" Of course, the answer is always no. And then
> you turn around and say, "Well this method of teaching is actually not as
> good as other methods. Would you do that?"_

it's just teaching. which method pays more?

