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U.S. medical schools' valuing of curriculum time: self-directed learning versus lectures.

BACKGROUND: As medical schools implement curriculum changes to address the relevancy of medical education to today's health care needs, examining schools' grading systems and their valuing of curriculum hours has become a priority. METHOD: In 1991-92 all 126 U.S. medical schools were surveyed regarding various issues related to the schools' grading systems and valuing of curriculum time, including the ways in which the schools achieved a balance between lectures and self-directed learning activities. RESULTS: A total of 122 schools responded. Forty-eight schools calculated grade-point averages and used them to compute and publish class ranks; 72 published grade-point averages. Fifty schools reported curriculum revisions that decreased lecture hours, incorporated small-group discussion, or used problem-based learning and/or assessments using standardized patients. These 50 schools fell into four categories: had a system to balance lecture time and self-directed learning (11 schools); were moving toward such a system (27 schools); had tried but failed to balance lecture time and self-directed learning (one school); and had no policy to achieve a balance (11 schools). CONCLUSION: The survey results indicate that most schools have not established systems for the valuing of curriculum time that include balancing values for lecture time and values for self-directed learning. If needed curriculum reforms are to be implemented effectively, they must be valued meaningfully.

Curriculum↗

Diagnostic image use by nonradiologist lecturers in an introductory clinical medicine course.

RATIONALE AND OBJECTIVES: A curriculum-tracking study was designed to determine the type and amount of diagnostic imaging used by nonradiologists teaching an Introduction to Clinical Medicine (ICM) course to second-year medical students. METHODS: Two second-year medical students independently recorded the type and number of images shown, the length of the lecture, the departmental affiliation of the lecturer, and the amount of time devoted to either didactic radiology or radiologic images during each of 288 lectures in the 1990 ICM course. RESULTS: A total of 35.2% of the lectures presented some type of diagnostic image, and 7.0% of all lecture time was devoted to radiology. No mammography or diagnostic nonangiographic interventional images were shown. CONCLUSIONS: The results suggest that a more consistent and uniform presentation of diagnostic images across disciplines is required, emphasizing the need for more coordination of radiology instruction through consultation with the Department of Radiology.

Clinical Medicine↗

Are audiotapes cheaper than lectures?

First year pre-clinical medical students were taught about blood grouping and haemostasis using four audiotapes and associated booklets as the sole method of formal instruction. The audiotapes were readily accepted by the great majority of students as a replacement for lectures and those who listened to the tapes scored significantly higher in a multiple choice test 10 months later than did a previous years's student who had covered the same topics by means of lectures. If booklets are provided for each student, tapes are more expensive than lectures in terms of the time and running costs involved. By contrast, if booklets are sold or made available on loan with the audiotapes, then costs become equivalent when tapes are distributed to four to six average-sized medical schools and become increasingly cheaper as the number distributed increases. Other less readily quantifiable benefits of audiotape learning are discussed and it is concluded that in terms of both costs and effectiveness of learning, audiotapes can usefully replace a proportion of lectures in a conventional course. Consideration should be given to the provision of more space for audiotape tuition and less for formal lectures.

Audiovisual Aids↗

Videotaped vs traditional lectures for medical students.

Closed-circuit television (CCTV) provides medical departments with alternatives in instructional formats. Concern, however, has been voiced about teaching via TV because the medium itself might cause inattention. This study investigated whether TV will lower the test scores of medical students. Sixty-one students were randomly divided into two groups. The lecture (control) group received the information via traditional lectures, including use of 2" X 2" transparencies. The video group received concurrently the same information via CCTV. Multiple-choice examinations were given after each of the six sessions. The cumulative mean scores were similar: lecture group=87.56%, video group=87.99%, i.e., no significant difference (P=0.77). To detect attitudinal differences toward the two formats, the students were surveyed at the end of the series and intragroup agreement on specific questions was calculated. The students rated the lecture format more highly. In response to the question 'Did the audiovisual materials used by the instructor aid your learning?', the mean rating from the lecture group was 7.37 (scale of 0-9) compared to a mean rating of 5.93 from the video group (P < 0.0003).

Education, Medical, Undergraduate↗

The role of lectures in veterinary education.

OBJECTIVE: To study the role of lectures from the perspective of staff and students involved in the veterinary course at The University of Queensland. METHODS: The Nominal Group Technique of Delbecq et al, which provides the maximum opportunity for group members to put forward points, was used to help develop a questionnaire which was completed by 351 students (a response rate of 84%) and 35 staff (76%) from the five years of the veterinary course, and was analysed using the SAS System for Windows. RESULTS: Almost all the staff and students agreed that lectures should fulfil many roles including stimulating and motivating students and encouraging them to think, as well as presenting ideas and concepts and an indication of the structure and relevance of the material. They should provide a guide for effective deep learning, but not encourage rote (or superficial) learning. A smaller percentage of staff and even fewer students agreed that lectures did fulfil these roles, especially those directed at encouraging students to look beyond simple memorisation of facts. The perceived disparity between reality and the ideal was greater amongst the older, clinical students than amongst their more junior colleagues. CONCLUSIONS: The focus of attention in lectures needs to change from the superficial, rote learning of information to deep, active learning directed at using information to solve problems that are perceived by the students to be relevant. If done in a stimulating and interesting way, this should develop skills in reasoning and critical analysis as well as providing a framework for storage and recall. It should also increase the motivation towards learning both during the veterinary course, and over the professional lifetime. Furthermore, the place of the lecture in veterinary education needs to be reassessed regularly in the face of newly-emerging educational technology.

Adolescent↗

The role of handouts, note-taking and overhead transparencies in veterinary science lectures.

OBJECTIVE: To study student and staff views of the role and use of handouts, note-taking and overhead transparencies in veterinary science lectures at the University of Queensland METHODS: The Nominal Group Technique was used to help develop a questionnaire, which was completed by 351 students (a response rate of 84%) and 35 staff (76%) from the 5 years of the veterinary course. The data were analysed using the SAS statistical computer package. RESULTS: Staff and students held different views as to the frequency with which handouts should be used, their educational value, and whether they should be complete or partial. Fewer students than staff agreed that handouts discourage further reading in a subject. Almost all staff and students saw the central functions of note-taking to be provision of notes for subsequent revision and encoding information given by the lecturer. More students than staff however, considered that note-taking in lectures interferes with understanding. Staff and students held similar views as to the uses of overheads in lectures. Interestingly however, more staff than students agreed that overheads often contain too much information. CONCLUSION: Both students and staff saw the central role of note-taking as providing a set of good notes for revision. Generally students preferred that this information be provided in the form of partial or complete handouts, while staff preferred students to take notes and to read outside lectures. Surprisingly, more staff than students felt that overhead transparencies often contained too much information. Note-taking, handouts and overhead transparencies need to be linked in a coherent educational strategy to promote effective learning.

Adult↗

Using situational physiology in a didactic lecture setting.

This project used the approach of "human situations" to teach about the cardiovascular system within an undergraduate physiology course (PGY 412). About two-thirds of the students had previously taken a college-level physiology course (sophisticated), whereas one-third had not (naive). Nine didactic lectures were organized around the common human situations of orthostasis, blood donation, and exercise. For acceptance evaluation, the students were given a questionnaire consisting of six expectation statements (e.g., compared with other life science courses, I expect that I will better understand the material) and asked to rate the degree to which they agreed with each statement on a scale of 1 to 5. On completion of the lectures, the students were given a questionnaire asking them to compare experiences with expectations. Experiences were significantly less than expectations for naive (P < 0.05) but not for sophisticated students. On a scale of 1 to 5, sophisticated students preferred the situations approach more than did naive students (3.1 vs 2.4; P < 0.066). For performance evaluation, the students were given a set of questions used by the author in a previous PGY 412 course presented by traditional didactic lectures. There were no significant differences between present and previous scores (77 vs. 79%; P > 0.16). Furthermore, there were no significant differences between naive and sophisticated students in cardiovascular examination scores (P > 0.608) or in total course scores (P > 0.523). These results indicate that didactic lectures based on situational physiology will yield a performance outcome equivalent to traditional lectures. However, naive students may have difficulty with the procedure and require extra attention.

Education, Medical↗

Role of the lecturer practitioner in learning disability nursing.

The BA (Hons) Nursing course at Oxford Brookes University aims to develop reflective practitioners. The role of the lecturer practitioner has become established in order to bridge the theory-practice divide. Lecturer practitioners contribute to the common foundation programme in years 1-2 and to the specialist branch in years 3-4. Lecturer practitioners facilitate learning by working with students and mentors in practical and theoretical settings. Learning contracts containing evidence of achievement are used by students as a focus for reflection and demonstration of clinical competence. Lecturer practitioners have core responsibilities in their practice areas, e.g. practice input and formulation of policies, and in the School of Health Care Studies, e.g. module leadership and committee membership. In the field of learning disability, lecturer practitioners have contributed to the dissemination of ideas and developments locally and nationally. These include leadership of the Clinical Practice Development Unit and presentation of research papers and information about services in Oxfordshire at national conferences.

Humans↗

How can the clinical credibility of nurse lecturers be improved?: 2.

The movement of nurse education into the university sector has put further tension on the theory-practice gap and the clinical credibility of nursing lecturers. If the ideal is for the lecturer to guide the learner in applying theory to practice and vice versa (Jarvis and Gibson, 1985), this can only realistically be achieved if lecturers of nursing have experience as practitioners within the field(s) they teach and are viewed as being clinically credible (ENB, 1996). In the first article (Vol 7(8): 490-2) an innovative way of enabling lecturers of nursing to engage in practice was presented. In this second article a variety of other approaches which enable lecturers to engage in clinical practice will be explored.

Clinical Competence↗

An evaluation of the impact of lecturer practitioners on learning.

The aim of this study was to determine if nursing diploma students recognized a difference in the nature of classroom teaching between lecturer practitioners and university-based senior lecturers in nursing. The study generated both qualitative and quantitative data from a sample of 117 student nurses completing an elderly care module. Analysis of the data suggested that the students associate lecturer practitioners with a realistic, evidence-based presentation of contemporary nursing practice, which they found both academically liberating, and efficacious to their practical training. Such associations were less apparent when analysing student responses to senior lecturer teaching. The study underlines the potential of lecturer practitioners to make a positive and far-reaching contribution to the future of nurse education.

Attitude of Health Personnel↗

Handouts: making the lecture portable.

Previous medical literature on preparing lecture handouts has focused on their use in student education, where as part of a course there is a series of lectures followed by an examination. Conversely, resident and practising physicians usually attend single lectures on individual topics in order to update and improve their clinical skills. Handouts designed for the latter type of lecture can serve as a useful resource in subsequent day-to-day teaching and patient care. This article examines the purpose, distribution, structure, and substance of such handouts. Guidelines to assist the speaker in preparing lecture handouts are discussed.

Education, Medical↗

Pilot investigation of the utility of a student response system in medical student lectures.

An evaluation of a student response system was undertaken to investigate its effect on lectures. Use of the system in lectures at the University of Wales College of Medicine (UWCM) was observed for a trial period. Analyses of these observations, and the opinions of lecturers and students who used the system suggest that the system improves upon the 'conventional' lecture in various ways. Such benefits, and some limitations, are discussed. It is suggested that student response systems such as the one described may be a step towards making 'the lecture' a more effective medium for teaching.

Attention↗

Computer versus lecture: a comparison of two methods of teaching oral medication administration in a nursing skills laboratory.

The purpose of this study was to compare the effectiveness of both an interactive, multimedia CD-ROM and a traditional lecture for teaching oral medication administration to nursing students. A randomized pretest/posttest experimental design was used. Forty-two junior baccalaureate nursing students beginning their fundamentals nursing course were recruited for this study at a large university in the midwestern United States. The students ranged in age from 19 to 45. Seventy-three percent reported having average computer skills and experience, while 15% reported poor to below average skills. Two methods were compared for teaching oral medication administration--a scripted lecture with black and white overhead transparencies, in addition to an 18-minute videotape on medication administration, and an interactive, multimedia CD-ROM program, covering the same content. There were no significant (p < .05) baseline differences between the computer and lecture groups by education or computer skills. Results showed significant differences between the two groups in cognitive gains and student satisfaction (p = .01), with the computer group demonstrating higher student satisfaction and more cognitive gains than the lecture group. The groups were similar in their ability to demonstrate the skill correctly. Importantly, time on task using the CD-ROM was less, with 96% of the learners completing the program in 2 hours or less, compared to 3 hours of class time for the lecture group.

Administration, Oral↗

[Attitude of seniors to rationing in health care--before and after a lecture series].

UNLABELLED: Prior to the first lecture in the public series of lectures entitled "Rationing of Health Care: Are Elderly the Victims?" and before a lecture given to a Senior Citizens Association on the same subject, all participants were polled. The polling was repeated at the end of the lecture series. The initial participation totalled 69 with two-thirds women, average age 64 years (50% were from the health care or social welfare sector), and 57 retired business people (50% women). At the end, there were 45 listeners (average age 65 years), with 30 taking part in both surveys. The majority believed that rationing is already taking place, only 1/6 rejected such measures in principle. When asked, nearly all those surveyed were in favor of quality of life after treatment and life expectancy as criteria for the right to medical services. Personal criteria, such as nationality, social role, self-related causes and calendar age were rejected by the majority, although less clearly by the business people than by the general participants. This rejection became more marked after the lecture series. Those surveyed gave various specific judgements on decisions about the complex allocation of resources and favored decision-making by patients themselves unless they were senile. A large minority were opposed to very elderly patients making decisions themselves, even if they were not senile. CONCLUSION: The elderly persons polled demand that all rationalization measures be exploited before rationing is implemented. Rationing criteria must be of a universal nature and borne by the general public.

Adult↗

[Honorary lecturers in dentistry (1848-1951)].

On the Faculty of Medicine of Pest, respectively Budapest University, were 29 honorary lecturer dentists between 1848 and 1951. On the Faculties of Medicine of Universities of Kolozsvár, Szeged, Debrecen and Pécs there were 8 honorary lecturer dentists. In 1951 the communist regime abolished the institution of honorary lecturer and forbade honorary lecturers from using their titles. The paper lists the data of Hungarian honorary lecturer dentists.

Education, Dental↗

[Windmill principle versus clockwork principle--tradition and interaction in academic lectures. A. N. S. A. Radiologica].

In reply to depersonalization of teaching, students hiding behind anonymity and their decreasing effective presence in campus life, academic teaching has to become practice-oriented, attractive and at least more effective. The traditional teacher-based lecture competes with student-centered and issue-related academic events like problem-based learning, thus, concerning student-teacher interaction. The model of a clockwork represents the components of a traditional lecture. The model of a windmill is suitable for explaining synergistic effects in scope and experience during an interaction concerned lecture. An example of student-teacher interaction and students' activation even in a preclinical course of lectures on anatomy and radiology is given. A high response and acceptance of the lecture is assured by structure-and process-oriented features.

Anatomy↗

A comparison of educational interventions. Multimedia textbook, standard lecture, and printed textbook.

OBJECTIVE: To compare the instructional effectiveness and efficiency of a pediatric multimedia textbook (MMTB) with that of a standard lecture and of a printed textbook in a prospective, interinstitutional study. DESIGN: Randomized, prospective cohort. SETTINGS: An urban and a rural medical school affiliated with tertiary care hospitals. POPULATION: Third- and fourth-year medical students from June 1992 to June 1993. INTERVENTIONS/OUTCOME MEASURES: Students were randomized to one of four treatment groups: (1) computer-aided instruction with MMTBs (n = 39), (2) traditional lecture (n = 39), (3) printed textbook (n = 39), or (4) a control group (n = 62). Only the control group was pretested. Following their randomized instruction, all groups were tested via a 26-question multiple-choice test. Statistical analysis was accomplished by analysis of variance of mean post-test scores. The amount of time that students spent with each educational intervention was recorded. RESULTS: Three hundred two students were eligible for the study, 267 entered the study, and 179 completed the study. The instructional effectiveness of the MMTB was greater than that of the lecture (P < .05), and it was the same as that of the printed textbook. All instructional methods were more effective than the control group (P < .05). The instructional efficiency of the MMTB was equal to that of the lecture and of the printed textbook. The subjective response to the MMTB instruction was positive. CONCLUSION: The MMTBs constitute an educationally sound alternative instructional method and have a promising future in medical education.

Adult↗

The impact of a lecture on AIDS on knowledge, attitudes and beliefs of male school-age adolescents in the Asir Region of southwestern Saudi Arabia.

The aim of this study was to assess the levels of knowledge, attitudes and beliefs and AIDS among secondary school students in the Asir Region of Southwestern Saudi Arabia, and to assess the impact of a one-session AIDS education lecture given in some schools in the region during World AIDS Day, December 1992. An Arabic version of a previously reported self-administered questionnaire including factual and attitudinal items about AIDS was constructed. The questionnaire was given to two randomly selected groups of students; an experimental group of 335 students who had been exposed to a one-session lecture program about AIDS, and a control group of 503 students not previously exposed to the lecture. The results showed marked variability in correct responses to various specific items within and between groups. However, overall, 65% of the experimental group and 63% of the control group gave correct responses (P=0.517). Both groups were particularly less aware that casual contact cannot spread AIDS. However, fear of getting AIDS was significantly less among the experimental than among the control group (47% versus 58%, P = 0.011). Student knowledge about AIDS is inadequate, and the impact of an isolated one-session AIDS education lecture is less than satisfactory. AIDS education through a comprehensive school health program is recommended.

Acquired Immunodeficiency Syndrome↗