Thursday, 3 May 2012

Lecture Halls without Lectures — A Proposal for Medical Education

If you are a medical educationalist or are interested in medical education you should read this article:

Prober & Heath. Lecture Halls without Lectures — A Proposal for Medical Education. | N Engl J Med 2012;366:1657-1659.

Some extracts:

"It’s time to change the way we educate doctors. Since the hours available in a day have not increased to accommodate the expanded medical canon, we have only one realistic alternative: make better use of our students’ time."

"As Sir William Osler aptly said, “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” Yet conversations with medical students about the first-year medical curriculum reveal that about half of lectures proceed without even the briefest example involving patients."

".... rather than a standard lecture-based format, the instructors provided short online presentations. Class time was used for interactive discussions of clinical vignettes highlighting the biochemical bases of various diseases. The proportion of student course reviews that were positive increased substantially from the previous year. And the percentage of students who attended class shot up from about 30% to 80% — even though class attendance was optional."

"I am an old convert! Lectures are the worst platform for teaching; they encourage passive learning and turn medical students into zombies. When I was a 3rd year medical student I got so despondent with my pathology lecturer, who essentially was rehashing what he had written in his published book of pathology lecture notes, that I stopped going to pathology lectures. I spent the time learning pathology myself in the library using a text book and other sources. This made me an active learner. When something interested me, for example the pathology of the thymus, I asked the pathology tutors to show me thymic sections in our pathology practicals; pathology of the thymus was not in our syllabus. I won the pathology prize that year, with a mark that was nearly 10% higher than the second best student. After my pathology viva the head of pathology summoned me to a meeting to find out why I had done so well in my pathology exams and to encourage me to do an intercalated BSc in pathology, with a further option of a follow-on intercalated PhD. Needless to say I did not take up his offer, but I did stop going to medical school lectures. Not attending lectures turned me into an active learner, which was the main reason I did well at medical school.  I only attended lectures when the lecturer had an established reputation for giving inspirational talks; these were few and far between." 

"In short  this paper suggests doing away with classic lectures and using the time instead to encourage active, rather than passive, learning, around clinical cases. Becoming an active learner and putting patients at the center of your learning experience will change your life. It will also make you a neurophile. Try it!"


  1. Definitely agree that Prober and Heath's article is worth reading, but would like to point out that the above model (which is not part of the article) is incorrect.

    See the links on this page:
    The Learning Pyramid Deception