Med School: Can the Lecture!

Medical students frequently see patients with us in our office.   Their presence is welcome, if for no other reason than it makes us think young.

A second year student has been coming to our office for over a year and is excited about a future taking care of cancer patients.  She just completed the Hematology and Oncology section of lectures at the med school.  I asked her how it went.  “Frankly, “ she said, in the articulate way of the highly educated, “it sucked.”

I was astonished. How could such an exciting, complex and rapidly evolving field, yield teaching that would cause a motivated student to take such umbrage?   Too much information?  Too complex a topic?  Too much difficulty in the exams?  “No,” she said, it lacked “too” of anything.

It was not organized, not at the appropriate level, rambling and incomplete.  Without reviewing the critical information in texts and online, she would have learned little and the entire class would have failed the subsequent tests.

In a huff, wanting to assure that we not lose a crop of budding oncologists, I swore to find the cause of this didactic discord.  Surely, it must be possible to put together a set of clear, complete, cancer and blood lectures, so that the students were not only taught, but inspired.   Somehow, we would fix those lagging lectures.  But, then it occurred to me, why?

There are 141 medical schools in the United States, 2372 in the world. They teach 20,055 students in North America and hundreds of thousands around the globe.  In every school, every state, and country, they all teach about cancer.  In every school, cancer is the exact same disease.  On every continent, the possible treatments are the same. 

Therefore, why in the world do students listen to different lectures by different teachers on the exact same subject?

Why use the lecture hall format in medical school?  Why not find a few super-experts to write one perfect lecture, and then record that lecture one perfect time, given by a brilliant, inspiring, articulate educator (with translations)?

Done, once and perfect for every medical student to hear, at any time, at any pace, as many times as they need or wish.

Of course, this is just the beginning.  Watching that “perfect” lecture on a DVD or even a video stream is so 20th Century.  Each lecture should be placed into an interactive computer program, interlaced with examples of real biology, physiology and pathology, and the software should track each student’s understanding, re-teaching to weakness and reinforcing key concepts.

This would allow students to learn not only the vital basics, but assist exceptional or inspired students to delve deep into esoteric concepts.

There are already thousands of examples of high quality digital learning. Dr. Bryan Vartabedian, MD in his blog 33Charts this week, introduced ReelDx.  This is a semi-interactive video teaching tool for pediatrics. It shows actual patients and builds lessons around their experience in the context of their illness. Such instruction encourages retention by showing examples of each disease and allowing the student to collaborate with the program to learn about illness and treatment.

The TED series of online speeches shows what can be achieved when gifted instructors teach difficult topics.  The Ulm School in Germany teaches a two years Masters in Oncology, 80% of which is online.  Emmi produces interactive online teaching for patients, covering hundreds of different conditions and treatments. Research to Practice keeps practicing oncologists informed with innovative online mini-conferences, which are available in the evening after office hours.

The UpToDate medical database is the go-to-source for professional health information.  Surgeons learn robotic surgery on robotic simulators, even as airline pilots learn in to fly, solidly on the ground before rising an inch into the sky. You can learn conversational Italian, or 33 other languages, in a couple weeks, an hour a day, using Rosetta Stone.  WithYouTube, you can find someone to teach you anything.

Computer assisted teaching will transform all of education.  It allows immediate adjustment to each student’s needs, as apposed to a lecture format, which if there is more than one student listening, is already ahead or behind at least half the class.  E-learning can guarantee that nothing of value is missed.

It can detect gaps in knowledge quickly, not needing to wait for a quickly forgotten test, weeks too late. It can be modified easily and universally with advances in knowledge. It is cost efficient, effective and would allow senior physicians to spend their teaching time focused on analysis, real world decisions, the physician-patient relationship and critical manual skills.

Medical teaching must be of the highest possible standard.  Therefore, it should lead the charge to digital learning. We cannot afford to waste energy, time and dollars, boring our brightest students with inept education.  It is time to can the lecture.

James C. Salwitz, MD is a medical oncologist in private practice for 25 years, and a clinical professor at Robert Wood Johnson Medical School. He frequently lectures at the Medical School and in the community on topics related to cancer care, Hospice and Palliative Medicine. Dr. Salwitz blogs at Sunrise Rounds in order to help provide an understanding of cancer.

4 replies »

  1. My father in law went to medical school in the 1960’s. It was 4 years. I went to medical school 1997-2001, also 4 years. Wouldn’t we say that between the 1960’s and the 1990’s, medical knowledge has grown exponentially? Yet, the same amount of time is given to learn a great deal more material. Therefore, I can attest that teaching in the mid to late 1990’s SUCKED HORRIBLY! It was all about jamming material in one’s poor brain for either the next test or Step 1, as opposed to nurturing a passion.

    If not for the necessity of economics, shouldn’t med school be 10 years instead of 4? Would that improve the number of us that don’t burn out? I’m 7 years out of fellowship, and I’m looking to transition out of clinical medicine because my most inspired day was the day before medical school, and since then, it has simply been a mission to defend myself. In medical school, it was to defend myself from exams. In residency, it was to defend myself from attending egos (I learned that the most important thing in the world was to treat the attending). After training, it is to defend myself from lawsuits. If I had only had an inspiring medical education, even just a single class that gave me the luxury of time and exploration, I might have something I could hold on to.

  2. Agree completely. The retention is low with the lectures. I learned 5x as much in my 3rd year of med school alone than I did in the years preceding it (incuding the pre-med years). We know that people learn better by doing and using but we are still relying on lectures. Hopefully some innovative schools will start moving in that direction so that we can see how it works.

  3. A few of the lectures I attended in Med School (1970s) were excellent. Some were good. Some were average. Quite a few were terrible.

    And we learned from this. During the beginning of the first year, attendance was 100%. By the end of the second year attendance had dropped to less than 50% – much less.

    Some of the top students in my class never went to class. They stayed home, read the notes, read texts and other material. ( I actually went to a lot of classes because I learned well by listening.)

    You are absolutely right, there is no need to have lectures from faculty on material that is standard stuff. Pre-recorded lectures, You Tube Videos, DVDs, etc. would do just as well – and at a lower cost.

    The faculty is needed for the non-standard stuff; evaluation of difficult situation that don’t fit a simple category, patients with multiple conflicting problems, etc.

  4. James,

    Interesting post. I get that this is a theoretic thing. Let’s take this a step further. If you were designing an online course what MOOC lecturers would you include? But let’s take it a step farther. Sounds like you’ve poked around MOOC a bit —

    If not, just going by reputation, who would you select — if you were pulling together a “dream team”?