Thursday, February 20, 2014

6 things to make your medical school lectures better

So, I realize that many schools are trying to minimize lecture hours, but the truth is that this modality will not likely ever go away completely.  As such, I've made a draft of some guidelines for lecturers in the course I co-direct based on common mistakes I've seen.  Implicit in these guidelines is the idea that I have a lot of rotating lecturers, and some of these issues can be avoided by decreasing volume of presenters.  However, we're stuck in a cycle where I can't really easily change that in the next year.  Please share in the comments if you have other things I haven't addressed.

*Note - NSB stands for neuroscience and behavior -a 9 week introductory course on neuroanatomy, neurophysiology with and some clinical neurology, psychiatry, and neurosurgery.

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NSB lecturer guide:
Please adhere to the following guidelines when giving lectures for NSB.  These are general trends which I have noticed over the last few years in terms of best practices and things to avoid if possible.  In general, please remember that these are students who have spent the last year and a half going to lots of lectures.  Things which seem trivial to you as you only do one or two lectures, for them are agonizing as they see these issues over and over again for two years.

1)            Do look over the slides of lecturers who are talking about related topics to your lecturer.
- Helps a lot with keeping continuity through the course.  It would be nice to not have you say, “I’m not sure if you have been over this before or not.”  If you are not sure, please look it up or ask.

2)            Don’t ever say, “This will not be on the test.” 
- Sometimes it is a minor point in your lecture, but it is a major point in a prior lecture (again why it helps to talk to others) or a later lecture (maybe even in the next block).  OK to say, “This is a minor point for the purposes of this lecture,” or “For this lecture, this is primarily FYI.”  We tell the students that everything mentioned in class is potentially testable.  If you don’t want us to potentially test it, don’t mention it at all.  If you must say this, talk to the course director to be sure it REALLY will not be on the test.

3)            Try to stay away from disclosure slide jokes.
- The first person who puts up the “I am actively looking for people to give me money so I can disclose it” slide is funny.  The next five are not so much.

4)            Please know how much time your lecture is scheduled for, and try to stick to that.
- Our general lecture block time is 50 minutes.  In general, we plan our lectures to end 10 minutes prior to the next lecture.  So if your lecture is at 10, you should plan to be done by 10:50.  If you bleed over, this makes everyone behind you have to modify their talks.  If you have a lot of slides left, and are running short on time, consider stopping where you are at, and recording the end of the lecture to be posted online.
- If you are the last lecturer of the day, it is OK to keep going (within reason).  However, please announce that it is OK for students who need to leave to be able to get up and go.  Some students have tight commute times to get to community preceptor sites by 1 PM or have to walk across campus to do OSCE testing over the noon hour.  Also keep in mind that there are noon talks which occur periodically in the lecture hall.

5)            If you are not skilled at PP or basic functions of the audio/visual equipment, please learn minimum functions.
- For PP, you should be able to start and stop your presentation, restart  from the middle of a presentation, go backwards and forwards using only keyboard, understand what the purpose of a right click is, start and stop video presentations, be able to disengage auto-advancing of slides.
- For A/V, you should be able to turn on and off overhead projector, mute/ unmute the screen, turn on/off the mic,  Turn mic up/ down using front panel controls.
- If you are uncomfortable with this, talk to TSO, and they can help you learn how to do these things.

6)            Do feel free to experiment with audience participation techniques.
- Using clickers for in-lecture quizzing, use of pause for students to work through a problem together, and other techniques are great ways to get students involved in the lecture.

Friday, December 13, 2013

Does a practicing physician need to be in the primary literature?

This post is more of a thought experiment than a suggestion for a new policy statement for medical education.  So, please understand part of why I'm putting this question up is to get you all to think a bit about this concept.

The underlying theme I've heard over and over ever since I was a resident was that getting data from a primary source was better than an aggregate source.  The idea was that everybody is much better off seeing the primary data for themselves, and then coming to their own conclusion on whether it applies to their individual patient or not.  Thus, when a student or a resident brings in some medical literature for the team to review, there are more  'points' awarded if the literature is a randomized-controlled trial or a case report, than a printout of 'UpToDate'.  I've heard one of my colleagues in a meeting essentially say that he wished 'UpToDate' didn't exist as it was making residents 'lazy'.

My argument against this idea is that we are teaching students how to behave as they get into practice.  I've talked with many friends in private practice, who have good intentions, and do read some from the main journal from their physician group.  However, not many of them have the time nor the energy to look up primary literature on every patient issue they run across.  Also, the primary literature is messy.  If you have time to look up 2-3 articles on a topic like correct choice of an antihypertensive, which primary articles should I choose to look at?  How deep of a search into the primary literature is necessary?  Should a practicing physician need to know about current animal models on hypertension research?  Where do you draw the line?  Honestly, I don't have time to go the primary literature for every patient issue I'm confronted with.

I see this as another area where it used to be OK to be able to keep up on the primary literature for a give topic.  However, as the medical literature has exploded exponentially, it is literally going to be impossible for anyone person to keep up.  That's where we need to start trusting one another more.  Services that aggregate data from primary literature are very valuable.  I honestly won't look down on a student looking things up before rounds on 'UpToDate' as that is a practice that will likely be sustainable.  Is having them look deeper into the literature sustainable or not?  What do you think?