Friday, January 27, 2012

What I learned from the cerebellum yesterday about timeliness

*Note - photo is archived, and not from the lecture mentioned
My fellow course director yesterday gave what was actually a very nice lecture on the cerebellum to our second-year medical school neuroscience class.  It was clear, and it was logical.  But it caused a bit of trouble.  The trouble was that it included a lot of detail.  He had an hour and a half, and he covered 65 slides which for one of my lectures is usually more than I attempt, but I didn't think he was rushed as he went through, so I don't have a problem with that.  he was logical in his presentation and it was all pretty clear, so that wasn't a problem.  It was also organized relatively well.  No, the trouble came from the age-old medical student complaint that the test is today.  And he changed his slides the night before.  And did I mention that the test is today?  And they already had to review brainstem anatomy with cranial nerves and the motor system as well for this test earlier in the week.  And did I mention that the test is today.

I accept part of this is on me as a first-time course director.  There were somethings in the schedule which we purposefully changed in terms of timing to try to improve the flow of the course.  Of course, we have had the typical issues of lecturer availability changing up the timing of a session here or there.  But, some weeks we just kept as it was, as they worked last year.  This is one of those weeks.  I didn't even really revert my mind back to med student mode to realize that putting something as complex as the cerebellar anatomy the day before the test was a bad idea.  It was a bad idea, as basic educational literature supports the idea that concepts are retained more if they are repeated and if they are applied.  We really didn't have time to do either with the cerebellum.  So, next year we will rectify that problem.  This year, the schedule has been set for several months, and there's not much room now to swap things around.

My reason for this post isn't about whether this was an ill-fated lecture or not, it is more about the student reaction to the lecture.  I was in the back of the room as the lecture ended, and the reaction generally from those that sat in the entire auditorium was best described as anger and frustration.  Frustration I can understand.  I can understand that there was a lot of information presented and that this may have been perceived as not being 'fair'.  However, there was also an underpinning of anger that, although I understand where it comes from, I find a little troubling.  I've seen on Twitter some posts by med students after a bad lecture where the venting becomes more of a personal attack on the lecturer themselves.  That is where I think there is a bit of a problem.  This also comes out in the narrative evaluations we receive from students for courses.  There are plenty of comments which are truly helpful, and point out errors which can be corrected.  Then, there are those that don't give much rationale for why the lecture was not good and how to improve it for the future, but they are just downright mean.  I totally realize the the first and second year of medical school is a time of high pressure and stress.  I also understand that processing all that information in the time required is a monumental task.  I understand how a poorly organized talk can make things worse.  I understand that medical students are paying a lot of money for this.  But I also understand that as good as any educational program is, there are going to be times where you try something and it doesn't come off as planned.  I also know for sure that my co-course director's intent was to provide more details to clarify the major points he was making.  His intent was not to harm, but to help.  I think the majority of lectures I went to in medical school, the lecturer honestly wanted to help the students learn about things they are passionate about.  True it is not always presented with great oratory skills or organization, but I think the number of lecturers who truly despise students and purposefully are trying to mess them up is very small.  So, all I'm saying is that part of professionalism we are trying to teach in the medical school curriculum should include how to give reasonable feedback to educators without being judgmental.  Yes, the lecture was ill-timed, and changing slides on dense lecture the day before the test was ill-timed, and that feedback should be given.  It's not OK in frustration to launch an all-out personal assault.  Because, at the end of the day, most medical students still find a way to wade through those messes and learn what needs to be learned.  It's not fun, but as I move forward in the 'life-long learning' cohort, most of the stuff I'm presented with is a huge disorganized pile of information some of which is contradictory, and I need to work it out myself as I have a regular test I take regularly in the exam room of my clinic.  And also, the theory is that the course director's job is partly to take that reasoned feedback and create changes for next year to improve.


  1. A comment from one of the shame-faced students in the back:

    After the lecture (which was tough, but honestly, what did I expect from medical school?), in a moment of indiscretion and terror, I let fly with a stream of invective that I regretted just about as soon as it was out of my mouth. It was inappropriate, unprofessional, and, frankly, childish. I have spent the last several days trying to figure out how to make appropriate amends for my gross petulance, and have yet to figure that out.

    For what it's worth: the take-home for me was not so much about cerebellar physiology as grace under fire. I am embarrassed by how much I still have to learn about the professionalism in this career.

  2. No need to make amends for 'gross petulance'. My main point was the latter part about the lecture reviews. I tried very hard NOT to blame either the front or the back of room, as it seemed a universal sentiment. And we can all learn more about grace under fire, even course directors...

  3. Jeff, our school had a similar issue in which a student anonymously gave scathingly personal negative feedback regarding one particular lecturer. Fortunately, the occurrence spurred a discussion in the CC2 curriculum committee and subsequently it turned into a teachable moment for the students, who were indeed given some instruction about how to give constructive feedback. Nice post and reminder that, even though med students are adults, they (like anyone else) might not think through the ramifications of their actions.

  4. Ryan- Actually this post became something of a way to get formative feedback to the students. As you can see from the comment above, an OHSU student read this post, and I actually heard verbally from several other students that my points on this post had worked their way through the class. This is evidenced by the stats on this post, where I had 120 views on this post in the first week, prior posts usually had about 30-40. There are a little over 120 students in the med school class. Which taught me in a surreptitious way that a blog is an effective way to give immediate feedback to med students in large group settings.