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.

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.