A modest proposal (which would probably go over about as well as Jonathan Swift’s)

Today a friend and I played a fun game we like to call, “Let’s see how a 55 minute lecture compares to 2 paragraphs in First Aid!”*

Ideally, I think a lecture should give you a deeper perspective.  It should be filled with phrases like, “This is why -“, “And that makes sense because -“, “Don’t confuse X and Y – they sound similar, but the difference is -“.

That’s why lectures are supposed to be useful.  They’re supposed to go beyond a cursory overview of a subject and actually delve into why and how it happens – ways that you can use in the future to remember why you can’t vaccinate, or how the pathogenesis leads to the symptoms, why you should order that serum test.

But if I was right about this – if the goal of a lecture was “to teach” – med school wouldn’t be set up the way it is.  Currently we’re taught mostly by PhDs – the more well-known, published, and pioneering, the better.  This usually has nothing to do with their teaching ability – we’ve definitely had some brilliant PhDs who have actually stood up with a handful of paper and read their lecture directly from it.

(I can’t decide if that’s better or worse than just reading off the powerpoints, but that’s another problem.)

To be fair, that’s not the norm – it only happened twice.  What is the norm, however, is just stating the facts in a very textbook way – this is what you need to know for the test.  This achieves one goal, which is narrowing down the information from the textbook into what we’ll actually be tested on.

The question is, do you need a lecture to accomplish that?  What’s stopping med schools from just publishing the lecture in a syllabus format?

Most likely:  PhD lecturers are useful because you can ask them any question about the lecture and they should be able to give you the most correct and current answer – so that’s the second goal of the current system. If we didn’t have PhD lecturers, you might ask a question and get an “I don’t know… but it’s not tested on Step 1, so don’t worry about it” – which we all probably agree would be less than stellar.

But how important is it to get the answer right then and there?  $200 worth of important? What about most of your tuition money for the first two years – would you pay $50,000?

I think you can argue for $50,000 if you usually make good use of the opportunity to talk with the PhD and get the most current information on the molecular mechanism behind the Type III secretion system or whatever.  My question is, how many of us do?  I have yet to ask a lecturer a question.  I doubt I ever will, but even if I do it twice, that’s still $25,000 per question.  Is it worth it?

Wouldn’t a better way of achieving the 2nd goal – up-to-date answers from an authority in the field – just be to make the PhDs available by e-mail or forum to answer questions?  Pay them half the amount they’d get for a lecture – because not that many people ask questions, and they can now do it on their own time between checking cell cultures.

Lectures could be taught by clinicians chosen on the basis of how successful they are at teaching, rather than how successful they are at getting research published.  They could also work for multiple schools across the country because they’d just record it and put it online.  You could actually have medical students being taught by the best possible teacher, the person who makes you actually understand the material the most – in every single subject.

Of course, none of that is going to happen.  I just like trying to figure out why it won’t happen.

*  This is related to a not-really-a-game-because-it’s-serious-damnit we play called “Convince the pre-med sitting in on the lecture that we also have some really good ones.”  Cause, you know, we really do, and I think most of us feel bad when a pre-med happens to be interviewing on a day where there’s a dud.

Also, today First Aid won against the lecture.  In two skimpy paragraphs, with very few complete sentences, First Aid still managed to tell us more about “why?” than the powerpoint did.