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.

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

  1. I think this is a common problem across the board. I rarely rarely had a professor who taught me something that the book didn’t cover.

    Okay, the one prof taught me that NOT going skinny dipping in Nicaragua with the Fullbright Scholar (who was married, as was the prof, but he divorced shortly after the trip, wonder why?) would net me a C- in a course. The lowest grade of my college career. So when in doubt, skinny dipping with faculty is always a sure bet.

    Once I scoped out a prof and class to see what the parameters were, I skipped and showed up only for tests. I can read, you know? If the lecture wasn’t cutting it, I didn’t waste my time unless attendance was required.

    I did manage to graduate with honors despite my shameless lack of skinny dipping.

    Have you seen the recent news coverage showing college students really aren’t learning all that much?


    • “When in doubt, skinny dipping with faculty is always a sure bet.” <– that's just begging to be put on a cross-stitch somewhere. Awesome.

      I definitely didn't waste my time with classes where attendance wasn't required in college. This actually got me into a bit of trouble, since I only had 1 faculty LOR when applying to med school (most schools wanted 2), but I still think the saved time was worth it.

      Yep, I saw that – have to admit, I'm not surprised. It seems like the whole goal of college has changed since it's gone from "totally optional and kind of impressive" to, for most kids, "mandatory".

    • Our equine medicine prof taught us (and actually had a question on our final) about eating raw horse testicles in Mongolia. The question on the final was: “what do people in Mongolia eat that is disgusting?” That wasn’t in our textbooks. 🙂 Thats about the only thing I got from him that wasn’t in our notes.

  2. This sounds like a great plan. Actually at my med school they do just publish the lectures in a syllabus format. And record the lectures and place them online (video, audio, plus the powerpoint). With all that available, less than 25% of the class actually shows up to lecture.

    I’m not really sure why medical school tuition is so expensive, but I’m pretty sure quite a few of the lecturers are “volunteers” in that they don’t get any direct compensation for lecturing.

    • Love that! Our school does the same thing with the lectures (the syllabi sound nice!)

      When a lecture is cancelled or the recording doesn’t work, they’ll post the lecture given the year before. That’s what happened yesterday, and got me thinking about the monetary value of re-hiring lecturers each year.

      That’s a good point. I don’t think ours are volunteers.. not sure how I’d go about looking into that, though. Hmm.

      • Actually, Metropolis Meds lecturers don’t get paid. They don’t get any recognition for good teaching. They have to teach one lecture a year to retain their tenure track, so it’s more of a nuisance to them than anything else. Sad, right?

  3. If your school is like mine it will get much, much better 2nd year!! Though we still have dud lecturers, many more are MDs and there is a lot more pathophys. I don’t know how your curriculum is set up, though.

    However, I’m sure it’s hard to get MDs to lecture…especially the ones who would give the best lectures. I don’t know about you, but I’m sure as hell not going to med school for 4 years, residency for 4 years and fellowship for 4 years to lecture med students everyday….

    • We condense the 1st year down to 1 semester – so we’re done in 3 semesters total.

      We’re on “2nd year” now, and you’re right, this semester is SO much better! Just like you said, a lot more MD lecturers and more pathophys. (Honestly, that’s why the PhD lectures bug me this semester. Now I know what I’m missing!)

      I think scarcity would definitely be one of the reason video posting would be so important – if you could just solicit videos *nationally* from MDs willing to do it… (I may be biased, though, as I totally got into medicine hoping to eventually teach part-time.)

  4. Dear AP — You do realize that only 2 schools that I know of do the format that yours does — mine and and one other…

    I’ve often thought about what a rip off paying for lectures was when you could just watch them on videotape. On the other hand, I seem to get more from having to sit and listen than I do from reading, so there is that. I think school is important for teaching you the soft skills, though, even though they seem like a total waste while you’re doing them. Just a thought.

    Wait until 4th year. Talk about a waste of tuition.

  5. The first semester of med school was the worst taught for sure- it’s way better now that most of the teaching is by MDs. Though no matter what degree they have, there are some who just suck…

  6. Ugh. So glad to be done those insufferable lectures.

    I remember learning cardiology in first year and having to watch a lecture on blood pressure and having the following dialogue.

    “So class, why does the blood pressure [or something like that] move in this particular pattern?”
    *Stunned Silence*
    “Because it follows a biphasic wave function”
    (Me)”But sir, that’s just describing HOW it moves; why does it move that way?”
    “It moves that way because it’s a biphasic wave”
    “No, I understand that it’s a biphasic wave, but physiologically, WHY is it that way”
    “Okay, let me explain again: the biphasic wave has two peaks…”

    Times like that made me start calculating how much money I was actually wasting per hour in that class.

  7. This is SO true. We just started our 2nd year cardio block. The MD teaching EKGs speaks to us like we are fellows. Someone asked him to point out how he knew the T wave in a particular EKG was a T wave, and he said, “I just know.” Really helpful! So, I have been relying on Dubin and Lilly to teach me EKGs.
    I totally agree with having the best teachers share their lectures nationally. Isn’t this the same as all of us using Goljan audio?

  8. This reminds me of the DJ vs live band debate I’ve had with friends. DJ’s are great – they play exactly the songs you want to hear, with no interpretation. Most people want that.

    A live band has more potential for chemistry with the crowd. There’e a visual show, interpretation of a song (the art part). While a DJ can instruct the audience to clap, sing, or do the gator, a band can communicate with the song – slowing, extending, speeding up, emphasizing certain beats or melodies, getting the bride to sing back-up – when the chemistry is good.

    I don’t think lecturing needs to be replaced, but lecturers need to know the art, and not consider themselves DJ’s, since we’ve got the collection at home.

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