Thursday, 11 October 2012

Lecturing for learning

It’s that time of year again! Lecture halls are filling with eager new learners and those a little less keen, having been there before. Lecturers blow the dust of their slides (symbolically, if not actually) and start a process of refreshing materials,  in order to show that they are absolutely up to date, have read all the right journals and are ‘experts in their field’. Lectures are undoubtedly good for the lecturer’s learning, but what about the often passive recipients of their academic prowess, beautifully displayed on power-points up and down the country? 
Are lectures good for learners’ learning? What is the nature of the relationship between ‘a good lecture’ and ‘good learning’?

Kugel (2003) provides an interesting account of how professors develop as teachers, noting shifts from teacher-centric to learner-centric behaviours over time. Novice teachers are concerned about their own preparation and performance, preoccupied with the content of their lecturers, and ways to put together audio visual materials to impress and entertain! More experienced teachers however,  start with their learners, seeking to establish what they already know, what their learning needs might be and how they can make new ideas and information accessible– re-contextualising knowledge so it can be put to use.  In other words, they are preoccupied with making lectures good for learning.

If you are preoccupied with ways to make lectures good for learning, I have a few suggestions.

Establish learners’ needs.

Don’t treat a group of 100 learners as if they were of one mind and don’t assume that because something has been ‘taught’ it has been learned. This was a salutary lesson for me, when I asked a group of speech therapy students to quickly sketch a picture showing pre and post operative anatomy of a patient having a total largyngectomy, as a basis for discussing voice restoration. 6 hours of ENT lecturers left 5 out of 80 students able to complete the task! A quick quiz with a show of hands at the start of a lecture, primes students for what is about to follow and offers you some information about where to concentrate your efforts.

Structure your lectures

Brown and Manogue (2001) share insights into observed medical and dental lectures and the structures often used. How often do you resort to the ‘classical iterative’ structure in clinical teaching, following signs, symptoms, diagnoses, management and prognosis? It may mirror how classic medical textbooks are organized, but does that mirror how you think when faced with a new patient? The problem-centred /case-based lecture, where you start with a clinical case as a trigger for thinking through options engages students in diagnostic reasoning processes before they meet patients on the wards and in clinics. In doing this, you are showing how clinicians put knowledge to use in practice.

Build in interaction

 For me this is perhaps the most important element in increasing the learning value of lectures, but is often avoided. Learners need opportunities to think in lectures, to test out new ideas, to explore their relevance and put them to use. Interaction can be in a variety of forms.

Interaction with the lecturer is most obvious but not necessarily the best strategy. Too often questioning becomes a series of one-to-one teaching interactions in a whole group. Those asked questions go into panic /show off mode, the remaining 99 breathe a sigh of relief and switch off. Only the brave dare ask questions, which may not reflect where the whole group is. There are ways to get round this. Asking students to talk to each other for a couple of minutes and come up with a really good question to ask you works well. If they write them on a slip of paper, you can gather them and get excellent in-task feedback about what they are understanding (or otherwise).

Interaction with each other works well too. Set them a challenge, a question to answer or give them some clinical material to analyse (spot the fracture, identify the anomaly).

Interaction with data is important - a graph to interpret, a dataset to consider a set of symptoms to think through.

Interaction with their own ideas is seldom included but really valuable. Offering students 3 minutes to write down their key learning points from the lecture so far keeps them on track and allows you a moment to gather your thoughts.

Provide a clinical context

Finally, and perhaps most importantly, offer your learners what a text book can’t – your experience and professional wisdom. We know medical students are incredibly bright, they have shown their capacity for book learning long before they reach you. They can distill and regurgitate facts much quicker than those of us with aging brains can. What they can’t do quite so readily is put their knowledge to use. You can bring the clinic into the classroom through your use of examples, of clinical situations and scenarios, through stories of patients and patient care.  Bring lectures to life by sharing your lived experiences.

Addendum: in response to twitter chat, some other 'tips'

'Managing' lectures

Always set the scene so learners know what to expect. If using interactive methods, explain why (goal is to encourage them to develop understanding of subject matter, not memorise) and what will happen when (a road map). 
Set ground rules about when 'talk' is ok and how you will get them back on track. I use 'blank' screen - so if powerpoint goes blank (press b or w on keys) this means silence. You can also have row monitors who have to pay attention and 'sh' the rest of their row. You can use bells, whistles too!

Further examples of interactive strategies

Quiz /voting - use show of hands if you don't have whizzy technology. You can do hands up with the 'right answer' or use likert scales and ask them to put hand up to show strength of agreement/disagreement. 

Ask a question post its - all students collect a post it note on way in, which they can use to ask a question at any point. They write their question and pass to end of row. You collect when they are doing another interactive task, then answer most popular questions in a plenary.

Buzz groups - you don't have to take feedback / comments from every group, rationale is to get them talking, thinking. You can offer to take comments from a certain number of groups who think they have a brilliant contribution to make.

Interactive handouts. i.e handouts with deliberate gaps to fill. Use these creatively! I use these for clinical topics where I am using a problem based structure. A single side of A4 with an empty table. Along the top put diagnosis, down the side put boxes for signs, symptoms, investigation findings, management options, prognosis etc. As the lecture reveals similarities and differences between 'case' being discussed and two differentials, students populate the handout. This way they have a classical handout at the result of a problem based lecture.