Medical Education Should Say Goodbye to Lectures

Abstract

To the Editor: Prober and Norden 1 present another compelling argument for transforming the medical school classroom into a place where real learning can occur. Surprisingly, medical education has been slow to adopt evidence-based practices for instruction that do not include lectures as a teaching and learning strategy, especially because other fields such as business and science, technology, engineering, and mathematics (STEM) have adopted more effective approaches. 2,3 We are convinced that classroom-based, learner-centered collaborative learning strategies in medical education will lead to better academic and communication skills outcomes than those achieved using lecture-based pedagogy. Since 2017, our medical school has had a lecture-free curriculum, with no more than 3 hours/day in the classroom, allowing ample time for self-directed learning. The first cohort, the Class of 2021, has done well on all the traditional metrics, including performance on Steps 1 and 2 Clinical Knowledge of the United States Medical Licensing Examination. We fully embrace the power of in-class, peer–peer learning with faculty content experts facilitating every session, and we vigorously encourage reading, as opposed to watching video lectures, as preparation for class. We do not mandate attendance because each learning activity revolves around a daily assessment that is very low stakes, accounting for less than 1% of a student’s grade, which assures attendance rates of 95% or more, as our experience has been that medical students are highly motivated by grades, no matter how little they count in a final course grade. Additionally, students are learning through the sessions—so they simply do not want to miss them! Such daily assessments provide students and faculty with robust, continuous feedback on learning. Just before the launch of our new curriculum in 2017, 4 our school was emboldened by the Freeman et al publication 3 on the active learning classroom for STEM fields and the comments by Nobel Laureate Carl Wieman, 5 who considered persistence of lectures as “the pedagogical equivalent of bloodletting.” It is not an easy transformation for faculty, students, or medical school leadership—but it is so worthwhile, as the majority of our faculty and students do not want lectures because the richness of learning is so evident with the other learning modules. Prober and Norden’s prodding of medical educators, based on their experience at Stanford and the evidence, is so appreciated.

Topics & Concepts