How skipping medical school lecture is preparing doctors for the future

by Chris Chen

Recently in lecture, our professor wryly mentioned that in his many years of teaching, he had never seen so many laptops out as well as so many people taking advantage of the option to watch videos instead of attending class.

That was fine with him, he commented, as long as people were learning—although he was skeptical that students on laptops would learn as much, given the infinite internet distractions available, as well as skeptical whether the students who elected to watch videos would absorb the information as well.

I think most of my classmates, including myself, would agree with his assessment.  There’s something about sitting studiously in class, with only pen and paper, that is more conducive to focusing on mind-bewilderingly complex molecular pathways than watching a lecture video in the comforts of home.  But in many ways the fast-paced, perpetually distracting lifestyle of the 2011 medical student is also training us for a new world of medicine in a way that rigorous pen-and-paper lecture attendance will never do.

The last generation of physicians expected to work brutal hours but in return have intimate relationships with their patients, total control over their professional decision-making, and be fiercely independent.  They were the masters of their own domain, and as insurance billing increasingly encroached on physicians’ time via complex billing practices and HMO utilization review, job dissatisfaction soared.

But our generation of medical students ignored those warnings to enter medicine anyway because we have a very different set of expectations.  Many of us fully expect to never enter private practice and instead to be paid a salary by a hospital.  Many of us know that our skill as an advocate for our patients before insurance companies may be as critical to our professional success as our physical exam skills.  We have accepted that our performance will be measured against quality metrics, and that our medical decision-making will be scrutinized against evidence-based protocols.  We expect not to be parochial small business owners but instead to be organizational leaders and national policy advocates.

In other words, we don’t expect to ever have the luxury of total control over our own schedules, sitting in front of our patients with pen and paper without other distractions.  Instead, we’ll be asked to juggle a complex set of expectations and duties.  But unlike the previous generation of doctors, we don’t resent these changes; instead, we’re preparing to meet them.  Last week, I skipped class in order to follow-up with patients I had seen in our school’s free clinic and make phone calls to a specialty center on their behalf.  Later in the day, as I watched the lecture video of our professor calling me out for not attending class, I recognized the truth in his statement.  But I didn’t feel guilty, because I hadn’t been playing hooky.  I had just been tending to a different part of my medical training.

Chris Chen is a medical student who blogs at Progress Notes.

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  • Christopher Bayne

    I skipped significant chunks of my second year because I was living an hour away at that time. I watched some lectures, but my main mode of learning was reading book reviews, ordering and reading the books, and using those books in concert with other resources. I don’t feel guilty about missing my classes because at least a third of the time the PhD lecturer danced around his own knowledge of minutia.

    My independent second-year taught me to learn on my own and have confidence in my learning. I had to find the resources, evaluate them, digest them, and combine them with other resources.

    Honestly, I think I will be a better physician because of that year.

    • Dr. Mario

      “…at least a third of the time the PhD lecturer danced around his own knowledge of minutia.”

      With that I think you have identified a key problem in current medical education quite eloquently.

      The sheer difficulty of gaining acceptance into medical school tends to require individuals with an aptitude for self-learning, and so it is no surprise that many students prefer to read from textbooks or review lectures at their leisure at home when the option is available to them. It has been said before that one could lock himself in a room with Robbins for two years and come out knowing what he needs — and while this is certainly an exaggeration, there’s value in the statement. What I do recall from lectures in my preclinical years, though, is that students would not miss lectures from an excellent lecturer.

      We all knew who they were. They were those few speakers who engaged their audiences and facilitated learning in intangible ways. They knew their material inside and out, but they also knew their audience. As a result, when they lectured, the room was usually full, and students left feeling as though their education had been enriched. These are true educators.

      Sadly, there were so few of them. The majority of lecturers that I remember were PhDs wrapped up in their own research, hastily reading off of ill-prepared PowerPoint slides with zero attention paid to teaching methods. The room was thus nearly empty, as few students felt guilty missing such a lecture. Their time would be better spent elsewhere.

      To paraphrase a Japanese proverb: “better than a thousand days of study is one day with a good teacher.” It is tragic, then, that so few good teachers are available in medical education — and an outrage when one considers the staggering rise in tuition in recent years.

  • Bladedeoc

    Eh, I say whatever works. We received all the lecture notes for our first two years prior to the class. My general move was to go to the first class of each new professor and see if they read the notes to me. If so, I reasoned, I could read at least as well as they and so didn’t go to any more of their lectures.

  • IVF-MD

    This brings back memories. I worked hard during medical school, but did not physically sit in lecture much. My strategy in the first two years of medical school consisted of a adapted approach depending on if the tests for that particular class were fabricated by the lecturers themselves or if it was a expertly-written national standardized test. If it was a standardized test, I’d do self-study from a variety of books and learn the subject matter in great depth on my own. If it was based on arbitrary favorite pet questions of the lecturers, I’d review the old exams that they released and have my friends tape the lectures. Then I would listen to the tapes while running, doing chores, driving, etc.

    I think the great value of medical school was the fantastically rich learning experience we get 3rd and 4th years from direct patient interaction. The first two years could easily be done online for much cheaper and much better learning. Or better yet, they could greatly condense things like biochemistry and histology. How many doctors who see patients find the things they learned in those classes of critical use in their daily practice today? I’d venture to guess it’s less than 5% and most of those are histopathologists. That’s my opinion, anyway.

  • Andrew M Ibrahim

    Don’t forget that you can watch in x2 speed!

    I think the pen – paper format is dated, and frankly no longer appropriate to communicate complex concepts in medicine. As educators, we need to get much more creative. For example, look at what Khan Academy has been able to do in grade schools:

    Twiiter: @AndrewMIbrahim

  • Dr Sam Girgis

    My medical school lecture halls were like abondoned ghost town. And back then, there weren’t many laptops. The reason we had for not attending class was that we had a note taking service and we also thought that we could more efficiently utilize our time on our own.

    Dr Sam Girgis

  • Thomas Reid MD PhD FACP

    Embrace “these changes” all you want. I am eternally grateful not to be in your cohort. I at least, have the option (and have taken the advantage) to interchange the types of clinical setting where I practice: academic, private practice, hospital based, multi-D etc. Neither you nor members of your cohort will have this luxury.

    Medicine requires many personality types to make this a great profession, including entrepreneurs. If you wish to ruin US medicine and support PPACA (and the many false claims on which it is based), go right ahead. But please, wait until I’m gone, I’d really appreciate it.

  • Tex D0c

    Blade gets it right – even back in the Day (70′s) Colorado had a grant to audiotape classes and put slide up in library – could rapid scan the lecture at normal tone, got notes in advance every wandered all over at time…
    But then there was Immunology with J.J. Cohen – Best I ever heard, criterion-based testing – fantastic. I hear he is behind their Medicine for the People (or similar?) programs in Denver.

  • soloFP

    Ditto on the few really good lectures who engaged the student making it worthwhile. I went to the majority of my lectures. The few really good profs made it worthwhile.

    I think they should publish the lectures to let the public know what med school is really like. The majority of the profs simply read old fashioned slides or Powerpoint slides to the class.

    I had a biochem professor who would simply stand in front of the few people who showed up to his class and read the biochem book to us. I had an embryology prof who missed lectures to fly his plane on vacation twice and to make up for his missed lectures took a 6 hour lecture and read it as fast as the micromachine man to finish the material in less than two hours. Half the pharmacology profs sat there telling us about their research on mice and could not apply the use of drugs to treating patients. I remember talks on the various classes of antibiotics and what kinds of bacteria they could treat, but when students asked how to use them in a clinical situation, the Ph D could not answer the questions. I think most of the Ph Ds in med school preferred research to teaching and none of them had direct patient contact.

    There were two anatomy Ph Ds who routinely showed up to Friday afternoon lectures and dissections with beer breath and buzzed. There was a neurology and physiology professor fired for having intercourse with a student, showing up drunk to class, and smoking marijuana in his office. I thank my lucky stars that I invested in board review books, or I would not have had a chance on the boards. The majority of the students in my class looked at 80% of the lectures as a waste of time with less than 50% attendance at most lectures. Self study was the key to my med school, despite dropping $20k a year.

  • jerry

    That is a shame. My medical school was filled with interesting professor based lectue. No phd candidates lecturing us. I attended 90% or more. I declined the pre-made lecture notes and tapes. I took my own notes and that kept me focused enough to ask pertinent questions and to learn the material. So, I rarely had to even look at my notes later.
    It was the clinical years that taught me to read up to prepare for roumds. Too often the clinical teaching was based on folklore and anecdotes that I would learn in fellowship had little basis in science. Level 3 science… expert opinion is not to say it was not important. But it was hard to tell where level 1 & 2 science existed.

  • Chris Porter MD

    Different world at work and at home for a doctor now. Glad you have insight and remain up to the task. Medicine remains a tremendously rewarding career.

    Everyone learns differently. I suspect time would be better spent elsewhere for half of the those sitting in on lecture.

    My take on the generation gap in surgery:

  • buzzkillersmith

    Not going to lecture?! Who could be so bold? You rebel.
    But then again we are just plodders with total control over our schedules, sitting with a pen and paper without distractions, living our parochial lives, not savvy enough to juggle complex duties.
    Wow, the med students of today are so special.

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