Public release date: 2-May-2012 [ | E-mail | Share ]

Contact: Ruthann Richter richter1@stanford.edu 650-725-8047 Stanford University Medical Center

STANFORD, Calif. Dramatic changes are needed in medical student education, including a substantial reduction in the number of traditional lectures, according to a perspective piece to be published May 3 in the New England Journal of Medicine by two Stanford University professors.

Medical education has changed little in the past 100 years despite dramatic changes in the world of medicine, the explosion in biomedical information and the ever-growing complexity of the health-care system. The traditional lecture format persists even as class attendance is plummeting and as many complain that the current system is failing to produce compassionate, well-trained physicians.

"Students are being taught roughly the same way they were taught when the Wright brothers were tinkering at Kitty Hawk," write co-authors Charles Prober, MD, senior associate dean for medical education at the Stanford School of Medicine, and Chip Heath, PhD, professor of organizational behavior at the Stanford Graduate School of Business. (Heath and his brother, Dan, also authored a bestselling book, Made to Stick: Why Some Ideas Survive and Others Die.) In contemplating medical education reform, Prober reached out to Heath because a critical goal of any educational effort is to optimize the retention of lessons to increase their "stickiness."

In their perspective, titled "Lecture halls without lectures," Prober and Heath propose a new approach to teaching to make better use of the fixed amount of educational time available to train doctors.

"That's the vision that we want to chase: education that wrings more value out of the unyielding asset of time," the authors write. "Why would anyone waste precious class time on a lecture?"

Prober also has been working closely with Salman "Sal" Khan, the Silicon Valley-based online learning pioneer whose nonprofit effort, Khan Academy, is widely credited, in the words of Bill Gates, for having "turned the classroom and the world of education on its head." Prober and Heath's perspective piece proposes a Khan Academy-styled "flipped-classroom" model of teaching. Lecture content is packaged in 10- to 15-minute videos that are watched by the students at their own pace and as often as necessary to learn the material. Class time is then freed up for more interactive education, with greater emphasis on patients' clinical stories as a way to increase the relevance of the necessary scientific and medical knowledge.

"Teachers would be able to actually teach, rather than merely make speeches," the authors write.

The core biochemistry class at Stanford medical school was redesigned this year to follow this model. The instructors replaced the lecture-based format with short online videos made available to students. "Class time was used for interactive discussions of clinical vignettes that highlighted the biochemical bases of various diseases," the article said. "Student reviews of the course improved substantially from the previous year, and class attendance increased from 30 to 80 percent, even though class attendance was optional."

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Stanford professors propose 'lecture-less' medical school classes