By Dr. Pelham Mead III

1. The changing role of the teacher
   1. The one room school house generalist
   1. The specialist teacher in the 20^th and 21 century
   1. The adjunct Medical Doctor instructor

Changing the Pedagogy of Medical College Faculty in Lectures

                        By Dr. Pelham Mead, Director of Faculty Development at NYiT, College of Osteopathic Medicine, Old Westbury, L.I., N.Y.

The problem in most medical colleges is their over-dependence on the lecture method of instruction to get across information to first and second year medical students. The pedagogy of “lecture and leave,” is out of date and ineffective. The pedagogy for faculty for the 21^st century is to engage the students in the process of analytical thinking so that it becomes natural in the real life profession of medicine.

There has been a growing trend since the late 1990’s to move from large lectures to small groups at most Osteopathic, and Allopathic medical colleges across the United States. (Cite) Lectures are convenient and require less space in terms of many classrooms vs. one large lecture hall. Using lectures only allows a medical school to have a smaller faculty since it takes more faculty members to facilitate many classrooms than it does to have one person lecturing to a large body of students at one time. The pedagogy of the instructor has to change from lecturing and depending 100% on Powerpoint to engaging students with case study scenarios, motivating medical students to read and prepare the assignments in advance of the group discussion class. As the class gets larger the distance of the instructor from the back of the class increases. An effective instructor will move away from the podium and use a remote clicker for Powerpoint and walk down the aisles to communicate with the students at the back and the middle of the room. What an instructor can do with a class of 30 students, they can do with 200 or 300. The same rules apply. Engage the student in discussion. Wait for their answer. Allow them to consult with a student on either side of where they are sitting as they do on the show “Millionaire,” “Consult an Expert.”  

Even the way a professor speaks to a medical student makes a difference. “Student Physician Smith, can you tell me the solution is to this case and how you determined that solution?”  By using the term student Physician or student doctor the instructor has given the medical student some power and pride. This style of teaching is the pedagogy of medical education for the 21^st century. It is used at Univ. of Texas Osteopathic School of Medicine, at NYCOM and many other medical schools. Treating medical students with respect and giving them the responsibility to solve case studies empowers them and gives them the motivation to perform better. 

Another method of student empowerment is to get the students to assess the classes, labs, and lectures as well as the faculty teaching. At NYCOM we adapted an approach used by Mayo Medical School in randomly assigning teams of students to each course and have them compile a professionally written Executive report on the course in two pages. Likewise, one to two pages summarized briefly regarding the faculty and their performance. The Executive report is first made to the end of course round table with the Director of the course; thread coordinators, and faculty who taught the course. The student assessment group of CFA (class/faculty assessment) team selects a few representatives to give their recommendations regarding the course to the faculty at the round table. After discussion, the recommendations that are approved by the round table are then presented to the NYCOM Curriculum Committee for a brief 5-minute presentation regarding just the course recommendations. The faculty recommendations are kept confidential and are reported to the Associate Dean of Academic affairs, which in turn follow up on the positive and negative reports on faculty by sharing the information with the appropriate Department Chairperson.

At the NY College of Osteopathic Medicine, streaming video has been provided for almost a decade. It first replaced television broadcasts, and was a unique tool in learning. Eventually by 2008, it became so good that is threatened to leave the lecture halls empty. The administration struggled to find a solution to the attendance problem without removing streaming. Attendance was mandatory and the administration was not about to change this policy.

 In addition to computer streaming of lectures, the NY College of Osteopathic Medicine provided all first and second year medical students with notes on Moodle, outlined in advance. The notes and Powerpoint presentations were printed out and put in all students’ mailboxes.  On the surface this seemed like a great sup portative idea to provide the students with all the study aids possible to improve learning and test scores. In reality, however, students took the notes into the lecture and yellow highlighted all the facts deemed necessary. Little real learning was going on and as research has shown they only remembered 20-30% of the whole lecture after they left the lecture hall.

Quizzes and test scores seemed to indicate a lack of comprehension on the student’s behalf. Professors were teaching rote when they should have been teaching concepts through case studies. One case study was presented each week and not covered in the lectures as a rule, even thought it was supposed to be included.

The top down mandate from the College administration that lecture attendance be mandatory did not work.  Students were doing what ever they wanted to do without consequences. The administration felt attendance should be mandatory because the students needed to interact with the faculty. The interaction did not exist except for one or two professors. Many adjunct faculty as well as full time faculty did not understand how to teach an interactive lecture and felt comfortable rather than just repeating what the Powerpoint slide had on it.

Solution.

That lecture/discussion approach had become a big problem in terms of fluctuating attendance by the fall of 2008.  The problem of the student’s poor attendance, lack of professionalism, punctuality, and student engagement was becoming a problem that needed a solution.

In the fall of 2008 change was needed. A strategy was developed to approach the lecture/discussion aspect of the medical student education. 

         Strategy for Change

1. Get the full-time faculty and visiting lecturers to buy into establishing a new approach to lectures.
2. Survey all faculty opinions as to what works in lectures and what doesn’t work.
3. Compare previous quiz and test scores from the previous three years with any change pilot program to see if student test scores improve.
4. Survey student satisfaction before any pilot program is initiated and after a pilot is introduced to the lecture program.
5. Interview and bring on-board the most outstanding interactive Professors on the staff and encourage them to help change in the lecture program by modeling correct approaches to lecturing. Video these presentations and make them available in streaming and podcast format to all faculty.
6. Provide a new form of Faculty evaluation that only looks at the pedagogy of the professor in utilizing an interactive lecture approach with collaborative student learning groups.
7. Attempt to recruit 3^rd year and 4^th year clinical students to come back to help part-time as discussion group leaders after lectures for first and second year medical students.
8. In exchange for working as group discussion leaders the medical students would be given a tuition rebate.
9. The Lecture schedule would be modified to allow for a 60-minute discussion group session immediately following the lecture.
10. Some lectures would involve a lecture facilitator and Collaborative Learning Groups. Note: the same groups as the discussion groups.
11. The new Interactive Lecture approach would not be implemented until the fall of 2009 to phase in the change with the first year medical students only.
12. In the fall of 2010 the second cohort of first year medical students would get the Interactive Lecture approach as well as the second year medical students who were introduced to this approach the year before.

Faculties who know how to model an interactive lecture were chosen to be filmed for a podcast for the other faculty to see. A faculty party was planned in which to gather opinions, and comments from adjunct faculty and full-time faculty. The social aspect of the party drew a lot of adjunct professors who were a great part of the problem.  Comments were sought how to best improve the lectures. These comments were recorded and then sent out after the party for all faculty to review and make additional suggestions. From these suggestions some pilot studies were planned having the best interactive pedagogical faculty on the staff taking the lead. Students were evaluated before interactive lectures were used for the same professor and after he or she utilized academic games, demonstrations, collaborative learning, walking down the isle asking questions, and installation of 6 microphones for students to ask questions during a lecture also.

The design of the lecture hall with 350 fixed seats bolted into the ground and swing out lecture arm style was not conducive to collaborative learning groups. No change could be made immediately as to the seating arrangement, but it was recommended to the Dean of the College to have the chairs removed next year and replaced with round tables and free standing chairs that would enable collaborative learning groups to sit around each table and have a discussion on the lecture of the day.

The officers of the first year medical students and the second year medical students met with the Director of Faculty Development to voice their opinions. Their suggestions were taken into consideration. They were informed as to what planned changes would occur after the faculty was surveyed for their opinions.

The next step was to phase out the streaming to get the students to come to the lectures or change the mandated attendance policy. Since the Virtual Medical Center pulled groups of students from lectures a backup such as streaming was necessary. This access could be limited to those students who missed a lecture due to being pulled from the lecture to attend Virtual Medical Center sessions. Podcasts could be a more practical approach rather than streaming lectures. Podcasts can be edited down to represent a portion of the lecture but not the entire lecture. Eventually NYCOM administration will need to address this problem and move forward to new educational outcomes.

• Adjunct technical instructors
• The changing role of the student
  • The students of yesterday
  • The students of today 21^st century
    • Surrounded by media, technology, laptops, ipods, cell phones
• The generational conflict
  • Education is always a generation behind the trends
  • Textbooks vs, experience
• The fear of technology and change
  • The fear of computers, ipods, iphones, ipads, new tools
  • The comfortable teacher
  • Being open to change
• Technology tools in the 21^st Century Classroom
  • Blackboard
  • Electronic Whiteboards
  • Manual and auto podcasting
  • Streaming
  • Student response systemsClickersremotes
  • Laptops in the classroomEmpowering the studentUsing laptops as part of a lectureThe evils of laptops
  • Smart Classrooms
    • Trends past and present
    • Keeping up with the trends
    • Do they really work?
• Solutions to large and small classrooms
  • Large lecture hall solutions
  • Small classroom solutions
  • Online courses
• Engaging students in lectures
  • Getting out from behind the lectern
  • The “Phil Donahue” approach
  • Setting up collaborative groups
  • Projects within the lecture hall
  • Student participation
• Embracing Technology tools
  • Student clicker response programs
  • Electronic Whiteboards for student interactive lectures
  • Wireless access in classrooms and lecture halls
  • PowerPoint that blows the students out of their chairs
  • Sound effects that can be heard clearly in all corners of a lecture hall
  • Blackboard as a backup support system
  • WEBsites or Blogs to keep up the narrative between teacher and students or students and students.
  • Using group e-mail to alert your students as to reminders, homework due, reading preparation
  • Provide a study guide for each reading or homework assignment with questions to be answered
  • Give Quickie 1 minute quizzes using PowerPoint to keep students preparing, to check attendance, instant feed back, assessment as to whether students are keeping up with the assignments and lectures.
  • Another assessment technique. Give 10 slides and a one question quiz after relating to the ten slides just given. 
  • Have students come up to the Electronic Whiteboard and write answers
  • Have students give PowerPoint slide presentations on Project or Research assignments.
  • Move around the classroom with a wireless microphone and ask students questions on the fly. Bring in group discussion
  • Divide the class into collaborative learning groups and give each group the same assignment in class to do or different assignments. Walk around the room and join in listening to their research and discussion process. Encourage the use of laptop computers in class to do these projects. Wireless printers provide within 50 ft. range to print out project results.
  • Live demos using a document camera
  • Live microscope hooked up to a computer demonstrations
  • Introduce 3D graphics into presentations
  • Streaming or podcasting of lectures
  • Storing lectures on Blackboard
  • Using an iPad or iTouch hooked up to a digital HD large 60”+ TV for display
  • Create your own manual podcast clips in video and or audio or both. Store online.
  • Use cloud to syn all your computers with the same files
  • Introduce music as a background to lectures; keep it soft and low unless you want an upbeat response with a pop song.
  • Don’t ever post a Facebook page and communicate with students on a personal basis. It may backfire on you.
  • Never post blogs expressing your political or personal views. Keep the blogs focused on course content only.
  • Don’t tweet personal comments to students
  • Use Second Life if you are familiar with it and have taken time to buy land.
  • Educate your students in Second Life. Use it as an out of class instructional tool.
  • Use Second Life to drop in on worldwide conferences to learn what is happening in other countries.
  • Create online clinics as information centers for basic medical knowledge.
  • Give a quiz using 3×5 cards with student name and the quiz answers on it.
  • Try different approaches such as small skits using students as actors; debate teams, dividing the class in half and have one side play checkers on an electronic white board by answering course content questions created by the students; Play Jeopardy 
•          Technology drives Education and Education trains for Technology
• Writing Syllabi for Faculty development