Democracy Dies in Darkness

To Your Health

Medical school without the 'sage on a stage'

By Lenny Bernstein

July 29, 2017 at 7:00 AM

Kelly Butnor, center, professor of pathology and laboratory medicine at the University of Vermont's Larner College of Medicine, conducts a team-based learning session with second-year students. (Erin Post/Larner College of Medicine)

When the University of Vermont's medical school opens for the year in the summer of 2019, it will be missing something that all but one of its peer institutions have: lectures.

The Larner College of Medicine is scheduled to become the first U.S. medical school to eliminate lectures from its curriculum two years from now, putting it at the leading edge of a trend that could change the way the next generation of physicians learn their profession. (The medical school at Case Western Reserve University also has a no-lecture curriculum, established when the school opened in 2004.)

As anyone who has fallen asleep during a three-hour lecture class can attest, taking notes from "a sage on a stage" isn't as effective as other ways to absorb information, and research confirms this. The main reason for the traditional method seems to be, well, tradition; medical professors and other teachers have been doing it this way for centuries.

"Retention after a lecture is maybe 10 percent," said Charles G. Prober, senior associate dean for medical education at the Stanford University School of Medicine. "If that's accurate, if it's even in the ballpark of accurate, that's a problem."

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Instead, medical schools across the country are experimenting with various forms of "active learning" — dividing students into small groups and having them solve problems or answer questions. In addition to improving retention, the approach more closely mimics the way work is accomplished in the real world.

"It creates a stickier learning environment where the information stays with you better and you have a better depth of understanding," said William Jeffries, senior associate dean for medical education at Vermont's Larner College of Medicine, who is leading the effort.

The trend at medical schools is just part of a reform movement in the teaching of science, technology, engineering and mathematics (STEM) that emphasizes active learning instead of lecturing. Research supports the approach. When a team of researchers analyzed 225 studies that compared active learning and lectures in these fields, they found that test scores improved about 6 percent for students in active learning classes and that students in lecture classes were about 1.5 times more likely to fail than their counterparts in active learning classes.

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Their 2014 analysis, published in the Proceedings of the National Academy of Sciences, also found that active learning is effective in all class sizes, though best in smaller groups.

The Larner school has moved most quickly toward the new approach, funded by a $66 million gift from Robert Larner, who graduated from the medical school in 1942. The money will be used to build facilities more suitable for small group instruction and train faculty in the new approach, Jeffries said.

Under the Larner model, students do their homework the night before class, rather than after it. They study the material in texts and online before a class, then take a short quiz to gauge how well they've learned it. After that, they break up into groups of six and attempt to solve a medical problem, then discuss their conclusions, led by a professor who acts as both a facilitator and an instructor, Jeffries said.

"You're expected to learn the information prior to attending [a class]," he said. "You do your homework first. Then you come and work, usually in groups, to solve a problem based on that knowledge."

The role change is not easy — and sometimes it shows. Collin York, who will graduate from the school in 2020, said he strongly favors active learning. But "the main complaint I have is when active learning sessions aren't run particularly well, the atmosphere becomes a little chaotic." Classes can get noisy, and students' attention shifts quickly from problem to problem. Instructors sometimes struggle to maintain control, he said.

"If the class is run well, you genuinely do not have to revisit that material," he said.

York said he also feels a responsibility to learn material before each class so he won't let his classmates down when it's time for problem solving. "The real meat of these sessions, if you ask me, is really in the reasoning through different answers," he said.

With so much material — including recordings of lectures — now online, medical students are making the transition easier, Prober said.

"When you go into a lecture in medical schools across the nation, you will find a minority of students actually present," he said. "Medical students are adults. One generally believes that adults try to make decisions that are in their best interests. They have seemingly made the decision that it is not in the lectures."


Lenny Bernstein covers health and medicine. He started as an editor on the Post’s National Desk in 2000 and has worked in Metro and Sports.

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