Professor-led classroom lectures end as students are expected to do much of their traditional learning outside of class. Will this influence how many medical students go on to choose pathology for their residency?

Medical Colleges, hospital universities, and healthcare trade schools nationwide are considering “Active Learning” techniques to replace lectures. These bastions of higher education—where anatomic pathologists, medical laboratory scientists, doctors, nurses, clinical laboratory technicians, and other healthcare professionals learn their skills—are adopting evidence-based teaching styles that resonate with modern technology-savvy students.

In September, the University of Vermont Larner College of Medicine (UVM) became the latest institution to embrace this trend when it announced it would abolish lectures across all of its programs beginning in 2019. This makes UVM the first member of the Association of American Medical Colleges (AAMC) to drop lectures from its curriculum.

“What we know about learning in general is different than it was decades ago,” Lisa Howley, PhD, AAMC Senior Director of Strategic Initiatives and Partnerships, told Inside Higher Education. “Our medical students are of a generation that has grown up differently when it comes to technology and the impact that has on their ability to receive and retain information.”

Dubbed a “flipped classroom,” students do homework before classes rather than after, as would be done in a traditional education setting. They are expected to learn material online and through textbooks, and then complete self-assessments to gauge their understanding of what they’ve learned. Classroom time involves so-called “active learning,” which includes problem-solving in small groups, question-and-answer sessions, and group discussions.

UVM Not First to Drop Lectures

While UVM’s announcement has generated headlines and controversy, it is not the first medical school to abandon traditional lectures. Cleveland Clinic’s Lerner College of Medicine at Case Western Reserve University opened in 2004 with a no-lecture format.

A growing body of research, such as this study published in the Proceedings of the National Academy of Sciences of the United States of America (PNAS), indicates that active learning improves student performances, especially in science, technology, engineering, and mathematics. With the specialties of pathology and medical laboratory medicine heavily dependent on technology and science, this may be a favorable development for medical students who decided to specialize in these fields.

“We teach evidence-based medicine all the time,” William Jeffries, PhD, Senior Associate Dean for Medical Education at UVM, stated in the Inside Higher Education article. “If you have the evidence to show one treatment is better than the other, you would naturally use that treatment. So, if we know that there are methods superior to lecturing, why are we lecturing at all?”

Kelly J. (McDonough) Butnor, MD (center), Surgical Pathologist and Professor of Pathology and Laboratory Medicine at University of Vermont College of Medicine, conducts a team-based learning session with second-year students. (Photo and caption copyright: The Washington Post, Erin Post, Larner College of Medicine.)

In 2112, Charles G. Prober, MD, Senior Associate Vice Provost for Health Education and Professor of Pediatrics at Stanford School of Medicine, and Chip Heath, PhD, Professor of Organizational Behavior in the Stanford Graduate School of Business, called for a “change in the way we educate doctors.”

In “Lecture Halls without Lectures—A Proposal for Medical Education,” published in the New England Journal of Medicine (NEJM), Prober and Heath wrote, “Students are being taught roughly the same way they were taught when the Wright brothers were tinkering at Kitty Hawk.” They suggested five years ago that active learning and short online videos were more effective and a better use of students’ limited time than auditorium-style mandatory lectures. Today, with mobile technologies and streaming Internet technologies, their argument is even more valid.

Lack of Funds Blocks Innovation

Jeffries contends the cost of making wholesale changes in how students are taught, which requires retraining faculty and renovating classrooms, keeps most medical schools from overhauling teaching methods. “Most schools do not have the resources to turn the battleship around,” he told Inside Higher Education.

At UVM, however, a $66-million gift last year by Robert Larner, MD, and his wife Helen, is helping fund the school retrain its medical school teaching staff and redesign classroom spaces to support active learning. Larner is a dual-degree alum whose name now adorns the medical school.

In a recent NEJM article, Richard M. Schwartzstein, MD, Professor, Beth Israel Deaconess Medical Center (BIDMC) at Harvard Medical School, and David H. Roberts, MD, Dean for External Education at Harvard Medical School, point out that “the movement away from traditional lecture-based courses has been under way in US medical schools for more than three decades.” They question, however, whether the push to do away with all lectures is “merely the latest fad in medical education” or is it truly evidence-based?

“We can often serve our students best by fusing elements of various methods, such as team-based or case-based learning and interactive large-group learning sessions, rather than feeling obliged to adhere to a particular format,” they wrote. “But we must also use evidenced-based approaches whenever possible and rigorously evaluate our innovations, acknowledging that important outcomes may include student engagement and problem-solving skills, team dynamics, and the learning environment as much as exam scores.”

Prober told the Washington Post that medical school students already vote with their feet for the type of teaching format they prefer.

“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 adults try to make decisions that are in their best interests. They have seemingly made the decision that it is not in the lectures.”

For the past two decades, many pathologists have regularly pointed out that advances in technologies and procedures in both anatomic pathology and clinical laboratory medicine have outpaced the ability of medical schools and residency programs to incorporate these new developments into training programs. Thus, clinical laboratory scientists and pathologists will be watching with interest to see if these new models for medical school education are capable of incorporating new advances in laboratory medicine into their training formats in a timely fashion.

—Andrea Downing Peck

Related Information:

Become a Doctor, No Lectures Required

Medical School Without the ‘Sage on a Stage’

Active Learning Increases Student Performance in Science, Engineering, and Mathematics

Lecture Halls without Lectures–A Proposal for Medical Education

Saying Goodbye to Lectures in Medical School–Paradigm Shift or Passing Fad?

UVM Names Robert Larner, MD, College of Medicine