Recently we've spoken to students and medical school administrators who say that attendance and participation in medical school classrooms are on the decline. With fewer students participating, providing interactive and thought-provoking lectures has become more difficult. This begs the question: why, with tuition rates and inter-class competition on the rise, are some students opting out of attending class? The answer is simple—they believe that they can perform better in their classes and on board exams while studying independently. The wide availability of pass/fail courses in medical schools has given students the liberty of studying on their own and they agree overwhelmingly that it is more efficient. With lecture slides, podcasts and course materials readily available online, students can often access all the materials necessary to pass their courses without even attending class, so why bother? Some students view the classroom as an obstacle as opposed to a practical tool.
We surveyed a small group of medical school students and graduates and discovered a disconnect between what students expect from classes, and what they receive. Here are some of our findings:
The majority of the group said that their attendance in class was rare and only a few considered themselves regular classroom attendees
Among those who did attend class, reasons varied: one hoped to catch hints for future exam questions, another attended expecting explanations for the more complex topics, many went simply to keep up with course material.
The majority expressed that they anticipated attending class would help them do better on board exams.
Similarly, questions regarding the efficacy of classroom instruction were met with varying responses.
Most students agreed that classes including active student participation and illustrative slideshows were most effective and captivating
While students found powerpoint material helpful, they wished that it was supplementary to lectures
Students desired hands-on teaching of clinically relevant knowledge. They expressed that reading from powerpoints and lecturing on minutia focuses time and energy inefficiently and is the type of work they’d prefer doing on their own time and at their own pace.
The main points gathered from our survey were that students expected class to prepare them for board exams and provide clinically relevant knowledge on each subject area. While power points and lecture-podcasts were widely considered valuable resources for gaining knowledge in a subject area, students valued active teaching, practice questions and clinical experience more highly—methods rarely found in their classrooms. From the sound of their comments, it seemed that the students were referring to a "flipped classroom" teaching style. Using this method, instructors provide lecture material before the class providing the opportunity for time in the classroom spent going over homework and learning through active engagement and activities.
The majority of the students we surveyed believed that classroom instruction should play a leading role in their preparation for Step 1 and Step 2 examinations. That's logical—the USMLE “assesses a physician's ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care”. And strong USMLE scores provide students the opportunity to practice medicine at the highest level. Fundamentally, it becomes clear why students are dissatisfied with the current method of instruction and why students often choose to focus their studies independently.
Students agree that studying class material on their own, as opposed to attending class, provides them the opportunity to more effectively and efficiently study for their courses, while simultaneously saving them time to focus their studies on the exam they find most important, the USMLE. When asked, students agreed that the addition of board exam style questions and preparation would provide value and added incentive to attend class. A recent Tulane graduate we spoke with summarized the average student’s opinion well: “I would rather get 95% of the diagnosis, treatments, etc. 100% of the time than get 100% of them 70% of the time. I.e. I would rather miss a totally obscure question on Step 1 from my attending class every once in a while then ever miss a basic question about diabetes or heart disease, for instance.”
Is low classroom attendance an issue at your institution? How does this perspective make you think about the way your institution's curriculum is organized? Do you think involving board exam preparation material would increase classroom attendance?